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The Evolutionary Perspective
Daily Archives: August 2, 2016
Evolution : Pictures , Videos, Breaking News
Posted: August 2, 2016 at 4:38 pm
Mostly evolution this week, except for one excellent piece on "what about that 3% of climate scientists who reject the consensus?" Could they be on to...
Ann Reid
Executive Director, National Center for Science Education
Let's pretend for a moment that you are a giraffe. You live on the grasslands of the African savannah. You have a neck that is 7 feet long (2.1 meter...
James Clear
Entrepreneur, weightlifter, and travel photographer at http://jamesclear.com
One thousand years ago, when the United States of America did not exist and Oxford and Cambridge were backwaters of ignorance, the light of human reason shone brightly in places like Tunis, Cairo, and Baghdad. During the Abbasid caliphate for much of the 8th through middle 11th centuries, and also sporadically thereafter, tolerance of certain non-Muslim groups was enshrined in law.
What do you think? Does the sacred express itself in the material world? Or are we mortals pretty much on our own here in this humongous universe? Here's what a friend of mine, neonatal pathologist Geoff Machin has to say on the question:
Lots of great stuff last week, but if you only have time to read one thing this week, read the interview with Mary Schweitzer below. What might the wo...
Ann Reid
Executive Director, National Center for Science Education
"So shall I do to the freshest things now reigning, and make stale the glistering of this present" (TIME, as the Chorus in The Winter's Tale by Shakes...
Ajay Chaturvedi is the founder of HarVa, the first BPO set up in rural India which employs only women and author of the widely acclaimed, Lost Wisdom ...
Ajay Chaturvedi
Entrepreneur, Thinker, Author, Wanderer, Yogi, Apprentice to a Himalayan Master! Founder - HarVa, Author - 'Lost Wisdom of The Swastika', http://www.ajaychaturvedi.in
We must realize we aren't grown up. We must realize we have to grow up and extend the vision that change is possible. We must learn about the nature of the human mind and ego and how it traps us in limited, fear-based thinking, and then teach our children how to be greater.
Cate Montana
Author of The E Word: Ego, Enlightenment & Other Essentials
One of the great things about the minds of creatives is how well they think outside the box. They - or you - have the ability to see things not only f...
We all are guilty of procrastination from time to time, putting off those important tasks and saying 'oh, I'll do it tomorrow." For many of us though, tomorrow never comes. So how do we defeat procrastination?
Atif Rashid
Freelance writer, community events organiser, speaker on religious platforms and aspiring journalist.
I concur with the New York Times editorialists who, among others, declared President Obamas speech in Dallas this week a rhetorical highpoint...
STEM is steadily earning a place as the dazzling star in the high school curriculum and for good reason. The benefit of high-level science and math co...
We are a species. Perhaps thats a bit of a blow to our modern, so-over-biology, Homo sapien arrogance; but its true just the same. Lik...
Owing to a technical difficulty, I can't provide any illustration to accompany today's What We're Reading feature. But hey, you don't only read it for...
Ann Reid
Executive Director, National Center for Science Education
While a bunch of NCSE staff members are rafting down the majestic Colorado River and another is making his way to Washington DC for the National Edu...
Ann Reid
Executive Director, National Center for Science Education
Playing 'Spore' is a good way to explore evolution. 'Spore' screenshotBy Alex Leith, Michigan State University You look down from the ...
The Conversation US
Independent source of news and analysis, from the academic and research community.
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circular economy news, closed loop, resource efficiency
Posted: at 4:36 pm
How to make coconut chia pudding
This crazy Singapore school looks like it's made from rainbow lollipops
A new LEED pilot credit for Water Restoration Certificates
Parksmart enables our clients to meet their sustainability goals
Green Sports Alliance leads GADOS volunteers at Houstons Yes Prep Northside
CDC issues historic Zika virus warning for northern Miami
AutoNaut secures investment from Seike Group to advance R&D
Basurama transforms landfill trash into playgrounds in Taipei
Sydney artist upcycles wooden blinds into beautiful pendant lamps
A rural Montana farm is turned into an artistic dream destination called Tippet Rise
BMW to rival the Tesla Model 3 with an all-electric 3 Series
Hyperloop One opens the world's first Hyperloop factory
New protective timber slats shield the renovated Escu House from Sydney's sun
New chemical-free desalination tech helps bring water surplus to Israel
Mother trees recognize kin and send them "messages of wisdom"
Experts to Rio Olympic athletes: Don't put your head underwater
Take a spin inside this psychedelic ball made of hammers at Porto's midsummer festival
San Diego's first off-grid Passive House has its very own wind turbine
Herzog & De Meuron's stunning Elbphilharmonie to finally open in January
PSU students design Pickathon concert stage out of wooden 2x4's
Plan Review Services
World's most efficient electric car gets an outrageous 26,135 MPGe
UWE to install largest single roof-mounted solar panel array in UK University sector
Beautiful brick ambulance station in the UK renovated as a cozy vacation home
Tesla is building an electric minibus based on the Model X
This cool Tournesol swimming pool opens up like a futuristic flower
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What Is Nihilism? History, Profile, Philosophy and Philosophers
Posted: at 4:34 pm
By Austin Cline
Updated September 04, 2015.
What is Nihilism?
The term nihilism comes from the Latin word nihil which literally means nothing. Many believe that it was originally coined by Russian novelist Ivan Turgenev in his novel Fathers and Sons (1862) , but it probably first appeared several decades earlier. Nevertheless, Turgenevs use of the word to describe the views he attributed to young intellectual critics of feudal society generally and the Tsarist regime in particular gave the word its widespread popularity. Read More...
Important Books on Nihilism:
Fathers and Sons, by Ivan Turgenev Brothers Karamazov, by Dostoyevsky Man Without Qualities, by Robert Musil The Trial, by Franz Kafka Being and Nothingness, by Jean-Paul Sartre
Important Philosophers of Nihilism:
Dmitri Pisarev Nikolai Dobrolyubov Nikolai Chernyshevski Friedrich Nietzsche
Origins of Nihilism:
The basic principles which underlie nihilism existed long before there was a term that attempted to describe them as a coherent whole.
Most of the basic principles can be found in the development of ancient skepticism among the ancient Greeks. Perhaps the original nihilist was Gorgias (483-378 BCE) who is famous for having said: Nothing exists. If anything did exist it could not be known. If it was known, the knowledge of it would be incommunicable. Read More...
Is Nihilism a Violent Philosophy?
Nihilism has been unjustly regarded as a violent and even terroristic philosophy, but it is true that nihilism has been used in support of violence and many early nihilists were violent revolutionaries. Russian Nihilists, for example, rejected that traditional political, ethical, and religious norms had any validity or binding force on them. They were too few in number to pose a threat to the stability of society, but their violence was a threat to the lives of those in power. Read More...
Are Nihilists all Atheists?
Atheism has long been closely associated with nihilism, both for good and for bad reasons, but usually for bad reasons in the writings of critics of both. It is alleged that atheism necessarily leads to nihilism because atheism necessarily results in materialism, scientism, ethical relativism, and a sense of despair that must lead to feelings of suicide. All of these tend to be basic characteristics of nihilistic philosophies. Read More...
Where does Nihilism lead?
Many of the most common responses to the basic premises of nihilism come down to despair: despair over the loss of God, despair over the loss of objective and absolute values, and/or despair over the postmodern condition of alienation and dehumanization. That does not, however, exhaust all of the possible responses just as with early Russian Nihilism, there are those who embrace this perspective and rely upon it as a means for further development. Read More...
Was Nietzsche a Nihilist?
There is a common misconception that the German philosopher Friedrich Nietzsche was a nihilist. You can find this assertion in both popular and academic literature, yet as widespread as it it, it isnt an accurate portrayal of his work. Nietzsche wrote a great deal about nihilism, it is true, but that was because he was concerned about the effects of nihilism on society and culture, not because he advocated nihilism. Read More...
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What Is Nihilism? History, Profile, Philosophy and Philosophers
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VA NSA Fastpitch Tournament Results and Rankings – Virginia NSA
Posted: at 4:33 pm
Date 2015-2016 Tournament Classes Region Sep 12-13 Fall Brawl 12U 14U 16U Richmond Sep 19-20 NoVA NSA September Clash 12U 14U 16U 18U NoVA Sep 19-20 Peninsula Scramble 10U 12U 14U 16U Williamsburg Sep 26-27 Blue Ridge Fall Classic 10U 12U 14U 16U 18U Madison Sep 26-27 Williamsburg Fall Festival Tournament Canecelled 12U 14U 16U Williamsburg Oct 3-4 Fall Frenzy Tournament Cancelled 12U 14U 16U 18U Richmond Oct 10-11 NoVA NSA Playing for a Cure 12U 14U 16U 18U NoVA Oct 10-11 Hampton Roads Challenge 10U 12U 14U 16U Williamsburg Oct 17-18 Last Blast Classic 12U 14U Richmond Oct 24-25 Halloween Havoc 10U 12U 14U 16U Madison Oct 24-25 College Exposure Showcase 18U Richmond Oct 24-25 NoVA NSA Fall Chill Down 12U 14U 16U 18U NoVA Nov 7-8 NSA Fall Championships CANCELLED due to weather 12U 14U 16U Richmond Mar 12-13 NoVA Spring Thaw 10U 12U 14U NoVA Mar 13-13 High School Series Wbg 1 (15-18U) High_School Williamsburg Mar 19-20 Dust Off the Rust 10U 12U 14U Richmond Mar 20-20 High School Series Richmond #2 Cancelled due to weather High_School Richmond Apr 2-3 Chesterfield Classic 12U 14U Richmond Apr 3-3 High School Series Richmond #3 High_School Richmond Apr 9-10 Kaboom Classic 10U 12U 14U NoVA Apr 9-10 NSA Fastpitch Challenge 10U 14U Richmond Apr 16-17 Williamsburg Spring Fling 12U 14U Williamsburg Apr 17-17 High School Series #3 High_School Madison Apr 17-17 High School Series (15-18U) #6 High_School Williamsburg Apr 23-24 NSA Spring Fling 10U 12U 14U NoVA Apr 23-24 Virginia Cup 10U 12U 14U Richmond Apr30 - May1 Peninsula Season Opener - One day event due to weather 10U 12U 14U Williamsburg May 1-1 High School Series #7 (15-18U) - cancelled due to weather High_School Williamsburg May 7-7 Mother's Day Open 10U 12U 14U Madison May 14-15 Queen of Diamonds 10U 12U 14U NoVA May 14-15 Summer Showdown 12U 14U Richmond May 21-22 OBX Travelodge Classic 10U_American 10U_National 12U_American 12U_National 14U_National 14U_American Williamsburg Jun 4-5 Ft Magruder Wbg Colonial Sunday play cancelled due to weather 10U 12U-A 12U-B 14U-A 14U-B 16U Williamsburg Jun 11-12 NSA 14U A&B States 14U NoVA Jun 11-12 NSA 12U A States 12U-A Richmond Jun 11-12 NSA 18U A&B States 18U Richmond Jun 11-12 NSA 10U A/B States 10U Williamsburg Jun 11-12 NSA 16U A/B States 16U Williamsburg Jun 18-19 NSA 12U B State Championships 12U-B Richmond Jun 25-26 Wbg Vacations Summer Classic 10U 12U 14U 16U 18U 23U Williamsburg Jun 25-26 June Jamboree 10U 12U 14U 16U 18U NoVA Jul 9-10 World Series Warmup 12U 14U 16U Richmond Jul 16-17 Summer Slam 10U 12U 14U 16U Madison Jul 23-24 Summer Finale 12U 14U 16U 23U Richmond Jul 30-31 Battle of the Blue Ridge 10U 12U 14U 16U 18U 23U Madison Aug 6-7 16th Busch Gardens Williamsburg Classic 10U-A 10U-B 12U-A 12U-B 14U-A 14U-B 16U-B 16U-A 18U 23U 23U-Adult Williamsburg Sep 10-11 Fall Brawl 10U 12U 14U 16U Richmond Sep 17-18 Peninsula Scramble 10U 12U 14U Williamsburg Sep 24-25 Fall Festival 10U 12U 14U Williamsburg Oct 1-2 Fall Frenzy 10U 12U 14U 16U Richmond Oct 8-9 Hampton Roads Challenge (Fight for a Cure) 10U 12U 14U High_School Williamsburg Oct 15-16 Last Blast Classic 10U 12U 14U 16U Richmond Oct 29-30 College Exposure Showcase 18U Richmond Nov 5-6 NSA Fall Championships 10U 12U 14U 16U Richmond
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VA NSA Fastpitch Tournament Results and Rankings - Virginia NSA
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Atopic dermatitis | American Academy of Dermatology
Posted: at 4:30 pm
Atopic dermatitis (AD) looks different in infants, children, and adults. The following gives you the signs (what you see) and symptoms (what you feel) for each age group.
AD can begin early. A child may be 2 or 3 months old when AD begins. When AD begins early, it often causes:
Parents often worry that their babies are getting AD in the diaper area. A babies rarely gets AD in his or her diaper area. The skin stays too moist for AD.
In time, the skin with AD can:
The thickened skin can itch even when the AD is not flaring.
When talking about the thickened skin, your dermatologist may use the word lichenification. This word means thickened skin.
It is rare for adults to get AD. Most people (90%) get AD before age 5. About half (50%) of people who get AD during childhood continue to have milder signs and symptoms of AD as an adult. When an adult has AD, it often looks different from the AD of childhood. For adults, AD often:
If a person has had AD for years, patches of skin may be thick and darker than the rest of the skin (or lighter). Thickened skin can itch all the time.
Adults who had AD as a child and no longer have AD can have the following:
Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides
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Atopic dermatitis | American Academy of Dermatology
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Eczema, Causes, Tests, Diagnosis & Treatment
Posted: at 4:30 pm
Have you ever had a red, itchy rash that does not go away? Chances are, it may be eczema. While mild eczema is not life threatening, it may be extremely uncomfortable with an itch. Symptoms usually vary depending on the individual, and may include dry, scaly, red and itchy skin. If left untreated, constant scratching may lead to bleeding, crusting, or broken skin open to possible infection. It is usually easily diagnosed by doctors by a physical check-up, and most of the time, does not require biopsies or additional testing.
According to the National Eczema Association, the term "eczema" is a general term used to describe dermatitis and can be interchangeably used. Although it comes in many forms, eczema mostly describes a dry skin condition that may be relieved by moisturizers and emollients. This skin condition is not contagious, so you cannot pass it on to other people or catch them from someone else.
A specific cause for eczema has yet to be identified. Many believe that this skin condition is attributed to a combination of factors that include:
Many of these factors are still speculation, with further research needed to confirm a specific cause for eczema. Factors like asthma and hay fever that are often associated with eczema could pose as possible leads. However, not all people who have been diagnosed with eczema have shown these particular medical conditions.
Since eczema can refer to various types of irritated skin, the types can almost be endless. Here are some of the more common types of eczema:
The most common symptom of eczema is red, swollen and itchy skin. The symptoms may vary depending on the specific type of eczema you are dealing with. Blisters and scaly patches are also possible symptoms of eczema. These blisters might also ooze, crust and even bleed. Skin color may also change, and can even become thick and leathery. These outbreaks can appear practically anywhere on the body, and the location of the affected area can be used to classify the particular type of eczema that the person is suffering from.
Unfortunately, there is no known treatment for eczema, but there are many ways to relieve symptoms. For example, there are several easy home remedies that can help relieve itch and irritation should a breakout take place.
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Eczema, Causes, Tests, Diagnosis & Treatment
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Compare 182 Eczema Medications | Drugs.com
Posted: at 4:30 pm
Generic name:hydrocortisone topical
Brand names: Cortizone-10, Westcort, Anucort-HC, Locoid Lipocream, Locoid, Proctozone HC, Hytone, Proctosol-HC, Hydrocortisone with Aloe, Beta HC, Cortaid, Proctocort, Ala-Cort, Ala-Scalp, Ala-Scalp HP, Anumed-HC, Aqua Glycolic HC, Aquanil HC, Bioelements Immediate Comfort, Caldecort, Cetacort, Cortaid Maximum Strength, Corticaine, Cortizone-5, Cortizone-10 Anal Itch Cream, Cotacort, Dermarest Plus Anti-Itch, Dermasorb HC, Dermtex HC, Gly-Cort, Gynecort Maximum Strength, Hemorrhoidal HC, Hemril-30, Hemril-HC Uniserts, Instacort, Itch-X Lotion, Keratol HC, Lacticare-HC, Nutracort, Pandel, Pediaderm HC, Procto-Kit 1%, Procto-Kit 2.5%, Procto-Med HC, Procto-Pak 1%, ProctoCare-HC, Proctocream-HC, Proctosert HC, Proctozone-H, Recort Plus, Rectasol-HC, Sarnol-HC, Scalacort, Scalp-Cort, Scalpicin, Texacort, U-Cort
Drug class: topical steroids
For consumers: dosage, interactions, side effects
For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information
Generic name:triamcinolone topical
Brand names: Kenalog, Aristocort A, Aristocort R, Cinolar, DermacinRx Silazone, Dermasorb TA, Oralone, Pediaderm TA, Triacet, Trianex, Triderm
Drug class: topical steroids
For consumers: dosage, interactions, side effects
For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information
Generic name:clobetasol topical
Brand names: Clobevate, Clobex, Clodan, Cormax, Cormax Scalp, Dermovate, Embeline, Embeline E, Olux, Olux-E, Olux / Olux-E Kit, Temovate, Temovate E
Drug class: topical steroids
For consumers: dosage, interactions, side effects
For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information
Generic name:dexamethasone systemic
Brand names: Dexamethasone Intensol, Decadron, Baycadron, Dexpak Taperpak, De-Sone LA, Dexacen-4, Dexasone, Dexasone LA, Solurex, Solurex LA, Zema Pak
Drug class: glucocorticoids
For consumers: dosage, interactions, side effects
For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information
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Compare 182 Eczema Medications | Drugs.com
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Types of Eczema : National Eczema Society
Posted: at 4:30 pm
Information and advice on the different types of eczema from atopic to varicose.
The term atopic refers to a personal and family tendency to develop eczema, asthma and/or hay fever.
Contact dermatitis is the most common type of work related skin disease.
Seborrhoeic dermatitis in adults tends to affect the scalp, face, torso and flexures.
Infantile seborrhoeic dermatitis (also called seborrhoeic eczema) is a common skin condition seen in infants under the age of one year. Often, but not always it affects the scalp as cradle cap.
Discoid eczema is very distinct with coin shaped discs of eczema the size of a fifty pence piece.
The key characteristic of pompholyx eczema is blistering that is restricted to the hands and feet.
Also known as eczema cracquele, Asteatotic eczema almost always affects people over the age of 60.
Varicose eczema (also called gravitational or stasis eczema) is common later in life.
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Types of Eczema : National Eczema Society
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Psoriasis at Patient. Symptoms and treatment for Psoriasis …
Posted: at 4:30 pm
What is psoriasis?
Psoriasis is a common condition where there is inflammation of the skin. It typically develops as patches (plaques) of red, scaly skin. Once you develop psoriasis it tends to come and go throughout life. A flare-up can occur at any time. The frequency of flare-ups varies. There may be times when psoriasis clears for long spells. However, in some people the flare-ups occur often. Psoriasis is not due to an infection. You cannot pass it on to other people and it does not turn into cancer.
The severity of psoriasis varies greatly. In some people it is mild with a few small patches that develop and are barely noticeable. In others, there are many patches of varying size. In many people the severity is somewhere between these two extremes.
There are different types of psoriasis. However, chronic plaque psoriasis (described below) is by far the most common and typical type.
Between 8 and 9 out of 10 people with psoriasis have chronic plaque psoriasis. The rash is made up of patches (plaques) on the skin. The picture shows typical plaques of psoriasis next to some normal skin.
Each plaque usually looks pink or red with overlying flaky, silvery-white scales that feel rough. There is usually a sharp border between the edge of a plaque and normal skin.
The most common areas affected are over elbows and knees, the scalp and the lower back. Plaques may appear anywhere on the skin but they do not usually occur on the face.
The extent of the rash varies between different people and can also vary from time to time in the same person. Many people have just a few small plaques of a centimetre or so when their psoriasis flares up. Others have a more widespread rash with large plaques of several centimetres across. Sometimes, small plaques that are near to each other merge to form large plaques. Chronic plaque psoriasis can be itchy but it does not usually cause too much discomfort.
There are two variations of chronic plaque psoriasis:
This type of psoriasis usually just affects the palms of the hands and soles of the feet. In this situation it is sometimes called palmoplantar pustulosis. Affected skin develops crops of pustules, which are small fluid-filled spots. The pustules do not contain germs (bacteria) and are not infectious. The skin under and around the pustules is usually red and tender. Pustular psoriasis which just affects the palms and soles is the second most common type of psoriasis.
Rarely, a form of pustular psoriasis can affect skin apart from the palms and soles. This more widespread form is a more serious form of psoriasis and needs urgent treatment under the care of a skin specialist (a dermatologist).
About half of people with any type of psoriasis can have fingernail psoriasis. In some people toenails are also affected. Nail psoriasis may also occur alone without the skin rash. There are pinhead-sized pits (small indentations) in the nails. Sometimes, the nail becomes loose on the the nail bed. Nails may also change colour and the area around the bed of the nail can become orange/yellow. See separate leaflet called Psoriatic Nail Disease for more details.
This typically occurs following a sore throat which is caused by a germ (bacterium). Round/oval plaques of psoriasis are small (less than 1 cm - drop size) but occur over many areas of the body. Guttate psoriasis normally lasts a few weeks and then fades away. However, it may last for three to four months in some people. In many people, once it goes it never returns.
This type of psoriasis causes a widespread redness (erythema) of much of the skin surface, which is painful. Individual plaques of psoriasis cannot be seen because they have merged together. There is still redness and scaling of the skin and the skin feels warm to touch. A person with erythrodermic psoriasis may also have a high temperature (fever). This type of psoriasis is rare but it is serious and needs urgent treatment and admission to hospital. This is because it can interfere with the body's ability to control temperature and it can cause excessive protein and fluid loss, leading to lack of fluid in the body (dehydration), heart failure and severe illness.
Role of accupuncture in psoriatic arthritis
Clobaderm 0.05% side effects
Itchy hands , feet and more
About 1 in 50 people develop psoriasis at some stage of their life. Psoriasis is more common in white people. It can first develop at any age but it most commonly starts between the ages of 15 and 30 years.
Someone with psoriasis may have other family members with the same problem. Also, one large study found that smokers (and ex-smokers for up to 20 years after giving up) have an increased risk of developing psoriasis compared with non-smokers. One theory for this is that poisons (toxins) in cigarette smoke may affect parts of the immune system involved with psoriasis.
Normal skin is made up of layers of skin cells. The top layer of cells (horny layer of the epidermis) is flattened and gradually sheds (they fall off). New cells are constantly being made underneath (in the basal layer of the epidermis) to replace the shed top layer. Cells gradually move from the basal layer to the top horny layer. It normally takes about 28 days for a cell in the basal layer to reach the top layer of skin and to be shed. The diagram shows a cross-section of normal skin.
People with psoriasis have a faster turnover of skin cells. It is not clear why this occurs. More skin cells are made which leads to a build-up of cells on the top layer. These form the flaky patches (plaques) on the skin, or severe dandruff of the scalp seen in scalp psoriasis.
There are also some changes in the blood vessels that supply the skin in people with psoriasis. Small blood vessels can widen (dilate) and increase in number. This is why the skin underneath a patch of psoriasis is usually red. Cells involved in inflammation also increase in number in the skin of people with psoriasis.
The cause of the increased cell turnover and skin inflammation of psoriasis is not known. Inherited (genetic) factors seem to play a part, as about 3 in 10 people with psoriasis have a close relative also affected. It may be that some factor in the environment (perhaps a virus) may trigger the condition to start in someone who is genetically prone to develop it. Another theory is that the immune system may be overreacting in some way to cause the inflammation. Research continues to try to find the exact cause.
In most people who have psoriasis, there is no apparent reason why a flare-up develops at any given time. However, in some people, psoriasis is more likely to flare up in certain situations. These include the following:
People with psoriasis are more likely to have or develop some other problems. However, just because you have psoriasis does not mean that you will definitely develop these. The problems include the following:
Some people with psoriasis may feel embarrassed about their skin problem and develop a negative body image. They may avoid certain activities such as swimming because of fear of uncovering their skin and of other people seeing it. Personal relationships may be affected. Some people with psoriasis develop anxiety and depression.
Psoriasis is usually diagnosed by the typical appearance of the rash. No tests are usually needed. Occasionally, a small sample (biopsy) of skin is taken to be looked at under the microscope if there is doubt about the diagnosis.
There is no once-and-for-all cure for psoriasis. Treatment aims to clear the rash as much as possible. However, as psoriasis tends to flare up from time to time, you may need courses of treatment on and off throughout your life. There are various treatments options. There is no 'best buy' that suits everybody. The treatment advised by your doctor may depend on the severity, site and type of psoriasis. Also, one treatment may work well in one person but not in another. It is not unusual to try a different treatment if the first one does not work so well.
Many of the treatments are creams or ointments. As a rule, you have to apply creams or ointments correctly for best results. It usually takes several weeks of treatment to clear plaques of psoriasis. Make sure you know exactly how to use whatever treatment is prescribed. For example, some preparations should not be used on the skin creases (flexures), on the face or on broken skin, and some should not be used if you are pregnant. Do ask a doctor, nurse or pharmacist if you are unsure as to how to use your treatment, or for how long you should use it.
The following is a brief overview of the more commonly used treatments for chronic plaque psoriasis. Unless psoriasis is very severe, treatment tends to start with topical treatments. This means treatments that can be applied directly to the skin, such as creams or ointments. If these treatments are not successful, you will usually be referred to a skin specialist for advice about other treatments such as medicines and light treatments.
If you have psoriasis, you may also get some benefit from quitting smoking and also limiting your alcohol intake. See separate leaflets called Tips to Help You Stop Smoking and Recommended Safe Limits of Alcohol for details. Regular exercise and a healthy diet may also be helpful. This is because, as explained above, people with psoriasis may have an increased risk of developing heart disease and stroke. Regular exercise and a healthy diet can help to prevent these conditions.
Note: treatments of the less common forms of psoriasis are similar but are not dealt with here. Your doctor will advise.
Many people have a few patches (plaques) of psoriasis that are not too bad or not in a noticeable place. In this situation, some people do not want any treatment. If you opt for no treatment, you can always change your mind at a later time if the psoriasis changes or worsens.
These help to soften hard skin and plaques. They may reduce scaling and itch. There are many different brands of moisturising creams and ointments. A moisturiser may be all that you need for mild psoriasis. You should also use one in addition to any other treatment, as often as needed, to keep your skin supple and moist. They can also help to prevent itching, reduce cracking of the skin and can help to remove scales. Using a moisturiser may also mean that other treatments can be more effective. However, apply the emollient first and allow plenty of time for it to be absorbed into your skin before applying any other treatment.
Moisturisers can also be used in place of soap. Be careful when using an emollient in the bath or the shower as they can make the surface slippery.
Calcipotriol, calcitriol and tacalcitol are commonly used and often work well. They seem to work by slowing the rate at which skin cells divide. They are creams, ointments or lotions that are easy to use, are less messy and have less of a smell than coal tar or dithranol creams and ointments (below). However, they can cause skin irritation in some people. There is also a scalp preparation of calcipotriol that can be used to treat scalp psoriasis.
A vitamin D-based treatment is sometimes used in combination with other treatments for psoriasis if either treatment is not sufficient. For example, an ointment that contains calcipotriol and a steroid is sometimes used.
If you are trying for a baby, are pregnant or are breast-feeding, vitamin D-based treatments are only prescribed if the benefits outweigh the risks. You should discuss with your doctor whether you should use vitamin D-based treatment if you are trying for a baby, are pregnant, or are breast-feeding.
Calcipotriol may cause skin irritation which can lead to redness, soreness or itch in around 1 in 5 users. Any skin irritation that does develop usually settles but sometimes a break in treatment is needed. Occasionally, treatment needs to be stopped because of skin irritation. Because of the risk of skin irritation, you should not use calcipotriol on your face and flexures such as the front of elbows, behind knees, armpits, groins, etc.
Generally, calcipotriol is thought to be safe, provided that you follow the manufacturer's instructions. The instructions include that you should not exceed the maximum dose. This is:
Note: if you are using calcipotriol as a cream or ointment for your body and you are using a scalp lotion that contains calcipotriol, you need to consider both of these. In this situation, the maximum amount of each is less than stated above. You should follow the instructions given by your doctor.
If you are also using an emollient for your skin, you should make sure that you use this first. Then, wait for 30 minutes before you apply calcipotriol or one of the other vitamin D analogues.
You should wash your hands after applying calcipotriol. This prevents you from inadvertently transferring the cream or ointment to other areas of your body.
Calcitriol and tacalcitol ointments contain different vitamin D analogues to calcipotriol. An advantage of calcitriol and tacalcitol is that they are less irritating than calcipotriol. Therefore, one or other may be suitable for use on the face and flexures if advised by your doctor. You should not use more than 30 g of calcitriol ointment per day and it should not be applied to more than a third of your body surface each day. You should not use more than 10 g of tacalcitol ointment per day.
Topical steroids are other commonly used treatments. They work by reducing inflammation. They are easy to use and may be a good treatment for difficult areas such as the scalp and face. However, one problem with steroids is that in some cases, once you stop using the cream or ointment, the psoriasis may rebound back worse than it was in the first place. Also, side-effects may occur with long-term use, especially with the stronger (more potent) preparations.
Therefore, if a steroid is used, a doctor may prescribe it for a limited period only (a few weeks or so, and less for a strong steroid), or on an intermittent basis. As a rule, a steroid cream or ointment should not be used regularly for more than four weeks without a review by a doctor. Steroid lotions are useful for flare-ups of scalp psoriasis. Only milder steroid creams or ointments should be used on your face or for psoriasis affecting flexures.
These have been used to treat psoriasis for many years. It is not clear how they work. They may reduce the turnover of the skin cells. They also seem to reduce inflammation and have anti-scaling properties. Traditional tar preparations are messy to use but modern formulas are more pleasant. Creams, ointments, lotions, pastes, scalp treatments, bath additives and shampoos that contain coal tar are available to treat psoriasis.
As a rule, do not use coal tar creams or other coal tar treatments on flexures such as the front of elbows, behind knees, groins, armpits, etc. Also, avoid using them on your face, as you need to be careful not to get them into your eyes. However, some of the milder creams can be used on your face and flexures - your doctor will advise. Your doctor will also advise you on whether it is safe for you to use coal tar treatments on your genital areas.
Coal tar preparations can have an unpleasant smell and can stain clothes. They may cause skin irritation in some people and skin can become sensitive to sunlight whilst using them. Coal tar preparations should not be used during the first three months of pregnancy. However, they can be used later in the pregnancy and during breast-feeding.
Dithranol has been used for many years for psoriasis. In most cases a daily application of dithranol to a psoriasis plaque will eventually cause the plaque to go. However, dithranol irritates healthy skin. Therefore, you need to apply it carefully to the psoriasis plaques only. To reduce the chance of skin irritation, it is usual to start with a low strength and move on to stronger ones gradually over a few weeks.
Short-contact dithranol therapy is popular. This involves putting a high-strength dithranol preparation on the plaques of psoriasis for 5-60 minutes each day and then washing it off. Dithranol may stain skin, hair, clothes, bedding, baths, etc. You should not use dithranol on your face unless suggested by a skin specialist.
When using dithranol, you should follow the instructions given by your doctor carefully, and those that come with the packet of the preparation that you are prescribed. Also, persevere with the treatment, as success often takes several weeks. The instructions may include the following:
Salicylic acid is often combined with other treatments such as coal tar or steroid creams. It tends to loosen and lift the scales of psoriasis on the body or the scalp. Other treatments tend to work better if the scale is lifted off first by salicylic acid. Salicylic acid can be used as a long-term treatment. However, it can cause skin irritation in some people. You should not use this treatment if you are allergic to aspirin.
Tazarotene is another cream that is sometimes used. It is a vitamin A-based preparation. Irritation of the normal surrounding skin is a common side-effect. This can be minimised by applying tazarotene sparingly to the plaques and avoiding normal skin. Tazarotene treatment must not be used if you are pregnant, because of potential risks of harm to the developing baby. It should also not be used during breast-feeding.
A coal tar-based shampoo is often tried first and often works well. Some preparations combine a tar shampoo with either a salicylic acid preparation, a coconut oil/salicylic acid combination ointment, a steroid preparation, calcipotriol scalp application, or more than one of these.
If you have scalp psoriasis, you may also find it helpful to wear lighter-coloured clothes so that scales falling from your scalp may be seen less easily. You may also wish to talk to your hairdresser about changing your hairstyle to cover up the psoriasis as much as possible. Be careful to brush your hair gently. Scalp treatments can also stain your pillow/pillowcase. So you may wish to cover your pillow with an old pillowcase.
Some preparations use a combination of ingredients. For example, calcipotriol combined with a steroid may be used when calcipotriol alone has not worked very well. As mentioned, it is not usually wise to use a steroid long-term. Therefore, one treatment strategy that is sometimes used is calcipotriol combined with a steroid for four weeks, alternating with calcipotriol alone for four weeks.
Other combinations such as a coal tar preparation and a steroid are sometimes used. Using both a vitamin D preparation and a steroid preparation at the same time can also be more effective than using either one by itself in some people. Other rotating treatment strategies are sometimes used. For example, a steroid for a few weeks followed by a course of dithranol treatment.
Scalp treatments often contain a combination of ingredients such as a steroid, coal tar, and salicylic acid.
If you have severe psoriasis then you may need hospital-based treatment. Light therapy (phototherapy) is one type of treatment that can be used. This may involve treatment with ultraviolet B (UVB) light. Another type of phototherapy is called PUVA - psoralen and ultraviolet light in the A band. This involves taking tablets (psoralen) which enhance the effects of UV light on the skin. You then attend hospital for regular sessions under a special light which emits ultraviolet A (UVA).
Sometimes people with severe psoriasis are given intense courses of treatment, using the creams or ointments described above, but in stronger strengths and with special dressings.
If psoriasis is severe and is not helped by the treatments listed above then a powerful medicine which can suppress inflammation is sometimes used. For example, methotrexate, ciclosporin, acitretin, etanercept, infliximab, efalizumab, ustekinumab and adalimumab. There is some risk of serious side-effects with these medicines, so they are only used on the advice of a specialist.
Psoriasis affects different people in different ways. In general, plaque psoriasis is a persistent (chronic) condition with flare-ups that come and go. However, some studies have shown that, over time, plaque psoriasis may go away completely at some point in around 1 in 3 people. Some people have a number of years where they are free from psoriasis and then it may flare up again.
As mentioned above, the less common guttate psoriasis usually goes away completely after a few months. But, if you have an episode of guttate psoriasis, you have a higher than usual chance of developing chronic plaque psoriasis at a later time.
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