August is Psoriasis Awareness Month, a campaign that aims to empower patients to take control of their health, while raising awareness for the 7.5 million Americans affected by psoriatic disease. At Modern Dermatology we treat many patients suffering from Psoriasis, so we asked Dr. Mraz to tell us more about the disease and the treatment options available.
WHAT IS PSORIASIS?
Psoriasis is a chronic autoimmune disease that causes a buildup of skin cells. Like with all autoimmune diseases, your body's internal protection system misfires, and essentially begins attacking itself. White blood cells in the body, called T cells, mistakenly think that your body is under attack, so in response begin to produce proteins that cause inflammation. The skin cells (keratinocytes) respond by reproducing but the old skin can’t shed fast enough, so it builds up and forms thick plaques. Research shows that there is a genetic link to the disease that doesn’t present until triggered by an infection or stress.
Most people have what we refer to as mild-to-moderate psoriasis, but 20% of people have moderate-to-severe psoriasis, meaning it covers more than 5% of one’s body surface area. There are several types of psoriasis, which is why it’s important to see a board-certified Dermatologist so that you can tailor your treatment plan accordingly.
WHAT DOES IT LOOK LIKE?
This buildup of skin cells causes rough plaques that are often itchy, scaly, red, and inflamed. While psoriasis can affect any part of the body, it most commonly develops on the elbows and knees, as well as the scalp, back, face, palms, and feet.
IS IT CONTAGIOUS?
NO! This is a myth that campaigns like Psoriasis Awareness Month aim to educate people about.
IS IT DANGEROUS?
Not in and of itself, however patients with psoriasis are more likely to develop additional autoimmune diseases. The National Psoriasis Foundation estimates that up to 30% of people with psoriasis develop psoriatic arthritis. Due to increased inflammation, psoriasis patients are at greater risk of developing cardiovascular disease and therefore optimizing cardiovascular health is of utmost importance. Psoriasis patients are also at greater risk of developing depression and other health conditions.
HOW DO YOU TREAT IT?
First, it’s important to identify the type of psoriasis. There are several forms (in order of most common to least) plaque, gutatte, inverse, pustular, and erythrodermic. Symptoms and treatment plans are tailored to each form.
Topical - typically, using a topical application is the first line of treatment. Some topical treatments include topical steroids, vitamin D analogs, tar, LCD, and retinoids. Topical regimens usually need to be applied once or twice a day for best efficacyAdditionally, about half of all psoriasis patients suffer from patches on their scalp, which can be treated with dandruff shampoos like Head & Shoulders, antifungal shampoos, or tea tree shampoos when the case is mild. For more stubborn or severe scalp breakouts, prescription shampoos with zinc or selenium sulfide, ketoconazole, steroid, or vitamin D analogs may be used. I like Vanicream Free & Clear Medicated Shampoo for my patients with scalp psoriasis.
Systemic – if topical treatments aren't providing adequate relief, systemic treatments may be considered. The oral and injectable therapies may require blood monitoring for safety and also have other side effects or contraindications that will be discussed during consultation.
Lifestyle – I always urge patients to try to identify triggers for outbreaks. And in general, advise avoiding alcohol, minimizing stress, and maintaining a healthy weight.
Biologics – We frequently use biologics to target specific pathways that are pathogenic in psoriasis. Biologics block the action of a specific type of immune cell called a T-cell, or block protein, in the immune system, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A or interleukins-12 and -23 that play a key role in developing psoriasis and psoriatic arthritis.
At Modern Dermatology we have experience treating all forms of psoriasis. Psoriasis is one of the many examples of how skin health can be both a health issue and a cosmetic issue. We know that with psoriasis often comes insecurity or embarrassment for patients, and we’d love to help you achieve your clearest skin.
