Medical Dermatology

Psoriasis

Psoriasis is a chronic, autoimmune disease of the skin and joints, characterized by raised, red patches (plaques) covered with an often thickened  silvery-white scale.  Normally skin replaces itself every 27-30 days, however, in psoriasis the skin turns over every 5-6 days.  It should be noted that while the cells are dividing more rapidly, similar to cancer cells, they do not become malignant.  Psoriasis occurs most often on the extensor areas of the body such as elbows and knees and back of the scalp.  The average age of onset is 27 but it may first appear in infancy or in old age.  It affects approximately two percent of the world’s population.   Psoriasis is not contagious.

Psoriasis can affect almost any area of the body.  Frequently, it is merely a nuisance disease.   However, it can certainly affect one’s quality of life, especially if it is extensive, in visible areas, or accompanied by psoriatic arthritis.  Up to one third of patients with psoriasis have arthritis.

Due to its chronic nature, psoriasis can be challenging to treat.  The most common treatments include topical preparations such as corticosteroids, calcium-containing salves, and retinoids (derivatives of vitamin A) ; light therapy such as Goeckerman (crude coal tar plus UVB) or PUVA (psoralens plus ultraviolet A) or narrowband ultraviolet light;  antimetabolites such as methotrexate;  immunosuppressants such as cyclosporine’s; oral retinoids; and the immunobiologic agents such as Enbrel®, Humira®, Remicade®, Stelara®, and others.  Patients with psoriasis are more prone to metabolic syndrome-including obesity, hypertension, diabetes, and elevated triglycerides.

Warts

Warts (verrucae) are caused by infection with the human papilloma virus (HPV).  They present as growths on the skin or mucous membranes that may protrude and be rough or they may be very smooth and flat. They can be spread from person to person or be transmitted on inanimate objects, such as towels or shoes.  They normally disappear after a few months, but they can persist and spread for years.  Even though warts are contagious, infection is more dependent on a person’s lack of immunity to the virus rather than its virulence.

There are approximately 130 strains of human papilloma viruses.  Some strains are responsible for deep warts on the bottom or “plantar” surface of the foot (“plantar warts”). Other strains are responsible for flat warts, and still other strains are responsible for genital warts. Some strains of HPV may cause cancer of the cervix, mouth, larynx, trachea and lung

There is not one good treatment for warts which is why there are so many different treatments. One theory in the treatment of warts is that treatments are really stimulating one’s own immune system to eradicate the wart virus.  In instances where the immune system is severely compromised as in HIV/AIDS, it is very difficult to eradicate the warts.

Liquid nitrogen cryotherapy; lasers; various chemicals such as cantharidin, salicylic acid, dinitrochlorobenzene (DNCB) or squaric acid dibutyl ester immunotherapy, intralesional bleomycin, 5-fluorouracil,  imiquimod; and electrodesiccation are all used with variable success. Hypnotherapy is also useful in some people.  The goal of all treatments is removal of the wart(s) without leaving a scar.

This discussion would be incomplete without advocating that all young adolescents be immunized with Gardasil which protects against several strains of HPV that are responsible for most dysplasia and carcinoma of the cervix.  Initially it was recommended solely for young women, but immunizing young men will confer more complete protection from this devastating condition.

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