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, the bellybutton, 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 psoriasis is unknown, there is evidence of the disease running in families. A variant of psoriasis, called palmo-plantar psoriasis, presents with patches, plaques, and pustules on the palms and soles. Palmo-plantar psoriasis can cause severely disfigured nails when the disease affects the nails. This variant can sometimes be precipitated by certain treatments for psoriasis or Crohn’s disease.
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
- Skin Trauma: 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: These are common triggers seen in individuals with psoriasis
What is the treatment?
While there is no cure for psoriasis, there are many treatment options available that can help get your skin, nails, and joints in a healthier state to improve your quality of life. It is important to nurture your skin and keep it free of infections or trauma. Psoriasis is also associated with an 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. An Excimer laser, which delivers targeted treatment over small areas through a hand-held device, can be used for localized psoriasis om scalp or palms and soles.
- Topical medications: First-line treatment for psoriasis includes over the counter or prescription medications designed to be applied directly to the skin such as topical steroids. Sometimes dermatologists use compounded medications that contain steroids, tar, and salicylic acid to help exfoliate the thick plaques of psoriasis. For localized disease that presents with thick plaques that might not respond to topical treatment, steroid suspensions can be injected directly into the plaques to reduce inflammation in the area.
- Systemic drugs: Oral medications can be used in the treatment of moderate to severe plaque psoriasis, either singularly, or in conjunction with other treatment options. Drugs like methotrexate, cyclosporine, apremilast, and systemic retinoids have been used successfully. However, because of the potential side effects of systemic medications, regular monitoring with blood work and office visits are often required.
- Biologics: Biologicals are a class of medications given via injection or intravenously (IV). These drugs deliver antibodies against specific molecules that play a vital role in psoriasis.
With excellent choices available for psoriasis, we are now able to offer multiple options to reduce the symptoms of psoriasis and the risk of joint destruction to improve a patient’s quality of life. Our
dermatologists will partner with you to create a healthy lifestyle, even with psoriasis.
