Psoriasis

Psoriasis is an auto-immune skin condition that presents clinically as thick, pink, scaly plaques on elbows, knees, scalp, back and sometimes in the folds of the skin like armpits, belly-button, groin folds and breast folds in females. It is a chronic condition marked by periodic flares and remissions of skin plaques. A percentage of patients will also have psoriasis of the joints, called psoriatic arthritis, which is a destructive joint disease.  Psoriasis of the nails can present with nail discoloration, splitting of nails, and pitting or spotting on nail bed. While the exact cause of the disease is not known, we do see it run in the families. A variant of psoriasis presents with patches, plaques and pus-heads on palms and soles, called palmo-plantar psoriasis. This variant can sometimes be precipitated by some treatments for psoriasis or Crohns disease, and can cause severe disfigured nails when the disease affects the nails.

While flares and remissions are common, psoriasis has certain triggers including the following:

  • Infections- bacterial infections, such as strep throat, strep infections of genital skin and other folds and strep gingival infections

  • Stress- emotional stress is a well-known trigger for psoriasis flare

  • Trauma to skin- sunburns, scrapes, scratches and other skin injuries can trigger psoriasis

  • Medications- certain medications can cause psoriasis flares, including antimalarial drugs, beta-blockers and Lithium

  • Winter months- Lack of sunshine during winter months especially in the northern parts of the country, can cause flares

  • Diet, allergies and smoking- are  a few triggers seen in individuals with psoriasis

 

What are the treatment options?

While there is no cure for psoriasis, there are a number of treatment options available that can help get your skin, nails and joints in healthier state to improve your quality of life. It is important to nurture your skin, to keep it free of infections or trauma. Psoriasis is also associated with increased risk of heart disease, high cholesterol levels, diabetes, depression, obesity, metabolic syndrome, visual problems and vitamin D deficiency. It is important to initiate healthy lifestyle habits early on and to seek treatments for psoriasis to reduce the risk of heart disease. 

  • Phototherapy (UV) – exposing affected areas of skin to a specific wavelength of ultraviolet light on a regular basis, as prescribed and monitored by a dermatologist, either as monotherapy or combination therapy with other options, can help get psoriasis under control. For localized disease like scalp, palms and soles, an Excimer laser which delivers targeted treatment over small areas through a hand-held device, can be used.

  • Topical medications – over-the-counter or prescription medications designed to be applied directly to the skin, including steroids, are considered a first-line treatment option. Sometimes dermatologists use compound medications that contain steroids, tar and salicylic acid to help exfoliate the thick plaques of psoriasis. For localized disease that presents with thick plaques, steroid suspensions can be injected directly into the plaques

  • Systemic drugs – are used in the treatment of moderate to severe plaque psoriasis, either alone, or in conjunction with other treatment options. Drugs like methotrexate, cyclosporine, apremilast and acitretin have been used successfully, but because of their potential side effect profile, regular monitoring with blood work and visits are often required.

  • Biologics – given via injection or intravenously (IV), these drugs deliver antibodies against specific molecules that play a role in psoriasis.

 

With excellent choices available for psoriasis, we are now able to offer multiple options to reduce the symptoms of psoriasis and risk of joint destruction, as well as improve patient's quality of life. Find a dermatologist who will partner with you to a healthy life, even with psoriasis.