Psoriasis is a chronic condition of the skin that is best managed by a dermatologist. The condition can arise rarely in childhood but predominantly starts in adulthood. Once you have psoriasis, it is considered a life-long condition without a cure but thankfully we have a variety of topical, systemic, and drug-free options available that can make an awesome impact on your skin. The condition can be as mild as a small annoying skin rash to becoming severe enough to effect the entire body, leading to social stigma and extreme discomfort. Psoriasis is also associated with arthritis as well as an increased risk of cardiovascular disease such as heart attack and stroke.
Psoriasis is usually diagnosed clinically based on the physical examination of the skin. It characteristically presents as red, scaly plaques on the scalp, elbows and knees. The trunk and less commonly the face can also be involved. Inverse psoriasis occurs in the skin folds such as the underarms and groin. Nails can be pitted, have oil-spots, or can lift up off of the nail bed (onycholysis). The joints may be swollen and tender.
Treatment of psoriasis depends on first getting the correct diagnosis by your dermatologist. Most cases of psoriasis can be managed with topical therapies alone such as topical steroid and other anti-inflammatory creams, topical vitamin D analogue creams (calcipotriene for example), or topical retinoids (tazarotene). Some more severe cases may require full body phototherapy or excimer laser treatments. Oral medications that are frequently used include methotrexate, acitretin, and otezla. There are also a variety of biologic medications that have made a significant impact in severe psoriasis patients or those who suffer from arthritis. We can discuss the pros and cons of these various therapies and choose which one is the best for you based on the severity of your psoriasis and your overall health and current medical history. A referral to a rheumatologist (arthritis doctor) will be indicated should you have serious joint involvement.
Excimer laser is something that we are happy to offer at Cinco Ranch Dermatology. It is a laser that emits a wavelength of light that has been proven to help improve psoriatic plaques. It is ideal for patients with persistent plaques that have not improved with topical therapies alone but the patient is not a good candidate for systemic therapy or desires a drug-free, non-systemic option. Excimer laser therapy has been awesome for many of my patients, particularly those with severe scalp involvement because topical medicines are difficult and messy to apply through your hair. While I am hoping to add full body phototherapy to my practice, that is not something I can offer at this time but I am happy to help get you referred to another office that offers phototherapy or help you get a home phototherapy unit should that treatment be indicated for you.
You can improve your psoriasis through natural, holistic methods as well and these are not to be downplayed as adjuvants in your psoriasis management strategy. Stopping smoking has been clearly shown to improve palmarplantar pustulosis, a type of psoriasis seen on the hands and feet. Because psoriasis is linked to metabolic syndrome (round apple-shaped belly, high glucose levels, and insulin resistance), a whole-foods diet as well as a routine exercise program leading to healthy weight loss can dramatically improve your health as well as your psoriasis. Sunlight, normally scorned by dermatologists because of its association with skin cancer, is also used in careful moderation to improve psoriasis. I recommend using sunscreen on areas not affected, particularly the face, neck, chest, and tops of hands/arms and 15-20 minutes of natural sunlight a day can be safe and effective for mild to moderate psoriasis.