From Egyptian mummies to cutting-edge research, we take a look at the disease through the ages
Kept under wraps for thousands of years, psoriasis showed up when Egyptian mummies were unearthed. The Greeks had a word for it—psora, "to itch"—which could qualify as the understatement of the centuries!
Other than isolating that symptom, even the most respected medical minds of ancient times remained baffled by psoriasis. Greek "Father of Medicine" Hippocrates (460-377 B.C.) replaced superstition with knowledge in treating skin ailments by introducing tar into the mix—but he also prescribed topical arsenic. Noted physician Galen (133-200 A.D.) identified psoriasis as a skin disease through clinical observation and was the first to call it psoriasis. But, along with arsenic, he suggested applying broth in which a viper had been boiled.
Lumped together with similar skin disorders that were believed to be contagious, the condition led to confusion with leprosy (Old Testament descriptions didn't help) and its accompanying social stigma, isolation and shunning. People with psoriasis—thousands in medieval Europe—were forced to warn others of their arrival by ringing a clapper.
Misconceptions, mistreatments: Enough to make your skin crawl
In the past, possible culprits thought to cause psoriasis included poor nutrition, microbes, the blood stream, poor hygiene, allergies and malfunctioning internal organs. Numerous pre-19th-century, ill-conceived treatments were put forth to "cure" skin problems akin to psoriasis. Patients on the receiving end were subjected to remedies and recipes that included cat and dog dung, fresh oil, goose oil and semen, onions mixed with sea salt and urine, and other waste-product, ingredient-rich formulations.
Hit-or-miss ideas included lubricating the skin and wrapping the body in sheets for days to create an occlusion (cover) to loosen scales. Popular applications sometimes included toxic ingredients such as nitrate, sulfur and mercury, causing side effects harmful enough to outweigh any benefits. Most solutions were smelly, irritating and time-consuming.
(I wonder what these pre-19th-century patients would think of the 21st-century alternative therapy, used in Turkey and Croatia, that offers psoriasis as fish food. Certain fish [called garra rufa or "doctor fish"] feed on scaly skin that has been softened in a pool.)
Here are some of the many historical "firsts" that contributed to progress in understanding psoriasis and treating it. The modern-day medical Enlightenment began in the 19th century and gained momentum in the 20th and 21st centuries.
- At the Hospital Saint-Louis Paris in the early 19th century, Jean-Louis Ailbert classified skin diseases according to cause, appearance, duration, course and response to treatment.
- England's Dr. Robert Willan, around 1809, first recognized psoriasis as a specific clinical entity and described it accurately. Willan made the study of skin his life's work.
- In 1836, Henry Daggett Bulkley opened Broome Street dispensary in New York, the first in the United States for treating psoriasis and other dermatological disorders.
- Doctor Ferdinand von Hebra, founder of modern dermatology, in the 1840s eliminated the word "lepra" from the clinical description of psoriasis, separating it from leprosy for all time.
- In the 1960s, investigation of psoriasis as an autoimmune condition began. Psoriatic arthritis was finally identified as a clinical entity in its own right.
- Twentieth-century recognition of the underlying mechanisms by which psoriasis manifests itself led to treatments based on evidence of effectiveness for each person, according to individual needs rather than trial and error. These include topical (applied to the skin), laser and phototherapy, and systemic (oral, injected or IV medications that suppress the immune system). Although known for its healing properties since biblical times, Israel's Dead Sea began to be touted as an effective therapy source in the 1970s.
- The early 1990s produced the Human Genome Project, sparking the systematic search to identify the genes that determine psoriasis.
- Biologic medications, introduced in the latter part of the 20th century, became the cutting edge for psoriasis research and treatments. These agents are made from substances found in living cells and act on the body's immune system. They treat psoriasis by targeting overzealous immune cells, which cause the disease.
What's on the horizon for your well-being?
The history of psoriasis—with its off-the-wall theories about how the disease originated and some outrageous remedies along the way—did not bode well for patients at first. But with improved understanding of its cause, new research technology, treatments based on evidence rather than trial and error, targeting genes that cause psoriasis, and developing medications that block haywire immune cells, the story of psoriasis has changed for the better.
Research efforts remain focused on treatments that are tailored to fit the individual needs of patients with psoriasis. The possibility exists, for example, of developing personalized vaccines formulated from the patient's own immune cells to inhibit cell growth. The search continues on scientific, social and educational fronts to find the way to switch psoriasis off forever. Today's psoriasis researchers are creating tomorrow's history.