Jeffrey Sassmannshausen, MD
A very common skin disorder treated at my practice with a lot of misconceptions is psoriasis. Psoriasis is a condition where areas of the skin grow much faster than normal and form red, scaly patches and plaques that are flaky and itchy. Many patients wonder if it is contagious but it is not. The cause of psoriasis is actually related to the immune system, where one part of the immune system is over active, working harder than normal.
A triggering factor that plays a major role in contributing to psoriasis episodes is stress. Both emotional and physical stress to the body affect the immune system and therefore, can prompt the inflammatory response of those irritating, sometimes painful and debilitating psoriasis patches. Because stress contributes to activating this disorder, I often advise patients to take active steps toward changing their lifestyle. Even small changes like rest and minimizing stress can help a great deal in quality of life for psoriasis sufferers.
Strep infections are also well known activators for psoriasis, so it is important to take good care of yourself if you are susceptible to flare-ups during the fall and winter months when illnesses are passed around frequently.
When I consider treatment options for psoriasis patients there are many factors to consider, like area of the body that needs to be treated and severity of the condition. Depending on the area of the body involved, what works on one site may be ineffective or inappropriate for another. An example is that I would not treat the scalp the same way I may treat an armpit or groin. A few common misconceptions are that psoriasis causes hair loss, diet affects the condition, and nerves cause the disorder (although stress can contribute to flare-ups).
One exciting regimen I may recommend for mild to moderate psoriasis management that is fast, easy, and non-invasive is XTRAC laser. It is performed right here in the office and requires no anesthesia or down time. I use a laser that concentrates the light allowing me to focus on the affected areas to achieve rapid improvement. This allows me to deliver the high doses necessary for great results while minimizing exposure to healthy skin. Treatment only takes a few minutes and I usually recommend 10-20 total visits at a pace of about two per week. Psoriasis sufferers can enjoy effective relief with long lasting results from XTRAC treatment.
The most life changing therapies for psoriasis are the biologic treatments that you may see on television. Over the last 15 years, these medications have proven to be some of the safest systemic treatments available for severe diseases caused by inflammation. I have seen people covered in red scaling psoriasis clear in 4-6 weeks. Yes, 100% free of their psoriasis. What is most exciting is that there are so many different agents available, each with their own target of treatment, thus all psoriasis sufferers should be nearly clear of the disease. Remember, these are safe medications.
Oral medications are kind of a last resort option for extensive cases because there are more side effects that need to be carefully monitored. Also, it is important to keep in mind that psoriasis is a lifetime disease and oral medications like Cyclosporine, Methotrexate, or Soriatane can only be used for a short time. Otezla is a new oral treatment that is very safe, but will only be effective in about a third of psoriasis patients.
Topical preparations are probably the most common treatment method I use for patients because they are readily available and generally excellent at managing symptoms. The most common are topical steroids. Other agents that can be prescribed include tar, anthralin, a topical retinoid called Tazorac, vitamin D derivatives called Dovonex and Vectical, and combinations of Dovonex and a steroid.
Psoriasis is unpredictable and incurable, often wreaking havoc on the emotional well-being of many patients because it itches and is unsightly. Thirty percent of the time, it may also cause arthritis. If you or someone you know is affected by this disease, I would be happy to review your medical history with you and discuss your best treatment options. Don’t live in pain and suffering because of embarrassment. Medical advancements for psoriasis sufferers can greatly improve your quality of life.