About the Treatment
Psoriasis is a common skin condition that causes the formation of scales and red patches on the skin. These can be itchy and painful. Psoriasis is a chronic disease that doesn’t have a cure, but at Signature Plastic Surgery we can help you manage your symptoms.
What is psoriasis?
Psoriasis speeds up the life cycle of the patient’s skin cells. This causes a build-up of cells on the skin surface. These areas with extra cells form scales and red patches that can be itchy and painful. The goal of treatment is to stop the accelerated rate of skin cell growth.
What causes psoriasis?
There is no cure for psoriasis, and its causes aren’t fully understood. It is thought to be an immune system problem, especially relating to your T cells and white blood cells called neutrophils. T cells usually course through the body looking for viruses and bacteria to attack, but with psoriasis, the T cells attack healthy skin cells by mistake. This causes inflammation.
These overactive T cells also trigger increased production of healthy skin cells, more T cells, and other white blood cells, particularly neutrophils. These cells also travel into the skin causing inflammation and sometimes creating pustular lesions. Psoriasis-affected areas become warm and red, due to dilated blood vessels.
The inflammation triggers more skin cells to be produced and they move to the outermost layer of the skin too quickly — a process that should take weeks occurs in only days. These cells build up on the skin surface in thick, scaly patches.
Can psoriasis be triggered?
The reason a person’s T cells perform abnormally isn’t fully understood. It’s thought that both genetics and environmental factors play a role. There are various ways a person can, in effect, trigger an outbreak. These are some potential triggers:
- Infections, such as strep and skin infections
- Skin injury, such as a bug bite, cut, or a severe sunburn
- Heavy alcohol consumption
- Vitamin D deficiency
- Certain medications, such as lithium, blood pressure medications, anti-malarial drugs, and iodides
Symptoms of Psoriasis
There are various types of psoriasis (see below), most of which go through cycles of flare-ups and calming down. It can even go into complete remission. Signs and symptoms vary between people, but there are some common symptoms:
- Red patches of skin covered with thick, silvery scales
- Dry, cracked skin that may bleed
- Itching, burning, or soreness
- Thickened, pitted, or ridged nails
- Swollen and stiff joints
- Small scaling spots (usually in children)
These patches can range from just a few spots to major eruptions that cover large areas of the body.
Different Types of Psoriasis
- Plaque psoriasis — This is the most common form of psoriasis, where dry, 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 inside the mouth.
- Nail psoriasis — Psoriasis can affect the fingernails and toenails, causing abnormal nail growth and discoloration, pitting, and even causing the nail to loosen from the nail bed or crumble.
- Guttate psoriasis — This type of psoriasis is usually triggered by a bacterial infection such as strep throat, and it usually affects children and teens. Small water-drop-shaped, scaly lesions form on the trunk, arms, legs, and scalp. These lesions aren’t as thick as most other plaques. This type may occur just a single time, or it may have repeated episodes.
- Inverse psoriasis — It’s thought that fungal infections trigger this type of psoriasis. 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 with friction and perspiration.
- Pustular psoriasis — This is a rare form that affects the hands, feet, or fingertips. Pus-filled blisters develop quickly, appearing just hours after the skin 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 burn intensely.
What is psoriatic arthritis?
This combines the symptoms of psoriasis, inflamed scaly skin, with those of arthritis, joint pain. Psoriatic arthritis isn’t as crippling as other forms of arthritis (such as rheumatoid arthritis), but it can cause stiffness and progressive joint damage in the most serious cases.
Can psoriasis be cured?
There is no cure for psoriasis. The goal is to slow the growth of the patient’s skin cells and to manage the symptoms when an outbreak occurs.
How is psoriasis diagnosed?
Diagnosing psoriasis is not difficult. Usually, all that is necessary is a physical examination of your skin, scalp, and nails, and a review of your medical history. In rare cases, we may take a skin biopsy to examine under the microscope to help determine the exact type of psoriasis.
At Signature Plastic Surgery, we usually approach psoriasis treatment with the mildest treatments and progress to stronger options as needed. The goal is to find the most effective way to slow cell turnover.
Topical Treatments for Psoriasis
For patients with mild to moderate psoriasis, the use of creams and ointments may be all that is necessary. Here are some of the options we use:
- Topical corticosteroids — These drugs are the first choice for treating psoriasis. They reduce inflammation and relieve itching, and they can be combined with other treatments. Long-term use can cause the skin to thin, however, so it’s best to use these as a short-term treatment during flare-ups.
- Vitamin D analogues — These synthetic forms of vitamin D slow the growth of the patient’s skin cells.
- Anthralin — This drug helps slow skin cell growth and it can remove scales and make the skin smoother.
- Topical retinoids — These vitamin A-based medications decrease inflammation, but they can also irritate the skin and make the skin light sensitive.
- Calcineurin inhibitors — These reduce inflammation and plaque build-up, but are not good for long-term use.
- Salicylic acid — Commonly used in chemical peels, salicylic acid promotes sloughing of dead skin cells and reduces scaling.
- Coal tar — Coal tar reduces scaling, itching, and inflammation, but it is messy, stains clothing and bedding, and has a strong odor.
Natural sunlight and artificial ultraviolet light can be effective with psoriasis.
- Sunlight — Exposure to UV light in natural sunlight or from artificial sources slows skin cell turnover and reduces scaling and inflammation. Too much exposure, however, can worsen symptoms.
- UVB light — This is the UV light that doesn’t cause sunburns, but instead penetrates into the dermis layer of the skin. Controlled broadband and narrowband UVB exposure can be effective with psoriasis.
- Goeckerman therapy — This is a combination of UVB treatment and coal tar. The coal tar makes the skin more receptive to UVB light.
- Psoralen plus UVA — This is an aggressive treatment that can cause the same problems as long-term sun exposure, but it is effective for more severe cases of psoriasis. It involves taking psoralen, a light-sensitizing medication, prior to exposure to UVA light. The psoralen makes the skin more responsive to the UVA light.
- Excimer laser — This is a controlled beam of UVB light that is directed onto only the affected skin without harming the unaffected skin.
Oral and Injected Medications
The use of prescription oral or injected medications is known as systemic treatment. These drugs have side effects, so they are used only for brief periods, usually alternating with other forms of treatment.
- Retinoids — This vitamin A-based drug can be used with severe psoriasis, but it has side effects such as hair loss
- Methotrexate — This drug decreases the production of skin cells and suppresses inflammation. In can slow the progression of psoriatic arthritis in some people.
- Cyclosporine — Cyclosporine suppresses the immune system, but it has serious side effects and can only be taken short-term.
- Injected immune system drugs — A variety of drugs are approved for the treatment of moderate to severe psoriasis that isn’t responding to other treatments.
Although there isn’t any research showing across the board effectiveness, for some patients changes in diet or taking certain supplements may help. Aloe vera and barberry can be used topically, while fish oil is taken orally.