Psoriasis is a common inflammatory condition of the skin which presents as red patches with thick silvery scales. It can present anywhere on the body but favors the scalp, elbows, knees, and lower back.
Psoriasis can affect people of all ages but is more common in adults, with an average age of onset between 30-35 years. It is thought to be caused by over-activation of a specific part of the body’s immune system which results in inflammation and thickening of the skin. Some patients may also develop nail changes such as pitting, thickening, or discoloration of the nails. Common symptoms include inflammation, itching and irritation of the skin, but up to 30% of patients may also experience arthritis with joint pain. Psoriasis is not contagious, but a chronic condition which can wax and wane over time. There are a variety of environmental factors that can affect or trigger psoriasis, such as infections, injury to the skin, stress, smoking, alcohol consumption, and certain medications.
There are a few distinct types of psoriasis with different clinical presentations and symptoms:
- Plaque Psoriasis: The most common type of psoriasis that affects about 80% of patients. Classically presents as inflamed thick scaly patches on the skin.
- Guttate Psoriasis: Common form of psoriasis which appears as small red scaly spots usually on the trunk and extremities. Guttate psoriasis is more common in children and younger adults, and typically has a sudden onset following infections such as strep.
- Inverse Psoriasis: Presents as inflamed red patches in skin folds such as the armpits, genitals, and under the breasts. Inverse psoriasis is often exacerbated by moisture, sweating, and friction.
- Pustular Psoriasis: Uncommon form of psoriasis which presents as white blisters or pustules surrounded by inflamed red skin. Triggers for pustular psoriasis include stress, overexposure to ultraviolet radiation, infections, and certain medications.
- Erythrodermic Psoriasis: Least common form of psoriasis that presents with severe inflammation and scaling of the skin that can involve most of the body. Patients can experience severe itching and systemic symptoms. Triggers include severe sunburn, infections, and medications (including withdrawal of certain medications).
Treatment of Psoriasis
Psoriasis is classified as mild to moderate when it affects 3-10% of the body, and severe when it covers more than 10% of the body. Depending on the type and severity of disease, there are a variety of treatment options aimed at reducing inflammation and controlling the symptoms of psoriasis. Treatment can range from topical creams to systemic medications such as injections or pills.
Topical Medications: Creams & Ointments
- Topical Corticosteroids: Steroid creams and ointments are the most commonly used medications for the treatment of psoriasis. They are applied directly to the affected area and help reduce inflammation, itching, and scaling of the skin. When using topical steroids, it’s best to take periodic breaks to prevent the body from getting used to the medicine. In addition to topical corticosteroids, frequent moisturization and avoiding triggers are also important in controlling psoriasis.
- Calcipotriene: Topical medication derived from vitamin D which helps regulate the turnover of skin cells and reduce scaling and inflammation. Combining Calcipotriene with a topical steroid often provides better control of psoriasis.
- Tazarotene: Topical retinoid cream which helps regulate turnover of skin cells and reduce scaling and thickening of the skin.
- Moisturizers: Moisturizing the skin regularly helps reduce dryness that can aggravate psoriasis. Using a moisturizer with alpha-hydoxy acid, such as Amlactin, helps soften the skin and reduce scaling.
Light Therapy / Phototherapy
Light therapy consists of exposure to ultraviolet radiation or lasers which help reduce inflammation of the skin. Phototherapy may be an effective treatment option for patients with moderate to severe psoriasis.
- Natural Sun (UVA & UVB): Controlled exposure to ultraviolet radiation from the sun helps reduce inflammation associated with psoriasis. It’s important to adjust and control exposure to sunlight as it also increases the risk of sunburn and skin cancer.
- Narrowband UVB Therapy: Utilizes light with a specific wavelength of ultraviolet radiation (310-312 nm) to treat inflammatory conditions such as psoriasis. Multiple regular treatments are often needed to see improvement.
- Excimer Laser: Laser which emits a high-intensity beam of light to targeted areas of psoriasis. May be an appropriate treatment option for patients with a few “hard to treat” areas. Repeat treatments are often needed to see improvement.
Systemic therapy for psoriasis is often reserved for patients with moderate to severe psoriasis who do not have sufficient improvement with topical therapy. Patients with psoriatic arthritis may also benefit from certain systemic medications.
- Oral Medications: Soriatane, Cyclosporine, and Methotrexate are systemic medications taken as pills which help with moderate to severe psoriasis.
- Biologics (Humira, Enbrel, Stelara): New class of injectable medications that work by suppressing a specific part of the immune system associated with psoriasis. These medications are also effective in treating and preventing the progression of psoriatic arthritis.
Although systemic therapy is effective in controlling moderate to severe psoriasis, patients on these medications will need regular monitoring and lab-work due to potential risks and side effects. Depending on your skin type and the severity of your condition, our doctor can determine which treatment options are best for you.
Contact our office today at 817-427-3376 to learn more about Psoriasis or to make an appointment with Dr. Aboutalebi.