Psoriasis Classification and external resources
A person whose back and arms are affected by psoriasis.
ICD-10	L40.
ICD-9	696
OMIM	177900
DiseasesDB	10895
MedlinePlus	000434
eMedicine	emerg/489  Dermatology:derm/365 plaque derm/361 guttate derm/363 nails derm/366 pustular Arthritis derm/918 Radiology radio/578 Physical Medicine pmr/120
MeSH	D011565

Psoriasis (pronounced /səˈraɪəsɪs/) (suh-RI-uh-sus) is a disease which affects the skin and joints. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings L00-L99 - Diseases of the Skin and Subcutaneous tissue (L00-L08 Infections of the Skin and Subcutaneous tissue The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books The skin is the outer covering of living tissue of an animal (or plant A joint is the location at which two or more Bones make contact It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Skin rapidly accumulates at these sites and takes a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals. The elbow is the region surrounding the elbow-joint&mdashthe ginglymus or Hinge joint in the middle of the Arm. The knee is the lower extremity Joint connecting the Femur, Patella, and the Tibia. The scalp is the anatomical area bordered by the Face anteriorly and the Neck to the sides and posteriorly A sex organ, or primary sexual characteristic, as narrowly defined is any of the anatomical parts of the body which are involved in sexual reproduction and constitute Psoriasis is hypothesized to be immune-mediated^[1][2] and is not contagious. A hypothesis (from Greek) consists either of a suggested explanation for a phenomenon (an event that is observable or of a reasoned proposal suggesting a possible Immune-mediated diseases are conditions which result from abnormal activity of the body's immune system An infectious disease is a clinically evident Disease resulting from the presence of Pathogenic microbial agents including Pathogenic viruses Pathogenic

The disorder is a chronic recurring condition which varies in severity from minor localised patches to complete body coverage. A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly In Medicine, a chronic disease is a Disease that is long-lasting or recurrent Fingernails and toenails are frequently affected (psoriatic nail dystrophy) - and can be seen as an isolated finding. A nail is a horn -like structure at the end of an animal's Finger or Toe. Psoriasis can also cause inflammation of the joints, which is known as psoriatic arthritis. Psoriatic arthritis (also arthritis psoriatica, arthropathic psoriasis or psoriatic arthropathy) is a type of Inflammatory Arthritis Ten to fifteen percent of people with psoriasis have psoriatic arthritis. In Mathematics, a percentage is a way of expressing a number as a Fraction of 100 ( per cent meaning "per hundred" Human beings, humans or man (Origin 1590–1600 L homō man OL hemō the earthly one (see Humus

The cause of psoriasis is not known, but it is believed to have a genetic component. Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is Several factors are thought to aggravate psoriasis. These include stress, excessive alcohol consumption, and smoking. Regularly having more than two drinks a day increases the risk of developing Alcoholism, Alcoholic liver disease, and some forms of Cancer. Tobacco Smoking is the inhalation of smoke from burned dried or cured leaves of the Tobacco plant most often in the form of a Cigarette. ^[3] Individuals with psoriasis may suffer from depression and loss of self-esteem. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression In Psychology, self-esteem reflects a Person 's overall evaluation or appraisal of her or his own worth As such, quality of life is an important factor in evaluating the severity of the disease. Quality of life is the degree of well-being felt by an individual or group of people There are many treatments available but because of its chronic recurrent nature psoriasis is a challenge to treat.

Contents 1 History 2 Types of psoriasis 3 Diagnosis 4 Severity 5 Effect on the quality of life 6 Epidemiology 7 Cause 8 Treatment 8.1 Topical treatment 8.2 Phototherapy 8.3 Photochemotherapy 8.4 Systemic treatment 8.5 Alternative therapy 9 Historical treatment 10 Future drug development 11 Prognosis 12 "The heartbreak of psoriasis" 13 Notable Persons With Psoriasis 14 References 15 External links 15.1 Research and non-commercial

History

Psoriasis is probably one of the longest known illnesses of humans and simultaneously one of the most misunderstood. Some scholars believe psoriasis to have been included among the skin conditions called tzaraat in the Bible. Tzaraath ( Hebrew צרעת and numerous variants of English Transliteration, including tzaraas, tzaraat, tsaraas and Etymology According to the Online Etymology Dictionary, the word bible is from Latin biblia, traced from the same word through Medieval Latin and Late Latin ^[4] In more recent times psoriasis was frequently described as a variety of leprosy. Leprosy (from the Greek lepi (λέπι meaning scales on a fish or Hansen's disease, is a chronic disease caused by the bacterium The Greeks used the term lepra (λεπρα) for scaly skin conditions. They used the term psora to describe itchy skin conditions. It became known as Willan's lepra in the late 18th century when English dermatologists Robert Willan and Thomas Bateman differentiated it from other skin diseases. Dermatology (from Greek grc δέρμα derma, "skin" and grc -λογία -logia) is a branch of Medicine dealing with Robert Willan (born 12 November, 1757 near Sedbergh, Yorkshire; died 7 April, 1812, Madeira) is the founder They assigned names to the condition based on the appearance of lesions. Willan identified two categories: leprosa graecorum and psora leprosa.

While it may have been visually, and later semantically, confused with leprosy it was not until 1841 that the condition was finally given the name psoriasis by the Viennese dermatologist Ferdinand von Hebra. Semantics is the study of meaning in communication The word derives from Greek σημαντικός ( semantikos) "significant" from Leprosy (from the Greek lepi (λέπι meaning scales on a fish or Hansen's disease, is a chronic disease caused by the bacterium For the game see 1841 (board game. Year 1841 ( MDCCCXLI) was a Common year starting on Friday (link Vienna ( in Wien; see also other names) is the Capital of Austria, and is also one of the nine States of Austria. Ferdinand Ritter von Hebra was an Austrian Physician and Dermatologist, ( September 7, 1816, in Brno, Moravia The name is derived from the Greek word psora which means to itch. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly ^[5]

It was during the 20th century that psoriasis was further differentiated into specific types.

Types of psoriasis

The symptoms of psoriasis can manifest in a variety of forms. Variants include plaque, pustular, guttate and flexural psoriasis. This section describes each type (with ICD-10 code [6]). The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases ^[6]

Plaque psoriasis (psoriasis vulgaris) (L40. 0) 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.

Flexural psoriasis (inverse psoriasis) (L40. 83-4) 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 stomach (pannus), and under the breasts (inframammary fold). Skin folds are areas of Skin where it folds Many skin folds are distinct heritable anatomical features and may be used for identification of animal Species, while A sex organ, or primary sexual characteristic, as narrowly defined is any of the anatomical parts of the body which are involved in sexual reproduction and constitute The axilla (or armpit, underarm, or oxter) is the area on the human body directly under the joint where the Arm connects to the Shoulder Pannus is a medical term for a hanging flap of tissue. When involving the abdomen it is called a Panniculus and consists of Skin, Fat, The breast is the upper Ventral region of an animal’s Torso, particularly that of Mammals including Human beings. Inframammary fold (IMF inframammary crease or inframammary line is the feature of Human anatomy which is a natural boundary of a Breast from It is aggravated by friction and sweat, and is vulnerable to fungal infections. Friction is the Force resisting the relative motion of two Surfaces in contact or a surface in contact with a fluid (e Mycosis (plural mycoses) is a condition in which Fungi pass the resistance barriers of the human or animal body and establish Infections Classification

Guttate psoriasis (L40. 4) is characterized by numerous small round (teardrop-shaped) spots (differential diagnosis - pityriasis rosea - oval shape lesion). These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and scalp. The scalp is the anatomical area bordered by the Face anteriorly and the Neck to the sides and posteriorly Guttate psoriasis is associated with streptococcal throat infection. Streptococcal pharyngitis or streptococcal sore throat ( Strep throat AmE) is a form of Group A streptococcal infection that affects the

Pustular psoriasis (L40. 1-3, L40. 82) appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding 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.

Nail psoriasis (L40. 86) produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail. Nail diseases are distinct from diseases of the Skin. Although nails are a Skin appendage, they have their own signs and symptoms which may relate to other

Psoriatic arthritis (L40. Psoriatic arthritis (also arthritis psoriatica, arthropathic psoriasis or psoriatic arthropathy) is a type of Inflammatory Arthritis 5) involves joint and connective tissue inflammation. Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, Muscle, and Nervous tissue) Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis. Dactylytis or sausage digit is a fusiform swelling of an entire finger or toe and can be painful Psoriatic arthritis can also affect the hips, knees and spine (spondylitis). Not to be confused with Spondylosis. Spondylitis is an inflammation of a Vertebra. About 10-15% of people who have psoriasis also have psoriatic arthritis.

Erythrodermic psoriasis (L40. 85) 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. ^[7]

Diagnosis

A diagnosis of psoriasis is usually based on the appearance of the skin. Diagnosis is the identification by Process of elimination, of the nature of anything There are no special blood tests or diagnostic procedures for psoriasis. Sometimes a skin biopsy, or scraping, may be needed to rule out other disorders and to confirm the diagnosis. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues Skin from a biopsy will show clubbed Rete pegs if positive for psoriasis. Another sign of psoriasis is that when the plaques are scraped, one can see pinpoint bleeding from the skin below (Auspitz's sign). Auspitz's sign is the appearance of punctate bleeding spots when Psoriasis scales are scraped off

Severity

Psoriasis is usually graded as mild (affecting less than 3% of the body), moderate (affecting 3-10% of the body) or severe. Several scales exist for measuring the severity of psoriasis. The degree of severity is generally based on the following factors: the proportion of body surface area affected; disease activity (degree of plaque redness, thickness and scaling); response to previous therapies; and the impact of the disease on the person.

The Psoriasis Area Severity Index (PASI) is the most widely used measurement tool for psoriasis. Psoriasis Area Severity Index (PASI is the most widely used tool for the measurement of severity of Psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease). ^[8] Nevertheless, the PASI can be too unwieldy to use outside of trials, which has led to attempts to simplify the index for clinical use. ^[9]

Effect on the quality of life

Psoriasis has been shown to affect health-related quality of life to an extent similar to the effects of other chronic diseases such as depression, myocardial infarction, hypertension, congestive heart failure or type 2 diabetes. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic Depending on the severity and location of outbreaks, individuals may experience significant physical discomfort and some disability. Itching and pain can interfere with basic functions, such as self-care, walking, and sleep. Walking (also called ambulation) is the main form of Animal Locomotion on land, distinguished from Running and crawling Sleep is a Natural state of bodily rest observed throughout the animal kingdom Plaques on hands and feet can prevent individuals from working at certain occupations, playing some sports, and caring for family members or a home. The hands ( med / lat: manus pl manūs are the two intricate prehensile multi- Fingered body parts normally located at the end of each arm of a The foot is an Anatomical structure found in many Animals It is the terminal portion of a limb which bears weight and allows Locomotion. Sport is an Activity that is governed by a set of rules or Customs and often engaged in competitively The frequency of medical care is costly and can interfere with an employment or school schedule.

Individuals with psoriasis may also feel self-conscious about their appearance and have a poor self-image that stems from fear of public rejection and psychosexual concerns. Psychological distress can lead to significant depression and social isolation. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression Social isolation can contribute toward many emotional behavioural and physical disorders including anxiety panic attacks eating disorders addictions substance abuse violent behaviour

Epidemiology

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. An organism's sex is defined by the gametes it produces males produce male gametes (spermatozoa or Sperm) while females produce female gametes (ova or Egg cells; individual Ageing or aging (American English is the accumulation of changes in an organism

The prevalence of psoriasis in Western populations is estimated to be around 2-3%. In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given The prevalence of psoriasis among 7. 5 million patients who were registered with a general practitioner in the United Kingdom was 1. 5%^[10]. A survey ^[11] conducted by the National Psoriasis Foundation (a US based psoriasis education and advocacy group) found a prevalence of 2. Statistical surveys are used to collect quantitative information about items in a population The National Psoriasis Foundation wwwpsoriasisorg is the United States’ leading patient-driven Nonprofit advocacy organization that serves the estimated 7 The United States of America —commonly referred to as the Education encompasses both the Teaching and Learning of Knowledge, proper conduct, and technical competency An interest group (also advocacy group, lobby group, pressure group or special interest group) is an organized collection of people who seek 1% among adult Americans. For the 2008 British film by Noel Clarke see Adulthood (film. The United States of America —commonly referred to as the The study found that 35% of people with psoriasis could be classified as having moderate to severe psoriasis.

Around one-third of people with psoriasis report a family history of the disease, and researchers have identified genetic loci associated with the condition. In Medicine, a family history consists of information about disorders that a patient's direct blood relatives have suffered from In the fields of Genetics and Evolutionary computation, a locus (plural loci) is a fixed position on a Chromosome such as the position of a Studies of monozygotic twins suggest a 70% chance of a twin developing psoriasis if the other twin has psoriasis. Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. The concordance is around 20% for dizygotic twins. For other uses see Concordance. Concordance as used in Genetics usually means the presence of the same trait in both Twins are Offspring resulting from the same Pregnancy, either of the same or opposite Sex. These findings suggest both a genetic predisposition and an environmental response in developing psoriasis^[12].

Onset before age 40 usually indicates a greater genetic susceptibility and a more severe or recurrent course of psoriasis.

Cause

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. Epidermis is the outermost layer of the Skin. It forms the waterproof protective wrap over the body's surface and is made up of stratified squamous Epithelium with The keratinocyte is the major cell type of the epidermis, making up about 90% of epidermal cells 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. Immune-mediated diseases are conditions which result from abnormal activity of the body's immune system An immune system is a collection of mechanisms within an Organism that protects against Disease by identifying and killing Pathogens and Tumor 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. T cells belong to a group of White blood cells known as Lymphocytes, and play a central role in Cell-mediated immunity. The dermis is a layer of Skin beneath the epidermis that consists of Connective tissue, and cushions the body from stress and strain Cytokines are a category of signalling Proteins and Glycoproteins that like Hormones and Neurotransmitters, are used extensively in cellular Tumor necrosis factor ( TNF, cachexin or cachectin and formally known as Tumor necrosis factor-alpha) is a Cytokine involved in systemic 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. An immunosuppressant is a substance that performs Immunosuppression of the Immune system. However, the role of the immune system is not fully understood, and it has recently been reported that an animal model of psoriasis can be triggered in mice lacking T cells. An animal model is a non-human Animal that has a Disease or injury that is similar to a human condition ^[13] Animal models, however, reveal only a few aspects resembling human psoriasis. An animal model is a non-human Animal that has a Disease or injury that is similar to a human condition

Psoriasis is a fairly idiosyncratic disease. Idiosyncrasy, from Greek ιδιοσυγκρασία idiosunkrasia, "a peculiar temperament" "habit of body" ( idios "one's own" The majority of people's experience of psoriasis is one in which it may worsen or improve for no apparent reason. Studies of the factors associated with psoriasis tend to be based on small (usually hospital based) samples of individuals. These studies tend to suffer from representative issues, and an inability to tease out causal associations in the face of other (possibly unknown) intervening factors. Causality (but not causation) denotes a necessary relationship between one event (called cause and another event (called effect) which is the direct consequence Conflicting findings are often reported. Nevertheless, the first outbreak is sometimes reported following stress (physical and mental), skin injury, and streptococcal infection. Streptococcus is a Genus of spherical Gram-positive bacteria belonging to the phylum Firmicutes and the Conditions that have been reported as accompanying a worsening of the disease include infections, stress, and changes in season and climate. Climate encompasses the temperatures humidity rainfall atmospheric particle count and numerous other meteorogical factors in a given region over long periods of Certain medicines, including lithium salt and beta blockers, have been reported to trigger or aggravate the disease. Lithium in pharmacology refers to use of the Lithium Ion, Li+ as a drug Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias Excessive alcohol consumption, smoking and obesity may exacerbate psoriasis or make the management of the condition difficult. ^[14][15]

Individuals suffering from the advanced effects of the Human immunodeficiency virus, or HIV, often exhibit psoriasis. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome ^[16] This presents a paradox to researchers as traditional therapies that reduce T-cell counts generally cause psoriasis to improve. T cells belong to a group of White blood cells known as Lymphocytes, and play a central role in Cell-mediated immunity. Yet, as CD4-T-cell counts decrease with the progression of HIV, psoriasis worsens. ^[17] In addition, HIV is typically characterized by a strong Th2 cytokine profile, whereas psoriasis vulgaris is characterized by a strong Th1 secretion pattern. T helper cells (also known as effector T cells or Th cells) are a sub-group of Lymphocytes (a type of White blood cell or Cytokines are a category of signalling Proteins and Glycoproteins that like Hormones and Neurotransmitters, are used extensively in cellular T helper cells (also known as effector T cells or Th cells) are a sub-group of Lymphocytes (a type of White blood cell or ^[18] It's hypothesized that the diminished CD4-T-Cell presence causes an over-activation of CD8-T-Cells, which are responsible for the exacerbation of psoriasis in HIV positive patients. It is important to remember that most individuals with psoriasis are otherwise healthy and the presence of HIV accounts for less than 1% of cases. The prevalence of psoriasis in the HIV positive population ranges from 1 to 6 percent, which is about 3 times higher than the normal population. ^[19]

Treatment

There can be substantial variation between individuals in the effectiveness of specific psoriasis treatments. Because of this, dermatologists often use a trial-and-error approach to finding the most appropriate treatment for their patient. Dermatology (from Greek grc δέρμα derma, "skin" and grc -λογία -logia) is a branch of Medicine dealing with The decision to employ a particular treatment is based on the type of psoriasis, its location, extent and severity. The patient’s age, sex, quality of life, comorbidities, and attitude toward risks associated with the treatment are also taken into consideration. In Medicine, comorbidity (literally "additional Morbidity " is either * The presence of one or more disorders (or diseases in addition to

Medications with the least potential for adverse reactions are preferentially employed. If the treatment goal is not achieved then therapies with greater potential toxicity may be used. Toxicity is the degree to which a substance is able to damage an exposed organism Medications with significant toxicity are reserved for severe unresponsive psoriasis. This is called the psoriasis treatment ladder. ^[20] As a first step, medicated ointments or creams, called topical treatments, are applied to the skin. An ointment is a viscous semisolid preparation used topically on a variety of body surfaces If topical treatment fails to achieve the desired goal then the next step would be to expose the skin to ultraviolet (UV) radiation. Ultraviolet ( UV) light is Electromagnetic radiation with a Wavelength shorter than that of Visible light, but longer than X-rays This type of treatment is called phototherapy. Light therapy or phototherapy consists of exposure to daylight or to specific wavelengths of light using Lasers, LEDs Fluorescent lamps, The third step involves the use of medications which are taken internally by pill or injection. An injection is an infusion method of putting Liquid into the Body, usually with a hollow needle and a Syringe which is pierced through This approach is called systemic treatment.

Over time, psoriasis can become resistant to a specific therapy. Treatments may be periodically changed to prevent resistance developing (tachyphylaxis) and to reduce the chance of adverse reactions occurring. Tachyphylaxis is a medical term describing a rapidly decreasing response to a drug following administration of the initial doses This is called treatment rotation.

Topical treatment

Bath solutions and moisturizers help soothe affected skin and reduce the dryness which accompanies the build-up of skin on psoriatic plaques. Moisturisers or moisturizers (see spelling differences) are complex mixtures of chemical agents specially designed to make the external layers of the Skin Medicated creams and ointments applied directly to psoriatic plaques can help reduce inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques. Ointment and creams containing coal tar, dithranol (anthralin), corticosteroids like desoximetasone (Topicort), vitamin D₃ analogues (for example, calcipotriol), and retinoids are routinely used. Coal tar is a brown or black liquid of high Viscosity, which smells of Naphthalene and Aromatic hydrocarbons Coal tar is among the by-products when coal Dithranol ( INN) or Anthralin ( USAN and former BAN) is a Hydroxy Anthrone, Anthracene derivative Medicine applied Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. Desoximetasone is a medication belonging to the family of medications known as topical Corticosteroids. Vitamin D is a group of fat-soluble Prohormones, the two major forms of which are vitamin D2 (or Ergocalciferol) and vitamin D3 (or Calcipotriol ( INN) or calcipotriene ( USAN) is a synthetic derivative of Calcitriol or Vitamin D. The retinoids are a class of Chemical compounds that are related chemically to Vitamin A. Argan oil has also been used with some promising results. See also Argan Argan oil is an oil produced from the kernels of the endemic Argan tree that is valued for its nutritive cosmetic ^[21] The mechanism of action of each is probably different but they all help to normalise skin cell production and reduce inflammation. In Pharmacology, the term mechanism of action (MOA refers to the specific biochemical interaction through which a drug substance produces its pharmacological effect Activated vitamin D and its analogues are highly effective inhibitors of skin cell proliferation.

The disadvantages of topical agents are variably that they can often irritate normal skin, can be time consuming and awkward to apply, cannot be used for long periods, can stain clothing or have a strong odour. Irritation or exacerbation, in Biology and Physiology, is a state of Inflammation or painful reaction to Allergy or cell-lining damage A stain is a discoloration that can be clearly distinguished from the sufrace Clothing (also called clothes, accoutrements, accouterments, or habiliments) protects the Human body from extreme Weather As a result, it is sometimes difficult for people to maintain the regular application of these medications. Abrupt withdrawal of some topical agents, particularly corticosteroids, can cause an aggressive recurrence of the condition. This is known as a rebound of the condition. Withdrawal, also known as withdrawal/abstinence syndrome, refers to the characteristic signs and symptoms that appear when a drug that causes Physical dependence is

Some topical agents are used in conjunction with other therapies, especially photo therapy.

Phototherapy

It has long been recognized that daily, short, non-burning exposure to sunlight helped to clear or improve psoriasis. Sunlight, in the broad sense is the total spectrum of the Electromagnetic radiation given off by the Sun. Niels Finsen was the first physician to investigate the therapeutic effects of sunlight scientifically and to use sunlight in clinical practice. Niels Ryberg Finsen ( December 15, 1860 &ndash September 24, 1904) was a Icelandic / Faroese / Danish A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health This became known as phototherapy. Light therapy or phototherapy consists of exposure to daylight or to specific wavelengths of light using Lasers, LEDs Fluorescent lamps,

Sunlight contains many different wavelengths of light. Sunlight, in the broad sense is the total spectrum of the Electromagnetic radiation given off by the Sun. In Physics wavelength is the distance between repeating units of a propagating Wave of a given Frequency. It was during the early part of the 20th century that it was recognised that for psoriasis the therapeutic property of sunlight was due to the wavelengths classified as ultraviolet (UV) light. Ultraviolet ( UV) light is Electromagnetic radiation with a Wavelength shorter than that of Visible light, but longer than X-rays

Ultraviolet wavelengths are subdivided into UVA (380–315 nm) UVB (315–280 nm), and UVC (< 280 nm). Ultraviolet B (UVB) (315–280 nm) is absorbed by the epidermis and has a beneficial effect on psoriasis. Epidermis is the outermost layer of the Skin. It forms the waterproof protective wrap over the body's surface and is made up of stratified squamous Epithelium with Narrowband UVB (311 to 312 nm), is that part of the UVB spectrum that is most helpful for psoriasis. Exposure to UVB several times per week, over several weeks can help people attain a remission from psoriasis.

Ultraviolet light treatment is frequently combined with topical (coal tar, calcipotriol) or systemic treatment (retinoids) as there is a synergy in their combination. Synergy (from the Greek el-Latn syn-ergo, el συνεργός meaning working together is the term used to describe a situation where the final outcome The Ingram regime, involves UVB and the application of anthralin paste. Dithranol ( INN) or Anthralin ( USAN and former BAN) is a Hydroxy Anthrone, Anthracene derivative Medicine applied The Goeckerman regime combines coal tar ointment with UVB.

Photochemotherapy

Psoralen and ultraviolet A phototherapy (PUVA) combines the oral or topical administration of psoralen with exposure to ultraviolet A (UVA) light. Psoralen (also called psoralene) is the parent compound in a family of natural products known as Furocoumarins ' PUVA is a Psoralen + UVA treatment for Eczema, Psoriasis and Vitiligo, and Mycosis fungoides[http //www Precisely how PUVA works is not known. The mechanism of action probably involves activation of psoralen by UVA light which inhibits the abnormally rapid production of the cells in psoriatic skin. In Pharmacology, the term mechanism of action (MOA refers to the specific biochemical interaction through which a drug substance produces its pharmacological effect 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. Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort A headache ( cephalalgia in medical terminology is a condition of pain in the Head; sometimes Neck or upper back pain may also be interpreted Long-term treatment is associated with squamous-cell and melanoma skin cancers. In Medicine, squamous cell carcinoma (SCC is a form of Cancer of the Carcinoma type that may occur in many different organs including the Skin Melanoma is a Malignant Tumor of Melanocytes which are found predominantly in skin but also in the Bowel and the Eye (see Skin cancer is a Malignant growth on the Skin which can have many causes

Systemic treatment

Psoriasis which is resistant to topical treatment and phototherapy is treated by medications that are taken internally by pill or injection. In Medicine, a topical Medication is applied to body surfaces such as the Skin or Mucous membranes for example the Vagina Light therapy or phototherapy consists of exposure to daylight or to specific wavelengths of light using Lasers, LEDs Fluorescent lamps, Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease An injection is an infusion method of putting Liquid into the Body, usually with a hollow needle and a Syringe which is pierced through This is called systemic treatment. Patients undergoing systemic treatment are required to have regular blood and liver function tests because of the toxicity of the medication. A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via Liver function tests (LFTs or LFs which include liver enzymes, are groups of Clinical biochemistry laboratory blood assays designed to give information about the Toxicity is the degree to which a substance is able to damage an exposed organism Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease Pregnancy must be avoided for the majority of these treatments. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female Most people experience a recurrence of psoriasis after systemic treatment is discontinued.

The three main traditional systemic treatments are methotrexate, cyclosporine and retinoids. Ciclosporin (ˌsaɪkləˈspɔrən cyclosporine ( USAN) or cyclosporin (former BAN) is an Immunosuppressant drug widely The retinoids are a class of Chemical compounds that are related chemically to Vitamin A. Methotrexate and cyclosporine are immunosupressant drugs; retinoids are synthetic forms of vitamin A. For a list of immunosuppressive drugs see the Transplant rejection page. Vitamin A refers to a family of similarly shaped molecules the Retinoids. Other additional drugs, not specifically licensed for psoriasis, have been found to be effective. Effectiveness means the capability of producing an Effect. In Physics, an effective theory is similar to a phenomenological theory a framework intended These include the antimetabolite tioguanine, the cytotoxic agent hydroxyurea, sulfasalazine, the immunosupressants mycophenolate mofetil, azathioprine and oral tacrolimus. An antimetabolite is a chemical with a similar structure to a substance (a Metabolite) required for normal biochemical reactions yet different enough to interfere with the normal Tioguanine ( INN) formerly Thioguanine ( BAN) is a drug that is used in the treatment of Cancer. Cytotoxicity is the quality of being toxic to cells Examples of toxic agents are a Chemical substance, an Immune cell or some types of Venom Hydroxyurea or hydroxycarbamide (the latter being the recommended International Nonproprietary Name) is an Antineoplastic drug used in hematological Sulfasalazine (brand name Azulfidine in the US, Salazopyrin in Europe) is a Sulfa drug, a derivative of Mesalazine For a list of immunosuppressive drugs see the Transplant rejection page. Mycophenolic acid ( INN) (ˌmaɪkoʊˈfɛnɒlɪk or mycophenolate is an immunosuppressant drug used to prevent rejection in Organ transplantation Azathioprine is an immunosuppressant used in Organ transplantation Autoimmune disease such as Rheumatoid arthritis and Pemphigus or inflammatory Tacrolimus (also FK-506 or Fujimycin) is an immunosuppressive drug whose main use is after allogenic Organ transplant to reduce the These have all been used effectively to treat psoriasis when other treatments have failed. Effectiveness means the capability of producing an Effect. In Physics, an effective theory is similar to a phenomenological theory a framework intended Although not licensed in many other countries fumaric acid esters have also been used to treat severe psoriasis in Germany for over 20 years. Fumaric acid is the Chemical compound with the formula HO2CCH=CHCO2H Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe.

Biologics are manufactured proteins that interrupt the immune process involved in psoriasis. Biologics include a wide range of medicinal products such as Vaccines Blood and blood components allergenics Somatic cells Gene therapy, Unlike generalised immunosuppressant therapies such as methotrexate, biologics focus on specific aspects of the immune function leading to psoriasis. For a list of immunosuppressive drugs see the Transplant rejection page. These drugs (interleukin antagonists) are relatively new, and their long-term impact on immune function is unknown. They are very expensive and only suitable for very few patients with psoriasis. Ustekinumab (IL-12 and IL-23 blocker) shows hopeful results for psoriasis therapy. For Il-12 see also Ilyushin Il-12 Interleukin 12 ( IL-12) is an Interleukin that is naturally produced by Dendritic Interleukin 23 alpha subunit p19, also known as IL23A, is a human Gene.

A new natural systemic option, XP-828L, for mild to moderate psoriasis relief has been developed by a Canadian life science and technology company. This oral product with clinically proven efficacy and safety is extracted through a patented process from whey and has immuno-modulatory effects. ^[22][23][24]

Alternative therapy

Milk thistle is believed to help prevent psoriasis outbreaks by encouraging proper liver function. Milk thistles are Thistles of the genus Silybum Adans Flowering plants of the daisy family ( Asteraceae) The liver neutralizes certain toxins associated with psoriasis. ^[25]

Antibiotics are not indicated in routine treatment of psoriasis. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa However, antibiotics may be employed when an infection, such as that caused by the bacteria Streptococcus, triggers an outbreak of psoriasis, as in certain cases of guttate psoriasis. Streptococcus is a Genus of spherical Gram-positive bacteria belonging to the phylum Firmicutes and the

Climatotherapy involves the notion that some diseases can be successfully treated by living in a particular climate. Climate encompasses the temperatures humidity rainfall atmospheric particle count and numerous other meteorogical factors in a given region over long periods of Several psoriasis clinics are located throughout the world based on this idea. The Dead Sea is one of the most popular locations for this type of treatment. The Dead Sea (יָם הַ‏‏מֶ‏ּ‏לַ‏ח, "Sea of Salt"البَحْر المَيّت, "Dead Sea" is a salt lake between

In Turkey & in Croatia (Altermedica), doctor fish which live in the outdoor pools of spas, are encouraged to feed on the psoriatic skin of people with psoriasis. Turkey (Türkiye known officially as the Republic of Turkey ( is a Eurasian Country that stretches Croatia (Hrvatska ˈxȓvatska officially the Republic of Croatia ( Republika Hrvatska) is a southern Central European country at the crossroads between This article is about the Freshwater fish used for treatment of skin diseases notably in Kangal district Turkey. The fish only consume the affected areas of the skin. The outdoor location of the spa may also have a beneficial effect. This treatment can provide temporary relief of symptoms. A revisit to the spas every few months is often required. Best known is the spa “Kangal Thermal Springs”, near the Turkish village of Kavak. According to the testimony of numerous psoriasis patients, the fish lead to a significant relief. This spa is located south of the historic silk road in Anatolia. The Silk Road, or Silk Routes, are an extensive interconnected network of Trade routes across the Asian continent connecting East South and Western Asia with the Anatolia (Anadolu Ανατολία Anatolía) or Asia minor, comprising most of modern Turkey, is the geographic region bounded by the Black The next big city is Sivas. Sivas (the late-Classical and Medieval Sebastia, sometimes spelt Sebastea or Sebasteia, Greek: Σεβάστεια, Armenian Treatment in this hot spring has been examined until now in two small clinical trials, with positive results. ^{[26] [27]}

Some people subscribe to the view that psoriasis can be effectively managed through a healthy lifestyle. This view is based on anecdotal evidence, and has not been subjected to formal scientific evaluation. For other uses see Anecdota. For a comparison of anecdote with other kinds of stories see Myth legend fairy tale and fable. Nevertheless, some people report that minimizing stress and consuming a healthy diet, combined with rest, sunshine and swimming in saltwater keep lesions to a minimum. This type of "lifestyle" treatment is suggested as a long-term management strategy, rather than an initial treatment of severe psoriasis.

A number of patients have reported significant improvements from sun and sea water: unfortunately, salt alone does not have any effect. Sea water contains so many minerals and different life forms (thousands of species of bacteria alone^[28]) that it will be hard to determine which of these is causing the observed effects. Interestingly, people in the tropics differentiate between "live" and "dead" sea water: "live" sea water is water that has never been covered. ^[29]

Some psoriasis patients use herbology as a holistic approach that aims to treat the underlying causes of psoriasis. Herbalism is a traditional Medicinal or Folk medicine practice based on the use of Plants and Plant extracts Herbalism is also known as Some alternative therapies consider Oil of Oregano to be a powerful herbal method of treatment. Oregano or ( Origanum vulgare) is a species of Origanum, native to Europe, the Mediterranean region and southern and central Asia

A psychological symptom management programme has been reported as being a helpful adjunct to traditional therapies in the management of psoriasis. ^[30]

Zinc oxide (ZnO) is used for several skin afflictions and according to some patients also provides relief.

Historical treatment

The history of psoriasis is littered with treatments of dubious effectiveness and high toxicity. These treatments received brief popularity at particular time periods or within certain geographical regions. The application of cat faeces to red lesions on the skin, for example, was one of the earliest topical treatments employed in ancient Egypt. WikipediaManual of Style (spelling, articles should conform to one overall spelling style of English typically the one most linked to the article topic (if it is geographic Feces, faeces, or fæces (see spelling differences) is a waste product from an animal's digestive tract expelled through the Anus This article is about the country of Egypt For a topic outline on this subject see List of basic Egypt topics. Onions, sea salt and urine, goose oil and semen, wasp droppings in sycamore milk, and soup made from vipers have all been reported as being ancient treatments. Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. Physiological aspects Internal and external fertilization Depending on the Species, spermatozoa can fertilize The Viperidae are a family of Venomous snakes commonly referred to as vipers, although the term viperids is more specific and distinguishes them from

In the more recent past Fowler's solution, which contains a poisonous and carcinogenic arsenic compound, was used by dermatologists as a treatment for psoriasis during the 18th and 19th centuries. Fowler's solution is a solution containing Potassium arsenite that once was prescribed as a Remedy or a Tonic. In the context of Biology, poisons are substances that can cause damage, Illness, or Death to Organisms usually by The term carcinogen refers to any substance Radionuclide or radiation that is an agent directly involved in the promotion of Cancer or in the fatation of its propagation Arsenic (ˈɑrsənɪk is a Chemical element that has the symbol As and Atomic number of 33 Grenz rays (also called ultrasoft X-rays or Bucky rays) was a popular treatment of psoriasis during the middle of the 20th century. Grenz Rays are a type of Ultrasoft radiation waves used in the treatment of skin conditions such as Dermatitis, Warts, Psoriasis and Hand This type of therapy was superseded by ultraviolet therapy.

Undecylenic acid was investigated and used for psoriasis some 40 years ago. Undecylenic / Undecenoic Acid is an organic unsaturated Fatty acid derived from natural Castor oil. (cir. 1950~)^[31]

All these treatments have fallen out of favour.

Sulphur was fashionable as a treatment for psoriasis in the Victorian and Edwardian eras. It has recently re-gained some credibility as a safe alternative to steroids and coal tar.

Future drug development

Historically, agents used to treat psoriasis were discovered by experimentation or by accident. In contrast, current novel therapeutic agents are designed from a better understanding of the immune processes involved in psoriasis and by the specific targeting of molecular mediators. Examples can be seen in the use of biologics which target T cells and TNF inhibitors.

It has been suggested that cannabis might treat psoriasis, due to the anti-inflammatory properties of its cannabinoids, and the regulatory effects of THC on the immune system. Cannabis, also known as marijuana or marihuana, or ganja (from Hindi / Sanskrit: गांजा gānjā hemp) is a Cannabinoids ( are a group of terpeno[[phenol]]ic compounds present in Cannabis ( Cannabis sativa L ^[32] The adverse effects of cannabis might be overcome by use of more specific cannabinoid receptor medications,^[33] to inhibit keratinocyte proliferation. ^[34]

Future innovation should see the creation of additional drugs that refine the targeting of immune-mediators further. ^[35]

Research into antisense oligonucleotides carries the potential to provide novel therapeutic strategies for treating psoriasis. An oligonucleotide (or oligo) is a short segment of RNA or DNA, typically with twenty or fewer bases. ^[36]

ABT-874 is a human anti-IL-12 monoclonal antibody being developed by Abbott Laboratories in conjunction with Cambridge Antibody Technology for the treatment of multiple autoimmune diseases including psoriasis. For Il-12 see also Ilyushin Il-12 Interleukin 12 ( IL-12) is an Interleukin that is naturally produced by Dendritic Monoclonal antibodies ( mAb or moAb) are monospecific antibodies that are identical because they are produced by one type of immune cell Abbott Laboratories ( is a diversified pharmaceuticals Health care company Phase II trials have been completed and showed promising results. ^[37] Abbott was planning to initiate Phase III trials in 2007. ^[38]

In 2004, Tas and Avci ^[39] demonstrated cyclopamine’s clinical potential for the treatment of psoriasis and basal cell carcinoma in two preliminary proof of concept studies. By treating 31 psoriatic lesions in 7 patients, these authors asserted that topical cyclopamine was more effective in the clinical and histological clearance of guttate and plaque psoriasis than the topical steroid clobetasol-17 propionate. Furthermore, they demonstrated that concurrent application of cylopamine and clobetasol-17 propionate accelerated regression and clearance of selected lesions greater than cyclopamine alone with clearance times as early as 48 hours. They assert that cyclopamine inhibits the abnormal proliferation of epithelial cells, induces terminal differentiation, and is associated with the decreased presence of inflammatory cells, including CD41 lymphocytes.

On August 27, 2006, scientists led by Jeung-Hoon Lee created in the laboratory synthetic lipids called pseudoceramides which are involved in skin cell growth and could be used in treating skin diseases such as atopic dermatitis, a form of eczema characterized by red, flaky and very itchy skin; psoriasis, and glucocorticoid-induced epidermal atrophy, in which the skin shrinks due to skin cell loss. A scientist, in the broadest sense refers to any person that engages in a systematic activity to acquire Knowledge or an individual that engages in such practices A laboratory (informally lab) is a facility that provides controlled conditions in which scientific Research, Experiments and The skin is the outer covering of living tissue of an animal (or plant In Medicine, a dermatosis is a generic term for disease of the skin. Atopic dermatitis, also known as atopic eczema, is a disease characterized by Chronic inflammation of the skin which is atopic, hereditary and non-contagious Eczema (from Greek έκζεμα) is a form of Dermatitis, or Inflammation of the Epidermis. ^[40]

Prognosis

Psoriasis is a lifelong condition. ^[41] There is currently no cure but various treatments can help to control the symptoms. Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including skin cancers, lymphoma and liver disease. Skin cancer is a Malignant growth on the Skin which can have many causes Lymphoma a type of Neoplasm that originates in Lymphocytes (a type of White blood cell in the vertebrate Immune system) However, the majority of people's experience of psoriasis is that of minor localized patches, particularly on the elbows and knees, which can be treated with topical medication. Psoriasis does get worse over time but it is not possible to predict who will go on to develop extensive psoriasis or those in whom the disease may appear to vanish. Individuals will often experience flares and remissions throughout their lives. Controlling the signs and symptoms typically requires lifelong therapy.

According to one study,^[42] psoriasis is linked to 2. 5-fold increased risk for non melanoma skin cancer in men and women, with no preponderance of any specific histologic subtype of cancer. This, however could be linked to antipsoriatic treatment.

"The heartbreak of psoriasis"

The phrase "the heartbreak of psoriasis" is often used both seriously and ironically to describe the emotional impact of the disease. Irony is a literary or Rhetorical device, in which there is an incongruity or Discordance between what one says or does and what one means or It may include both the effect of having a chronic uncomfortable disorder and the social effects of being self conscious of one's appearance. The term can be found in various advertisements for topical and other treatments; conversely, it has been used to mock the tendency of advertisers to exaggerate (or even fabricate) aspects of a malady for financial gain. While many products today use the phrase in their advertising, it originated in a 1960s advertising campaign for Tegrin, a coal tar-based ointment. Coal tar is a brown or black liquid of high Viscosity, which smells of Naphthalene and Aromatic hydrocarbons Coal tar is among the by-products when coal

Notable Persons With Psoriasis

• Jason Donovan - Australian actor & singer. Jason Sean Donovan (born 1 June 1968, Malvern, Melbourne) is an Australian Actor and Singer.

• Robert I of Scotland, King of Scots,usually known in modern English as Robert the Bruce. Robert I King of Scots ( 11 July, 1274 &ndash 7 June, 1329) usually known in modern English as Robert the Bruce (

• CariDee English - American model and America's Next Top Model, Cycle 7 winner. CariDee Jenasia English (born May 22, 1978 in Fargo, North Dakota) is an American fashion model of Norwegian America's Next Top Model, Cycle 7 started airing on September 20, 2006 as the first to be aired on The CW network

• Paul John Ferris - a Scottish businessman, author and former gangster. Paul John Ferris (born 10 November 1963 in Blackhill Glasgow) is a Scottish Businessman, Author and former Gangster

• Mark Gastineau - American football player, New York Jets, 1979 to 1988. Marcus Dell Gastineau (born November 20, 1956) is a former American football player who was a leading defensive end for the New York Jets

• Tom Waits - American singer-songwriter, composer, and actor

• Abimael Guzmán - Leader of the Shining Path ^[43]. Thomas Alan Waits (born 7 December 1949) is an American Singer-songwriter, Composer, and Actor. Manuel Rubén Abimael Guzmán Reynoso (born 3 December 1934 also known by the Nom de guerre Presidente Gonzalo ( English: President Gonzalo) The Communist Party of Peru (Spanish Partido Comunista del Perú) more commonly known as the Shining Path ( Sendero Luminoso) is a Maoist Guzmán was captured after Peruvian counter-terrorist agents found Psoriasis treating cream amongst the rubbish coming out of his hideout ^[43].

• William Halsey, Jr. - Admiral, U. Fleet Admiral William Frederick Halsey Jr, GBE, USN, ( October 30, 1882 &ndash August 16, 1959) (called "Bill S. Navy and Commander of the U. S. Third Fleet during WWII.

• Shawn Lane - musician, suffered from Psoriasis and Psoriatic Arthritis from the age of 13. Shawn Lane ( March 21, 1963 &ndash September 26, 2003) was an American Musician.

• Jerry Mathers - American Actor (Leave it to Beaver, Beav). WikipediaPersondata --> Jerry Mathers (born June 2, 1948 in Sioux City Iowa) is an American television film Leave It to Beaver is a 1950s and 1960s family-oriented American Television Situation comedy about an inquisitive

• Dennis Potter - English playwright (see his work The Singing Detective). Dennis Christopher George Potter (17 May 1935&ndash7 June 1994 was a controversial English Dramatist, best known for The Singing Detective The Singing Detective is a critically acclaimed BBC Television Miniseries, written by Dennis Potter and starring Michael

• Joseph Stalin - General Secretary of the Communist Party, Soviet Union, 1922 - 1953. Joseph Stalin ( ნამდვილი გვარი ჯუღაშვილი|Iosif Vissarionovich Dzhugashvili; March 5 1953 was General Secretary of the Communist Party

• Kenneth Starr - American lawyer, submitted to Congress the Starr Report, which led to former US President Bill Clinton's impeachment charges. Kenneth Winston Starr (born July 21, 1946) is an American Lawyer and former judge who was appointed to the Office of the Independent Counsel William Jefferson "Bill" Clinton (born William Jefferson Blythe III, August 19 1946 served as the forty-second President of the United States

• John Updike - American novelist. John Hoyer Updike (born March 18 1932 in Reading, Pennsylvania) is an American Novelist, Poet, Short story

• Eli Roth - American director (see his work Cabin Fever). Eli Raphael Roth (born April 18, 1972) is an American Film director, producer, Writer and Actor. Cabin Fever is an American Horror film about a group of College graduates who rent a cabin in the woods and begin to fall victim to a flesh-eating

• Alan Carr - British TV host and comedian. Alan Carr (born 14 June 1976 is a TV presenter and stand-up comedian noted for his camp demeanour and Innuendo -based humour

• Benjamin Franklin - Founding father of the US

References

External links

Research and non-commercial

• "Questions and Answers about Psoriasis" at National Institute of Arthritis and Musculoskeletal and Skin Diseases
• Psoriasis at National Institute of Arthritis and Musculoskeletal and Skin Diseases
• Psoriasis at Mayo Clinic
• National Psoriasis Foundation Homepage
• Psoriasis Cure Now Homepage
• Scalp Psoriasis
• Psoriasis Help Homepage
• The Psoriasis Association
• DermAtlas 7
• Psoriasis in Literature
• Ichthyotherapy as Alternative Treatment for Patients with Psoriasis: A Pilot Study

The National Institute of Arthritis and Musculoskeletal and Skin Diseases, or NIAMS, is an institute of the National Institutes of Health, an agency of the United The National Institute of Arthritis and Musculoskeletal and Skin Diseases, or NIAMS, is an institute of the National Institutes of Health, an agency of the United Mayo Clinic is a Non-profit medical practice Its headquarters the Mayo Medical School and its research facilities are in Rochester Minnesota in DermAtlas is an Open access Web site devoted to Dermatology that is hosted by Johns Hopkins University.

© 2009 citizendia.org; parts available under the terms of GNU Free Documentation License, from http://en.wikipedia.org
Dapyx Software network: MP3 Explorer | Ebook Manager | Zenithic