Psoriasis

What is psoriasis?

Psoriasis is a chronic, lifelong immune system disorder that causes inflammation in the skin and joints.  Approximately 7.5 million adults in the U.S. live with psoriasis, but it can also affect children.  Almost 30% of psoriasis patients develop joint inflammation called psoriatic arthritis. Psoriasis also increases the risks for obesity, diabetes and cardiovascular disease.

It is an autoimmune disease where the immune system attacks the body causing an overgrowth of skin cells that form a rash.

A majority of patients have mild to moderate disease. 20% of patients have moderate to severe disease that affects more than 5% of their bodies. 80-90% of patients have the most common form called plaque psoriasis.

Psoriasis impacts a patient’s physical and mental health. Patients with psoriasis have an increased risk of depression, anxiety, and self-harm. The reason is related to the biological impact of inflammation and the negative effects of the disease on self-image and quality of life due to the physical discomfort of the disease and the distress from the appearance of the lesions.

Despite the significant impacts on quality of life, psoriasis is under diagnosed which can increase distress and impair treatment.

What causes psoriasis?

Psoriasis is inherited in 80-90% of cases. Multiple genetic abnormalities are associated with psoriasis. It is an autoimmune disease that causes an overactive immune system. The immune system cells called T-cells produce chemicals that create inflammation and accelerate the growth of skin cells generating new skin cells in days instead of weeks. This causes the cells to pile up creating plaques of scaly, itchy skin.

It may be triggered by environmental forces like stress, a strep infection, some medications, cold and dry weather, and alcohol and tobacco consumption. Triggers can also worsen the condition.

Psoriasis increases the risk of developing other medical problems such as eye problems, mood changes, swollen and bleeding gums, abdominal pain, fever, Crohn’s disease, weight gain, fatigue, stiff joint and fluid retention. Many psoriasis patients also have diabetes, heart disease and depression.

It affects men and women alike but the first presentation of the disease in women with a family history occurs at ages 20-29 and 50- 59 years of age; and in men age of onset is at 30-39 and 60-69 years of age.

What are the symptoms?

Patches of scaly, itchy skin that are salmon-pink, red purple or dark brown with a slivery – white scale that are found on the elbows, knees, trunk and scalp, and 50% of patients also develop plaques on the finger and toe nails. Plaques tend to appear on both sides of the body so that it will affect both knees or elbows. Scales can shed leaving remnants of clothing and furniture. It is not contagious. Symptoms can be mild to severe and may flare and resolve.

Other forms of psoriasis can present as: smooth red sore patches of skin   underarms, genitals and buttocks; pus-filled bumps on the hands and feet; and in the nails causing pits, crumbling, and discoloration.

How is it diagnosed?

Dr. Michael Sotiriou will review your medical and family history, inquire about your symptoms and evaluate your skin. Diagnosis is based on symptoms, family history, and clinical appearance and rarely requires a skin biopsy, though in difficult cases a biopsy may be helpful to rule out other diagnoses.

What are the treatments?

The goal of treatment is to stop the rapid growth of skin cells and eliminate plaques.

For patients with mild psoriasis topical therapies are the mainstay of treatment including Corticosteroids to reduce inflammation and control itching. Newer prescription therapies rely on Vitamin D derivatives, Vitamin A derivatives, , and combinations of topicals. They are very effective and safe when used as directed.

Patients with more severe and stubborn symptoms may require systemic therapy that works on the entire body. The most difficult cases are treated with oral drugs like methotrexate and cyclosporin which are immune suppression drug.

New biologic treatments target the immune system and are an option for first-line treatment of moderate to severe plaque psoriasis without the risk of immunosuppression. These newer therapies are often injectable medications requiring injection anywhere from once a week to once every three months. Additionally, some biologic medications are specifically approved for the treatment of psoriatic arthritis.

Narrow-band UVB Phototherapy is the controlled use of ultraviolet light. It is recommended for people with moderate to severe skin psoriasis. Phototherapy may be combined with topical treatments or photosensitizing drugs in more severe and extensive psoriasis.

Rapid advancements have been made in the treatment of psoriasis especially with biologic treatments, and it seems like every year a new therapy is available. This is great news for our patients, but can cause confusion with all the options seen online and on TV, but our providers at Salt Lake Dermatology & Aesthetics are up to date on the latest treatments and guidelines.

Dr. Michael Sotiriou is a board-certified dermatologist who will work with you to find the best treatments for your skin. Schedule a consultation with Dr. Sotiriou at Salt Lake Dermatology & Aesthetics in Salt Lake City Utah today.