PSORIASIS
on the chest, arms, legs or scalp. This form of psoriasis often resolves within a number of weeks, and is more common in children and teenagers.3
Flexural psoriasis affects the creases of the skin at joint areas, such as armpits, groin, buttocks, and breasts. This type of psoriasis is made worse by sweating and friction, so can be very uncomfortable in warmer weather.2
Pustular psoriasis is a rare type, which causes puss fi lled blisters to appear on the skin. This type of psoriasis is further classifi ed into sub types, which affect different parts of the body. Generalised pustular psoriasis will appear on a wide area of skin with pus, consisting of white blood cells, however in this case not as a result of infection. Pustules reappear every few days or weeks, and can recur in cycles. Palmoplantar pustular psoriasis is characterised by the development of pustules on the palms of hands and soles of feet, and these too can reappear every few days or weeks. Acropustulosis pustules appear on the fi ngers and toes, and when they burst, leave bright red areas that may exude or become scaly and these can cause painful nail deformities.3
Erythrodermic psoriasis is yet another rare form of psoriasis and affects nearly all the skin on the body and causes an intense itching or burning sensation. Protein loss and dehydration are typical, and further problems such as heart failure, hypothermia, and malnutrition can
DERMACOOL
Pern Consumer Products leading Menthol in Aqueous cream brand Dermacool - which cools & soothes heated, irritated & itchy skin, will soon be SLS free across the key main strengths: 0.5%, 1.0% 2.0% . All lines are reimbursable in Primary Care. Note Dermacool 500g pumps have now replaced 500g pots. Dermacool is available from all major wholesalers in Scotland. For more details see
www.dermacool.co.uk or contact 0800 5999022
48 - SCOTTISH PHARMACIST
become a major concern if left untreated.2
THE SKIN
It is commonly misquoted that the skin is the largest organ in the human body. At 5.5% of the total body weight of a typical 70 kg man, the skin is an organ of signifi cant scale, however skeletal muscle is reported to total 42% of body weight in an adult male, based on mass alone. With respect to functional surface area, the lungs have been reported to have an estimated functional area of 70 m2
1.7 m2
whereas the skin is approximately , and so again cannot be
considered the largest, at least in terms of weight and functional surface area, organ in the body.4-6
Regardless,
the skin is host to signifi cant roles of homeostasis, protection, barrier, and has a complex anatomical structural composed of numerous layers of cells. These cells begin their journey from the innermost layers, and as they move outward they become keratinised, die, and become a hard outer layer, known as the stratum corneum. This process can take between three and four weeks from propagation of skin cells to maturation and subsequent shedding. This constant development of new cells, moving outwards, and eventually shedding off, gives the skin a natural ability to repair and act as a barrier, keeping pathogens from entering the body. In many skin conditions, these aspects can be disrupted – Psoriasis being no exception.
WHAT CAUSES PSORIASIS? Psoriasis results from an irregularity in the speed at which skin cells are replaced. In psoriasis the process of skin cell formation, maturation and movement outwards only takes about three to seven days. As a result, under matured cells rapidly build up on the surface of the skin, leading to the characteristic red, fl aky, crusty patches covered with silvery scales.
It has been suggested that psoriasis results, at least in part, due to a problem with the person’s immune system. T-cells, which normally help the body to fi ght off infections, incorrectly attack healthy skin cells, which may provoke the deepest layers within the skin to produce new skin cells more quickly than usual.7
This
in turn can trigger the production of more T-cells, propagating the cycle of destruction and incorrect renewal.
Psoriasis is a hereditary condition, with an estimated one in three people having a close relative with the condition. Currently the exact role that genetics and epigenetics (the study of changes in phenotype that do not involve DNA sequence changes) is not fully known, however it has been shown that many genes and epigenetic factors have been linked to the development to psoriasis.
Many people with psoriasis will develop mild symptoms with only occasional outbreaks or fl are-ups occurring. The resultant worsening of symptoms can usually be attributed to
HOW MUCH COULD YOU SAVE WITH ZERODERMA EMOLLIENTS?
By changing from leading branded emollients to the cost effective Zeroderma emollient range, NHS Scotland could save £1 million a year and one Scottish Health Board could save around £200,000 p.a. Zeroderma emollients are similar in formulation to around 50% of currently prescribed emollients and offer cost savings of up to 37%. Many Health Boards and Clinical Commissioning Groups (CCGs) have adopted the Zeroderma range onto their formularies and cost savings are being made without compromising on patient care.
To fi nd out how much your Health Board could save visit our “QIPP and emollients” toolkit at
www.qipp.trderma.co.uk
Developed by Medicines Management teams it contains everything needed to implement product changes at practice level, as well as a guide to the savings your Health Board could make.
All Zeroderma products are sodium lauryl sulphate (SLS) free and are available on prescription. To request samples for patient evaluation, email:
zeroderma@thorntonross.com www.trderma.co.uk
Thornton & Ross, Linthwaite, Huddersfi eld HD7 5QH 01484 842217
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