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Psoriasis of the Feet

Upon starting an assessment the client stated, “I’m getting this flaking and itching patch under the soles of my feet …” In many cases clients aren’t aware of the condition they are suffering from, and are usually in shock by the discovery. Most of us lead stressful lives,coupled with those who worry a lot . . . not good for psoriasis!

Psoriasis can affect you emotionally since the appearance isn’t always appealing to the eye, and some persons are quite self-conscious. Most importantly, understanding psoriasis is critical, especially since the precise cause is unknown. The fact that it’s an immune disease helps with the awareness, and in turn being able to educate others about it. While you should not interfere with the area with bare hands because of bacteria, it’s not a disease that is contagious via interaction with someone who has it.

Signs and Symptoms

A lifelong condition, psoriasis symptoms vary from person to person. While my focus is the feet, you should know that it can also affect the scalp, elbows/hands (including the palms), knees, buttocks, back and nails. On the feet, it mainly appears on the soles (especially in the defined arch area), and the border.

The common signs and symptoms are:
• Skin patches, generally raised and red, with silver/grey scales
• Itching, soreness and/or burning
• Dry, cracked skin, that may bleed
• Thickened, ridged or pitted nails
• Stiff/swollen joints.
Stages
• Mild – Few, small, scattered areas affected; a greater percentage of psoriasis sufferers are at the mild stage.
• Moderate – More widespread disease affecting larger areas, sometimes affecting the joints.
• Severe – Most of the skin surface is affected, sometimes affecting the joints.
Types
Several types of psoriasis exist. Those that could affect the feet include:
• Plaque – The most common form. It causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques itch or may be painful and can occur anywhere on your body. They may be a few, or many, and in severe cases, the skin around your joints may crack and bleed.
• Nail – Can affect all nails, causing pitting, abnormal nail growth and discolouration. Psoriatic nails may become loose and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
• Pustular – This uncommon form can occur in widespread patches (generalised pustular psoriasis), or in smaller areas on your hands, feet or fingertips. It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters dry within a day or two, but may reappear every few days or weeks. It may also cause fever, chills, severe itching and fatigue.
• Erythrodermic – It’s the least common type and can cover your entire body with a red, peeling rash that itches or burns intensely. It may be triggered by severe sunburn, corticosteroids and other medications, or by another type of psoriasis that’s poorly controlled.
• Psoriatic arthritis – In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discoloured nails and the swollen, painful joints that are typical of arthritis. It can also lead to inflammatory eye conditions, such as conjunctivitis. Symptoms range from mild to severe, and can affect any joint. Although the disease usually isn’t as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.
Risk Factors
In approximately thirty percent of persons with the condition, there’s psoriasis in their family. It also affects both men and women equally, and generally you have flares. Flares could be triggered by a stressful/emotional situation, a cut or scrape to skin, an insect bite, smoking, excessive drinking, a reaction to certain medications, obesity, and viral/bacterial infections.
Lifestyle Effects
Psoriasis, especially in highly visible places, can cause:
• Low self-esteem
• Depression
• Stress
• Anxiety
• Introverted behaviour.
Being an immune disease, persons are at risk of contracting other diseases, sometimes contributing to limited public appearances or mobility.

Treatments
Treatments aim to halt the cycle that increase the production of skin cells and remove scales and smooth the skin.
Treatment considerations
Although treatments are chosen based on the type, severity of the ailment, and the areas of skin affected, the traditional approach is to start with the mildest treatments. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.
In spite of a range of options, effective treatment of psoriasis can be challenging. The disease is unpredictable, going through cycles of improvement and worsening, seemingly at random. Effects of psoriasis treatments also can be unpredictable; what works well for one person might be ineffective for someone else. Your skin too, can become resistant to various treatments over time.
Home Care
To improve your quality of life, follow these tips:
• Soap/Bath wash – use products that are mild or medicated to avoid further irritation to the skin.
• Moisturiser – Ensure that the affected areas are always moist especially with a medicated cream or ointment. Dryness leads to cracking and this can be a very painful experience.
• Exposure to the elements – Natural air and some sunlight are important, as the skin lesions may be improved.
• Substance abuse – Avoid smoking and drinking, since the treatment being administered can be affected.
• Diet – Trigger foods have not been clearly identified thus far; however, a balanced/healthy diet is an important factor in fighting diseases, especially auto-immune ones.
• Monitoring – Note the things you do, and the foods you consume, to identify trends in flares.
Your feet mirror your general health . . . cherish them!

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