Chinese Medicine and Healthy Skin: Part IV
most common skin diseases, today we’ll look at psoriasis. And perfect timing as we’re entering winter, a season well-known for psoriatic exacerbations. Aside from my own struggles with acne well into my 20s and fingertip eczema well into my 30s, it was psoriasis that got me most interested in studying dermatology. One day, years ago, in the very early stages of my health care career when I was working as a therapeutic massage therapist, I had a new client. She was in a long skirt, and as we sat down for her intake the skirt lifted and I saw that both of her lower legs were covered in thick, dense, painful looking plaques. Not a single spot of clear skin could be found; her legs hardly looked human. We talked about it, she said she’d struggled with the condition for decades and “tried everything” to no avail. I remember thinking how there just had to be an answer for her, and how I wished I’d had it.
W What is Psoriasis? Psoriasis is a common skin disease, affecting 1-3% of the
population. The lesions of psoriasis are distinctive, starting as small, scaling bumps that typically coalesce into adherent, silvery-white plaques. These plaques can occur anywhere on the body, with a special affinity for the elbows, knees, scalp, fingernails, toenails, and gluteal cleft (medical-speak for your…well…your butt crack). In pre-disposed individuals, psoriasis can also develop at the site of physical trauma in what is known as Koebner’s phenomenon—ar- eas of scratching, sunburn, or surgery, for example. Psoriasis is genetic, meaning if one of your parents suffers from
psoriasis you have a 30% chance of developing it yourself; if both parents have psoriasis that chance increases to 60-70%. The onset of psoriasis typically occurs between the ages of 15-30, after which development drops off for a few decades only to rise once again in the 50s and 60s. Whatever the age, once developed, the disease is lifelong and characterized by chronic and recurrent exacerbations and remissions—meaning it will stick around for the long-term, sometimes better, sometimes worse. In my clinic I’m clear with
14 Essential Living Maine ~ November/December 2014
e’ve covered the basics (review the August online issue), and examined both acne (September print) and eczema (October online). To round out our triumvirate of the
patients that we can’t cure psoriasis; however it is possible to treat psoriasis successfully and send it into remission, or to keep the le- sions static over time.
Psoriatic exacerbations are physically debilitating, to be sure, but psoriasis is particularly notable in its emotional impact. It’s disfiguring. It’s not contagious, but patients with psoriasis often report that others are afraid to touch them for fear of “catching” the disease. Many psoriasis-sufferers live a life of concealment, avoid- ing situations and activities that could expose them, their skin, or lead them to be “discovered” in their illness. Skin disease doesn’t easily let you keep your disease a secret.
Psoriasis and Western Medicine
Psoriasis has been recognized as a disease entity in both Europe and China for at least two thousand years. In all that time, we haven’t figured out exactly what causes it. It appears to be an immune-mediated disease, meaning that for some reason the body’s immune system starts to attack its own skin cells. This response trig- gers a more rapid than normal turnover of healthy skin cells (on the order of days instead of weeks), leading to the build-up of skin that generates psoriatic plaques and scales. We have, over the millennia, identified some triggers for the development of psoriasis. These include:
• bacterial or viral infections • dry skin
• skin damage: like the Koebner phenomenon, as mentioned above • some medications: lithium, anti-malaria meds, and steroids can all trigger a massive reaction and what we call erythrodermic psoriasis, which can be a medical emergency • stress: which, as we all know, pretty much makes everything worse
• too much or too little sunlight: psoriasis tends to be better in the summer, but too much sun can also traumatize the skin and cause a Koebner reaction
• over-consumption of alcohol • smoking: particularly linked to a variety known as pustular psoriasis
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