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Psoriasis

Psoriasis is recurrent skin condition that is characterized by scaling and inflammation. Psoriasis is a common and chronic skin disorder that can affect adults and children alike. Psoriasis occurs when the affected skin cells are shed at an accelerated pace leading to accumulation on the visible layers of the skin. Psoriasis is not contagious. While some persons notice few psoriasis patches that improve over time, others need extensive medical treatment. The cause for psoriasis may be traced to an abnormality in the immune condition that leads to excessive production of immune cells in the skin. This results in inflammation and flaky skin - typical symptoms of psoriasis. Other factors that affect the extent and severity of psoriasis are smoking, emotional stress, exposure to sun, alcohol and certain drugs such as beta blockers and NSAID (non steroidal anti-inflammatory) drugs. There is increased severity of psoriasis during cycles of hormonal change such as puberty, pregnancy and menopause.


A person affected by psoriasis has red raised patches on the skin. The affected area may appear as silvery scales. This can occur on any part of the body. Usually psoriasis is most noticed on the elbows, knees and scalp. It can also affect the lower back, face, nails or genital tissues. The affected areas may itch or burn. The skin at joints may crack. In rare cases, it surfaces as psoriatic arthritis - a condition where psoriasis results in joint inflammation much like arthritis.


Regular use of moisturizers keeps the skin well lubricated. Products containing salicylic acid are known to be effective in removal of scales. Use of Epsom salts, Dead Sea salts or oatmeal in warm bath water is known to bring relief to persons suffering from psoriasis. Phototherapy involves artificial sources of UVB light to treat psoriasis. Another form of treatment is PUVA - a combination of oral medicine psoralen and exposure to UVA. PUVA treatment is known to be effective against psoriasis. Retinoids are often used in combination with phytotherapy in the treatment of psoriasis. TNF-Blockers are drugs that affect the body's immune system to clear inflammation.

Skin Biopsy

A biopsy of the skin is done to clear what is the condition of the skin such as psoriasis, to diagnose a disease such as skin cancer and to diagnose any bacterial or fungal skin infection. A skin biopsy is routinely done in a doctor's clinic as an outpatient procedure. You have to inform the doctor if you suffer any allergies to medications, especially any adverse reactions to local anesthetics or to iodine cleaning solutions. Keep the doctor informed if you are under any medication, are pregnant or suffer bleeding problems.


Skin biopsy procedures

If it is an excision biopsy, the entire suspect skin is cut out. Excision is normally done with a scalpel and the incision is closed up by stitches. If it is a punch biopsy, a sharp cutter is used to remove a small cylinder of skin. Stitches are made to close this type of biopsy wound as well. Such punch biopsies are quick, convenient and done for small wound. A pathologist can get a full thickness view of the skin. Sometimes more than one punch biopsy is necessary. The punch biopsy blade takes a small round core of tissue ranging from 2-6mm dia although 3-4mm is the usual size.


In a shave biopsy, the outermost part of a lesion is shaved off with a scalpel. Only if the top layer of the skin is suspected, a shave biopsy is adopted. A dermatologist will take a superficial slice of skin from the area of affected with a scalpel, dermablade or a razor blade. Although there are no stitches required, there will be a small scar that should heal in about a week's time. An aspiration is used to remove the skin that is fluid filled and not solid. The doctor inserts a small needle attached to a syringe into the lesion and the fluid is sucked out.

The biopsy site is cleaned with an iodine type solution with alcohol and with a sterile soap solution. A sterile towel is placed around the area once the skin is cleaned. A local anesthetic is injected into the skin to make it numb. You may feel a brief prick and stinging sensation as the medicine is injected. The doctor can perform the biopsy once the skin is numb. Now the tissue is removed and sent to the laboratory for analysis by a pathologist. If needed, the wound is stitched up.

A bandage is wound over the biopsy site. You may also be advised to wash the wound and apply antibacterial ointment and change the bandage daily. If you experience any pain in the biopsy site, consult the doctor about medication to relieve it.


  • Unexpected bleeding may occur; especially if you are on any blood thinning medications such as aspirin. For instance, arterial puncture on the forehead or temple may take time to stop bleeding.

  • There could be wound infections in about 1-5% of surgeries. There could be ulcerated or crusted skin wounds. Antibiotics may be used to clear this up.

  • Infection is also common in diabetics, elderly patients and those on immunosuppressive medicines.

  • If large scars, called keloids, there is an increased chance of forming a scar over the biopsy site.

Cortisone

Cortisone is a steroid and it prevents release of inflammation-causing substances. Cortisone injections are usually used to relieve pain and inflammation. Cortisone is effective against allergic conditions like psoriasis, ulcerative colitis, arthritis, lupus and breathing conditions. Cortisone is also administered to alleviate pain and inflammation in patients suffering from frozen shoulder, plantar fasciitis, carpal tunnel syndrome and bursitis. Typically, most patients experience headache, nausea, stomach pain and bloating. Severe side effects of cortisone include rapid weight gain, vision problems, Pancreatitis, reduced potassium and hypertension. Do not change your cortisone or steroid medication without consulting your physician.

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Collection of Pages - Last revised Date: December 13, 2017