Psoriasis

January 10, 2021

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Do you see a lot of patients suffering from psoriasis? How is your treatment of their condition different than your treatment of other chronic skin conditions?


Psoriasis is relatively common. It is estimated to affect about 2-3 % of the population and can start at any point in life- childhood or adulthood. 


The treatment of psoriasis is not necessarily different per se compared to other chronic skin conditions. In recent years psoriasis management has had so many new and highly effective therapeutic options relative to other skin conditions our approach may only vary in that we have more options to discuss. 




Can someone rid themselves of psorasis—or at least its symptoms? 
 
Psoriasis is a chronic immune mediated or autoimmune skin condition. There is no cure- our goal is effective management. Treatment options range from topicals, phototherapy to systemic medications. 


Psoriasis most often appears as pink scaling patches or plaques. Usually these are found on knees, elbows and the scalp. However, it can occur anywhere from head to toe. When it occurs under the breasts or in the fold between the hip and groin or under the belly it is often red, raw and shiny. When it affects the nails it can appear as little pits in the nails or oil spots. 





I break this down for patients as ranging from topicals, to light therapy to medications by mouth or injectables. This starts us at minimal side effects to more. The choice is for me a personal decision from the patients. I can’t  judge a patient’s day to day experience living with this type of skin condition. Although most people that choose light therapy or injectables/ oral medications tend to have more extensive disease, anyone can consider these based on their quality of life.




Topical medications tend to be steroids, nonsteroidals, vitamin D analogs, and retinoids. They work well with topical steroids as more effective. The issue tends to be the need to reapply, or extensively apply which can be difficult. 


Phototherapy is a great option for people not ready to do something more with systemic medications but need to treat larger parts of their bodies. Treatments are quick, 2-3 times per week. Many, if they do well, can get a lightbox for home use of it is established  that it could benefit them.


Oral medications and injectables have become very popular and are extremely effective. I find they have changed the face of psoriasis because we finally have options that can clear patients effectively.  These can work by either suppressing or altering the immune system that is overactive in psoriasis. 


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What areas of the body does psoriasis pop up on and what marks a severe case?


Psoriasis can be anywhere from head to toe but most commonly elbows, knees, scalp. 
Severity is dictated by location and extent of the disease . if psoriasis shows up in sensitive areas like the folds (under the breasts or belly) or hands and feet that can make it difficult to get through work or the day.  how extensive the body surface area covered by psoriasis can also dictate how severe it is.






What tips do you offer to your psoriasis patients for how to live well and thrive with psoriasis? 
 
More research has indicated that healthier lifestyles and diets do seem to help several psoriatic patients manage their disease. This approach doesn’t work for everyone but it doesn’t hurt to try!


I find one of the most common triggers by far and away is stress. I’ve had two year olds with new onset of psoriasis when they start with a new babysitter or are potty training and I’ve had 85 year old patients with new onset of psoriasis when a spouse passes. I tend to tell patients to think of it as a ‘check engine light’- at times the flares will tell you that you are taking on more than you can handle! Take a step back and take care of yourself. For many, however, there is no rhyme or reason to the flares. Other common triggers are injuries to the skin (psoriasis can often show up in surgical scars), medications can trigger it, infections (strep throat is linked to a particular type of psoriasis called gut rate), weather changes, smoking and alcohol use. 


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Flares from psoriasis can come and go but it is overall a chronic condition. Those with psoriasis will often always have a tendency towards developing.


Be vocal about how psoriasis impacts your daily life with your dermatologist. Many patients feel embarrassed to discuss the realities of their day to day life with psoriasis. Some worry that they will be judged for discussing what they have considered a cosmetic condition. It’s not cosmetic! Psoriasis is a medical condition that has so many effective management options it is important to review these with your dermatologist to decide which is best for you.


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Be honest with your dermatologist about how your treatment plan impacts your daily life. I’ve had patients that have told me that they spend over 30 minutes twice daily on their topical routines. Can you imagine how much time they could free for other activities if they found a more efficient approach?


Don’t always assume your joint pains are just a product of getting older. I can’t tell you how often it is that a patient finally decides to make the move to a systemic medication only to find out that their joints feel amazing afterwards. They underestimated how much of their joint pains were psoriatic and had an effective option to treat and prevent from worsening. I had a patient tell me once that their hands ‘deflated’ one week into therapy- they had no idea they were even swollen until the swelling went down






 

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