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Psoriasis 101

Psoriasis 101

By Rhonda Klein, MD, MPH, FAAD

If Kim Kardashian has it, it must be good, right? Well, that’s not the case when it comes to psoriasis. Kardashian has openly talked about her struggle with this autoimmune disease that affects an estimated 7.5 million Americans according to the American Academy of Dermatology (AAD). In recognition of Psoriasis Awareness Month (August) we asked Dr. Klein to explain what this disease is, what it looks like, and the latest treatment therapies 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 efficacy.

Additionally, 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. 

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.

Light Therapy– the use of excimer laser and light therapy is also effective. We often use a narrow-band UVB phototherapy and home light box units are an option. 

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

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.