Understanding Psoriasis

Jeffrey Sassmannshausen, MD

If anyone watches TV today, you have been introduced to the skin condition known as psoriasis. Psoriasis is actually quite common, with most people having only small patches of red scaling skin. The classic presentation is having thick red plaques over the elbows and knees with a thick white scale. Sometimes it can be quite extensive to the point of covering the entire body. There are local forms of psoriasis as well. Scalp disease is very stubborn to treat. Involvement of the palms and soles of the feet leads to deep painful fissures and cracks, making daily activities impossible. There is also a form of psoriasis that effects the genitals and skin folds; this form is often mistreated as a yeast infection. Psoriasis can also cause destructive arthritis.

Psoriasis is often inherited. It does not have to be present in every generation or it can vary in its extent and severity. Why do we get psoriasis? In the last 20 years, we have been better able to understand the reason psoriasis occurs. It is actually not a disorder of the skin but rather it is a problem in the immune system. One type of white blood cell is responsible for psoriasis. This cell becomes too active and does not turn itself off. This overactive immune response presents as skin plaques and inflamed joints.

Treatment of psoriasis used to be very time consuming. Patients were admitted to the hospital for weeks receiving daily coal tar baths and light treatments. This was still being used when I was in my dermatology training (and I am really not that old!). Topical steroids and combinations of topical steroids and non-steroid ointments can be very helpful for local disease. I still use ultraviolet light treatments. Using light dosed like a medication can really help. Laser treatments for stubborn plaques or scalps is often another treatment that is used. Immune-suppressing drugs were once all we had to treat severe cases. While these are effective, they can come with severe side effects. But, the current "biologic" treatments, as seen on multiple TV commercials, can be miracle medications.

The “biologic” medications have been life-changing to patients with psoriasis. They have been in use for over 20 years so they are by no means a new medication anymore. What makes these medications so helpful is that they have very specific targets which turn off the immune response. Basically, they take an overactive immune system and bring it back to normal levels. When used correctly and monitored appropriately, they are very safe.

So why treat psoriasis? Having untreated spots of psoriasis will increase one’s risk for heart attack and stroke. The chronically active immune system actually will also drive harmful plaque formation in the arteries. These plaques can occlude the vessel stopping blood flow to the heart or brain. By controlling the immune response leading to psoriasis plaque formation, the entire immune system is quieted. The risks for heart attack and stroke return to normal levels.

If you, or someone you know, has psoriasis, even a single plaque, see a dermatologist. Choose one who has significant experience in treating psoriasis and using biologic medications. You will quickly find clear skin!

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