Psoriasis: new treatments, excellent results

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.

Psoriasis treatment

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.

psoriasis scalp

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.

psoriasis

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.

What is psoriasis and why should I care about it?

Psoriasis Skin Condition
Psoriasis Before Treatment

Psoriasis is an itchy skin condition that appears as patches and plaques of dry, scaly skin located most commonly on the elbows, knees and scalp. Psoriasis, however, can occur anywhere.

Sometimes it can be very mild with just a couple of spots, and in other cases it can be quite severe and widespread. Psoriasis can also make your fingernails and toenails rough and discolored with small pits.

Why should I care about psoriasis?

Psoriasis is extremely common, and approximately five percent of all people have this skin disease. Psoriasis has associations with arthritis, heart disease, diabetes and dental disease.

After Psoriasis Treatment
Psoriasis After Treatment

What causes psoriasis?

The exact cause of psoriasis is poorly understood; however, we do know that there is a genetic basis for psoriasis and it can run in families. There are probably several genes responsible for causing psoriasis.

 

How is psoriasis diagnosed?

Psoriasis is diagnosed by board certified dermatologists based on its classic clinical presentation. There are some rare forms of psoriasis where a biopsy may be required. Some versions that occur only on the hands and feet may also be present as painful pustules on the palms and soles. Continue reading What is psoriasis and why should I care about it?

Mending the Heartbreak of Psoriasis | By Charles E. Crutchfield III, M.D.

Descriptions of psoriasis have been present since the beginning of written history. Psoriasis manifests itself as red, scaling plaques that often itch, hurt and bleed. Commonly, it occurs on the elbows and knees, but it can be found anywhere on the body, including the face and scalp. It affects people in all walks of life and 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 3-5% of the world’s population. Of those affected, approximately 30% will develop an associated psoriatic arthritis, which is both progressive and degenerative.
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 role in the disease, with approximately 20% of all sufferers being able to identify a genetic relative with the disease.
Stress, injury, infection, medication or trauma can cause an initial episode or cause a flare-up.
There are many varieties of psoriasis, including:
  • psoriasis vulgaris (plaque psoriasis)
  • guttate psoriasis
  • pustular psoriasis, scalp psoriasis
  • inverse psoriasis.

 

The most common form of psoriasis, psoriasis vulgaris/plaque psoriasis, commonly manifests itself as scaling plaques on the knees and elbows.

 

Inverse psoriasis occurs in the axillae, under the breasts and in the skin folds around the groin, buttocks and genitals.

 

Scalp psoriasis is often mistaken for severe dandruff.

Guttate psoriasis usually begins shortly after a sore throat
associated with a streptococcal infection.
Small raindrop (guttate is German for raindrop) papules and plaques cover the trunk.
Pustular psoriasis is a painful condition that is limited almost exclusively to the palms and sole but in rare cases generally.
Pustular psoriasis can be quite debilitating. It can event prevent walking and the ability to work with the hands. There is also a generalized erythrodermic exfoliative form of psoriasis that is considered a dermatologic emergency necessitating hospitalization due to high cardiac output
failure.
Psoriasis can also affect the nails, imitating a fungal infection, cause pits in the nails or produce brown spots under the nails known as “oil spots.”
Psoriasis is also associated with inflammatory joint disease, psoriatic arthritis and recently linked in a published report from the Mayo Clinic to certain cases of cardiovascular disease.
hand psoriasis treatment
WHAT CAUSES PSORIASIS?
Psoriasis is a genetic disorder involving both autoimmune and inflammatory components. The pathogenesis of psoriasis involves a complex interaction of genetic and environmental factors. Markers for psoriasis have been identified on at least 11 chromosomes (1, 3, 4, 6, 8, 10, 16, 17, 18, 19 and 20).
The normal skin growth cycle requires approximately 28 days for the skin to grow from the basal layer to the upper level of the skin.
In psoriasis, this growth rate is dramatically accelerated and occurs in three to five days. As a result, the skin cannot shed normally and, instead, piles up upon itself, forming thick, scaling plaques. In the past, it was believed that psoriasis was a disorder of skin cells (keratinocytes) where the cells were unable to regulate their growth at a normal rate.
However, it is now understood that there are many contributing factors such as the immune system driving the psoriatic state. Sensitized lymphocytes cells can leave the bloodstream and park themselves in the skin and produce several cytokines (including TNF-alpha) that interact with keratinocytes inducing the rapid growth phase. The newer biologic treatments are targeted at the immune cells to interfere with their ability to produce the rapid growth of skin cells, either directly or indirectly by targeting the cytokines they produce, and also inhibit the inflammatory phase associated with psoriatic arthritis.
best psoriasis treatment
HOW IS PSORIASIS DIAGNOSED?
Dermatologists diagnoses psoriasis by examining the skin, nails and scalp. If the diagnosis is in doubt, skin biopsy is definitive. When examining the skin, hair and scalp, one looks for scaling plaques with punctate bleeding. Psoriasis also can occur or get exacerbated in areas of trauma (Koebner phenomenon).
HOW IS PSORIASIS TREATED?
My philosophy is to use a combination approach utilizing many different compounds in the treatment of psoriasis to achieve a synergistic effect. This includes but is not limited to topical medicine such as topical anti-inflammatories, topical tar containing treatments, topical vitamin A (retinoids) treatments and topical vitamin D treatments.
In addition to topical medicines, I also use phototherapeutic measures including narrow-band ultraviolet B phototherapy. Phototherapeutic treatments can be performed using the full body and a hand and foot light box to treat resistant hand and foot psoriasis. Additionally, I employ oral and systemic medications including methotrexate, cyclosporine and
oral retinoids. I also successfully employ the new generation of therapeutic medicines known as “biologic agents” that are
genetically engineered receptor proteins or antibodies that target lymphocytes or cytokines involved in producing the psoriatic state. When using systemic agents to treat psoriasis, the appropriate candidates must be selected and proper monitoring must be used.
Certain medications such as beta blockers can make it difficult to clear psoriasis. In resistant cases, I have patients check with their prescribing physician to see of a different class of anti-hypertensive can be used.
Additionally, I find it difficult to clear completely patients with psoriasis who consume heavy amounts of tobacco or alcohol.
Once again, I tend to use a combination of topical, oral and systemic agents to achieve the best results for my patients.
More research is being done every day giving us better insight into the cause of psoriasis. This will allow the disorder to be treated even more effectively in the future. As mentioned, there is a cascade of cytokines involved in the psoriatic state and several different cytokines are the targets of active research in the treatment of psoriasis and psoriatic arthritis. It is vital to detect and treat psoriatic arthritis early, since it is both degenerative and progressive.
Psoriasis is a very common skin disorder that can be devastating, mentally and physically, to patients. Fortunately, with the correct diagnosis and appropriate treatment program, psoriasis and psoriatic arthritis can be managed quite successfully.
There is an award-winning video called “My Skin’s on Fire — Living with Psoriasis” that provides tremendous insight into living with psoriasis. For more information, visit
www.sparklestone.org/skinfireorg
Charles E. Crutchfield III, M.D., is a clinical associate professor of dermatology at the University of Minnesota Medical School and is Medical Director of Crutchfield Dermatology, which is recognized internationally as a leading treatment center for psoriasis.
For additional information on psoriasis, visit
CrutchfieldDermatology.com.

What is psoriasis and why should I care about it?

Psoriasis is an itchy skin condition that appears as patches and plaques of dry, scaly skin located most commonly on the elbows, knees and scalp. Psoriasis, however, can occur anywhere. Sometimes it can be very mild with just a couple of spots, and in other cases it can be quite severe and widespread. Psoriasis can also make your fingernails and toenails rough and discolored with small pits.

Before Psoriasis Treatment
Before Psoriasis Treatment

Why should I care about psoriasis?

Psoriasis is extremely common, and approximately five percent of all people have this skin disease. Psoriasis has associations with arthritis, heart disease, diabetes and dental disease.

What causes psoriasis?

The exact cause of psoriasis is poorly understood; however, we do know that there is a genetic basis for psoriasis and it can run in families. There are probably several genes responsible for causing psoriasis.

psoriasis treatment
After Psoriasis Treatment at Crutchfield Dermatology

How is psoriasis diagnosed?

Psoriasis is diagnosed by board certified dermatologists based on its classic clinical presentation. There are some rare forms of psoriasis where a biopsy may be required. Some versions that occur only on the hands and feet may also present as painful pustules on the palms and soles.

Can psoriasis be prevented?

Because psoriasis is a genetic condition, it cannot be prevented. However, flare-ups can be minimized. Certain medications, heavy smoking, and heavy drinking are triggers that can be avoided to minimize flare-ups of psoriasis. Following a carefully developed treatment plan from your dermatologist will also help tremendously.

How is psoriasis treated?

There are many great treatments for psoriasis. Unfortunately, a recent survey demonstrated that almost 90 percent of patients with psoriasis are unhappy with their current treatment program. If you have psoriasis and are unhappy with your current treatment, this is something that needs to be discussed with your dermatologist.

Treatments for psoriasis include topical moisturizing creams, topical anti-inflammatory prescription creams and ointments, oral medications, special phototherapy/light treatments, and a new class of medications called injectable biologic medications. Many dermatologists will combine several of these for optimal results.

Because 25 percent of patients with psoriasis can also develop psoriatic arthritis, it is important to mention to your doctor if you’re having any joint pain, especially in your hands and feet in the morning lasting more than 20 minutes. This is an early sign for psoriatic arthritis; it’s important to note that arthritis can occur before, during, or years after psoriasis of the skin is diagnosed.

Action steps for anyone with psoriasis

  • See your dermatologist and develop a progressive treatment plan for your arthritis.
  • Let your dermatologist know if you’re having any joint pain.
  • Be sure to also ask your dermatologist about phototherapy treatments.
  • Schedule a regular general medical examination every year with the appropriate tests for your age and sex.
  • Let your primary care doctor know that you have psoriasis and are also concerned about arthritis, diabetes and heart disease.
  • Because psoriasis can also affect your teeth, make sure you have yearly dental examinations.
  • Remember, there are great treatments for psoriasis, and if your current program is not working, talk to your dermatologist to modify and/or change your current treatment program.

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 has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.

What is psoriasis and why should I care about it?

Dr. Charles CrutchfieldPsoriasis is an itchy skin condition that appears as patches and plaques of dry, scaly skin located most commonly on the elbows, knees and scalp. Psoriasis, however, can occur anywhere. Sometimes it can be very mild with just a couple of spots, and in other cases it can be quite severe and widespread. Psoriasis can also make your fingernails and toenails rough and discolored with small pits.

 

Why  should I care  about  psoriasis?

Psoriasis is extremely common, and approximately five percent of all people have this skin disease. Psoriasis has associations with arthritis, heart disease, diabetes and dental disease.

 

What causes psoriasis?

The exact cause of psoriasis is poorly understood; however, we do know that there is a genetic basis for psoriasis and it can run in families. There are probably several genes responsible for causing psoriasis.

 

How is psoriasis diagnosed?

Psoriasis is diagnosed by board-certified dermatologists based on its classic clinical presentation. There are some rare forms of psoriasis where a biopsy may be required. Some versions that occur only on the hands and feet may also present as painful pustules on the palms and soles.

Psoriasis before and after treatment

Psoriasis before and after treatment

 

Can psoriasis be prevented?

Because psoriasis is a genetic condition, it cannot be prevented. However, flare-ups can be minimized. Certain medications, heavy smoking, and heavy drinking are triggers that can be avoided to minimize flare-ups of psoriasis. Following a carefully developed treatment plan from your dermatologist will also help tremendously.

 

How is psoriasis treated?

There are many great treatments for psoriasis. Unfortunately, a recent survey demonstrated that almost 90 percent of patients with psoriasis are unhappy with their current treatment program. If you have psoriasis and are unhappy with your current treatment, this is something that needs to be discussed with your dermatologist.

Treatments for psoriasis include topical moisturizing creams, topical anti-inflammatory prescription creams and ointments, oral medications, special phototherapy/light treatments, and a new class of medications called injectable biologic medications. Many dermatologists will combine several of these for optimal results.

Because 25 percent of patients with psoriasis can also develop psoriatic arthritis, it is important to mention to your doctor if you’re having any joint pain, especially in your hands and feet in the morning lasting more than 20 minutes. This is an early sign for psoriatic arthritis; it’s important to note that arthritis can occur before, during, or years after psoriasis of the skin is diagnosed.

 

Action steps for anyone with psoriasis

See your dermatologist and develop a progressive treatment plan for your arthritis.

Let your dermatologist know if you’re having any joint pain.

Be sure to also ask your dermatologist about phototherapy treatments.

Schedule a regular general medical examination every year with the appropriate tests for your age and sex.

Let your primary care doctor know that you have psoriasis and are also concerned about arthritis, diabetes and heart disease.

Because psoriasis can also affect your teeth, make sure you have yearly dental examinations.

Remember, there are great treatments for psoriasis, and if your current program is not working, talk to your dermatologist to modify and/or change your current treatment program.

 

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 has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.

What is psoriasis and why should I care about it?

crutchfieldsquare Psoriasis is an itchy skin condition that appears as patches and plaques of dry, scaly skin located most commonly on the elbows, knees and scalp. Psoriasis, however, can occur anywhere. Sometimes it can be very mild with just a couple of spots, and in other cases it can be quite severe and widespread. Psoriasis can also make your fingernails and toenails rough and discolored with small pits.

Why should I care about psoriasis?

Psoriasis is extremely common, and approximately five percent of all people have this skin disease. Psoriasis has associations with arthritis, heart disease, diabetes and dental disease.

What causes psoriasis?

The exact cause of psoriasis is poorly understood; however, we do know that there is a genetic basis for psoriasis and it can run in families. There are probably several genes responsible forcausing psoriasis.

Psoriasis before and after treatment

Psoriasis before and after treatment

How is psoriasis diagnosed?

Psoriasis is diagnosed by board-certified dermatologists based on its classic clinical presentation. There are some rare forms of psoriasis where a biopsy may be required. Some versions that occur only on the hands and feet may also present as painful pustules on the palms and soles.

 

Can psoriasis be prevented?

Because psoriasis is a genetic condition, it cannot be prevented. However, flare-ups can be minimized. Certain medications, heavy smoking, and heavy drinking are triggers that can be avoided to minimize flare-ups of psoriasis. Following a carefully developed treatment plan from your dermatologist will also help tremendously.

 

How is psoriasis treated?

There are many great treatments for psoriasis. Unfortunately, a recent survey demonstrated that almost 90 percent of patients with psoriasis are unhappy with their current treatment program. If you have psoriasis and are unhappy with your current treatment, this is something that needs to be discussed with your dermatologist.

Treatments for psoriasis include topical moisturizing creams, topical anti-inflammatory prescription creams and ointments, oral medications, special phototherapy/light treatments, and a new class of medications called injectable biologic medications. Many dermatologists will combine several of these for optimal results.

Because 25 percent of patients with psoriasis can also develop psoriatic arthritis, it is important to mention to your doctor if you’re having any joint pain, especially in your hands and feet in the morning lasting more than 20 minutes. This is an early sign for psoriatic arthritis; it’s important to note that arthritis can occur before, during, or years after psoriasis of the skin is diagnosed.

 

Action steps for anyone with psoriasis

• See your dermatologist and develop a progressive treatment plan for your arthritis.

• Let your dermatologist know if you’re having any joint pain.

•  Be sure to also ask your dermatologist about phototherapy treatments.

• Schedule a regular general medical examination every year with the appropriate tests for your age and sex.

•  Let your primary care doctor know that you have psoriasis and are also concerned about arthritis, diabetes and heart disease.

• Because psoriasis can also affect your teeth, make sure you have yearly dental examinations.

Remember, there are great treatments for psoriasis, and if your current program is not working, talk to your dermatologist to modify and/or change your current treatment program.

 

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 has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, Psoriasis before and after treatment MABP.org

My Faith is Restored! Psoriasis Testimonial

Crutchfield Dermatology Website

“Dr. Crutchfield is amazing and has restored my faith in the physician community. He is gentle and kind and he always makes me feel comfortable with any procedure. The staff are respectful and kind, always making sure you know what is going on. I cannot tell you what a blessing Dr. Crutchfield has been in my life. I will recommend Crutchfield Dermatology to everyone I know!”
— Jennifer S.

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