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Psoriasis

What is psoriasis?

Psoriasis is a common, chronic inflammatory, immune disease affecting about 2% of adult Americans. It can affect children as well. While psoriasis is considered to be a skin disorder, the damage the inflammation causes can result in serious complications that affect multiple organ systems. 25% of patients develop joint inflammation called psoriatic arthritis. Beyond its physical manifestations, psoriasis has an extensive emotional and psychological impact, affecting social functioning and interpersonal relationships.

90% of patients have plaque psoriasis, which is the most common presentation. Psoriasis is not contagious, but is irritating and uncomfortable and often times cosmetically unappealing for patients. Psoriasis can last a lifetime. Symptoms may appear and remit.

What causes psoriasis?

Psoriasis is an inflammatory immune system disorder. An autoimmune disease is where the immune system attacks the body causing an overgrowth of skin cells that form a rash. One third of cases run in families but research reports that multiple genetic abnormalities have been associated with psoriasis. It begins when immune system cells, called T-cells, produce signals that lead to inflammation and accelerate the growth of skin cells within days rather than weeks.

Psoriasis can be triggered or worsened by environmental forces such as stress, infection, some medications, cold and dry weather, and tobacco consumption.

Psoriasis increases the risk of developing other medical problems and comorbidities such as joint problems, inflammatory bowel disease, diabetes, heart disease, and depression.

What are the symptoms?

The characteristic psoriasis plaques are thick, and red with silvery scales that shed. The plaques develop all over the body and most commonly are found on the knees, elbows, scalp, lower back, face, hairline, palms and soles of the feet. Studies report that about 50% of patients also have finger and/or toenail psoriasis. It may be confused with eczema which is intensely dry and itchy skin that usually develops on the backs of knees and elbows.

As mentioned, plaque psoriasis is the most common presentation. The second most common form is called guttate psoriasis. It is characterized by widespread small, red scaly spots on the arms and legs that develop weeks after strep throat or viral infection. This type often begins in childhood or early adulthood. It may go away on its own or develop into plaque psoriasis.

Other types:

  • Smooth, red patches that are sore and painful in folds of skin, such as, armpits, genitals, and buttocks.
  • Pustular psoriasis presents with pus-filled bumps usually on the hands and feet that are sore and painful and can be life-threatening.
  • Nail psoriasis leads to changes of the finger and toenails causing dents, discoloration, and lifting the nail due to buildup of skin cells below it.

It is important to note that symptoms can be mild or severe. Psoriasis can lead to negative  social impact for patients due to the appearance of the rash, discoloration of the skin after the rash has resolved, and shedding of scales. Treating psoriasis effectively can improve quality of life for patients.

How is psoriasis diagnosed?

Board certified medical dermatologist, Dr. Rachel White will conduct a physical examination of your skin or areas of concern, inquire about your symptoms, and whether there are family members with this disorder. Dr. White may take a biopsy of the skin to rule out other conditions.

Treatments

There are many options to manage psoriasis but there is no cure.

Topical therapies

Corticosteroids are first-line foundational treatments to reduce inflammation and control itching. However, topical steroids can thin and damage the skin so they are not used for long-term maintenance therapy. Other prescription therapies rely on Vitamin D (Dovonex) and Vitamin A (Tazorac) and combinations to treat psoriasis. They are effective and safe for long-term use.

Phototherapy

Phototherapy is the controlled use of ultraviolet light. It may be recommended as a treatment option. Phototherapy may be combined with topical treatments.

Systemic therapy

Patients with severe psoriasis, psoriatic arthritis or other comorbidities may require systemic therapy that works on the entire body. The most difficult cases are treated with oral drugs like methotrexate and cyclosporine, an immune suppressive medication. Biologic oral and injectable treatments target the immune system. They are used in moderate to severe cases, when the disease is negatively affecting your quality of life, and when traditional treatments cannot control psoriasis, or cause side effects.

Despite psoriasis’ considerable effect on quality of life, psoriasis is underdiagnosed and under treated. When you have concerns about a rash seek evaluation from a board certified skin expert at RW Dermatology in Buckingham Township, PA. Schedule a consultation to assure you receive the correct diagnosis and treatments that can help you restore your quality of life, self-image and confidence.


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