Psoriasis is a chronic skin disorder affecting more than 4.5 million men and women. It is a long-lasting disease that develops when your immune system sends faulty signals that tell your skin cells to grow too quickly.
When you have psoriasis, your new skin cells form in days instead of weeks, and your body cannot shed these excess cells. The rapid cell reproduction then piles up on the surface of your skin, resulting in red or pink areas of raised, dry, silvery patches or thickened plaques of raised skin. It might also have the appearance of flattened bumps or dry skin with large flakes.
Psoriasis commonly affects the skin of the elbows, knees, and scalp, but it can be found anywhere on the body. It is also more common in areas of repeated rubbing and constant use.
Types of Psoriasis
There are several different types of psoriasis, and some people get more than one type. Some patients start with one type of psoriasis but later change to a different type.
- Plaque or psoriasis vulgaris—The most common type of psoriasis characterized by thick, red patches of skin covered by flaky, silver-white scales.
- Guttate Psoriasis—Small, pink-red spots on the skin.
- Inverse Psoriasis (also known as Flexural Psoriasis or Intertriginous Psoriasis)—Skin redness and irritation on the armpits, groin, navel, buttocks, and in between overlapping skin.
- Pustular Psoriasis—White blisters surrounded by red, irritated skin and/or small, liquid-filled, yellowish blisters.
- Erythrodermic Psoriasis—Very intense skin redness covering a large area.
- Palmoplantar Psoriasis—A separate entity affecting primarily the palms of the hands and soles of the feet.
About 80% of people living with psoriasis have plaque psoriasis or psoriasis vulgaris.
What Are the Signs and Symptoms of Psoriasis?
Psoriasis can appear slowly or suddenly. In many cases, the condition goes away and flares up again repeatedly over time.
Symptoms of psoriasis may include:
- Itching where the psoriasis patches are located
- Joint pain or arthritis
- Nail changes
- Severe dandruff
- Genital lesions
The first symptoms of plaque psoriasis appear as red dots that can be very small. These eruptions slowly get larger, producing a silvery white surface scale that is shed easily. Patches spread over wide expanses of skin and can lead to intense itching, skin pain, dry or cracking skin, and swelling.
Thanks to ongoing research, there are many treatments for psoriasis available today. Treatments can reduce the symptoms of psoriasis, and some people see their skin completely clear.
Every treatment has benefits, drawbacks, and possible side effects, but our dermatologists at Comprehensive Dermatology Center of Pasadena specialize in the diagnosis and treatment of psoriasis and can help you find treatments that work for you and fit your lifestyle.
Some topical or skin applied medications include:
- Topical corticosteroids
- Vitamin D analogue creams such as Dovonex
- Topical retinoids such as Tazorac
- Topical immunomodulators such as Tacrolimus and Pimecrolimus
- Coal tar
Some oral medications useful in treating psoriasis are:
- Acitretin or Soriatane
- Mycophenolate Mofetil
- Oral Prednisone
There is no known way to prevent psoriasis, but keeping the skin clean and moist, while avoiding your specific psoriasis triggers may help reduce the number of flare-ups. Your dermatologist will recommend daily baths or showers, but do not scrub too hard, as this can irritate the skin and trigger a psoriasis attack. Your dermatologist will usually begin with the mildest therapy and work up to the one that is most effective in clearing up your skin problem.
Biologics are medications that are provided via injection or IV to people with moderate to severe psoriasis. These drugs are protein-based and created using live cultures. Unlike oral medications that enter all systems of the body, biologics are targeted to special parts of the immune system. These drugs block specific types of cells or proteins in the immune system that are known to be involved in the development of psoriasis. They can often be combined with other treatments.
Some of the most common biologics include:
- Enbrel, Humira, and Remicade, which all block TNF-alpha, a protein that causes inflammation in the body. In people with psoriasis, there is an excessive amount of TNF-alpha that causes the condition’s rapid cell growth.
- Stelara targets specific proteins called IL-12 and IL-23 that are known to cause the inflammation of psoriasis. This drug is injected under the skin by a doctor or nurse at our center.
- Cosentyx inhibits a particular protein called IL-17A that causes the plaque associated with psoriasis when there is too much of it in the immune system. Like Stelara, Cosentyx is injected under the skin at our center.
Narrow Band UV Treatment
UV treatment for psoriasis is sometimes called phototherapy and light therapy. These treatments, which are conducted at our center, expose the skin to therapeutic ultraviolet light. Repetition is the key. With regular treatments, the UVB rays slow the cell growth that leads to psoriasis eruptions.
Narrow band UV treatment refers to a small range of ultraviolet light. There are broad band treatments as well, but narrow band tends to work more quickly and last longer. The light is administered in a small booth several times per week for short periods. This treatment can cause redness and itching for a short time after the first appointments.
UV treatment is often combined with other types of treatments. Note that narrow band UV treatment is not the same as tanning, and tanning beds are not a substitute.
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