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Mayo Clinic Q&A: psoriasis; hip impingement

 
Published Sept. 28, 2017

PSORIASIS CAN BE TRIGGERED BY STRESS

What causes psoriasis, and what's the best way to treat it?

Psoriasis has a tendency to run in families, and exacerbations often are linked to the body's immune system responding to certain internal or external factors. The exact cause of psoriasis is not easy to determine. Treatment depends on how severe the psoriasis is and how responsive it has been to previous treatment. Treatment usually starts with mild approaches and proceeds to stronger remedies, but only as they are needed.

Psoriasis is a skin disease that affects the life cycle of skin cells. Normal skin grows and sheds every 28 days, or about once a month. Psoriasis skin regenerates every 72 hours. When the immune system becomes activated and attacks the skin cells, psoriasis causes the cells to build up rapidly on the skin's surface. Because the body cannot shed skin that quickly, a callous forms on the skin. The result is thick, silvery or white scales, and dry, red skin patches that can be itchy and even painful.

Psoriasis seems to have a genetic component, but it can occur in people who do not have any family members with the disease. Many people who are predisposed to psoriasis may be free of symptoms for years until the disease is triggered by some environmental factor.

One common trigger for psoriasis is stress. That can mean physical stress from illness, fatigue or sleep deprivation, or emotional stress. In some cases, a high level of stress may spark a dramatic psoriasis outbreak, with skin appearing normal one day and then developing multiple patches of psoriasis all over the body several days later.

Other factors that can raise the risk of psoriasis outbreaks include being overweight, smoking and exposure to secondhand smoke. These factors not only can trigger psoriasis, but also they can make the disease harder to treat.

A variety of treatment choices are available that may manage symptoms and decrease flare-ups. In mild to moderate cases, treatment usually starts with creams and ointments. In more severe cases, light therapy combined with topical treatment can be useful. Unfortunately, there isn't a cure for psoriasis.

Psoriasis that is severe or doesn't respond to other treatments may require oral or injected medications. These medications can have serious side effects, however. Ideally, they are used for limited periods of time.

Successfully treating psoriasis can be challenging. What works for one person might not work for another. Treatments may be effective for a while. Then, the body builds up resistance to them, and they no longer work. Psoriasis also can be unpredictable, going through cycles of improvement and worsening, seemingly at random.

Despite these challenges, it is important to continue with treatment and find one that works for you. If left untreated, psoriasis can lead to, or intensify, other medical problems, such as arthritis.

If you are being treated for psoriasis, but it persists, or if you are having uncomfortable side effects from treatment, talk to your health care provider about other options.

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Dawn Davis, M.D, Dermatology, Mayo Clinic, Rochester, Minn.

HIP IMPINGEMENT TREATMENTS VARY

What causes hip impingement, and will the pain worsen over time? How is it treated?

Hip impingement can happen for a number of reasons. If left untreated, the pain and other symptoms it causes may get worse as damage to the hip joint increases. Treatment for hip impingement depends largely on a person's individual circumstances. Generally, though, treatment options range from managing symptoms with medication and physical therapy in milder cases to surgery in more severe cases.

Hip impingement is a broad term used to describe conditions in which the ball and socket of the hip joint don't fit together properly. It's usually due to one of three main causes. First, the socket, also called the acetabulum, may develop abnormally as a child grows. This can lead to a condition known as acetabular retroversion, in which the socket grows too far over the front of the ball, or femoral head, of the hip joint.

Second, abnormal bumps called cam lesions can develop on the head-neck junction of the hip ball. Current research suggests that these cam lesions develop during adolescence, often when the growth plates are open. Participating in certain physical activity may lead to conflict between the ball and the socket, stimulating the bone to grow and create the cam lesion.

Third, an abnormal twist in the thigh bone, or femur, called femoral retrotorsion can lead to hip impingement. All three of these situations can combine in varying degrees to create the impingement.

Hip impingement can lead to loss of internal rotation of the hip. That triggers pain in the groin area during or after flexing the hip, such as when you run, jump or sit for long periods of time. Loss of hip internal rotation can be a good screening tool for possible hip impingement in adolescents.

Over time, impingement of the hip may tear the labrum, a fibrous ring of cartilage surrounding the hip socket. When the labrum is torn, it can cause hip pain. Hip impingement also may damage the protective cartilage that covers the ends of the bones in the joint, called articular cartilage. That can wear down the cartilage over time and eventually make it deteriorate completely, a condition known as hip osteoarthritis. Osteoarthritis can trigger hip pain, tenderness, stiffness and loss of flexibility. If nothing is done to correct severe hip impingement, these conditions likely will continue to worsen. As they do, hip discomfort, pain and other symptoms increase.

As each case of hip impingement is unique, treatment must be individualized to each patient. Multiple factors are considered when designing a custom treatment plan for patients, including their symptoms and desired activity level, hip bone anatomy, overall body mechanics and range of motion, as well as the amount of damage done to the labrum and articular cartilage.

In mild to moderate cases of hip impingement, symptoms may improve with nonsurgical treatment, such as activity modification, pain medication, physical therapy and corticosteroid injection. In more severe or complex cases, arthroscopic or open surgery may be used to reshape the bones, repair the labrum and treat articular cartilage damage.

If you are diagnosed with hip impingement, consult with a physician who specializes in orthopedics to review your options and decide on a treatment plan that best suits your situation.

Aaron Krych, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ&A@mayo.edu. For more information, visitmayoclinic.org. © 2017 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency, LLC. All rights reserved.