Treating Psoriasis

Psoriasis is a relatively common condition, affecting 2 to 4% of the population, but one that is poorly understood by many. It is first and foremost an immune disorder which causes skin to form prematurely in affected sites, causing the visible symptoms of psoriasis.

Psoriasis is a skin condition that many people are not aware of, despite it being a relatively common disease. In psoriasis, the skin cycle in which old dead skin on the surface is replaced by newer skin is significantly sped up. Where the skin goes through the process of formation and moves up towards the surface in 28 days in normal persons, in psoriasis, the skin can go through this cycle in 3 or 4 days in those with psoriasis, causing immature skin cells to pile on top of each other. The visible result of this piling is the psoriatic plaques which are the hallmarks of this condition.

What is Psoriasis?

  • Psoriasis is a complex autoimmune disorder which causes inflammatory reactions that speed up the skin cycle. It often runs in the family, but the initial bout most often begins in a person's thirties or forties.
  • Psoriasis varies widely from in severity from individual to individual. There are also several types of psoriasis, but the most common by far is plaque psoriasis, in which lesions of dry scaled skin pile on top of each other.
  • Psoriasis is a chronic disease which waxes and wanes. About 30% of those affected by psoriasis also suffer from a form of arthritis called psoriatic arthritis.
  • Psoriasis can cause itching and pain, interfering with daily activities as well as sleep. It is also a very visible condition, and its social and psychological effects can lead some patients to depression.

Lifestyle adjustments:

  • Psoriasis is a chronic condition with no cure at this time. Living with psoriasis means that patients will need to adjust their lifestyle to minimize factors that worsen psoriasis, and care for their skin appropriately.
  • Psoriasis plaques are patches of extremely dry and scalp skin. Moisturizing the affected sites minimizes itch and dryness, and just as importantly, improves the appearance of the affected sites. Moisturizing should be a daily routine for those that have visible psoriasis.
  • Injuries can cause psoriasis to form on the injured site via a well known phenomenon called koebnerization. For this reason, those with psoriasis need to take care to protect their skin from injury.
  • Stress, alcohol, or certain drugs can trigger psoriasis or cause existing psoriasis to worsen in many people. Living healthy overall is an important part of managing disease.
  • Psoriasis can have a social and psychological impact on many patients. Don't fight it alone. There are many support groups; they can be your doctor, family, friends, or an online support group.

Topical Treatments:

  • Topical treatments are the standard response to mild or moderate psoriasis. In addition to moisturizers which improve appearance and help remove scale, several topical medications help control inflammation.
  • Corticosteroids are considered to be the most effective short-term treatment for psoriatic plaques. They reduce inflammation and skin cell turnover, and have a suppressing effect on the immune system. Strong concentrations or prolonged use can have unwanted side-effects, but used appropriately, they are extremely effective at reducing plaques.
  • Calcipotriene is a synthetic form of vitamin D which helps control the rate at which skin cells grow. Although it can be irritating for some people, it is often used in conjunction with other treatment to control plaques.
  • Several other topical treatments like coal tar, salicylic acid, and clobetasol propionate can help treat psoriasis.
  • Topical therapy is generally considered the least risky and is the most commonly used form of treatment, and should control most cases of psoriasis effectively.

Light Therapy:

  • For moderate to severe psoriasis that covers a larger area of the body, treatment using topical medication becomes cumbersome for the patient, and often prohibitively expensive.
  • Light therapy treats psoriasis by exposing affected skin to UV light which suppresses the immune function in that area and reduces inflammation. Psoriasis patients often improve in the summer when exposed to natural sunlight. The theory of light therapy is based on this fact.
  • Light therapy can treat large areas of psoriasis at once, and is often more convenient for a patient. It generally requires several treatments to be effective however, and requires visiting a dermatologist or an otherwise skilled technician.
  • Artificial sources of UVA and UVB light, like sunlight, can have negative side-effects such as burning, skin damage, and increase the risk of skin cancer. Patients need to weigh the pros and cons of treatment, upon consultation with their doctor.

Systemic and Biologic Treatments:

  • Systemic (oral medicine) and biologic treatments affect the whole body, and are reserved for the rare and most severe cases of psoriasis due to their risk of serious side-effects.
  • These drugs are powerful and can suppress resistant psoriasis in ways that other treatments cannot. Many, however, can have unwanted side-effects for which the patient needs to be monitored periodically by a medical professional.
  • The benefits of treatment need to be considered against the potential negative side-effects of treatment.
  • Whether you have medical insurance coverage or not will likely play a factor as many of these treatments can be prohibitively expensive.
  • Some of these medications are not an option for those that are pregnant or those that plan to be for several months after ending medication due to the drug's damage on the fetus.