Psoriasis

MEDICAL DERMATOLOGY

What is Psoriasis?

Psoriasis is a skin disorder in which the cells of the skin multiply much faster than normal. This causes the skin to create bumpy red patches with white scales. These patches can appear anywhere but occur most frequently on the knees, elbows, lower back and scalp. It is not contagious and does not pass from person to person. Typically, psoriasis appears for the first time in early adulthood. Psoriasis is a chronic disorder and can heal and reappear throughout someone’s life.

Who Gets Psoriasis?

The cause of psoriasis is multifactorial. It can set in at any age, but the most common age of onset is in the teens and twenties. There seems to be a genetic link to psoriasis, so people with a family history are at a higher risk.

Signs and Symptoms of Psoriasis

There are several signs of psoriasis. Symptoms to look for include:

  • Plaques of reddened skin
  • Itchiness and pain on the plaques
  • Silver-colored scales on the patches of affected skin
  • Discoloration and pitting in the nails
  • Detachment of the nail from the nailbed
  • Crusting scales on the scalp

Between 10% and 30% of patients with psoriasis also develop psoriatic arthritis, which causes pain and swelling in the joints.

What Causes Psoriasis?

There is no known cause of psoriasis, but experts believe it may be due to a combination of immune system issues that lead to inflammation and genetic and environmental triggers. Psoriasis tends to run in families but it often skips generations. Environmental triggers that can lead to psoriasis include:

  • Cuts or scrapes
  • Surgery
  • Stress
  • Strep
  • Blood pressure medications
  • Antimalarials

Patients with a personal or family history of psoriasis should avoid triggers as much as possible.

How to Treat Psoriasis

While there is no cure for psoriasis, there are a multitude of treatments. If you suffer from psoriasis, it is important to be evaluated by a doctor to discuss the best course of treatment for you.

Non-Prescription Psoriasis Treatment
For those with milder forms of psoriasis, change in daily routine or diet may be able to help control flare-ups. Sunlight tends to help with psoriasis, but avoid a sunburn which can worsen the condition. Alcohol and certain foods seem to be triggers in certain individuals. Keeping track of when your psoriasis flares up can be an important part in treating the condition.

Topicals
The first-line defense for psoriasis is topical prescription steroids. These creams, lotions and ointments range in strength and efficiency, but if used consistently, can keep many psoriasis treatments under control. Topical vitamin D derivatives and retinoids are other options.

Intralesional Injections
For more stubborn focal areas, intralesional Kenalog injections can be used. This is an injection of a liquid steroid placed right below the skin. Topical treatment is usually recommended to maintain the benefits of this treatment.

Light Psoriasis Treatments

  • XTRAC: For focal or small areas, XTRAC is an effective and safe treatment. During the procedure, a provider will use a handheld machine to administer localized doses of a safe and effective narrow band of ultraviolet light. The treatment is best performed two to three times a week during quick office visits with a very minimal risk of side effects.
  • nbUVB: For more widespread or persistent psoriasis, nbUVB phototherapy treatments may be recommended. This treatment requires the patient to come in for two to three quick visits per week. The patient will then stand in a booth that provides a safe and effective band of ultraviolet light. This gives the patient the anti-inflammatory benefits of the sun, without the harmful rays that cause skin damage.

Systemic Psoriasis Treatments
If a patient’s psoriasis is resistant to multiple treatments or is extensive, systemic treatments may be recommended. These treatments are usually oral pills that need to be taken once a week or daily. They affect the patient’s immune system (a cause of psoriasis), decrease inflammation and mitigate the proliferation of skin cells. These medications can have serious side effects and require consistent monitoring and follow-up visits with your physician. These may also be prescribed as a prerequisite to trying biologic therapy.

Biologics
For severe and persistent psoriasis and psoriatic arthritis, biologics are a great option for healthy individuals. Biologics are medications that are injected, usually at home by the patient, during different intervals (every other week to once every three months). These powerful medications affect the body’s immune system in order to regulate the psoriasis. The most common biologics are Humira®, Stelara® and Enbrel®. Due to their strength, there are side effects that must be monitored regularly by a physician. Regular blood tests may be necessary. When used safely, biologics can be a very effective way at managing even the most severe cases.

Suggested Treatment Options


All cases of psoriasis are not the same, therefore we recommend seeing a specialist to help determine which treatment option is the best for you.

Light Therapy

Originally developed for Navy seals to help wounds heal quicker, light therapy has been shown to be highly therapeutic for skin. Learn More

Cyclosporine

Cyclosporine is used in a number of conditions where the immune system behaves erratically. Learn More

Biologic Injectables

Biologic injectables (Humira, Enbrel, Taltz, Stelara, Cosentyx) are biologics designed to be injected subcutaneously into the skin. Learn More

Intralesional Injection

Intralesional injection is a process whereby a corticosteroid is injected directly into a skin lesion or irregular growth. Learn More

Oral and Topical Medications

Dermatologists are experts in bacterial, viral and fungal infections in the skin and have a deep knowledge of how to best use antibiotics, antiviral and antifungal medications. Learn More

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