August Is Psoriasis Awareness Month
For most patients, psoriasis is a life-long condition. For this reason, it’s important to approach treatment discussions with your dermatologist with an eye towards long-term control.
Interested in more info on skin conditions? Explore the articles below:
We remain open for in-office visits.
All of us here at Dermatology of North Asheville remain fully committed to minimizing the risk of contracting COVID-19, and our office practices continue to evolve to reflect this commitment. This is particularly important at this time, given the increase in cases seen both in North Carolina and nationally. This includes protecting both our patients and our staff members. However, we are also committed to continuing to provide the absolute best care for our patients.
We are currently seeing patients in our office. Patients are asked to call the front desk to check in, rather than congregating in the waiting rooms. Patients are also asked to bring a mask if they have one; otherwise one will be provided for the visit. When it is time for their appointment, patients are ushered into the clinic and directly into an exam by a medical assistant. These protocols allow for a safe, measured resumption of routine visits, full body skin checks, surgeries, and even cosmetic visits. We are performing temperature checks on all staff daily, and checking patients’ temperature upon arrival as well. If you feel unwell, please tell us prior to your appointment and we will gladly reschedule your visit.
For patients who are uncomfortable coming into the clinic, we continue to offer telemedicine / online visits with video. Let us know how we can best meet your dermatology needs!
August is Psoriasis Awareness Month
In this month’s post, I’ll discuss how to recognize and treat this aggravating skin condition.
Background
Psoriasis is very common, with a worldwide prevalence of up to 11%. There are several forms of psoriasis, including body location-specific variants. Although the genetic basis of psoriasis is quite complex, the symptoms are essentially caused by increased rate of cell division in the skin and increased activity of immune cells in the skin. Instead of taking weeks for new skin cells (keratinocytes) to develop, the process can take only days. This leads to buildup of keratinocytes on the surface of the skin, resulting in the characteristic thick, scaly plaques. Increased blood flow causes the affected areas to become red and inflamed.
Any part of the skin can be affected, but the most common areas are the knees, elbows, lower back, around the belly button, and the scalp. Psoriasis can also affect the fingernails and toenails, which is why you may find me examining your hands and feet with my magnifying glass. Even the genital area can be involved, and in fact sometimes this is the only affected area.
For most patients, psoriasis is a life-long condition. The rash may be better for an extended period of time, but recurrences are common. For this reason, it’s important to approach treatment discussions with your dermatologist with an eye towards long-term control. Control is the key word here - psoriasis is not a disease that we can cure, but there are many great therapeutic options available today (more on this later).
Types of psoriasis
Plaque psoriasis is far and away the most common form. About 80 - 90% of patients with psoriasis have plaques, which are red scaly areas larger than 1 centimeter. The most common locations for plaque psoriasis include the knees, elbows, and lower back, but they can occur anywhere.
Guttate psoriasis is less common, and involves smaller “droplet-like” red, scaly lesions, primary on the trunk and extremities. This type of psoriasis often flares after a cold or an upper respiratory tract infection.
Inverse psoriasis occurs where skin touches skin, such as the creases of the thighs or the underarms. In inverse psoriasis, the skin is red and sore, and there is little scale.
Nail psoriasis causes pits and ridges in the finger and toenails, and is associated with a higher risk of psoriatic arthritis.
Psoriatic arthritis involves pain and swelling of the joints. It is typically worse in the morning, and improves with movement. Most patients with psoriasis do not develop arthritis, but some will develop arthritis before skin involvement - or in rare cases without any skin involvement at all.
Pustular psoriasis involves the development of numerous pustules (small bumps filled with white fluid). This can be limited to the palms and soles, or can be generalized over the whole body. Generalized pustular psoriasis requires immediate medical care, and may require hospitalization.
Erythrodermic psoriasis involves the entire body becoming red and inflamed. Like generalized pustular psoriasis, this is a medical emergency, and may require hospitalization.
Treatment options
“The important thing to remember is that psoriasis is more than skin deep! ”
As you can see above, psoriasis is a complex disease. Treatment options are likewise quite varied.
Topical steroids are a mainstay of psoriasis treatment. There are many available choices of different strengths; commonly used steroids include triamcinolone, betamethasone, and clobetasol.
Calcipotriene is a vitamin D derivative that is applied topically, usually in combination with topical steroids.
Biologic therapies are injected under the skin, with frequencies varying from every other week to once every 12 weeks. There are many biologic therapies on the market, and they all have different benefits and risks. These therapies can be effective for skin disease as well as psoriatic arthritis, and can help decrease the risk of atherosclerosis (hardening of the arteries) that can occur with psoriasis. Some examples of biologic medications include Humira, Enbrel, Taltz, Cosentyx, Cimzia … and there are others as well!
Otezla is a newer oral medication. It is not considered an immunosuppressive medication, and is also approved for treating psoriatic arthritis.
Methotrexate is an older oral medication that works by suppressing the immune system. It is used less frequently these days, as other, safer options are becoming available.
Cyclosporine is another immunosuppressive medication that is sometimes used for short term rescue therapy for patients with generalized pustular psoriasis or erythrodermic psoriasis (see above).
The important thing to remember is that psoriasis is more than skin deep!
For more information on other symptoms of psoriasis, see the American Academy of Dermatology website, and if you are concerned that you may have psoriasis, call us to make an appointment.
