WEBVTT - How Does Psoriasis Work? 0:00:01.840 --> 0:00:07.720 Welcome to Brainstuff, a production of iHeartRadio. Hey brain Stuff, 0:00:07.800 --> 0:00:12.360 Lauren Vogelbaum here. You may have heard that your body 0:00:12.400 --> 0:00:16.000 replaces and replenishes all of its cells every seven years. 0:00:17.079 --> 0:00:21.440 This isn't quite true. It's catchy, but our bodies are complicated, 0:00:21.760 --> 0:00:24.960 and your rate of cellular renewal depends person to person 0:00:25.079 --> 0:00:29.320 and organ to organ. Your skeletal cells might change out 0:00:29.320 --> 0:00:32.040 every ten to fifteen years or so. Some of the 0:00:32.080 --> 0:00:34.239 cells in your brain and heart will stay with you 0:00:34.280 --> 0:00:38.000 for your entire life. On the flip side, the cells 0:00:38.000 --> 0:00:40.879 in your liver get replaced every three years, and the 0:00:40.920 --> 0:00:44.400 ones in your gut turnover within a few months. But 0:00:44.520 --> 0:00:48.280 if it were a race, your skin would win. Under 0:00:48.280 --> 0:00:52.160 normal conditions, the cells in your epidermis, your skin's outermost layer, 0:00:52.479 --> 0:00:56.920 replace themselves in just four weeks. That's because the outer 0:00:57.000 --> 0:00:59.720 layer of the epidermis is actually made up of tough, 0:00:59.760 --> 0:01:03.400 dead cells that help protect us from germs and rough 0:01:03.400 --> 0:01:07.360 surfaces and everything else in the world around us. We're 0:01:07.440 --> 0:01:10.679 constantly sloughing off the old ones as they wear out. 0:01:11.080 --> 0:01:14.440 We shed some forty thousand dead skin cells every minute. 0:01:15.360 --> 0:01:17.360 That adds up to about one and a half pounds 0:01:17.360 --> 0:01:22.280 of skin around seven hundred grams shed every year, but 0:01:22.520 --> 0:01:27.759 that's assuming that everything is working properly. Sometimes, for reasons 0:01:27.760 --> 0:01:31.839 that we don't entirely understand, your skin can go into overdrive. 0:01:33.080 --> 0:01:36.360 In a condition called psoriasis, your skin tries to replace 0:01:36.360 --> 0:01:41.240 its outermost layer every four days or so. This leads 0:01:41.240 --> 0:01:44.280 to a build up of skin cells that can cause discolored, 0:01:44.440 --> 0:01:48.160 uncomfortable patches on your skin that are annoying at best. 0:01:48.920 --> 0:01:52.480 It's caused by your immune system being way overactive. So 0:01:52.680 --> 0:01:57.400 it's not contagious, but there's no cure, not yet anyway. 0:01:58.680 --> 0:02:01.640 But what's going on here? How could a process that's 0:02:01.640 --> 0:02:04.480 supposed to be good, the maintenance of our body's first 0:02:04.560 --> 0:02:09.120 line of defense turn against us today? Let's talk about 0:02:09.160 --> 0:02:14.320 what we know and don't know about psoriasis. First off, 0:02:14.639 --> 0:02:18.640 not allsrisis looks the same. The symptoms and their severity 0:02:18.760 --> 0:02:21.839 can really differ, and they come and go over time 0:02:21.960 --> 0:02:27.560 in flares. Very basically, soriasis usually manifests as patches of 0:02:27.600 --> 0:02:32.320 irritated skin that are tender, itchy, or even painful. The 0:02:32.360 --> 0:02:35.840 patches are often reddish or purplish in color, sometimes with 0:02:35.960 --> 0:02:39.519 scales or flakes coming off. They could occurb anywhere on 0:02:39.560 --> 0:02:42.520 the body, though they're most common around the elbows and knees, 0:02:42.680 --> 0:02:45.800 hands and feet, around the torso and scalp, and anywhere 0:02:45.800 --> 0:02:49.880 the skin folds, like under the arms. The finger and 0:02:49.919 --> 0:02:53.799 toenails can also be effected, showing pitting, discoloration, or other 0:02:53.840 --> 0:02:58.600 deformation of the nail, along with pain or tenderness. Psorisis 0:02:58.680 --> 0:03:02.359 can pop up in anyone at any age. People usually 0:03:02.360 --> 0:03:04.520 see their first flare between the ages of fifteen to 0:03:04.560 --> 0:03:08.600 twenty five, but it can happen earlier or later. We 0:03:08.639 --> 0:03:11.040 know that genetics has something to do with it. You're 0:03:11.080 --> 0:03:13.720 more likely to develop psoriasis if someone in your family 0:03:13.800 --> 0:03:18.000 has it. Researchers are investigating a number of associated genes 0:03:18.040 --> 0:03:21.760 but haven't really pinned any down yet. About a tenth 0:03:21.800 --> 0:03:26.040 of the population may be genetically predisposed to psoriasis, but 0:03:26.120 --> 0:03:30.080 only two to three percent of people will actually develop it. 0:03:30.080 --> 0:03:32.880 It seems that something has to trigger your immune system 0:03:32.960 --> 0:03:36.440 to start acting up. That something might be an injury 0:03:36.440 --> 0:03:39.880 to the skin or a seemingly unrelated illness like a 0:03:39.880 --> 0:03:43.040 strep infection. It can be a change in the weather 0:03:43.440 --> 0:03:47.680 or just stress, and once a flare happens, the condition 0:03:47.920 --> 0:03:52.240 is chronic, meaning it'll usually keep recurring and resolving and 0:03:52.400 --> 0:03:59.080 recurring throughout your life. And unfortunately, researchers aren't exactly sure 0:03:59.160 --> 0:04:03.560 why this happened. It seems like a combination of genetic 0:04:03.640 --> 0:04:08.680 predisposition and some environmental trigger causes your skin to stress out. 0:04:09.560 --> 0:04:11.800 Your skin and your immune system try to work together 0:04:11.880 --> 0:04:14.880 to protect you, which is good, but in this case, 0:04:15.040 --> 0:04:18.520 researchers think that some kind of feedback loop happens, a 0:04:18.560 --> 0:04:21.719 sort of perfect storm where your skin produces more and 0:04:21.760 --> 0:04:25.159 more replacement cells and your immune system is really gearing 0:04:25.240 --> 0:04:28.280 up for a fight, getting extra blood flow and defensive 0:04:28.279 --> 0:04:31.840 cells to the area, and nothing comes of it, so 0:04:32.040 --> 0:04:37.080 you're left with patches of flaky, inflamed skin. It doesn't 0:04:37.160 --> 0:04:40.360 help that this perfect storm that is psoriasis can present 0:04:40.480 --> 0:04:43.760 in a number of ways. Let's talk more about those 0:04:43.760 --> 0:04:48.680 different symptoms. Researchers divide them into five basic types of psoriasis. 0:04:49.839 --> 0:04:53.040 The most common by far is called plaque soriasis because 0:04:53.120 --> 0:04:57.039 it causes raised scaly patches on the skin known as plaques. 0:04:58.240 --> 0:05:01.359 On light colored skin, they often look red with white scales. 0:05:01.600 --> 0:05:04.960 On darker colored skin, they often look purple with gray scales. 0:05:06.080 --> 0:05:09.239 They usually appear on the elbows, knees, torso, and scalp, 0:05:09.480 --> 0:05:12.440 but can show up anywhere and can be puffy and 0:05:12.760 --> 0:05:17.400 itchy or painful. Plaques show up on about eighty percent 0:05:17.480 --> 0:05:22.280 of people with psoriasis. What's called inverse psoriasis is a 0:05:22.279 --> 0:05:26.400 little less common. It causes dark red to purple, sort 0:05:26.440 --> 0:05:30.320 of shiny patches in places where our skin folds, like 0:05:30.400 --> 0:05:33.200 under the arms, around the groin, and under the breasts. 0:05:34.400 --> 0:05:37.320 The patches aren't usually scally, but they can be really 0:05:37.360 --> 0:05:40.680 itchy and tender. Around twenty five percent of people with 0:05:40.839 --> 0:05:46.080 riasis experience these more rarely, like less than ten percent 0:05:46.120 --> 0:05:48.880 of the time. The condition can cause what's called gut 0:05:48.920 --> 0:05:52.839 tape csoriasis, which is sort of like plasoriasis, but the 0:05:52.880 --> 0:05:56.800 scally spots are smaller and more numerous, often spread over 0:05:56.839 --> 0:06:01.440 the entire arms, legs, or torso. It's a lot of small, 0:06:01.600 --> 0:06:04.720 thin patches of irritation rather than a few big ones. 0:06:05.560 --> 0:06:09.799 This one often shows up in adolescence rarely, in about 0:06:09.839 --> 0:06:13.520 three percent of cases. Psoriasis can cause pustules to develop 0:06:13.960 --> 0:06:17.640 a rash of painful, pus filled bumps across the palms 0:06:17.680 --> 0:06:21.280 or souls, or sometimes other areas. Of the body. That's 0:06:21.400 --> 0:06:26.719 called pustular psoriasis. Also, rarely, in about two percent of cases, 0:06:27.000 --> 0:06:31.680 you find really widespread discoloration and irritation over large areas 0:06:31.720 --> 0:06:35.800 of the body. This is called erythrodermic psoriasis, and it's 0:06:35.839 --> 0:06:38.520 a more severe version that can be accompanied by flu 0:06:38.680 --> 0:06:43.039 like symptoms like fever, chills, and fatigue. If this happens 0:06:43.040 --> 0:06:45.359 to you or a loved one, definitely call a doctor 0:06:45.440 --> 0:06:50.160 right away because it counts as a medical emergency. Generally speaking, 0:06:50.240 --> 0:06:52.960 if you have any of these symptoms, getting in touch 0:06:53.000 --> 0:06:55.440 with a healthcare professional is the best thing to do 0:06:55.720 --> 0:07:00.560 because well, a, you're probably uncomfortable, and b they'll be 0:07:00.600 --> 0:07:03.080 able to help with the diagnosis and figure out from 0:07:03.120 --> 0:07:06.280 there how best to manage and reduce those symptoms and 0:07:06.520 --> 0:07:10.640 any others that may come up. All forms of psoriasis 0:07:10.680 --> 0:07:14.320 are tricky to treat because, again, it's not caused by 0:07:14.360 --> 0:07:17.560 some germ that medicine can help you fight. It's an 0:07:17.560 --> 0:07:21.560 instance of your own body turning against you. A healthcare 0:07:21.600 --> 0:07:25.040 provider will evaluate your symptoms and do a skin biopsy, 0:07:25.480 --> 0:07:27.440 that is, take a small sample of skin to look 0:07:27.480 --> 0:07:31.040 at under a microscope to tell whether you're experiencing psoriasis 0:07:31.160 --> 0:07:34.760 or a different condition. Well, once you have a diagnosis, 0:07:34.800 --> 0:07:38.040 there are lots of treatment options for relieving discomfort and 0:07:38.120 --> 0:07:42.800 reducing the severity and occurrence of skin patches. There are 0:07:42.920 --> 0:07:46.480 topical treatments, creams, and other products that you apply directly 0:07:46.520 --> 0:07:49.360 to your skin. Some can be bought over the counter 0:07:49.400 --> 0:07:52.640 from drug stores or grocery stores, but others, like topical 0:07:52.640 --> 0:07:58.080 steroids and some strong alternatives, need a prescription. Topicals are 0:07:58.080 --> 0:08:01.360 great because, depending on the product, they're non invasive ways 0:08:01.400 --> 0:08:05.760 to reduce inflammation, or control skin growth or smooth rough patches. 0:08:07.080 --> 0:08:11.160 Then there's phototherapy. This is a category of also non 0:08:11.160 --> 0:08:14.960 invasive treatments that use ultraviolet light to slow down skin 0:08:15.000 --> 0:08:20.280 growth on an ongoing basis. Basically, a dermatologist will prescribe 0:08:20.320 --> 0:08:23.080 a consistent schedule for you to either go into a 0:08:23.080 --> 0:08:26.320 medical office or use a machine at home that exposes 0:08:26.360 --> 0:08:29.200 affected areas of your skin to a specific amount of 0:08:29.320 --> 0:08:34.480 ultraviolet light for a specific amount of time. Consistency is key, 0:08:34.840 --> 0:08:37.880 but home photo therapy especially can be a convenient and 0:08:37.920 --> 0:08:42.040 affordable treatment. Those are the first two categories of treatment 0:08:42.080 --> 0:08:46.040 that healthcare providers will usually try, but if they're not 0:08:46.200 --> 0:08:50.120 working or for whatever reason you need something different. There's 0:08:50.160 --> 0:08:55.280 what's called systemic treatments. They're called systemic because they're not 0:08:55.440 --> 0:09:00.000 applied to a particular topical area. Instead, these are prescripts 0:09:00.320 --> 0:09:05.240 medications that help control immune or skin activity throughout your body. 0:09:05.520 --> 0:09:08.200 Some can be taken orally and work to moderate your 0:09:08.200 --> 0:09:12.120 immune response or your skin growth in specific ways. Others, 0:09:12.320 --> 0:09:15.400 called biologic drugs, have to be given by either injection 0:09:15.640 --> 0:09:19.960 or IV. Biologics are super targeted drugs that block particular 0:09:20.000 --> 0:09:25.719 activity in your immune system. Systemics are powerful tools against soriasis. 0:09:26.440 --> 0:09:29.360 All of these treatments can come with risks and side effects. 0:09:29.720 --> 0:09:31.640 A health care provider can help you figure out which 0:09:31.679 --> 0:09:34.120 ones are right for you and manage any side effects 0:09:34.120 --> 0:09:38.679 that do occur. And it is important to treat psoriasis 0:09:38.920 --> 0:09:43.120 because first of all, it is uncomfortable and having skin 0:09:43.280 --> 0:09:46.120 problems can be embarrassing and you don't need to live 0:09:46.160 --> 0:09:50.640 with that. But also, untreated csoriasis is associated with greater 0:09:50.760 --> 0:09:54.640 risk of what's called comorbidities, which are other conditions that 0:09:54.720 --> 0:09:58.839 often occur alongside a health issue. In the case of psoriasis, 0:09:58.880 --> 0:10:02.760 they're often inflamma related and can include things like diabetes, 0:10:02.840 --> 0:10:08.720 inflammatory bowel disease and cardiovascular disease. It also includes a 0:10:08.800 --> 0:10:13.520 real specific one called syriatic arthritis. Around a third of 0:10:13.559 --> 0:10:17.320 people with psoriasis will experience this. It's a condition that 0:10:17.400 --> 0:10:20.800 causes swelling and stiffness or pain in the joints and 0:10:21.000 --> 0:10:24.600 places where connective tissues attached to the bones, but especially 0:10:24.679 --> 0:10:28.400 in the outer joints of the fingers and toes. As 0:10:28.440 --> 0:10:32.360 with psoriasis, the symptoms really vary. They can be mild 0:10:32.480 --> 0:10:36.360 or severe, and can flare up, then resolve, then flare 0:10:36.440 --> 0:10:40.199 up again over time. It's distinct from other kinds of 0:10:40.280 --> 0:10:43.920 arthritis for a few reasons, including where it occurs, and 0:10:44.120 --> 0:10:47.800 because it's often accompanied by the nail symptoms of psoriasis. 0:10:49.080 --> 0:10:52.800 Researchers aren't exactly sure what's going on here either, but 0:10:52.960 --> 0:10:56.720 it seems that the inflammation from that overactive immune system 0:10:56.840 --> 0:11:01.200 you see in psoriasis isn't just skin deep. If that 0:11:01.280 --> 0:11:06.920 inflammation reaches the joints, you get discoloration and discomfort there too. 0:11:07.200 --> 0:11:10.160 This can also damage the joints over time, so it's 0:11:10.240 --> 0:11:12.920 especially important to talk to a healthcare professional if you 0:11:13.000 --> 0:11:17.960 experience these symptoms. They might use different tests like X rays, MRIs, 0:11:18.120 --> 0:11:21.440 ultrasounds and blood tests to help rule out other conditions 0:11:21.480 --> 0:11:24.000 and make sure that you get the right diagnosis and treatment. 0:11:25.000 --> 0:11:28.080 Those treatments include the systemics we talked about a minute ago, 0:11:28.679 --> 0:11:32.280 oral medications or biologics that help control your immune system 0:11:32.480 --> 0:11:37.880 unlessen inflammation throughout your body. I don't have personal experience 0:11:37.920 --> 0:11:41.600 with psoriasis, but just as a human whose job it 0:11:41.679 --> 0:11:45.000 is to explain how things work, it's frustrating that this 0:11:45.120 --> 0:11:48.480 is such a complex condition that we don't entirely understand 0:11:48.520 --> 0:11:53.079 it and can't cure it. But research is ongoing and 0:11:53.120 --> 0:11:57.480 the treatments available are improving all the time. Our bodies 0:11:57.520 --> 0:12:01.160 are weird and wonderful. They can do amazing things and 0:12:01.320 --> 0:12:05.800 can also behave in very strange ways. Please take care 0:12:05.840 --> 0:12:13.600 of yours. Today's episode is an original written by me. 0:12:14.200 --> 0:12:16.560 Brain Stuff is production of iHeart Radio and is produced 0:12:16.559 --> 0:12:19.440 by Tyler Klang. For more podcasts from my heart Radio, 0:12:19.679 --> 0:12:22.920 visit the iHeartRadio app, Apple Podcasts, or wherever you listen 0:12:22.960 --> 0:12:24.000 to your favorite shows.