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Psoriasis

There are a few types of psoriasis with the most common and recognizable being plaque psoriasis.  This can affect the skin from the scalp all the way to the feet.  Commonly you will see these thick plaques on peoples elbows and knees, but can also appear other areas of the body.  These plaques can be small and dime sized or large and silver dollar sized.  Just like eczema and allergic contact dermatitis, psoriasis can be itchy.  

Another form of psoriasis that can occur is called guttate.  This is just a fancy word for drop or tear drop shaped plaques.  Many times, guttate psoriasis appears after catching a cold; specifically, a cold caused by streptococcus infection.  If you had a cold with sore throat a few weeks ago and all of a sudden develop a rash that looks like psoriasis you might have guttate psoriasis.  Unlike plaque psoriasis that tends to have large thick lesions these tend to be much smaller and thinner.  The good news is that guttate psoriasis usually resolves and is a one-time problem.  A small number of patients may develop life-long psoriasis after the development of guttate psoriasis.  

Pustular psoriasis is a rare form of psoriasis and can potentially be life-threatening.  This form of psoriasis can happen while pregnant, secondary to some type of infection, or even after being treated with oral steroids for psoriasis.  This is why we tend to stay away from oral steroids when treating psoriasis.

Inverse psoriasis is just a way to describe psoriatic areas on the body that are in the skin folds.  The groin, arm pits, perianal, under the breasts could all be locations where inverse psoriasis develops.

Another common form is nail psoriasis.  This can develop by itself, but typically is in conjunction with psoriasis of the skin.  We tend to see more psoriatic arthritis in patients with nail disease.  Nail psoriasis is sometimes difficult to treat because the problem is coming from where the nail grows (the nail bed), not necessarily the nail itself.  You may notice color changes in your nail, texture changes, or pitting of the nail.

We are starting to identify other systemic conditions associated with psoriasis.  For instance, it is well documented that uncontrolled diabetes can lead to cardiovascular complications such as stroke.  We are now learning that psoriasis can be associated with cardiovascular disease, high blood pressure, and even diabetes.  Although there is no agreed upon reason these diseases are associated with psoriasis; I tend to believe it is the chronic inflammation of psoriasis.

Luckily treatment options are bountiful.  Just turn on the TV and you will see commercials for psoriasis or psoriatic arthritis all the time.  This is good news for patients.  There is a lot of research going into treatments so every year we tend to see new treatment options.  But, just because they are new does not necessarily mean they are better.  They just provide another treatment option, which is always good a thing.  Typical psoriasis prescriptions can include:  topical steroid ointments and creams, medications that help thin out the thick plaques, oral medications like apremilast (Otezla), methotrexate, acitretin (Soriatane), and injectable medications such as adalimumab (Humira), ustekinumab (Stelara), and ixekizumab (Taltz).  Sometimes a combination of treatments is needed to obtain good clearance.  Sometimes a single medication does the trick.  Remember that we do not yet have a cure for psoriasis, but we have plenty of good treatment options to help.

 

What is Psoriasis?

Psoriasis is a chronic or long-term inflammatory condition that affects the skin and nails.  It can also have an internal component called psoriatic arthritis.  Psoriatic arthritis is typically treated along with a rheumatologist and psoriasis of the skin by a dermatologist.  Most people can identify psoriasis by its classic red, thick, scaly plaques on the body.  And those with a family history of psoriasis may be more likely to develop this skin condition than someone without a family history.

Interestingly, there are several other risk factors for developing psoriasis.  Some may make sense and others may surprise you.  Smoking, obesity, certain medications like beta blockers or lithium, and alcohol have all been studied and shown to be correlated with psoriasis.  This does not mean that every person that takes a beta blocker for their heart condition will develop psoriasis, but it is something to be aware of.

There are a few types of psoriasis with the most common and recognizable being plaque psoriasis.  This can affect the skin from the scalp all the way to the feet.  Commonly you will see these thick plaques on peoples elbows and knees, but can also appear other areas of the body.  These plaques can be small and dime sized or large and silver dollar sized.  Just like eczema and allergic contact dermatitis, psoriasis can be itchy.  

 

 

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