Skin Disorders
| Psoriasis | Eczema | Vitiligo | Alopecia |
Psoriasis is a chronic skin condition that affects 7 million people in the United States. The condition occurs equally in men and women of all ages, though it primarily affects adults.
Patches of inflamed red skin, sometimes called plaques,
characterize psoriasis. These develop because the outer layer of skin cells
reproduce too fast and pile up o the skin’s surface. Psoriasis can cause
discomfort, such as pain and itching, limited motion in the joints, as well as
emotional distress.
Recent research indicates that psoriasis may be an immune disorder. The immune system has a type of white blood cell, called a T-cell, which normally protects the body against infection and disease. In psoriasis, it is believed that an abnormal immune system causes T-cells to trigger the inflammation and excessive skin cell reproduction in the skin, which results in red plaques.
Exposing these activated T-cells to specific wavelengths of UV light causes them to die, a process called apoptosis. Apoptosis reduces inflammation and slows the overproduction of the skin cells that cause plaques. Frequent, short, non-burning exposure to UV light can help clear or improve psoriasis for many people. Therefore, many doctors include phototherapy as a treatment for psoriasis.
When prescribing phototherapy, doctors may select either UVB or UVA light. The administration of UVB is one of the main treatments for patients with mild to moderate psoriasis. Improved understanding of the UVB light spectrum has led doctors to refine their treatment methods to include a very precise range of UVB wavelengths, called Narrow Band UVB light or NBUVB. Evidence suggests that NBUVB phototherapy offers even better treatments results than broadband UVB therapy for certain patients.
When
using UVA light, doctors typically will combine oral or topical administration
of a medicine called psoralen. This treatment is commonly referred to as PUVA.
The addition of psoralen makes the skin more sensitive to the UVA light,
producing a greater effect than UVA light alone.
When comparing NBUVB and PUVA therapies, some studies have demonstrated that NBUVB is as effective as PUVA. However, NBUVB therapy had the added advantaged of producing significantly fewer side effects. These were mostly related to the adverse, long –term use of the medication psoralen.
You should talk to your doctor about the advantages of either therapy to decide which may be right for you. It is important to remember-phototherapy is a safe and effective treatment option for psoriasis that has helped many patients
The term “eczema” generally includes many different
inflamed skin conditions. But perhaps the most common is Atopic dermatitis, or
Atopic eczema. This skin disorder affects more than 15 million Americans of all
ages. It is characterized by itchy patches of dry, red skin, which sometimes
appear scaly or crusty.
Scientists believe eczema may be caused by an abnormal response of the body’s immune system, similar to that seen with psoriasis. However, it seems that people with eczema have an overactive inflammatory response to irritation substances. In fact, many people who have eczema also suffer from allergies or hay fever, or have members in their families who do.
Doctors have found the administration of UVB light is helpful for patients with eczema. An improved understanding of the UVB light spectrum has led doctors to refine their treatment methods to include a very precise range of UVB wavelengths, called Narrow Band UVB light or NUVB. Studies suggest that NBUVB phototherapy is an effective treatment option for eczema.
Vitiligo is a skin condition that affects 1 to 2 percent of the population. About half of all people who have Vitiligo develop it before age 20. Vitiligo is characterized by sharply bordered white patches in the skin resulting from loss of pigment. Any part of the body may be affected, though most commonly Vitiligo affects the face, lips, hands, arms, legs, and genital areas.
Scientists think Vitiligo is an autoimmune process, in which pigment cells in the skin, known as melanocytes, are destroyed by the bodies own defense system. When theses cells die, they can no longer make melanin (the pigment/color in skin, hair, and eyes). As a result, the skin becomes lighter or completely white.
One method commonly used for treating Vitiligo is called repigmentation. Essentially, doctors use UVA light with medication called psoralen (PUVA) to stimulate color-producing cells, much like tanning. Some studies have shown that the use of Narrow Band UVB light is as effective as PUVA, and there is no need for psoralen with its adverse side effects.
For repigmentation to work, neighboring pigment cells must produce new pigment cells. These may be located on the edge of the Vitiligo patch, at the base of hair follicles, or possibly within the patch itself, if the melanocytes haven’t been completely destroyed. Generally, patients who respond to Narrow Band UVB phototherapy obtain over 90% repigmentation within a year.
You should talk to your doctor about the advantages of phototherapy to decide if it is right for you. It is important to remember that phototherapy is a safe and effective treatment option for Vitiligo that has helped many patients.
What Is Alopecia Areata?
Alopecia areata is considered an autoimmune disease, in which the immune system, which is designed to protect the body from foreign invaders such as viruses and bacteria, mistakenly attacks the hair follicles, the tiny cup-shaped structures from which hairs grow. This can lead to hair loss on the scalp and elsewhere.
In most cases, hair falls out in small, round patches about the size of a quarter. In many cases, the disease does not extend beyond a few bare patches. In some people, hair loss is more extensive. Although uncommon, the disease can progress to cause total loss of hair on the head (referred to as alopecia areata totalis) or complete loss of hair on the head, face, and body (alopecia areata universalis).
What Causes It?
In alopecia areata, immune system cells called white blood cells attack the rapidly growing cells in the hair follicles that make the hair. The affected hair follicles become small and drastically slow down hair production. Fortunately, the stem cells that continually supply the follicle with new cells do not seem to be targeted. So the follicle always has the potential to regrow hair.
Scientists do not know exactly why the hair follicles undergo these changes, but they suspect that a combination of genes may predispose some people to the disease. In those who are genetically predisposed, some type of trigger--perhaps a virus or something in the person's environment--brings on the attack against the hair follicles.
Who Is Most Likely To Get It?
Alopecia areata affects an estimated four million Americans of both sexes and of all ages and ethnic backgrounds. It often begins in childhood.
If you have a close family member with the disease, your risk of developing it is slightly increased. If your family member lost his or her first patch of hair before age 30, the risk to other family members is greater. Overall, one in five people with the disease have a family member who has it as well.
Is My Hair Loss a Symptom of a Serious Disease?
Alopecia areata is not a life-threatening disease. It does not cause any physical pain, and people with the condition are generally healthy otherwise. But for most people, a disease that unpredictably affects their appearance the way alopecia areata does is a serious matter.
The effects of alopecia areata are primarily socially and emotionally disturbing. In alopecia universalis, however, loss of eyelashes and eyebrows and hair in the nose and ears can make the person more vulnerable to dust, germs, and foreign particles entering the eyes, nose, and ears.
Alopecia areata often occurs in people whose family members have other autoimmune diseases, such as diabetes, rheumatoid arthritis, thyroid disease, systemic lupus erythematosus, pernicious anemia, or Addison's disease. People who have alopecia areata do not usually have other autoimmune diseases, but they do have a higher occurrence of thyroid disease, atopic eczema, nasal allergies, and asthma.
Can I Pass It on to My Children?
It is possible, but not likely, for alopecia areata to be inherited. Most children with alopecia areata do not have a parent with the disease, and the vast majority of parents with alopecia areata do not pass it along to their children.
Alopecia areata is not like some genetic diseases in which a child has a 50-50 chance of developing the disease if one parent has it. Scientists believe that there may be a number of genes that predispose certain people to the disease. It is highly unlikely that a child would inherit all of the genes needed to predispose him or her to the disease.
Even with the right (or wrong) combination of genes, alopecia areata is not a certainty. In identical twins, who share all of the same genes, the concordance rate is only 55 percent. In other words, if one twin has the disease, there is only a 55 percent chance that the other twin will have it as well. This shows that other factors besides genetics are required to trigger the disease.
Will My Hair Ever Grow Back?
There is every chance that your hair will regrow, but it may also fall out again. No one can predict when it might regrow or fall out. The course of the disease varies from person to person. Some people lose just a few patches of hair, then the hair regrows, and the condition never recurs. Other people continue to lose and regrow hair for many years. A few lose all the hair on their head; some lose all the hair on their head, face, and body. Even in those who lose all their hair, the possibility for full regrowth remains.
In some, the initial hair regrowth is white, with a gradual return of the original hair color. In most, the regrown hair is ultimately the same color and texture as the original hair.
What Can I Expect Next?
The course of alopecia areata is highly unpredictable, and the uncertainty of what will happen next is probably the most difficult and frustrating aspect of the disease. You may continue to lose hair, or your hair loss may stop. The hair you have lost may or may not grow back, and you may or may not continue to develop new bare patches.
How Is It Treated?
While there is neither a cure for alopecia areata nor drugs approved for its treatment, some people find that medications approved for other purposes can help hair grow back, at least temporarily. Studies have shown that UVB Narrow Band Light Therapy can aid in the regrowth of hair. Consult your health care professional about the best option for you.