Psoriasis 101

Printed in the August 13, 2020 issue of The Worcester County Times

Skin limited psoriasis is a relatively common autoimmune condition that affects close to 10% of the United States population. It affects men and women equally and commonly occurs between the ages of 30-70.

Risk factors for psoriasis have been identified, and the most common one is that it is clearly genetic. It’s been estimated that approximately 40% of individuals with psoriasis have a family history of this condition. Other risk factors include smoking, obesity and alcohol use.

There are several ways that psoriasis manifests on the skin. The most common presentation is what is referred to as “plaque psoriasis.” Typically, this appears as a scaly, symmetrically distributed plaque on the scalp, elbows, knees and gluteal fold. Alternate manifestations include “guttate” psoriasis and “pustular” psoriasis. Recognition by a physician is key to determining the type and, ultimately, treatment for this condition.

There are several first line treatments available for patients once a diagnosis is made. Mild disease can be effectively treated with phototherapy or over-the-counter topical steroid creams. Phototherapy can be offered in some local dermatology offices and consists of ultraviolet light (UVB, not the type that is implicated in skin cancer) approximately three times a week. Over-the-counter steroid creams can treat mild disease, but need to be used on a limited basis; chronic use can lead to side effects.

Should the skin disease persist despite conservative therapies, the next medications usually used include disease modifying anti-rheumatic drugs (DMARDs) or systemic therapies such as Otezla and biologics. These medications are usually aimed at modifying a patient’s immune system to prevent the body from causing the skin lesions. Suppressing the immune system carries more inherent risks that topical creams, so we usually reserve these for more moderate to severe disease.

The patient should be aware that if a diagnosis of psoriasis is made, about 30% of the time the manifestations can spread beyond the skin to involve the joints. This is called psoriatic arthritis. Treatment for this condition is similar to the skin manifestations, but we usually forgo the topical and light therapy and start with immune suppressive agents. Further, when the joints are involved, treatment is usually given in combination with dermatologists and rheumatologists.

Without treatment, psoriasis can be a severe, debilitating disease. Fortunately, we are living in a time when patients have access to numerous effective therapies that can essentially eliminate the skin rash and reduce the chances of long-term joint damage. Proper treatment can only be given when a correct diagnosis is made, however, so it’s important to talk to your healthcare provider right away if you’re experiencing symptoms.