Psoriasis
I have Psoriasis. Now what?
Psoriasis is a chronic inflammatory skin condition. It occurs when our skin replicates more quickly than it normally should causing our skin cells to build up on itself and create the typical plaque that you see. The inflammation causes redness, itchiness and sometimes pain. It can affect any part of the body from the scalp to the feet. It can even cause noticeable changes to the outward appearance of your finger or toe nails. No one knows for sure what causes Psoriasis, but it is believed to have a genetic connection in most cases. Some possible triggers for psoriasis that may cause flare ups could include stress, trauma to the skin (cuts, scrapes or bruises), infections, some medications, diet (alcohol consumption) and environmental factors (change in weather, cold weather).
Patients with psoriasis can also experience joint involvement. we call this Psoriatic Arthritis. You can have arthritis symptoms which can include painful stiff joints usually worse in the morning that get better throughout the day. Any joint can be affected, but I see it most often in the hands and feet. There can be swelling in the fingers and toes that can limit your daily activities. If you suffer from psoriatic arthritis symptoms you should not delay treatment. Delaying treatment can cause long term permanent joint damage. Early treatment is key in reducing the pain and inflammation of psoriatic arthritis and preventing long term joint damage.
Treatment of psoriasis often requires the use of prescribed topical medications and oral anti-histamines to help manage the itching. Topical steroid medications are a great first line in quickly managing the flare up, but are not something that should be used long term. Their are some steroid-free topical medicines that are sometimes good choices for certain patients. These products are creams and ointments that are Vitamin D based and can offer some benefit for long term management.
Tradtional therapies include light therapy - using ultraviolet light to our advantage to help treat and maintain psoriasis. This is a good treatment but is sometimes a burden for patients because of the frequency needed to see results. Patients will need to do light therapy at least three times per week, if not more, to see results. Light therapy can also be combined with an oral medication called Oxsoralen which produces better results than standard light therapy alone. But, this medication also has it's own limitations and restrictions and makes light therapy somewhat more challenging. One major side effect and concern for any patient undergoing light therapy treatment is the cumulative exposure of UV rays and the increased risk of skin cancer as the patient ages. It can also affect the eyes and special glasses need to be worn to protect against the UV rays damaging the eyes and causing cataracts.
An older, but proven, oral medication is Acitretin (Soriatane). For a long time this medication changed the way psoriasis was treated. It helped and continues to help many people today. Their are some unique side effects to this drug, but when managed properly it can be a very effective tool in the fight against psoriasis.
In the last ten to twenty years some newer and more effective treatments have been developed that offer us a whole new way to approach treating patients with psoriasis and psoriatic arthritis. Many of these medications are in a class of drugs called "biologics" - injectable medications that target the pathway which causes the increase skin replication I spoke about earlier. There are many prescribed medications in this category - and newer ones are being approved all the time. Some examples of these types of medications are Enbrel, Humira, Stelara, Tremfya, Cosentyx and Taltz. Not only do these medications work well for the skin, they also can have a profound impact on the joints for the arthritis component. These help protect the joints from further inflammation and breakdown and limit the damage that can be caused. They have also been shown to improve the appearance of the nails when affected by psoriasis changes. Although these medications work very well, they do not come without certain side effects. They can increase your risk of developing certain infections, or re-activate some older infections. They should not be taken if you have a history of a certain type of heart disease, or a history of Multiple Sclerosis or similar neurological disease. They can also increase your risk of developing a certain form of cancer. However, despite the potential side effects I discussed, these medications work very well for the right patient with the proper monitoring. Even though I grouped all of these injectable medications together, there are some distinct differences among them that set them apart. During our visit I will explain all the differences in how they are administered, the unique side effects of each one and tell you what medication(s) I think would be best for you and your type of psoriasis.
One other newer medication that was not mentioned already is a novel oral medication called Otezla. Otezla also works in our body to target the pathway involved in the over replication of our skin, but it does it differently than the injectable drugs. This medication has a different set of side effects that you have to be aware of. This medication can cause diarrhea for many patients when they first begin taking it. This usually goes away after taking it for a while, but it sometimes can last a few months until it does. It can also worsen depression and you should not take it if you suffer from depression. If this medication would be appropriate for you I will happily explain everything you need to know during our encounter together.