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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.
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.
There are several signs of psoriasis. Symptoms to look for include:
Between 10% and 30% of patients with psoriasis also develop psoriatic arthritis, which causes pain and swelling in the joints.
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:
Patients with a personal or family history of psoriasis should avoid triggers as much as possible.
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.
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.
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.
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.
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.
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.