Psoriasis is a common skin disorder affecting approximately 7 million Americans. People afflicted with psoriasis often have scaly, red, itchy, thickened plaques on their elbows, knees, scalp, trunk, extremities, and any other body areas. Up to a third of patients report someone on their family having psoriasis. In addition, approximately 30% of patients with psoriasis develop psoriatic arthritis which commonly affects the fingers, toes, spine, and other joints. Although psoriasis usually is not life threatening, this disease severely impacts the quality of one’s life in terms of job performance, schooling, and relationships. People with psoriasis are embarrassed with their condition and are often socially isolated and depressed. For this reason, it is important that patients with psoriasis seek medical attention.
Although there is no permanent cure for psoriasis, there are effective treatment modalities. These include topical creams such as hydrocortisone, Dovonex®, and Tazorac®. For more severe cases of psoriasis, ultraviolet light therapy and ultraviolet laser (B-Clear) are used. Oral agents such as methotrexate, cyclosporine, and Soriatane® are effective in treating psoriasis. Finally, newer agents called biologic agents are very safe and effective to treat psoriatic disease. These are injections comprised of monoclonal antibodies and fusion proteins. At our center, we employ the latest biologic agents to treat psoriasis and psoriatic arthritis including Enbrel®, Humira®, Remicade®, Simponi®, and Stelara®.
Eczema and Seborrheic Dermatitis
Eczema is a skin condition which may be present since childhood (atopic dermatitis). Eczema typically is a scaly, itchy, red rash that occurs on any body area. Atopic dermatitis frequently is present in front of the elbows, behind the knees, and on the face and may or may not be associated with asthma. Eczema and atopic dermatitis are treated with moisturizers, topical anti-inflammatory creams such as prescription strength hydrocortisone and non-hydrocortisone creams, and oral and topical antihistamines. Eczema and atopic dermatitis tend to recur when the weather gets too dry or if a certain allergen triggers the condition. Seborrheic dermatitis is simply dandruff of the scalp and the skin. Seborrheic dermatitis of the scalp is treated with medicated shampoos (prescription or non-prescription strength) and for more moderate flaking and itching, cortisone based foams and solutions are used. Seborrheic dermatitis of the face typically affects the “T-zone” (eyebrows and around the nose) and the ears. Redness and flaking are common symptoms. Hydrocortisone and non-hydrocortisone creams are effective in controlling seborrheic dermatitis.
Rosacea is a medical condition is which persistent redness and the development of telangiectasias (broken capillaries) appear on the cheeks, forehead, nose, and chin. Rosacea is most common in fair skinned individuals and has varying degrees of severity ranging from only redness and telangiectasias of different intensities, to the appearance of acne-like cysts, red bumps, and pustules, and in more extreme cases, the enlargement of the nose (rhinophyma). Rosacea is managed in several ways. Topical creams such as metronidazole (Metrogel®, Noritate®), azelaic acid (Finacea®), and various sodium sulfacetamide products are common used. For more inflammatory rosacea, topical antibiotics such as doxycycline or minocycline are prescribed. A very common and effective treatment modality for rosacea is the pulsed dye laser. The pulsed dye laser is effective in decreasing the redness and telangiectasias seen in rosacea as well reducing the inflammatory cysts and pustules.
Click here to learn more about Telangiectasia Rosacea
Actinic Keratosis (AK) , also known as solar keratoses, is a scaly, flaky growth on the skin caused primarily by exposure to ultraviolet (UV) rays from the sun or even sunless tanning beds. AK is considered precancerous skin lesions that may become a type of skin cancer if left untreated. While individual lesions can be eliminated, it is common for patients to continue to develop the precancerous lesions throughout their life, so regular treatment may be necessary. Before AK forms, the skin may begin to feel scaly and dry, not unlike sandpaper. When AK does develop, it looks like rough, red or brown patches of skin and can become thick, scaly, and discolored over time. Some AK grow so quickly that they develop into a horn-shape that is more likely to become cancerous. To be examined by a board certified Dermatologist please contact Dermatology Institute and Skin Care Center today!
These are caused by the human papilloma virus (HPV) and transmitted from skin to skin contact. Typical affected areas are the soles, hands, face, genital areas, and almost any other body area. Common treatment modalities for warts are freezing with liquid nitrogen, pulsed-dye laser, laser resurfacing, and the application of various topical agents such as salicylic acid, Aldara®, and tape.
Nail Disorders – Fungus of the nails (onychomycosis) often associated with athelete’s foot is treatable with oral agents (Lamisil®, Sporanox®) and topical agents. Biotin, a naturally occurring vitamin, is beneficial for strengthening brittle nails.
Vitiligo is an autoimmune disease whereby the pigment in the skin is destroyed by the body’s own immune system leading to the development of white patches on the body, typically in a symmetric pattern. Vitiligo can be a devastating condition emotionally and may be associated with a thyroid disorder, diabetes, anemia, or Addison’s disease. Vitiligo is treated with topical anti-inflammatory creams (cortisone and non-cortisone based) and ultraviolet light therapy and ultraviolet lasers.
WARNING SIGNS OF ABNORMAL MOLES (the ABCDE’s of what to look for)
Normally a mole should be symmetric but if the shape is lopsided, not symmetric, that is one of the warning signs.
A mole should have nice, crisp, sharp borders. If a mole has fuzzy, indistinct, jagged, irregular borders, this is a warning sign.
A mole ideally should have only one color (black, brown, tan,). However, if a mole is two-toned or has multiple colors, looks like a fried egg with a dark center, has a white halo around it, this is something to watch out for.
If a mole is greater than 6 mm (about the diameter of the tip of pencil eraser), this is a warning sign.
If there is a change in the appearance, size, shape, or color of a mole, for example a sudden elevation of a mole or a change in color of a mole, this may be a warning sign.
Finally, if a person has an abundant number of moles, any mole that stands out or jumps out visually, looks different whether it be darker, larger, more irregular compared to the rest of the moles is a warning sign. A mole that has a hair growing out of it usually means that is was present since birth or at a young age and is typically normal. If a moles is found to be abnormal by biopsy, it is excised out surgically under local anesthesia.
Other Dermatologic Conditions
The only way to detect a melanoma is through a biopsy of the lesion. If a mole has any of the ABCDE’s that is more extreme than usual, the possibility of a melanoma needs to be excluded. Often times a relative such as a parent or sibling may have a history of melanoma or atypical moles and so a family history is a risk factor for melanoma. Melanomas are treated with surgical excision, possible exploration of lymph nodes, and in more severe cases, with chemotherapy or immunotherapy. In addition, a chest x-ray and blood test to check for liver enzyme elevations is performed upon diagnosis of a melanoma. Once a diagnosis of melanoma is established, full body checks must be performed every 3 months for at least a year.
Skin Cancers and Pre-Cancerous Lesions
The most common cause of skin cancer is due to excessive sun exposure. Skin cancers do not occur immediately but start to develop 10 – 30 years later after chronic sun exposure. Typically, they become evident after the age of 40 but may occur in the 20’s and 30’s. Skin cancers and pre-cancerous lesions typically are present on sun exposed body areas such as the face, scalp, arms, chest, upper back, lower legs, but can occur in any location. Some signs of skin cancers are a rough, red lesion that can be flat or raised, a growth that bleeds and does not want to heal, or a growth that is pink and has a pearly appearance to it. Actinic keratosis are precancerous lesions that are rough and pink and treated by freezing with liquid nitrogen. Actinic keratosis need to be treated because they can become skin cancers if left untreated. Basal cell carcinomas and squamous cell carcinomas are common skin cancers. They rarely spread but if left untreated, can continue to grow and invade on the skin. These kinds of skin cancers are treated by surgical excision or Mohs micrographic surgery which are performed under local anesthesia.
Birthmarks such as port-wine stains, café-au-lait macules (tan patches), Becker’s nevus (tan patches with excessive course hair which can worsen at puberty), Nevus of Ota, and Mongolian spots are amenable to different types of lasers treatments.
What causes psoriasis?
The causes of psoriasis aren’t fully understood. It’s thought the skin condition iscaused by a problem with the person’s immune system, specifically the T cellsand certain white blood cells called lymphocytes. T cells usually course throughthe body looking for viruses and bacteria to attack, but with psoriasis, the T cellsproduce high levels of proteins called cytokines. Causing the skin to grow tooquickly. In addition, these cytokines lead to inflammation by recruiting otherlymphocytes and other white blood cells called neutrophils to the skin.
The areas affected become warm and red, due to dilated blood vessels. Theseprocesses trigger the body to produce more skin cells and they are moved to theoutermost layer of the skin much more quickly than normal. This makes the skinthick and scaly in the affected areas.
Can psoriasis outbreaks be triggered?
The reason a person’s T cells overproduce these cytokines isn’t fully understood.It’s thought that both genetics and environmental factors play a role. There arevarious ways a person can, in effect, trigger an outbreak. These are somepotential triggers:
- Infections, such as strep and skin infections
- Skin injury, such as a bug bite, cut, surgical incision, or a severe sunburn
- Heavy alcohol consumption
- Certain medications, such as lithium, blood pressure medications,antimalarial drugs, and iodides
Are there different forms of psoriasis? Psoriasis in a common skin condition, and it can show itself in different forms.
- Plaque psoriasis — This is the most common form of psoriasis, wheredry, raised, red skin lesions (plaques) covered with silvery scales form.Areas may be small or large, and they can occur anywhere on the body,even the scalp, palms and soles.
- Nail psoriasis — Psoriasis can affect the fingernails and toenails, causingabnormal nail growth and discoloration, pitting, and even causing the nailto loosen from the nail bed or crumble.
- Guttate psoriasis — This type of psoriasis is usually triggered by abacterial infection such as strep throat, most often affecting children andteens. Small water-drop-shaped, scaly lesions form on the trunk, arms,legs, and scalp. These lesions aren’t as thick as most other plaques. Thistype may occur just a single time, or it may have repeated episodes.
- Inverse psoriasis — It’s thought that fungal infections trigger this type ofpsoriasis. It mainly affects the skin in the armpits, groin, under the breasts,and around the genitals. Smooth patches of red, inflamed skin form,without the isolated plaques of other types. These patches worsen withfriction and perspiration.
- Pustular psoriasis — This is a rare form that affects the hands, feet, orfingertips. Pus-filled blisters develop quickly, appearing just hours after theskin first becomes red and tender.
- Erthrodermic psoriasis — This is the least common form of psoriasis.The entire body is covered with a red, peeling rash that can itch and burnintensely.
Will psoriasis affect my daily life?
Psoriasis is a chronic skin disease, and there is no cure. The symptoms comeand go in cycles. It can flare up for a few weeks or even months, but it can thencalm down or go away for a period. It can even go into complete remission. Thegoal is to stop the skin cells from growing so quickly. Managing the symptomsbecomes paramount to living with psoriasis.
How psoriasis impacts your daily life can depend, in part, on the type of psoriasisyou’re dealing with. For instance, nail psoriasis won’t have the same impact onlife as a plaque psoriasis outbreak on exposed skin or the genitals.
Who is most likely to develop psoriasis?
Psoriasis is common, affecting about two percent of the United States population.Psoriasis is about twice as likely to affect whites as it is people of color. It is notcontagious, despite rumors to that effect, and it cannot be acquired fromswimming in a pool, touching a person with the condition, or sexual contact.
Psoriasis can occur at any age, but usually develops after the age of 20. There isa definite genetic predisposition to developing psoriasis.
These are the risk factors for developing psoriasis:
- Family history — If you have at least one parent with psoriasis, yourodds of developing the disease are elevated, even more so with bothparents.
- Viral and bacterial infections — People with compromised immunesystems are more likely to develop psoriasis. This occurs with HIV andrepeated strep throat infections, and even the common cold.
- Stress — High levels of stress impact your immune system, making itmore likely you’ll develop the skin disease.
- Obesity — Excess weight increases risk. Plaques associated with alltypes of psoriasis often develop in skin folds.
- Smoking — Smoking seems to impact the chances of developingpsoriasis, and it increases the severity.
Why does psoriasis seem to change throughout the year?
For many people with psoriasis, their skin seems to improve in the spring andsummer, but then it relapses in the fall and winter. It is thought this is due mainlyto the sun. Psoriasis often responds well to exposure to both natural and artificialultraviolet light. In the summer we wear less clothing, so more of our skinreceives the sun’s UV rays. This shouldn’t be overdone, however, as sunburnscan trigger flare-ups.
In the winter our skin is covered, the sun is lower and less strong, thetemperatures are colder, and indoor heated air is dry. Plus, it’s more likely yourimmune system is taxed by colds and the flu, which can trigger flare-ups.
How long after I start treatment will my psoriasis heal?
There are a wide variety of treatments, just as there are a variety of types ofpsoriasis. The disease varies in individuals. Although it is usually worse duringthe cold weather months, the frequency and severity of a person’s outbreaks arequite haphazard.
At Dermatology Institute & Skin Care Center, we employ a number of differenttreatment methods. For milder cases of psoriasis, topical creams are sufficient.When the psoriasis is more extensive and topical therapy is not adequate, thenpills or injections called biologics are commonly prescribed. Our center willrecommend the best treatment for your psoriasis.
Although there is no cure for psoriasis, we are very successful helping ourpatients overcome or manage their symptoms.