Psoriasis's changing face: Therapies, understanding of disease continue to evolve -

Psoriasis's changing face: Therapies, understanding of disease continue to evolve - - DermatologyTimes

ModernMedicine ModernMedicine Community

Email|Print|

|Save|License |Discuss On Sermo

Psoriasis's changing face: Therapies, understanding of disease continue to evolve

Jul 1, 2009
By: Ilya Petrou, M.D.
Dermatology Times

History of psoriasis
Ancient treatments
New treatment modalities

Robert Willan/Public Domain-Wikimedia Commons

Herakleitos, the Greek philosopher from Ephesus, once said, "Ta panta rei," which means "Everything changes and is in a state of flux." Perhaps no other quote better suits the ever-changing theories surrounding the nature, origin and cause of the dermatosis we call psoriasis.

Ferdinand von Hebra/Public Domain-Wikipedia

Today, psoriasis is thought to affect an estimated 2 percent to 3 percent of the world's population. According to the National Institutes of Health, between 5.8 million and 7.5 million Americans have psoriasis, and studies show that approximately 10 percent to 30 percent of psoriasis patients also develop psoriatic arthritis.

The early days

One of the first references to psoriasis dates back to before 400 B.C., when Hippocrates spoke of a skin condition resembling psoriasis and grouped that condition with skin diseases such as eczema, red flat lichen, tubercular lupus and leprosy. It wasn't until the late 18th century when English dermatologists Robert Willan and Thomas Bateman identified two distinct forms of the disease (leprosa graecorum and psora leprosa) that psoriasis became an independent disease entity.

Though many historians believe that the Roman physician Galen, of Greek origin, coined the term "psoriasis vulgaris," it is well known that in 1841, Viennese dermatologist Ferdinand von Hebra ascribed the name psoriasis to the condition.

A twenty-four-year-old man from Norway, suffering from leprosy, is pictured in a book from 1886. (Public Domain-Wikimedia Commons)

Regarding the social stigma historically attached to psoriasis, it's interesting to note that Greeks used the term lepra to describe scaly skin conditions and psora to describe itchy skin conditions. Because of the scaly nature of psoriasis and the pruritus sometimes seen in psoriasis guttata, an erroneous association with leprosy arose, which led to the ostracizing of psoriasis sufferers until only a few centuries ago.

"The biblical sun is the forerunner of the modern ultraviolet therapy. In ancient times, lepers — and who we today recognize as psoriatics — were banished into the desert, and surely, the psoriatic skin symptoms got better likely due to the therapeutic effects of sunlight exposure," says Steven R. Feldman, M.D., Ph.D., professor of dermatology, pathology and public health sciences and director of the Psoriasis Treatment Center, Wake Forest University School of Medicine, Winston-Salem, N.C.

Age-old primitive therapies used to treat psoriasis were much less scientific than today's topical and systemic therapies. They relied on anecdotal and trial-and-error approaches and included such topical applications as cat feces, onions, sea salt and urine, goose oil and semen, and wasp droppings in sycamore milk.

In the early 19th century, physicians believed that psoriasis resulted from an internal metabolic disturbance. This belief led to the use of arsenic compounds, which were popularized in Fowler's solution, a commonly prescribed solution up until the 18th and 19th centuries.

Before artificial ultraviolet therapy became a mainstay in psoriasis therapy, "Patients with severe or disabling psoriasis went to specialized treatment centers where they received a concentrated combination treatment of UVB and topical crude coal tar known as the Goeckerman regimen, instituted by Dr. William H. Goeckerman at the Mayo Clinic in the early 1920s," Dr. Feldman says.

"Well into the 1990s, when phototherapy centers sprouted up around the country, these centers were still using the Goeckerman regimen. This combination therapy was found to be very effective and its success can be paralleled to that seen with today's TNF inhibitors," he says.