in Westerville OH
Most of us have heard of the condition known as psoriasis, often from TV commercials for dandruff shampoos. For those with chronic psoriasis, it’s much more than a few flakes on the shoulder of a winter sweater. Psoriasis can be an ongoing source of embarrassment and itchy irritation during flareups.
While there is no cure for psoriasis, our three board-certified dermatologists at Westerville Dermatology help patients manage their flareups and their overall condition.
What is psoriasis?
Psoriasis is a chronic autoimmune condition that causes the rapid buildup of skin cells. It simply speeds up the lifecycle of the skin cells. This buildup of skin cells forms scales and red patches that can be itchy and painful. Typical psoriatic scales are whitish-silver and develop in thick, red patches. Sometimes these patches will crack and bleed.
In the normal development of skin cells, the typical cycle takes about one month. New skin cells grow deep in the dermis layer of the skin and slowly rise to the surface to eventually be shed. In people with psoriasis, this production process may occur in just a few days. This doesn’t give the skin cells time to slough off, leading to a buildup and the formation of scaly patches.
What causes psoriasis?
Why some people develop psoriasis is still somewhat of a mystery. It’s thought to be an immune system problem, especially relating to your T cells and white blood cells called neutrophils. T cells usually course through the body looking for viruses and bacteria to attack, but with psoriasis, the T cells attack healthy skin cells by mistake. This causes inflammation.
These overactive T cells also trigger increased production of healthy skin cells, more T cells, and other white blood cells, particularly neutrophils. These cells also travel into the skin causing inflammation and sometimes creating pustular lesions. Psoriasis-affected areas become warm and red, due to dilated blood vessels.
The inflammation triggers more skin cells to be produced and they move to the outermost layer of the skin too quickly — a process that should take weeks occurs in only days. These cells build up on the skin surface in thick, scaly patches.
What are the symptoms of psoriasis?
Symptoms differ from person to person, depending upon the type of psoriasis. Most forms go through cycles of flare-ups and calming down. The condition can even go into complete remission. Signs and symptoms vary between people, but there are some common symptoms:
- Red patches of skin covered with thick, silvery scales
- Dry, cracked skin that may bleed
- Itching, burning, or soreness
- Thickened, pitted, or ridged nails
- Swollen and stiff joints
- Small scaling spots (usually in children)
These patches can range from just a few spots to major eruptions that cover large areas of the body.
Is psoriasis contagious?
People assume from its appearance that psoriasis is contagious, such as other skin rashes like Athlete’s foot or ringworm. This is not the case at all. You cannot catch psoriasis from contact with someone who has the condition.
What’s the difference between psoriasis and eczema?
People confuse psoriasis and eczema (also known as atopic dermatitis), but they are not the same. Here are the differences:
- A thick patch of white scales is characteristic of psoriasis. This is caused by a chronic autoimmune condition that results in the overproduction of skin cells. As the excess skin cells build up, silvery-white scales form. This causes the skin to become inflamed, red, and often itchy.
- Eczema occurs because of a hypersensitivity reaction. This causes the skin to overreact to certain triggers, such as dyes, fabrics, soaps, animals, and other irritants. With eczema, the skin may appear red, inflamed, peeling, cracked, blistered, or pus-filled. But, unlike psoriasis, it’s not covered with scales of cell buildup.
- There is no cure for psoriasis, and flareups aren’t always able to be linked to any cause. Most eczema can be cleared with topical treatment and by avoiding triggers.
Does sunlight help psoriasis?
Light therapy is a first-line treatment for moderate to severe psoriasis. It may be used alone or in combination with medication. Sunlight, of course, is light therapy. Brief, daily exposure to sunlight (known as heliotherapy) can improve psoriasis. Too much UV exposure can worsen the flareups, however.
How is psoriasis treated?
At Westerville Dermatology, we employ many different treatments for psoriasis. This is because there are many different forms, and different patients respond in different ways. We begin treatment with the mildest, least aggressive treatments, progressing to stronger options as needed. The goal is to slow the cell production and buildup. Here are the many options we may use:
For patients with mild to moderate psoriasis, the use of creams and ointments may be all that is necessary. Here are some of the options we use:
- Topical corticosteroids — These drugs are the first choice for treating psoriasis. They reduce inflammation and relieve itching, and they can be combined with other treatments. Long-term use can cause the skin to thin, however, so it’s best to use these for short-term treatment during flare-ups.
- Vitamin D analogs — These synthetic forms of vitamin D slow the growth of the patient’s skin cells.
- Anthralin — This drug helps slow skin cell growth and it can remove scales and make the skin smoother.
- Topical retinoids — These vitamin A-based medications decrease inflammation, but they can also irritate the skin and make the skin light sensitive.
- Calcineurin inhibitors — These reduce inflammation and plaque build-up but are not good for long-term use.
- Salicylic acid — Commonly used in chemical peels, salicylic acid promotes the sloughing of dead skin cells and reduces scaling.
- Coal tar — Coal tar reduces scaling, itching, and inflammation, but it is messy, stains clothing and bedding, and has a strong odor.
- Sunlight — As mentioned above, exposure to UV light in natural sunlight or from artificial sources slows skin cell turnover and reduces scaling and inflammation. Too much exposure, however, can worsen symptoms.
- UVB light — This is the UV light that doesn’t cause sunburns but instead penetrates into the dermis layer of the skin. Controlled broadband and narrowband UVB exposure can be effective with psoriasis.
- Goeckerman therapy — This is a combination of UVB treatment and coal tar. The coal tar makes the skin more receptive to UVB light.
- Psoralen plus UVA — This is an aggressive treatment that can cause the same problems as long-term sun exposure, but it is effective for more severe cases of psoriasis. It involves taking psoralen, a light-sensitizing medication, prior to exposure to UVA light. The psoralen makes the skin more responsive to the UVA light.
- Excimer laser — This is a controlled beam of UVB light that is directed onto only the affected skin without harming the unaffected skin.
Oral and injected medications
The use of prescription oral or injected medications is known as systemic treatment. These drugs have side effects, so they are used only for brief periods, usually alternating with other forms of treatment.
- Retinoids — This vitamin A-based drug can be used with severe psoriasis, but it has side effects such as hair loss
- Methotrexate — This drug decreases the production of skin cells and suppresses inflammation. In can slow the progression of psoriatic arthritis in some people.
- Cyclosporine — Cyclosporine suppresses the immune system, but it has serious side effects and can only be taken short-term.
- Injected immune system drugs — A variety of drugs are approved for the treatment of moderate to severe psoriasis that isn’t responding to other treatments.
Although there isn’t any research showing across the board effectiveness, for some patients changes in diet or taking certain supplements may help. Aloe vera and barberry can be used topically, while fish oil is taken orally.
What are the risks involved with various psoriasis treatments?
These are mostly topical treatments, such as the various light therapies and topical medications. But there are also oral and injected medications. Most medications have potential side effects if used incorrectly or if taken for long periods of time. When we move you into one of these treatment options, we thoroughly discuss the possible side effects of medication. They vary with each drug.
Schedule Your Consultation
If you’re interested in learning more about psoriasis treatment please contact us for a consultation at 614-895-0400 or fill out our contact us form below. We will discuss your needs and concerns, and determine your best course of action.