Psoriasis

Psoriasis can vary in severity from mild to severe and can go through periods of flare-ups and remission. Common triggers for psoriasis flare-ups include stress and injuries to the skin, smoking, and heavy alcohol consumption.

Symptoms of psoriasis can include:

• Red patches of skin covered with silvery scales (plaque psoriasis)
• Dry, cracked skin that may bleed or itch
• Thickened, brittle or pitted nails
• Swollen, painful and stiff joints (psoriatic arthritis)
• Thin red patches without scale in the armpits and groin (inverse psoriasis)
• Widespread small, red scaly spots on the arms and legs that develop rapidly (guttate psoriasis)

The exact cause of psoriasis is not fully understood, but it is believed to result from a combination of genetic, immune system, and environmental factors. Psoriasis tends to run in families. In fact, one in three patients will have a family member with psoriasis. Psoriasis is not contagious but may develop after a recent viral or bacterial illness. In psoriasis, the immune system mistakenly attacks healthy skin cells, triggering an inflammatory response by T cells (a type of white blood cell) that accelerates the production of skin cells. Normally, skin cells mature and are shed from the skin’s surface in about a month. However, in psoriasis, this process is accelerated to just a few days, leading to the accumulation of thickened, scaly patches.

Medical History

The team at Apex Skin Center will begin by asking about your medical history, including any symptoms you are experiencing, the duration and pattern of those symptoms, previous skin conditions or treatments, previous joint pains, family history of psoriasis or other autoimmune disorders, and any potential triggers or exacerbating factors.

Physical Examination

Board-certified dermatologist Dr. Knackstedt will conduct a thorough examination of the skin, nails, and scalp, looking for characteristic signs of psoriasis.

Skin Biopsy (if necessary)

In some cases, a skin biopsy may be performed to confirm the diagnosis of psoriasis and rule out other skin conditions with similar features. During a skin biopsy, a small sample of skin tissue is removed and examined under a microscope by a pathologist to look for characteristic histopathological changes consistent with psoriasis. In most cases of psoriasis, this is not necessary.

Psoriasis treatment aims to reduce inflammation, alleviate symptoms, prevent flare-ups, and improve quality of life. Avoiding triggers such as stress, smoking, heavy alcohol consumption, and certain medications can help reduce the frequency and severity of psoriasis flare-ups. The choice of treatment depends on the type and severity of psoriasis, as well as individual factors such as age, overall health, and treatment preferences.

Topical Treatments:

• Moisturizers: Regular use of moisturizers can help soothe dry skin and reduce irritation associated with psoriasis.
• Corticosteroids: These anti-inflammatory creams or ointments can help reduce redness, itching, and inflammation associated with psoriasis plaques. Topical corticosteroids come in various strengths and formulations. Topical corticosteroids are typically applied to affected areas of the skin for a limited duration until symptoms improve.
• Vitamin D analogs: Topical medications containing vitamin D derivatives, such as calcipotriene, help slow down the growth of skin cells and reduce inflammation.
• Retinoids (vitamin A derivatives): Topical retinoids, such as tazarotene, can help normalize skin cell growth and reduce inflammation, especially for psoriasis on the hands and feet.

Phototherapy

• Phototherapy is the controlled use of targeted, narrow band ultraviolet light. It may be recommended for people with moderate to severe psoriasis. Phototherapy may be combined with topical treatments or photosensitizing drugs in more severe and extensive psoriasis.

Systemic Medications:

• Oral Medications: Systemic medications taken by mouth, such as methotrexate, cyclosporine, or acitretin (vitamin A), may be prescribed for moderate to severe psoriasis that does not respond to topical treatments or phototherapy.
• Biologic Therapies: Biologic therapies, such as tumor necrosis factor (TNF) inhibitors, interleukin inhibitors (IL-17, IL-23, IL-12/23), and selective T-cell inhibitors, target specific immune system pathways involved in psoriasis inflammation. Biologics are typically reserved for moderate to severe psoriasis and are administered by mouth, injection or, rarely, infusion.