PSORIASIS - Goldenberg Dermatology

Introduction

Psoriasis is one of the most common skin diseases. Red, well defined spots that are covered with thick, silvery scales characterize the condition. These skin patches are dry, thick, itchy and sometimes even painful.

Psoriasis is uncomfortable and can make a person self-conscious because of its obvious and unpleasant appearance. While there is no cure, psoriasis can be successfully controlled with treatment and medications. Following is information about the types of psoriasis, the causes, and possible treatments at the Goldenberg Dermatology office in NYC.

Different Types of Psoriasis

Psoriasis is a chronic, inflammatory, autoimmune skin disease. The word psoriasis is derived from the Greek word “psora” meaning scale and refers to the red and silvery scales that are visible on the skin. Marked by periodic flare-ups and remissions, psoriasis can improve and worsen over the course of time.

Psoriasis is a genetic condition. Those with a family history of psoriasis are often predisposed to this skin condition. Psoriasis is not contagious. Skin disorders usually become visible for the first time 20-30 years old and 50-60 years old, however, psoriasis symptoms can show up at any age.

There are several forms of psoriasis, with the 5 main types being: Psoriasis Vulgaris (or plaque psoriasis), guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis. Though symptoms vary from individual to individual, the identifying characteristics of the different types are as follows:

Psoriasis Vulgaris

Psoriasis Vulgaris is the most common type of psoriasis and affects about 80-90% of people with psoriasis. Vulgaris is the terminology for “the most regular form”, but this type is also referred to as plaque psoriasis because of the presence of large plaques on the skin.

The identifying symptoms include areas of raised patches of dry skin and red lesions that are covered with silvery scales, which can be a singular spot or widespread. These patches or plaques most often show up on the scalp, knees, elbows and lower back, but can crop up anywhere on the body. A characteristic of Psoriasis Vulgaris is that the spots occur more or less symmetrically on the body. Furthermore, Psoriasis Vulgaris can cause significant discomfort, as the plaques are prone to inflammation, can crack and bleed, and are often itchy and painful.

Guttate Psoriasis

This type of psoriasis is also called eruptive psoriasis and primarily affects young adults. Guttate psoriasis is characterized by numerous small patches scattered over the body as droplets, especially in the area of the legs, arms, torso, and scalp. Immediate causes for guttate psoriasis are usually an upper respiratory tract infection, such as strep throat (caused by the Streptococcus bacteria) or the intake of antihypertensive drugs (beta-blockers).

Inverse Psoriasis

Smooth, red patches that typically appear in skin folds characterize inverse psoriasis. It is called inverse as it appears on the inner side, such as on the armpits, beneath the breasts, in the groin area, gluteal (buttocks) cleft, and around the genitals. Sometimes it is misinterpreted as a form of eczema or yeast infection. Many people that suffer from inverse psoriasis have another type of psoriasis elsewhere on the body as well.

Pustular Psoriasis

Pustular psoriasis is a less common form that presents as pus-filled bumps or blisters surrounded by red skin. This purulent exudate is commonly called pus and consists of white blood cells. In spite of its appearance and naming, pustular psoriasis is not an infection, nor is it contagious. Pustular psoriasis occurs most often on hands, fingertips or feet, but can also occur on any part of the body. Pustular psoriasis may follow, accompany or precede Psoriasis Vulgaris, plaque-type psoriasis.

Erythrodermic Psoriasis

The least common type of psoriasis is erythrodermic psoriasis. This type can develop on the entire body where a strong inflammatory reaction is accompanied by a massive dilation of blood vessels in the skin. Erythrodermic literally means “red skin”.

People with erythrodermic psoriasis experience a peeling, burning rash that can appear on the face, hands, feet, nails, torso, and extremities. The skin is red, tight, warm, swollen, scaly, and very itchy. A patient with erythrodermic psoriasis usually feels sick. This is a serious condition because the vasodilation causes the patient to lose a lot of fluids, proteins, and minerals. There is a risk of dehydration and acute kidney failure. A patient with erythrodermic psoriasis may need to be hospitalized and treated.

Other Types of Psoriasis

The five types of psoriasis described above are the most common types of psoriasis. Other so-called types of psoriasis usually refer to the location where the skin is affected, such as psoriasis capitis (on the head, scalp), psoriasis unguium (on the nails), psoriasis palmoplantar (on the hand palms), psoriasis arthropathic (on the small joints of the hands, fingers, and feet, also called psoriatic arthritis). During a consultation at Goldenberg Dermatology, in NYC, we can determine your type of psoriasis and advice the best possible treatment for your case.

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 AT GOLDENBERG DERMATOLOGY, NYC

The objective of treatment is to interrupt the overactive cellular growth cycle and allow the skin to heal. To treat psoriasis, our doctors use the most current therapies available. Our doctors 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 biologic injections. Some common topical treatments include topical corticosteroids, synthetic vitamin D, and topical retinoids.

Otezla Oral Treatment

Otezla is used in the treatment of moderate to severe psoriasis. It can also be the treatment in cases of psoriatic arthritis, as well as for patients who had insufficient benefit from a previous oral medicine (pill or tablet) or who could not tolerate a previously prescribed drug. The active ingredient of this oral medication (tablets) is Apremilast. Psoriasis and psoriatic arthritis are inflammatory diseases caused by an overactive immune system.

Otezla (Apremilast) reduces the activity of the enzyme PDE4, responsible for the development of inflammation. With the Otezla treatment, inflammation can be reduced so that the symptoms of psoriasis will decrease or even disappear. At Goldenberg Dermatology in NYC, we can advise if an Otezla treatment would be the best solution in your specific situation.

Biologic Injections

Biologics are formulated to decrease the inflammation in the body responsible for psoriasis and psoriatic arthritis. The development of biologics is based on extensive, scientific research on inflammation processes in the human body. Biologics can bind certain inflammatory proteins that play an important role in the development of psoriasis. The reduction or disappearance of the inflammation will have a positive impact on psoriasis and can clear existing spots.

Biologics are administered via injections. These can be administered at home or at Goldenberg Dermatology. Treatment with biologics is generally reserved for cases that have been unresponsive to more conventional treatments, such as topical medications, or for patients with moderate to severe disease.

Our dermatologists at Goldenberg Dermatology in NYC specialize in biologic therapies and are actively involved in research related to the use of biologics.

Diagnosing Psoriasis at Goldenberg Dermatology, NYC

Doctors Gary and Kristina Goldenberg are board-certified dermatologists. Dr. Gary Goldenberg is also a dermatopathologist, specializing in pathology, biopsies, and the analysis of chronic skin disorders. If you are suffering from symptoms of psoriasis, our doctors can make a precise diagnosis and recommend the most advanced, effective treatment and management of the skin condition. Our cutting-edge team uses the newest and most effective treatments for psoriasis. With the proper psoriasis treatment, your discomfort can be alleviated and you can reduce the likelihood of flare-ups. Contact Goldenberg Dermatology’s New York City office to schedule a consultation.