Psoriasis is a chronic autoimmune disease characterized by inflammation and the rapid buildup of skin cells that lead to the formation of thick patches of skin. It affects 3% of the US adult population or more than 7.5 million adults. Psoriasis is associated with several comorbidities that occur alongside psoriasis, such as psoriatic arthritis, cardiovascular disease, depression and anxiety. Not everyone with psoriasis will develop these comorbid conditions.  Psoriasis and its comorbid conditions can have a negative impact on quality of life.

While there is no cure for psoriasis, there are effective treatment options available to manage the condition and alleviate its symptoms. These treatments aim to reduce inflammation, slow down the excessive skin cell growth, and provide relief from discomfort.

What causes psoriasis?

Psoriasis occurs when the immune system mistakenly attacks healthy skin cells, causing them to reproduce at an accelerated rate. While the exact cause of psoriasis is not fully understood, it is believed to result from a combination of genetic, immune system, and environmental factors. In its most common form, chronic plaque, is a consequence of genetic susceptibility, and environmental triggers such as a strep infection, stress, smoking, obesity and alcohol consumption.

What are the symptoms?

There are several types of psoriasis, with plaque psoriasis being the most common. The symptoms of plaque psoriasis typically present as red, raised patches of skin covered with silvery-white scales. These patches can be itchy, painful, and may crack and bleed. Other forms include guttate psoriasis, pustular psoriasis, inverse psoriasis, and erythrodermic psoriasis, each with its own unique characteristics.

How is it diagnosed?

Psoriasis diagnosis primarily relies on the clinical presentation of skin lesions and characteristic features, and, in some cases, additional tests to confirm the condition. Dr. Michael Rains will review your medical history and inquire about any family history of psoriasis or other skin conditions which are risk factors associated with psoriasis. He will closely inspect the affected skin, looking for key characteristics of psoriasis, which include well-defined, raised, red patches of skin covered with silvery scales. These patches may be itchy or painful, and their presence is a crucial indicator for diagnosis. In addition, he will look for signs of psoriatic nail disease and scalp disease, working to exclude other skin conditions that can mimic psoriasis such as eczema, seborrheic dermatitis and fungal infections. If psoriatic arthritis is suspected, he will order additional testing including x-rays or MRI scans to assess the joints.

What are the treatment options?

Current management strategies for psoriasis aim to alleviate symptoms, improve quality of life, and prevent disease progression.

Topical Treatments

These are applied directly to the skin and are often the first line of treatment for mild to moderate psoriasis. They include:

• Topical Corticosteroids: These anti-inflammatory creams or ointments help reduce redness and itching.
• Topical Vitamin D Analogues: These creams regulate skin cell growth and can be used alone or in combination with other treatments.
• Topical Retinoids: Derived from vitamin A, these products are applied to the skin to decrease inflammation and reduce skin cell turnover.

Phototherapy (Light Therapy)

Phototherapy involves exposing the skin to ultraviolet (UV) light under medical supervision. This can be done using natural sunlight, UVB light, or PUVA (psoralen plus UVA) therapy. Phototherapy helps slow skin cell growth and reduce inflammation.

Systemic Medications

For moderate to severe psoriasis, oral or injectable medications may be prescribed. These include:

• Oral Retinoids: These medications are derived from vitamin A and help control cell turnover.
• Methotrexate: An immunosuppressant that can slow skin cell growth.
• Cyclosporine: Another immunosuppressant that can be effective for short-term use.
• Biologic Drugs: These are advanced treatments that target specific immune system responses involved in psoriasis. Biologics have shown high efficacy in managing moderate to severe psoriasis.

Topical Calcineurin Inhibitors

These non-steroidal creams or ointments can be used for sensitive areas like the face or genitalia.

Salicylic Acid

Over-the-counter or prescription-strength products containing salicylic acid can help remove scales.

Moisturizers

Regular use of moisturizers can help soothe dry skin and reduce itching.

The choice of treatment depends on the type and severity of psoriasis, as well as individual factors such as age, overall health, and preferences. Additionally, lifestyle factors such as stress management, a healthy diet, and avoiding triggers can complement medical treatments in managing psoriasis effectively.

While there may not be a cure, these treatment options can significantly improve the quality of life for individuals with psoriasis by reducing symptoms and minimizing flare-ups.

Contact Dr. Michael Rains at Beacon Dermatology in Asheville, North Carolina to schedule a consultation. He will work with you to develop a personalized treatment plan to improve your condition.

Dr. Michael Rains is a board-certified dermatologist and the founder of Beacon Dermatology in Asheville, North Carolina. His approach to aesthetic and dermatological treatments are holistically focused on revealing and enhancing a patient’s natural beauty. Dr. Rains is known for his caring and compassionate approach to medicine, listening to his patients’ concerns and goals and ensuring they receive excellent care and education to ensure they can make informed decisions about their treatments.