Psoriasis is a complex, inflammatory condition that affects approximately 7 million American adults. The most common form is plaque psoriasis, characterized by scaly, red, raised patches on the arms, elbows, and knees. However, many other forms can severely impact patients’ physical and emotional health.
The team at IDI offers comprehensive diagnosis and management solutions for people suffering from plaque psoriasis or Other Skin Ailments. Here are a few facts you should know about this stubborn skin condition.
What is Psoriasis?
Psoriasis is a chronic condition that can be managed effectively but not cured. It is believed to be an immune system disorder that causes the skin to engage in extraordinarily fast cell turnover, resulting in inflammation, gray scaly skin, and deep red plaques.
The most common areas affected by Psoriasis are the scalp, nails, elbows, knees, abdomen, and lower back/buttocks. Itching may or may not be present.
Although psoriasis is seen in patients of all ages, two-thirds of cases are first diagnosed in adulthood. It can occur in anyone, but people with a family history of the condition are more likely to suffer outbreaks.
The following circumstances can also trigger flare-ups:
- Certain skin infections
- Very cold and dry weather
- Antimalarial drugs
- Some high blood pressure medications
- Consumption of alcoholic beverages
Plaque psoriasis – the formation of itchy and inflamed red skin patches – is the most widely seen form, but there are several variants. They include:
- Erythrodermic psoriasis: An extremely rare but serious condition that causes painful, burn-like inflammation and peeling that covers a significant portion of the body. Symptoms also include elevated heart rate, swelling of the feet, and dramatic body temperature fluctuations.
- Guttate psoriasis: The development of teardrop-shaped lesions on the body and extremities. It accompanies certain common illnesses, such as the flu or strep throat. It occurs in approximately 8% of people predisposed to psoriasis.
- Inverse psoriasis: A condition thought to be triggered by Fungal Infection. This version develops within skin folds, most commonly the undersides of the breasts, in the groin, and underneath the buttocks. The outbreaks are inflamed, red, tender, and itchy and made more severe by moisture and friction.
- Nail psoriasis: This form attacks the Nails Of The Fingers And Toes, resulting in nails that become discolored, thick, pitted, and loose. It can be a predictor of psoriatic arthritis.
- Psoriatic arthritis: Swelling and joint stiffness that might accompany nail changes.
- Pustular psoriasis: A rare version that causes painful, pus-filled lesions, generally on the palms of the hands and soles of the feet. Severe cases (general pustular psoriasis or GPP) cause outbreaks of pustules all over the body, along with elevated heart rate and internal temperature fluctuations. GPP is a very serious condition and should be addressed immediately.
A dermatologist will review your medical history and consult with you about your symptoms and the events that trigger outbreaks. Because it is important to screen out other medical disorders, a skin biopsy might be performed.
Treatments involve strategies that slow the development of new skin cells and facilitate the shedding of scaly patches. Numerous treatment options could be appropriate depending on the type and severity of the condition. While the condition will likely return, it can be managed effectively, and flare-ups can be minimized. Patients typically find that a personalized combination of different treatments works best. They might involve:
- Topical medications: These could be prescription or over-the-counter corticosteroid creams, which lower inflammation and inhibit the overproduction of skin cells. Calcineurin inhibitors are also effective in curtailing the hyperactive immune response that triggers outbreaks. Salicylic acid solutions might also be used to help exfoliate and allow other medications to penetrate more effectively.
Topical Steroids, Coal Tar distillates, and Anthralin have been used to treat Psoriasis for a long time (over 50 years).Recently, a combination of a Vitamin D derivative (Calcipotriol) and a strong topical Steroid (Betamethasone Dipropionate) named Taclonex has been found to be reliably effective in a majority of cases of Psoriasis with limited skin area involvement.More recently, a novel Vitamin D product named Vectical has also shown marked effectiveness.
- Light therapy: Phototherapy offers targeted treatment of stubborn patches that do not respond to topical medications. Light therapy has been shown to inhibit the formation of plaques and slow skin cell growth. Multiple sessions could be needed depending on the type of therapy and severity of the outbreak.
- Injections or oral medications: Isolated plaques could respond well to steroid injections at the site. Your doctor may also recommend injecting biologic drugs that manage your immune response and reduce the severity of existing flare-ups. Oral immunosuppressant medications like cyclosporine are generally prescribed for severe cases.
Methotrexate has been used in the treatment of Psoriasis for almost 50 years. With close supervision, it can be very effective in treating numerous cases of Psoriasis.
- Laser treatments: for limited areas affected by Psoriasis. For more limited areas affected by Psoriasis, such as palms and soles, or both, and for some large patches on the trunk or limbs, the Xtrac Laser (XTRAC) – a relatively new and safe laser treatment – can be very effective. Between 5 and 10 treatments every 7 to 14 days, can clear up resistant patches. Most insurance plans cover these treatments.
The XTRAC Excimer Laser Treatment System is a laser that emits very concentrated ultraviolet light.Highly precise and sophisticated, the XTRAC excimer laser allows the physician to concentrate the high dose of UVs right on the problem spot (Excimer lasers are commonly used in eye surgeries).
- Biologic injectable agents: to treat large areas of skin affected by Psoriasis. For resistant and widespread cases of Psoriasis and many cases involving the face, palms, and soles, the Biological Treatments, often in conjunction with UVB Treatments, can be very effective.
As an autoimmune disease, psoriasis can be markedly improved by antagonizing some segments of the immune system that are overactive in Psoriasis.FOR ANY PATIENT CONSIDERED FOR TREATMENT WITH BIOLOGICS, TB SCREENING AND PROPHYLAXIS ARE A MUST. THE NEW QUANTIFERON GOLD TEST IS MUCH MORE RELIABLE THAN THE OLD INTRADERMAL TEST.ALSO, HEPATITIS SCREENING AND PROPHYLAXIS ARE MANDATORY.
ALSO, HIV HAS TO BE RULED OUT.
- Ultraviolet Lamp Treatments for Psoriasis: For patients with large areas of skin involved with Psoriasis, a series of Narrow Band Ultraviolet treatments can be very beneficial, especially if used in combination with topical treatments. In more severe cases, for women of nonchildbearing age and for men, adding a Retinoid Soriatane (Acitretin) can be of great benefit. One inconvenience is that 2 or 3 treatments weekly are necessary, often for several weeks.
IDI is dedicated to providing highly effective and personalized treatment programs for patients with mild to severe psoriasis outbreaks. If you’re struggling with painful inflammation and plaques, please don’t hesitate to schedule a consultation with our team of experts today.