Psoriasis Basics

Psoriasis is an autoimmune disease that appears on the skin. It occurs when the immune system mistakes the skin cells as a pathogen, and sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious. There are five types of psoriasis: plaque, guttate, inverse, pustular and erythrodermic.

There are several different kinds of scarring, each caused by differing amounts of collagen over expression. In plaque psoriasis, skin rapidly accumulates at these sites, which gives it a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area, including the scalp, palms of hands and soles of feet, and genitals. In contrast to eczema, psoriasis is more likely to be found on the outer side of the joint. Psoriasis vulgaris (chronic stationary psoriasis, plaque-like psoriasis) is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques.

Psoriatic erythroderma (erythrodermic psoriasis) involves the widespread inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extreme inflammation and exfoliation disrupt the body's ability to regulate temperature and for the skin to perform barrier functions.

Pustular psoriasis appears as raised bumps that are filled with noninfectious pus (pustules). The skin under and surrounding the pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised with widespread patches occurring randomly on any part of the body.

Inverse psoriasis (flexural psoriasis, inverse psoriasis) appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight abdomen (panniculus), and under the breasts (inframammary fold). It is aggravated by friction and sweat, and is vulnerable to fungal infections.

Guttate psoriasis is characterized by numerous small, scaly, red or pink, teardrop-shaped lesions. These numerous spots of psoriasis appear over large areas of the body, primarily the trunk, but also the limbs and scalp. Guttate psoriasis is often preceded by a streptococcal infection, typically streptococcal pharyngitis.

Psoriasis Pathophysiology

The cause of psoriasis is not fully understood. There are two main hypotheses about the process that occurs in the development of the disease.

The first considers psoriasis as primarily a disorder of excessive growth and reproduction of skin cells. The problem is simply seen as a fault of the epidermis and its keratinocytes.

The second hypothesis sees the disease as being an immune-mediated disorder in which the excessive reproduction of skin cells is secondary to factors produced by the immune system. T cells (which normally help protect the body against infection) become active, migrate to the dermis and trigger the release of cytokines (tumor necrosis factor-alpha TNFα, in particular) which cause inflammation and the rapid production of skin cells. It is not known what initiates the activation of the T cells. The immune-mediated model of psoriasis has been supported by the observation that immunosuppressant medications can clear psoriasis plaques.

Psoriasis affects both sexes equally, and can occur at any age, although it most commonly appears for the first time between the ages of 15 and 25 years. The prevalence of psoriasis in Western populations is estimated to be around 2-3%.

Treatment Options:

Typically topical agents are used for mild disease, phototherapy for moderate disease, and systemic agents for severe disease.

  • Topical agents:
    Bath solutions and moisturizers, mineral oil, and petroleum jelly may help soothe affected skin and reduce the dryness which accompanies the build-up of skin on psoriatic plaques.Ointment and creams containing coal tar, dithranol (anthralin), corticosteroids like desoximetasone (Topicort), fluocinonide, vitamin D3 analogues (for example, calcipotriol), and retinoids are routinely used.

  • Phototherapy:
    Phototherapy in the form of sunlight has long been used effectively for treatment. Wavelengths of 311-–313 nm are most effective and special lamps have been developed for this application.The amount of light used is determined by a persons skin type. Increased rates of cancer from treatment appear to be small. Psoralen and ultraviolet A phototherapy (PUVA) combines the oral or topical administration of psoralen with exposure to ultraviolet A (UVA) light. The mechanism of action of PUVA is unknown, but probably involves activation of psoralen by UVA light, which inhibits the abnormally rapid production of the cells in psoriatic skin. There are multiple mechanisms of action associated with PUVA, including effects on the skin immune system. PUVA is associated with nausea, headache, fatigue, burning, and itching. Long-term treatment is associated with squamous cell carcinoma (but not with melanoma).

  • Systemic agents:
    Psoriasis that is resistant to topical treatment and phototherapy is treated by medications taken internally by pill or injection (systemic). Patients undergoing systemic treatment are required to have regular blood and liver function tests because of the toxicity of the medication. Pregnancy must be avoided for the majority of these treatments. Most people experience a recurrence of psoriasis after systemic treatment is discontinued.The three main traditional systemic treatments are methotrexate, cyclosporine and retinoids. Methotrexate and cyclosporine are immunosuppressant drugs; retinoids are synthetic forms of vitamin A.
In 2008, the FDA approved three new treatment options available to psoriasis patients:
  • 1) Taclonex Scalp, a new topical ointment for treating scalp psoriasis
  • 2) the Xtrac Velocity excimer laser system, which emits a high-intensity beam of ultraviolet light, can treat moderate to severe psoriasis
  • 3) the biologic drug adalimumab (brand name Humira) was also approved to treat moderate to severe psoriasis.

Available Systems:

The High Power UV handpiece uses high-power, spectral irradiance in the UVA wavebands to target and treat dermatoses such as psoriasis, leukoderma, vitiligo, stretch marks (striae distenase), atopic dermatitis (eczema), seborrheic dermatitis and hypopigmented scars. The treatment is much faster than either PUVA or UVB phototherapy. It involves no drugs and treats only specific areas to avoid exposure to healthy tissue. The UV module uses a xenon lamp, continuous spectrum with black body emission, unlike other light-based targeted UVB technologies. The UV light is delivered accurately to the target area, resulting in higher efficacy without exposure of normal skin and noneed for photosensitizing agents.

Handpiece Advantages:

  • Treat skin dermatosis such as psoriasis, leukoderma including vitiligo, stretch marks (striaedistenase), atopic dermatitis (eczema), seborrheic dermatitis and hypopigmented scars.
  • Fast - large spot size (6.4 cm2) enables rapid treatment.
  • Easy to use - ergonomic handpiece.
  • No downtime - safe and efficacious results.

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Using a carefully focused beam of laser light delivered through a sophisticated liquid light guide delivery system, the XTRAC system is designed to clear unsightly psoriatic skin plaques quickly and effectively. Because it concentrates light on active lesions, XTRAC allows your health care technician to deliver the high therapeutic doses necessary for rapid clearing without risk to healthy skin.

Ablative resurfacing: ideal for patients seeking a dramatic improvement in a single session. It is also the most effective treatment on deep scars.

XTRAC has been cleared by the FDA and cited in over 45 clinical studies and research programs with findings published in peer-reviewed medical journals around the world.

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The VTRAC Excimer Lamp System is a state-of-the art unit with a water cooled handpiece for maximum irradiance at 308nm. A light source, as opposed to a laser, VTRAC offers the targeted, therapeutic efficacy demonstrated by Excimer lasers, with the simplicity of design and reliability of a lamp system.

The VTRAC Advantage:

  • Software capable of a dose setting as low as 50 mJ/cm2
  • Small foot print, lightweight, mobile unit adapts easily to office floor space with four locking casters
  • Hand piece calibration with internal power density detector checks output for each treatment
  • Easy-to-operate touch screen user interface speeds learning
  • Treatment aids (e.g. aperture reducer, aperture extender and UV filters) for excellent control over shape, size and location of skin surface exposure
  • A system warranty of 12 months
  • A separate hand piece warranty (which includes the Excimer lamp) of 36 months or 300 hours whichever comes first.

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There are THREE CHOICES to be made when choosing a SolRx UVB phototherapy device. Each device "family", or SolRx "Series", is uniquely designed to perform a different type of phototherapy treatment, generally determined by the device's treatment area shape and size. Within each device family are several "device models" that share the same basic construction and features, but differ in the quantity of bulbs (or in the case of the E-Series, the number of devices), and the wavelength of ultraviolet light they produce (UVB-Narrowband or UVB-Broadband).

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