Weight loss and diet plan for a healthy lifestyle.

The nails are often affected, usually with evidence of psoriasis elsewhere but, occasionally, they alone are involved. In this case, the diagnosis may be missed and the problem thought to be due to fungal infection or some other cause.

The nail may show small pin-head size pits or the nail may separate from the underlying nail bed or it may be thickened and discolored.

Unfortunately, treatment produces little benefit. Psoriasis on the skin responds well, in most cases, to local applications but the nail seem particulary resistant.

Patients undergoing treatment with methotrexate often show an improvement in their nails.

It is worth repeating that most cases of psoriasis are mild and can be controlled by simple means. Self-medication should be avoided, as it may irritate the skin.

Sometimes a previously satisfactory treatment loses its effect. When this happens the sufferer will need to change to something else. Later, the original treatment may again be effective.

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The most common symptoms are abdominal pain and diarrhoea and the diagnosis may be missed and thought to be either an episode of mild appendicitis or the irritable-bowel syndrome.

Sometime ulcerative colitis may be suspected, if Crohn’s disease affects the large bowel. At times there is a fever and weight loss.

When the rectum and anus are affected there may be localised pain, bleeding and sometimes a fistula or track leading from the bowel and opening out on to the skin around the anus.

Involvement of large areas of the small bowel may lead to poor absorption of food, anaemia, vitamin deficiencies and malnutrition.

Treatment is not altogether satisfactory, as this is often so in diseases where the exact cause is not always known. Cortisone or its derivatives are often used as in any chronic inflammatory disorder.

One of the antibacterial sulpha drugs can be of value in acute flare-ups, but is of little use in long term maintenance.

It may be necessary to operate and remove the affected segment of the bowel when medical treatment fails.

Most patients can be kept in reasonable health and can live full and active lives.

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