Psoriasis Treatment
In normal skin, skin cells live for about 28 days and then are shed from the outermost layer of the skin. With psoriasis, the immune system sends a faulty signal which speeds up the growth cycle of skin cells. Skin cells mature in a matter of 3 to 6 days. The pace is so rapid that the body is unable to shed the dead cells, and plaques of raised red skin covered by scaly, white flakes form on the skin.
Up to 40 percent of people with psoriasis experience joint inflammation that produces symptoms of psoriatic arthritis.
Psoriasis is a genetic disease (it runs in families), and not contagious. There is no known way to prevent or cure psoriasis. Treatment aims to minimize the symptoms and speed healing.
Comorbidities Associated with Psoriasis
The incidence of Crohn's disease and ulcerative colitis, two types of inflammatory bowel disease, is 3.8-7.5 times greater in psoriasis patients than in the general population.
Patients with psoriasis also have an increased incidence of lymphoma, heart disease, obesity, type ll diabetes and the metabolic syndrome. Depression and suicide, smoking and alcohol consumption are also more common in patients with psoriasis.
Types of Psoriasis
There are five distinct types of psoriasis:
- Plaque Psoriasis (Psoriasis Vulgaris) — About 80% - 90% of all psoriasis sufferers get this form of the disease. It is typically found on the elbows, knees, scalp and lower back. It classically appears as inflamed, red plaques covered by silvery-white scales.
- Guttate Psoriasis — This form of psoriasis appears as small red dot-like spots, usually on the trunk or limbs. It occurs most frequently among children and young adults. Guttate psoriasis comes on suddenly, often in response to some other health problem or environmental trigger, such as strep throat, tonsillitis, stress or injury to the skin.
- Inverse Psoriasis — This type of psoriasis appears as bright red patches that are smooth and shiny. It is usually found in the armpits, groin, under the breasts and in skin folds around the genitals and buttocks.
- Pustular Psoriasis — Pustular psoriasis looks like blisters filled with white pus surrounded by red skin. It can appear in a limited area of the skin or all over the body. The pus is made up of white blood cells and is not infectious. Triggers for pustular psoriasis include overexposure to ultraviolet radiation, irritating topical treatments, stress, infections and sudden withdrawal from systemic medications.
- Erythrodermic Psoriasis — One of the most inflamed forms of psoriasis, erythrodermic psoriasis looks like fiery, red skin covering large areas of the body that shed in white sheets instead of flakes. This form of psoriasis is usually very itchy and may cause some pain. Triggers for erythrodermic psoriasis include severe sunburn, infection, pneumonia, medications or abrupt withdrawal of systemic psoriasis treatment.
- Nail Disease -- Nail involvement consists of pits in the nails. Nails may loosen, crumble or become thick.
Psoriasis triggers are specific to each person. Some common triggers include stress, injury to the skin, medications, allergies, diet and weather.
Treatment Options for Psoriasis
Psoriasis is classified as Mild to Moderate when it covers 3% to 10% of the body and Moderate to Severe when it covers more than 10% of the body. The severity of the disease impacts the choice of treatments.
Mild to Moderate Psoriasis
Mild to moderate psoriasis can generally be treated using prescription topical treatments and moisturizers.
Prescription topicals focus on slowing down the growth of skin cells and reducing any inflammation. They include:
- Anthralin used to reduce the growth of skin cells associated with plaque.
- Calcipotriene slows cell growth, flattens lesions and removes scales. It is also used to treat psoriasis of the scalp and nails.
- Calcipotriene and Betamethasone Dipropionate. In addition to slowing down cell growth, flattening lesions and removing scales, this treatment helps reduce the itch and inflammation associated with psoriasis.
- Calcipotriene, an active form of vitamin D3, helps control excessive skin cell production.
- Tazarotene, a topical retinoid, is used to slow cell growth.
- Topical steroids are the most commonly prescribed medications for treating psoriasis. Topical steroids fight inflammation and reduce the swelling and redness of lesions.
Moderate to Severe Psoriasis
Treatments for moderate to severe psoriasis include the above prescription medications, biologics, and light therapy/phototherapy.
- Oral medications. This includes acitretin, cyclosporine, methotrexate, apremilast (Otezla) and tofacitinib (Xeljanz). Dr. Oshman will recommend the best oral medication based on the location, type, and severity of your condition.
- Biologics. A new classification of injectable drugs, biologics, are designed to suppress the immune system.
- Phototherapy. Phototherapy involves exposing the skin to ultraviolet light on a regular basis under medical supervision. One form of phototherapy combines a photosensitizing drug (psoralens) with UVA light exposure. This treatment takes several weeks to produce the desired result. In some severe cases, phototherapy using narrow band UVB light may lead to better results.
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