Psoriasis is an autoimmune condition that causes red, raised, scaly plaques to appear on the skin. Psoriasis results from faulty signals in the immune system that cause skin cells to grow at an abnormally fast rate. This leads to the buildup of psoriasis plaques. Some patients with psoriasis are also affected with inflammation of their joints called psoriatic arthritis.
It is estimated that up to 30% of patients with psoriasis have psoriatic arthritis. Those affected by psoriasis are at an elevated risk of developing other chronic and serious health conditions known as “comorbidities.” Some of these comorbidities include, but are not limited to, cardiovascular disease, obesity, metabolic syndrome, diabetes, depression, and liver disease.
TYPES OF PSORIASIS
There are several types of psoriasis including:
- Plaque psoriasis is the most common form of psoriasis, affecting around 3 percent of the population. The plaques are scaly, red, itchy, and well-demarcated and most commonly found on the elbows, knees, sacral area and the scalp.
- Guttate psoriasis often appears suddenly in young adulthood and presents as small, pink and red scaly plaques on the skin. It is often triggered by stress, skin injury or upper respiratory infections, particularly streptococcus infections.
- Pustular psoriasis is a very uncommon form of psoriasis and presents as pus-filled bumps on the skin. Though the bumps may look infectious, they are typically sterile/non-infectious pustules. This type of psoriasis can be serious and should be treated by a dermatologist experienced in psoriasis treatment.
- Erythrodermic psoriasis, though the least common, is one of the most severe types of psoriasis. It causes widespread skin redness and scaling that resembles severely burned skin. People who suffer from erythrodermic psoriasis may experience severe itching, burning, peeling and may have difficulty regulating their body temperature. These patients need aggressive treatment and care by a dermatologist experienced in psoriasis treatment.
TREATMENT FOR PSORIASIS
Psoriasis treatment is often individualized for each patient. The most common treatments for psoriasis include:
- Topical medications such as creams or ointments that are applied to the skin. These are reserved for patients with a limited amount of skin/body surface area affected by psoriasis. They are usually the first line of treatment and include topical vitamin D analogues, retinoids and steroids.
- Injections of a steroid into a plaque of psoriasis is an effective option for isolated, persistent areas of psoriasis, but are not a good treatment option for widespread skin involvement.
- There are several oral systemic treatments used for those with moderate to severe psoriasis. Some of these may help to treat both skin and joint disease while others are mostly effective for the skin.
- Biologics are typically used to treat moderate to severe psoriasis of the skin. They can be given by injection into the skin or intravenous infusion. They are also typically helpful for psoriasis involving the joints.
- Phototherapy, which involves exposing the skin to a narrow band of ultraviolet B wavelengths (NBUVB), works well in the treatment of both plaque and guttate psoriasis. NBUVB has been shown to be the most effective wavelengths in treating psoriasis. Tanning beds use mostly UVA wavelengths which are less effective in treating psoriasis and have more side effects including an increased risk of burning, sun damage and skin cancers. NBUVB treatments can be preformed in a dermatology office using a NBUVB phototherapy unit or at home using a physician prescribed home unit.
- Systemic steroids should NEVER be used to treat psoriasis as this can precipitate severe flares upon discontinuation.