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Medical Dermatology

Psoriasis

What is psoriasis?

Psoriasis is a common, chronic inflammatory, immune disease affecting about 2% of adult Americans. However, it can affect children as well. While it is considered to be a skin disorder, in fact the damage it causes can result in serious complications that affect the organs. 25% of patients develop joint inflammation called psoriatic arthritis. Beyond its physical manifestations, psoriasis has an extensive emotional and psychological impact, affecting social functioning and interpersonal relationships.

90% of patients have plaque psoriasis. It is not contagious but is irritating and uncomfortable as well as cosmetically unappealing. Psoriasis can last a lifetime. Symptoms may appear and remit.

What causes psoriasis?

Psoriasis is an inflammatory immune system disorder. One third of cases run in families but research reports that multiple genetic abnormalities have been associated with psoriasis. It begins when certain immune system cells, called T-cells, produce chemicals that cause inflammation and accelerate the growth of skin cells producing new skin cells within days rather than weeks.

Psoriasis is triggered by environmental forces such as stress, a strep infection, some medications, cold and dry weather, and alcohol and tobacco consumption. Triggers can also worsen the condition. An autoimmune disease is where the immune system attacks the body causing an overgrowth of skin cells that form a rash.

Psoriasis increases the risk of developing other medical problems such as eye problems, mood changes, swollen and bleeding gums, abdominal pain, fever, Crohn’s disease, weight gain, fatigue, stiff joint and fluid retention. Many psoriasis patients also have diabetes, heart disease and depression.

What are the symptoms?

The characteristic psoriasis plaques are sore, thick, itchy and red with slivery scales that shed. The plaques develop on both sides of the body and are usually found on the knees, elbows, scalp, lower back, face, hairline, palms and soles of the feet. Studies report that about 50% of patients also have finger and/or toenail psoriasis. It may be confused with eczema which is intensely dry and itchy skin that usually develops in the crooks of the knees and elbows.

The second most common form is called guttate psoriasis. It is characterized by widespread small, red scaly spots on the arms and legs that develop weeks after a strep throat or viral infection. This type often begins in childhood or early adulthood and affects the body and limbs. It may go away on its own or develop into plaque psoriasis.

Other types:

  • Smooth, red patches that are sore and painful in skin that touches skin, such as in the armpits, genitals, and buttocks.
  • Pustular psoriasis is pus-filled bumps usually on the hands and feet that is sore and painful and can be life-threatening.
  • Nail psoriasis changes the fingernails and toenails causing dents in the nails, discoloration, and lift the nail because of the buildup of skin cells below the nail.

It is important to note that symptoms can be mild or severe. Discoloration of the affected skin is distressing, and the scales can shed onto clothing and furniture.

How is psoriasis diagnosed?

Leading New York City dermatologist Dr. Dhaval Bhanusali will conduct a physical examination of your skin and your patches or areas of concern, inquire about your symptoms, and whether there are family members with this disorder. Dr. Bhanusali may take a biopsy of the skin to rule out infection.

Treatments

There are many options to manage psoriasis but there is no cure.

Topical therapies

Corticosteroids are first-line foundational treatment to reduce inflammation and control itching. However, the drawback is that steroids thin and damage the skin. Newer prescription therapies rely on Vitamin D (Dovonex and Vectical) and Vitamin A (Tazorac) and combinations of topicals. They are very effective and safe. New biologic treatments target the immune system. They are for use in moderate to severe cases, when the disease is negatively affecting your quality of life, and when traditional treatments cannot control psoriasis, or cause side effects.

Phototherapy

Phototherapy is the controlled use of ultraviolet light. It may be recommended for people with moderate to severe psoriasis. Phototherapy may be combined with topical treatments or photosensitizing drugs in more severe and extensive psoriasis.

Systemic therapy

Patients with more severe and stubborn symptoms may require systemic therapy that works on the entire body. The most difficult cases are treated with oral drugs like methotrexate and cyclosporin an immune suppression drug.

Despite its considerable effect on quality of life, psoriasis is under diagnosed and under treated. When you have concerns about a rash seek evaluation from board-certified medical dermatologist Dr. Bhanusali in Hudson Yards, NY. Schedule a dermatology appointment to assure you receive the correct diagnosis and treatments that can help you restore your quality of life, self-image and confidence.


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