Psoriasis is both a common and an age-old problem that affects about five percent of people worldwide. It presents as red, scaling plaques on the skin that often itch and bleed. Most commonly psoriasis occurs on the elbows and knees, but it can be found anywhere on the body, including the face and scalp.
For centuries, it has affected people in all walks of life and all nationalities. It can be progressive and may appear at any time during one’s life. It is one of the most common skin diseases, striking an estimated five percent of the world’s population.
Of those affected, approximately 25 percent can develop an associated psoriatic arthritis, which is both progressive and degenerative. Psoriatic arthritis can be debilitating. Psoriasis is not contagious, but it can interfere with normal life and social relationships and cause many sufferers to isolate themselves from friends and family.
Heredity plays a part in the disease, with approximately 10 percent of all sufferers being able to identify a genetic relative with the disease. Stress, injury, infection, medication, or trauma can trigger an initial episode or cause a flare-up of psoriasis.
There are many varieties of psoriasis, including guttate psoriasis, pustular psoriasis, plaque psoriasis, scalp psoriasis, and inverse psoriasis. Inverse psoriasis occurs in the armpit, under the breasts, and in the skin folds around the groin, buttocks, and genitals.
Scalp psoriasis is often mistaken for dandruff. Guttate psoriasis can affect anyone, but it often starts after a sore throat associated with streptococcal infection.
Pustular psoriasis is a painful condition that is limited almost exclusively to the palms and soles. Pustular psoriasis can be quite debilitating, and can even prevent walking and the ability to work with the hands. Psoriasis can also affect the nails, imitating a fungal infection and causing pits in the nails or producing brown spots under the nails known as “oil spots.”
What causes psoriasis?
Psoriasis is a genetic disease involving both autoimmune and inflammatory components. The standard skin growth cycle requires approximately 28 days for skin cells to go from the basal layer to the top. In psoriasis, this growth rate is dramatically increased and occurs every three to five days. As a result, the skin cannot shed normally and instead piles up, forming thick scaling plaques.
In the past it was believed that psoriasis was a disorder of the skin cells, where the cells were unable to grow at a healthy rate. However, it is now understood there are many contributing factors, such as the immune system.
Often, immune cells can leave the blood stream and produce compounds that interact with cells in the skin to produce this rapid growth phase. Biologic treatments are targeted at the immune cells to interfere with their ability to produce the rapid growth and inflammatory phase associated with arthritis.
How is psoriasis diagnosed?
Dermatologists diagnose psoriasis by examining the skin, nails and scalp. If the diagnosis is in doubt, a skin biopsy may be helpful.
How is psoriasis treated?
My philosophy is to use a combination approach, utilizing many different compounds in the treatment of psoriasis to achieve an effective and synergistic result. At Crutchfield Dermatology, we are recognized as a “Psoriasis Treatment Center of Excellence.” I employ both topical medicines, light treatments (ultraviolet light and lasers), and systemic medicines.
Topical treatments include steroid creams, tar-based products, Vitamin A treatments, Vitamin D treatments, and our exclusive, patented, and very effective CutiCort1 steroid spray. In addition to topical medicines, I also prescribe phototherapeutic measures, including narrowband ultraviolet B phototherapy and targeted laser treatments.
Phototherapeutic treatments can be performed by using a full-body and hand-and-foot light box to treat resistant hand and foot psoriasis. Finally, oral/systemic medications including methotrexate, cyclosporine, oral retinoids, and the latest, most advanced generation of medicines that combat psoriasis known as “biologic agents” can produce exceptional results.
Future of psoriasis
More and more research is being done every day giving us better insight into psoriasis. This research will allow the disorder to be treated even more efficiently in the future.
We know that psoriasis is a genetic disease and is much more than a cosmetic concern. Physicians now recognize that having psoriasis is associated with an increased risk of developing cardiovascular disease, arthritis, obesity, intestinal diseases, kidney disease, high cholesterol, hypertension, diabetes and gum disease.
However, with the correct diagnosis and modern treatment program, psoriasis can be very successfully managed, as well as the many complications of psoriasis. If you have psoriasis, you don’t have to suffer. Talk to your dermatologist about the many new and significantly effective treatments now available.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.