Modern Hygienist - November 2008 - (Page 22)

patients | PATHWAYS Behind the mask Don’t be spooked by psoriasis. by Kristina Okolisan-Mulligan, RDH, BS For the most current information on treatments for psoriasis, visit the National Psoriasis Foundation Web site at psoriasis.org. As Halloween was approaching last month, my 4-year-old son and I made our way to the mall to find the right costume. While I was checking prices, my son blurted out ,“Is Halloween today, Mom? Because look! That man over there has a mask on.” He proceeded to loudly announce that the man had “stuff all over his face.” I looked up, embarrassed, and tried to apologize for my son’s comment, but the man, smiling, told me not to worry—this was not the first time it had happened and probably wouldn’t be the last. As we talked I could see that he most likely suffered from a severe case of psoriasis. His head, neck, and arms were completely covered with red patches that appeared to be very dry and scaly in some areas. It looked as though these red areas extended into his scalp, where he had severe dandruff. Much to my surprise, the gentleman went on to explain his disorder in a way that a child—my child—could comprehend. He told my son that he was not wearing a mask, but that everyone’s skin is different. He shared that just as leaves change color, dry out and shed as the seasons change, his skin changes color and gets dry as the weather gets colder. I could not have explained it any better myself. of the extremities, such as the elbows and knees.2 The scalp also may be affected, exhibiting severe dandruff. The skin lesions have the appearance of red macules (flat) or plaques (large slightly elevated area). Silvery scales—often referred to as hyperkertosis—may appear within the red surfaces. An affected patient may experience itching, after which the lesion actually peels off and slight bleeding occurs. ORAL FEATURES Although uncommon, some patients with psoriasis may exhibit oral lesions. Because these lesions range from white plaques to red ulcerations, it is difficult to establish the direct correlation between the oral lesions and skin lesions. Microscopically, the oral lesions of psoriasis appear similar to erythema migrans, referred to as “geographic tongue” by some authors.1 Lesions may occur on the tongue, buccal mucosa, labial mucosa or soft palate and usually are asymptomatic. Very rarely, a patient may complain of a burning sensation. WHAT IS PSORIASIS? pathways As hygienists, we recognize the importance of oral health screenings and are committed to raising patient awareness as it relates to good dental health. In addition, we must be capable of recognizing the clinical signs and symptoms of common oral diseases and lesions. This column will help you be able to differentiate normal from abnormal changes in your patients and to establish a differential diagnosis, enhancing your ability to communicate effectively with dentists, physicians, and other healthcare providers. Psoriasis is an incurable skin disorder affecting 1% to 2% of the world’s population. With all the modern technology we have today it’s hard to believe that 250,000 new cases are diagnosed each year.1 It is more common in some families, but not necessarily inherited.2 Some research shows that environmental agents possibly play a role in the cause. Psoriasis may start as early as a person’s teenage years, but most individuals have the onset in their 20s. This is a chronic condition with periods of remission. Exacerbations may be related to stress and to temperature change as weather gets colder. Some patients report that sunlight helps these lesions improve during the summer months. Psoriasis is usually asymptomatic, but occasionally some individuals experience psoriatic arthritis that may involve the temporomandibular joint.1 TREATMENT AND PROGNOSIS There are different treatment modalities based on case severity. Lesions that are rather mild often require no treatment. For moderate involvement, topical steroids ususally are prescribed.1 In the past, coal tar derivatives and retinoic acids were more commonly prescribed. Newer topical drugs that are effective include Vitamin D derivatives, and Calcipotriol. For severe cases, ultraviolet B therapy has been prescribed. This sometimes is considered controversial because of the increased risk for skin cancer according to certain studies.1 Systemic drugs like cyclosporine also may be used, but there are side effects, as with any immunosuppressive. mh Kristina Okolisan-Mulligan, RDH, BS, is a contributing editor for MH. References available upon request. E-mail mh@advanstar.com. CLINICAL FEATURES The skin lesions of psoriasis most often are symmetrically distributed in certain locations along the extensor surfaces 22 modernhygienist.com | November 2008 PHOTO: PHOTOGRAPHER/GETTY IMAGES, KRISTINA OKOLISAN-MULLIGAN http://www.psoriasis.org http://www.modernhygienist.com

Table of Contents Feed for the Digital Edition of Modern Hygienist - November 2008

Modern Hygienist - November 2008 Contents Editor's Letter Letters Modern Solutions Brace Yourself Pathways: Behind the Mask Faith In Place Ultimate Recall: You Can't Work Alone Going Public: Why Public Health? A Fresh Approach to Thanksgiving Ad Index Classifieds Moonlighting

Modern Hygienist - November 2008

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