In the United States, psoriasis affects approximately two percent of the population and there are 150,000 new cases each year. It is a chronic skin condition that can occur over a large percentage of the body, but it is usually found on very characteristic sites such as the elbows, knees, nails and scalp. Although psoriasis is very common in some families, it is not a contagious disease; it cannot be passed from one person to another. The skin lesions are generally described as red or erythematous plaques with thick white scale. With a classic presentation the diagnosis of psoriasis is seldom missed. However, certain individuals have non-classic presentations, and they may go undiagnosed for years before being seen by a dermatologist. Even to the trained dermatologist, a skin biopsy is sometimes needed to confirm the diagnosis. Once psoriasis is diagnosed, therapy may be as simple as a topical steroid cream once or twice a day. Other times a more advanced regimen may be required. Therapy is often customized to the individual. With a growing number of treatment options, the patient with moderate to severe psoriasis may choose to seek the care of a board-certified dermatologist.
What causes psoriasis?
Although the cause of psoriasis is still debated, psoriasis is likely a result of an abnormal immune response. Skin biopsies show a characteristic pattern of infiltration of white blood cells. This in turn causes abnormal skin growth. Specifically, the skin at sites of psoriasis grows too rapidly, resulting in a scaly appearance. The skin also changes in other ways. For example, blood vessels approach the surface of the skin resulting in easy bleeding when scales are picked off. Individuals with psoriasis often have a genetic predisposition for the disease, which is why it can run in families.
Types of Psoriasis
- Classical lesions occur on the scalp, elbow, knees, legs, arms, genitals, nails, palms, and soles.
- Inverse psoriasis occurs in skin folds and has little scale if any. It looks very different.
- Guttate psoriasis affects children and young adults. It often clears up spontaneously over several months.
- Pustular psoriasis has, in addition to characteristic psoriatic lesions, pustules with thick purulent material often on the palmar surface of the hands.
- Psoriatic arthritis is found in 30 percent of individuals with psoriasis. It does not respond to topical therapy.
- Topical corticosteroids
- Vitamin D analogues such as calcipotriene. (Note that ordinary vitamin D does not work.)
- Retinoids are are vitamin A analogues. Examples include creams such as tazarotene and oral medications such as isotretinoin, and acitretin.
- Coal Tar is a very old but still-used method.
- Goeckerman Treatment is offered at special centers. Again, it is a old treatment but still very effective. It uses coal tar dressings along with ultraviolet light.
- Light therapy uses natural sunlight or special UVB treatements.
- Methotrexate is a chemotherapy agent, which, when given in small doses, is very effective in treating psoriasis. It may also control the arthritis component of the disease seen in 30 percent of individuals.
- Cyclosporin is a strong anti-inflammatory agent that can be very effective in treating psoriasis.
- Biological agents are the newest therapy options, which have been heavily advertised in the media. They are very expensive but also very effective methods of controlling psoriasis. Efalizumab is one example. Biologics act by neutralizing the factors secreted by the inflammatory white blood cells or by inhibiting the receptors on the inflammatory cells, which normally guide the cells to the skin.
For more information on services, please call (916) 734-6111 or (800) 770-9282.