Psoriasis
Psoriasis is a long-lasting autoimmune disease characterized by patches of abnormal skin.[6] These skin patches are typically red, dry, itchy, and scaly.[3] On people with darker skin the patches may be purple in colour.[9] Psoriasis varies in severity from small, localized patches to complete body coverage.[3] Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon.[10]
There are five main types of psoriasis: plaque, guttate, inverse, pustular, and erythrodermic.[6] Plaque psoriasis, also known as psoriasis vulgaris, makes up about 90 percent of cases.[4] It typically presents as red patches with white scales on top.[4] Areas of the body most commonly affected are the back of the forearms, shins, navel area, and scalp.[4] Guttate psoriasis has drop-shaped lesions.[6] Pustular psoriasis presents as small non-infectious pus-filled blisters.[11] Inverse psoriasis forms red patches in skin folds.[6] Erythrodermic psoriasis occurs when the rash becomes very widespread, and can develop from any of the other types.[4]Fingernails and toenails are affected in most people with psoriasis at some point in time.[4] This may include pits in the nails or changes in nail color.[4]
Psoriasis is generally thought to be a genetic disease that is triggered by environmental factors.[3] In twin studies, identical twins are three times more likely to be affected compared to non-identical twins. This suggests that genetic factors predispose to psoriasis.[4] Symptoms often worsen during winter and with certain medications, such as beta blockers or NSAIDs.[4] Infections and psychological stress can also play a role.[3][6]Psoriasis is not contagious.[4] The underlying mechanism involves the immune system reacting to skin cells.[4] Diagnosis is typically based on the signs and symptoms.[4]
There is no cure for psoriasis; however, various treatments can help control the symptoms.[4] These treatments include steroid creams, vitamin D3 cream, ultraviolet light and immune system suppressing medications, such as methotrexate.[6] About 75 percent of cases can be managed with creams alone.[4] The disease affects two to four percent of the population.[8] Men and women are affected with equal frequency.[6] The disease may begin at any age, but typically starts in adulthood.[5] Psoriasis is associated with an increased risk of psoriatic arthritis, lymphomas, cardiovascular disease, Crohn’s disease and depression.[4] Psoriatic arthritis affects up to 30 percent of individuals with psoriasis.[11]
Midland
Midland is a city in the U.S. state of Michigan in the Tri-Cities region of Central Michigan. It is the county seat of Midland County.[7] The city’s population was 41,863 as of the 2010 census. It is the principal city of the Midland Micropolitan Statistical Area, part of the larger Saginaw-Midland-Bay City Combined Statistical Area. In 2010, Midland was named the no. 4 Best Small City to raise a family in by Forbes magazine.[8]
By the late 1820s, Midland was established as a fur trading post of the American Fur Company supervised by the post at Saginaw. Here agents purchased furs from Ojibwe trappers. The Campau family of Detroit operated an independent trading post at this location in the late 1820s.[9]
The Dow Chemical Company was founded in Midland in 1897, and its world headquarters are still located there. Through the influence of a Dow Chemical plant opening in Handa, Aichi, Japan, Midland and Handa have become sister cities.[10] The Dow Corning Corporation and Chemical Bank are also headquartered in Midland.
In 1969 the city unilaterally defined a Midland Urban Growth Area (MUGA), which at the time was a territory two-miles around the city limits of Midland in an attempt to control urban sprawl. [11] The central policy was that as the only capable supplier of drinking water, the city would provide water services to commnities outside the MUGA such as the nearby village of Sanford, but would not provide to water services to the area within the MUGA without annexation to the city of Midland thus controlling most of the growth in the county. Since 1991 however, the policy has since been revised with a series of Urban Cooperation Act Agreements with surrounding townships which has allowed case-by-case redrawings of the MUGA line to allow Midland to sell water to the surrounding townships without annexation.[11]