Psoriasis is a non-contagious, chronic auto-immune inflammatory skin disease that can affect the entire body. Marked by periodic flare-ups and remissions, psoriasis can improve and worsen over the course of time. Those with a family history of psoriasis are often predisposed to this skin condition. While there is no cure, psoriasis can be successfully controlled with treatment and medications.
There are several forms of psoriasis, with the 5 main types being plaque, guttate, inverse, pustular, and erythrodermic. Though symptoms vary from individual to individual, the identifying characteristics of the different types are as follows:
- Plaque psoriasis, also known as psoriasis vulgaris, the most common type, affects about 80-90% of people with psoriasis. The identifying symptoms are areas of raised patches of dry, red lesions, covered with silvery scales, which can be a singular spot or widespread. Usually seen on the elbows, knees, back, and scalp, plaque psoriasis can crop up anywhere on the body. The plaques are prone to inflammation and can cause itching and pain, leading significant discomfort.
- Guttate psoriasis, or eruptive psoriasis, primarily affects young adults and children. It is indicated by small sores on the legs, arms, torso, and scalp. It usually follows an upper respiratory tract infection, such as strep throat.
- Inverse psoriasis, characterized by smooth, red patches of inflamed, affects areas of the skin with folds, such as the armpits, beneath the breasts, in the groin area, and around the genitals.
- Pustular psoriasis is a less common form that presents as pus-filled bumps or blisters. Pustular psoriasis can be generalized, arising in larger patches in different parts of the body, or localized, occurring on hands, fingertips and feet.
- Erythrodermic psoriasis, the least common type, can develop on the entire body. People with the erythrodermic type experience a peeling, burning rash can appear on the face, hands, feet, nails, torso and extremities.
Psoriasis Causes and Flare-ups
The precise cause of psoriasis is not fully understood. It is estimated that about 10% of the general population has inherited one or more of the genes linked to psoriasis, however only about 2-3% present clinical signs of the skin condition. Because of this discrepancy, it generally acknowledged that psoriasis arises due to a combination of hereditary and environmental considerations.
Auto-immune condition: Psoriasis is an auto-immune disease in which the immune system causes too much inflammation and proliferation of skin cells. This causes several changes in the skin, including redness, thickening, increase scale and silvery scale. This immune mediated inflammation is very complex and multifactorial. The newest available medication blocks and modulates (decreases) this abnormal immune response, bringing the patient’s immune level closer to a normal level. The inflammation that is seen on the skin, can also be seen in the internal organs of patients with psoriasis. This is specifically why patients with psoriasis also suffer from psoriatic arthritis, heart disease, stroke, cardiovascular disease, diabetes, insulin resistance, obesity, alcohol abuse, and depression. This chronic inflammation also increases the lifetime lymphoma risk of a psoriasis patient by three times, meaning that a patient with psoriasis, regardless of any treatment received, has a three times higher chance of developing lymphoma than a person without psoriasis.
External factors. A range of external factors can provoke and exacerbate a flare-up. Though every individual will have his or own specific triggers and patterns, some common contributing causes include:
- Stress. Many individuals experience a direct correlation between high stress levels and flare-ups. In fact, stress is often related to the initial appearance and diagnosis of psoriasis.
- Lifestyle. Alcohol consumption and smoking have been linked to flare-ups.
- Seasonal changes. It is not uncommon for people to see variability in symptoms at different times of the year. Some individuals report a greater tendency to outbreaks during the winter months.
- Injury. Damage to the skin, such as sunburns and wounds, can aggravate psoriasis. Picking off psoriasis scale can also cause worsening.
- Medications. Heart medications, blood pressure medication, and some antidepressants, for example are considered triggers.
- Infections. Because of its connection to the immune system, infections can play a role in worsening psoriasis. For example, guttate psoriasis is typically triggered by a bacterial or respiratory infection, such as strep throat.
Psoriasis Treatment with Dr. Goldenberg, NYC
The objective of treatment is to interrupt the overactive cellular growth cycle and allow the skin to heal. To treat psoriasis, Dr. Goldenberg uses the most current therapies available. Dr. Goldenberg will also address some of the potential systemic manifestations of the disease and will work with other specialists to ensure that all possible manifestations of psoriasis are treated.
- Topical treatments. In mild cases, creams and ointments can be highly effective in ameliorating symptoms. In more persistent cases, topical treatment may be combined with systemic medications and/or light therapy. Some common topical treatments include topical corticosteroids, synthetic vitamin D, and topical retinoids.
- Light therapy (Phototherapy, eximer laser). Controlled exposure to ultraviolet (UV) light can slow cellular growth and decrease inflammation. Dr. Goldenberg uses a newer form of light therapy called narrow band ultraviolet B (UVB), which has been shown to clear psoriasis more quickly and increase remission periods. During an active flare-up, Dr. Goldenberg recommends 2-3 treatments a week. Once the psoriasis clears up, a weekly treatment can help maintain healthy skin. Similar effects can be seen with use of eximer laser, a new treatment approach for patients with resistant plaques.
- Biologics/Oral Medications. Administered via injection or intravenously (IV infusion), biologic drugs can modify the functioning of specific parts of the immune system. Biologics are generally reserved for those whose cases have been unresponsive to more conventional treatments, such as topical medications or for patients with moderate to severe disease. Dr. Goldenberg specializes biologic therapies and is actively involved in research related to the use of biologics. New oral medications that modulate the immune system are also currently available. These medications have a favorable side effect profile and good efficacy.
Diagnosing Psoriasis with Dr. Goldenberg, NYC
Dr. Goldenberg is a board-certified dermatologist and dermatopathologist, specializing in pathology, biopsies and the analysis of chronic skin disorders. If you are suffering from symptoms of psoriasis, Dr. Goldenberg can make a precise diagnosis and recommend the most advanced, effective treatment and management of the skin condition. Dr. Goldenberg is on the cutting edge of use of the newest and most effective treatments of psoriasis. With the proper psoriasis treatment, your discomfort can be alleviated and you can reduce the likelihood of flare ups. Contact his New York City office to schedule a consultation.