Psoriasis is a common, chronic skin condition that involves a rapid production of skin cells that build up on the surface of the skin and form scales, patches and other unwanted symptoms. Over seven million people in the US are affected by psoriasis, including men, women and children of all ages. Dr. Kaminester treats this disease almost every day and has many different methods of treatment for this often vexing and chronic disease!
This condition develops as a result of an autoimmune disorder, in which skin cells replace themselves every three to four days, rather than every 30 days, creating a buildup of cells and causing symptoms to develop on the scalp, elbows, knees, hands, feet and genitals. While there is no cure currently available for this chronic condition, there are several treatment options available to effectively relieve the symptoms of psoriasis.
Cause of Psoriasis
Psoriasis is caused by an immune system disorder involving a type of white blood cell called a T lymphocyte or T cell. While these T cells usually travel through the body to fight off viruses and other foreign substances, in patients with psoriasis they attack healthy skin cells instead, causing an increased production of healthy skin cells and more T cells that build up on the surface of the skin and cause the scaling and patches associated with this condition. There is a strong hereditary tendency to get this disease. About two percent of the US population have some form of psoriasis, and a family history is found in about 30% of affected patients.
The symptoms of psoriasis can worsen as a result of certain triggers, which may include:
- Infections
- Injury to the skin
- Stress
- Smoking
- Alcohol consumption
- Certain medications
Patients can sometimes prevent a flare up of symptoms by avoiding these triggers.
Types of Psoriasis
There are at least five different types of psoriasis, each causing different symptoms, as well as combinations of each. While patients usually only have one type of psoriasis at any given time, another type can appear once the first has cleared. The five types include:
- Plaque psoriasis – the most common type of psoriasis that affects about 80 percent of psoriasis patients, causing raised red lesions that are covered with silvery white scales, usually appearing on the elbows, knees, scalp and back.
- Guttate psoriasis – usually begins during childhood or early adulthood and causes small red spots to appear on the skin of the torso, arms and legs as a result of a bacterial infection such as strep throat.
- Inverse psoriasis – develops within the armpits, groin, under the breasts or other skin folds causing bright red lesions as a result of irritation from rubbing and sweating. This is most common in overweight patients.
- Pustular psoriasis – causes white blisters filled with pus surrounded by red areas of skin, often triggered by medications, UV light, pregnancy or infection and is most common in adults.
- Erythrodermic psoriasis – the least common type of psoriasis that often causes redness and scaling across the whole body, and may lead to serious illness if left untreated.
Symptoms of Psoriasis
Symptoms may vary depending on each patient’s individual condition, but often include:
- Red patches of skin covered with silvery scales
- Crusting
- Dry, cracked skin
- Itching or burning
- Soreness
- Thickened nails
While many cases of psoriasis are merely a cosmetic annoyance, some also cause severe pain, especially when associated with arthritis. Symptoms usually come and go as psoriasis is a cyclic disorder with remissions and flare ups throughout the patient’s life.
Treatment of Psoriasis
Treatment for psoriasis aims to help clear the skin of current symptoms and to interrupt the abnormal cycle that has caused an increased production of skin cells in order to prevent future symptoms from forming. This can be done through topical treatment, oral medication, light therapies or a combination of the three.
Topical treatment for psoriasis is usually in the form of corticosteroids, vitamin D or topical retinoids, which can target inflammation, skin cell growth and DNA activity to effectively treat the symptoms of mild to moderate psoriasis. Light therapy may be used in combination with topical treatments to slow the production of skin cells and improve the overall appearance of the skin, and can be done through exposure to natural sunlight, narrowband UVB therapy or excimer laser therapy. Oral medications may be prescribed for severe cases of psoriasis or those that are unresponsive to other types of treatment, and may include retinoids, methotrexate or cyclosporine. Biologic therapy does have a risk of malignancy and is not recommended in patients with a history of malignancy or increased risk of cancer. Dr. Kaminester does not use biologics in his practice at this time.
Dr. Kaminester has conducted several research studies on psoriasis and empathizes with such patients. Dr. Kaminester has been a member of the National Psoriasis Foundation for many years. We use a wide variety of topical medications and, when needed, a modified Goeckerman therapy using a UVB light box. We have the light box conveniently located in our North Palm Beach office and patients come in at their convenience for such light box treatments. We have had excellent results in our office using a walk-in UVB light box for total body exposure for patients with severe psoriasis.
Dr. K usually does not use “biologics” for treatment of severe psoriasis.
Most patients have a less severe disease that can be helped with creams, lotions and shampoos. There is no permanent cure for psoriasis, although many patients experience remission where it all goes away, sometimes for many years!
It has recently been found that going on a gluten free diet may help some small subset of patients with psoriasis, but further research is required on this subject. Dr. Kaminester knows how frustrating this chronic disease can be, and tries in different ways to make the patient more comfortable with himself and the disease.
Articles Written by Dr. Kaminester
Click on a link below to read the article:
- Psoriasis
- The Many Guises of Psoriasis
- Treatment of Psoriasis in Geriatric Patients with Medium Potency Topical Corticosteroids
Contact us to schedule a consultation or to learn more about Psoriasis
