Psoriasis Causes, Symptoms, and Remedies
By Dr. Jeremy Fenton
Psoriasis is a chronic condition that affects about 2% of the American population and causes a variety of skin and nail changes. The most common form, psoriasis vulgaris or plaque psoriasis, typically presents with silvery, scaly and red plaques on the skin. This often affects the elbows, knees, lower back, and scalp. These plaques can sometimes become thick and cause itching or irritation. Other common types of psoriasis include guttate, inverse, and pustular psoriasis. Guttate psoriasis usually occurs after a strep infection and is characterized by numerous small spots, or “drops,” of scaling plaques spread throughout the body. Inverse psoriasis usually affects the groin and armpits, with red patches that don’t have much scaling.
Psoriasis on Finger Nails, Face, and Scalp
Nails are very commonly affected with pits, grooves, thickening, or lifting off from the nail bed that gives a yellow discoloration. These type of nail changes are often confused with fungal infections. Psoriasis usually spares the face, but it is not uncommon for it to creep down slightly from the scalp along the hairline. It can even affect the joints. It is estimated that up to 30% of patients with psoriasis in the skin will develop some form of joint involvement. This psoriatic arthritis is a destructive arthritis that can be debilitating and permanent if not treated early.
On a cellular level, psoriasis is caused by the immune system. Certain types of cells, called T lymphocytes, are responsible for triggering the skin to rapidly divide and create inflammation within the affected areas. Although there is still much to be learned about psoriasis, we have a lot of information about the types of cells and signaling pathways that are involved in psoriasis. This has allowed us to create drugs that more specifically target those pathways, getting better results with less side effects.
We don’t completely understand why some people get psoriasis and others don’t, but we do know that it has a genetic component and can be triggered by certain environmental exposures. For example, certain types of infections, such as strep throat, have been associated with flares of psoriasis. Lifestyle and diet can also make psoriasis worse: smoking, poor diet, alcohol, and being overweight have all been associated with a worse outcome in psoriasis patients.
Avoiding Psoriasis Flare-Ups
There are a few things patients with psoriasis should be aware of to minimize flare-ups. Maintaining a healthy lifestyle is important – avoiding smoking, minimizing alcohol, keeping a healthy weight, and avoiding stress. Other triggers include trauma to the skin, infections/illness, and certain drugs such as beta blockers and aspirin. Patients can prevent flares by keeping their skin well moisturized, protected, and by using their topical medications at the first sign to prevent it from progressing.
Natural sunlight can help psoriasis as well. This may be one of the few instances when you will hear a dermatologist recommend tanning. Of course, sun exposure can increase the risk of skin cancer and aging, so it is much safer to get targeted ultraviolet light treatments in a doctor’s office. Dermatologists provide in-office UV exposure with a very specific wavelength of light (narrow-band UVB) that is the most effective on psoriasis.
Topical Treatment for Psoriasis
Psoriasis patients can benefit from over-the-counter topical treatments such as salicylic acid or tar-based treatments and shampoos (Neutrogena’s T-Gel or T-Sal shampoo are common recommendations). As for prescriptions, the mainstay of most psoriasis treatments starts with topical steroids to help reduce the inflammation, some topical vitamin D preparations and products to exfoliate the thick plaques.
Phototherapy Therapy and Medication
For psoriasis that won’t respond to the topicals, the UV therapy is a great drug-free option. Unfortunately, some people don’t respond to the more conservative measures and require systemic therapy. Luckily, many new psoriasis drugs that have entered the market in recent years that can often clear up even the most severe cases of psoriasis. The latest medications target specific signaling molecules of the immune system called interleukins. These are injectable medications that include Taltz, Cosentyx, and Tremfya. Dermatologists now have an excellent list of medications to choose from to tailor a patient’s treatment to minimize risk and maximize benefit.
For those that would like a pill instead of an injection, we also have an oral medication that we have been using for several years called Otezla. This drug blocks an enzyme called phosphodiesterase-4. Although it may not be as effective as the injectable medications, it offers an option for those seeking a pill that does not risk suppressing the immune system as much as other similar medications.
7.5 million Americans struggle with psoriasis, which can range from a minor nuisance to an embarrassing and debilitating illness. With a variety of treatment options ranging from topical creams to light therapy to systemic medications, we have a lot of options for our patients and there are many new ones in the pipeline.