August is Psoriasis Awareness Month.

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Psoriasis is an immune disease that causes raised, red, scaly patches that appear on the skin.  It typically affects the outside of the elbows, knees or scalp.  Although, it can appear on any location. Some people report that psoriasis is itchy, it burns and stings. Psoriasis can be associated with other serious health conditions, such as diabetes, heart disease and depression.  If you develop a rash that doesn't go away with an over-the-counter medication, you should consider contacting your doctor.  Scientists do not know what exactly causes psoriasis, but know that the immune system and genetics play major roles in its development.  Usually, something triggers psoriasis to flare.  When skin cells in people who have psoriasis grow at an abnormally fast rate, it causes the buildup of psoriasis lesions.

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Men and women develop psoriasis at equal rates. Psoriasis also occurs in all racial groups.  About 1.9 percent of African-Americans have psoriasis, compared to 3.6 percent of Caucasians.  According to research studies, more than 8 million Americans have psoriasis.  Psoriasis often develops between the ages of 15 and 35, but it can develop at any age.

Psoriasis is not contagious.  There are no special blood tests or tools to diagnose psoriasis. A dermatologist (doctor who specializes in skin diseases) or other health care provider usually examines the affected skin and determines if it is psoriasis.  Your doctor can take a piece of the affected skin (a biopsy) and examine it under a microscope. When biopsied, psoriasis skin looks thicker and inflamed when compared to skin with eczema.  Your doctor also will want to learn about your family history. About one-third of people with psoriasis have a family member with the disease, according to dermatologist Dr. Paul Yamauchi with the Dermatology and Skin Care Institute in Santa Monica, Calif.

 

There are five types of psoriasis. Learning more about your type of psoriasis will help you determine the best treatment for you.

 

1. Plaque Psoriasis

Plaque psoriasis is the most common form of the disease and appears as raised, red patches covered with a silvery white buildup of dead skin cells. These patches or plaques most often show up on the scalp, knees, elbows and lower back. They are often itchy and painful, and they can crack and bleed.

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2. Guttate

Guttate [GUH-tate] psoriasis is a form of psoriasis that appears as small, dot-like lesions. Guttate psoriasis often starts in childhood or young adulthood, and can be triggered by a strep infection. This is the second-most common type of psoriasis, after plaque psoriasis.

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3. Inverse

Inverse psoriasis shows up as red lesions in body folds, such as behind the knee, under the arm or in the groin. It may appear smooth and shiny.

 

4. Pustular

Pustular [PUHS-choo-lar] psoriasis in characterized by white pustules (blisters of noninfectious pus) surrounded by red skin. The pus consists of white blood cells. It is not an infection, nor is it contagious. Pustular psoriasis can occur on any part of the body, but occurs most often on the hands or feet.

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5. Erythrodermic

Erythrodermic [eh-REETH-ro-der-mik] psoriasis is a particularly severe form of psoriasis that leads to widespread, fiery redness over most of the body. It can cause severe itching and pain, and make the skin come off in sheets. It is rare, occurring in 3 percent of people who have psoriasis during their life time. It generally appears on people who have unstable plaque psoriasis.  Individuals having an erythrodermic psoriasis flare should see a doctor immediately. This form of psoriasis can be life-threatening.
 

Psoriasis can be mild, moderate or severe. Your treatment options will depend on how severe your psoriasis is. Severity is based on how much of your body is affected by psoriasis. The entire hand (the palm, fingers and thumb) is equal to about 1 percent of your body surface area.  However, the severity of psoriasis is also measured by how psoriasis affects a person's quality of life. For example, psoriasis can have a serious impact on one's daily activities, even if it involves a small area, such as the palms of the hands or soles of the feet.

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Mild psoriasis covers less than 3 percent of the body.

Moderate psoriasis covers between 3 and 10 percent of the body.

Severe psoriasis covers more than 10 percent of your body.

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Topical treatments, such as moisturizers, over-the-counter and prescriptions creams and shampoos, typically are used for mild psoriasis.

Treating moderate to severe psoriasis usually involves a combination of treatment strategies. Besides topical treatments, your doctor may prescribe photo-therapy (also known as light therapy). Your doctor may also prescribe systemic medications, including biologic drugs, especially if your psoriasis is significantly impacting your quality of life.

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Source:  National Psoriasis Foundation

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Psoriasis Treatment
 

Psoriasis treatments aim to stop skin cells from growing so quickly and to remove scales. Options include creams and ointments (topical therapy), light therapy (photo-therapy), and oral or injected medication.

Which treatments you use depends on how severe the psoriasis is and how responsive it has been to previous treatment. You might need to try different drugs or a combination of treatments before you find an approach that works for you. Usually, however, the disease returns.

Topical treatments:

• Corticosteroids: These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They are available as ointments, creams, lotions, gels, foams, sprays and shampoos. Mild corticosteroid ointments (hydrocortisone) are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches. Topical corticosteroids might be applied once a day during flares, and on alternate days or weekends only to maintain remission.

Your doctor may prescribe a stronger corticosteroid cream or ointment, triamcinolone (Acetonide, Trianex), clobetasol (Temovate) for smaller, less-sensitive or tougher-to-treat areas.

Long-term use or overuse of strong corticosteroids can thin the skin. Over time, topical corticosteroids may stop working.
 

• Vitamin D: Synthetic forms of vitamin D, such as calcipotriene and calcitriol (Vectical) slow skin cell growth. This type of drug may be used alone or with topical corticosteroids. Calcitriol may cause less irritation in sensitive areas. Calcipotriene and calcitriol are usually more expensive than topical corticosteroids.
   

• Retinoids: Tazarotene (Tazorac, Avage) is available as a gel and cream and applied once or twice daily. The most common side effects are skin irritation and increased sensitivity to light.

Tazarotene isn't recommended for pregnant or breast-feeding women, or if you intend to become pregnant.
 

• Calcineurin inhibitors: Calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel), reduce inflammation and plaque buildup. They can be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.

Calcineurin inhibitors are not recommended when you're pregnant or breast-feeding, or if you intend to become pregnant. This drug is also not intended for long-term use because of a potential increased risk of skin cancer and lymphoma.
 

• Salicylic acid: Salicylic acid shampoos and scalp solutions reduce the scaling of scalp psoriasis. It may be used alone, or to enhance the ability of other medications to more easily penetrate the skin.
   

• Coal tar: Coal tar reduces scaling, itching and inflammation. It's available over-the-counter or by prescription in various forms, such as shampoo, cream and oil. These products can irritate the skin. They're also messy, stain clothing and bedding, and can have a strong odor.

Coal tar treatment isn't recommended for women who are pregnant or breast-feeding.

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• Goeckerman Therapy: Some doctors combine coal tar treatment with light therapy, which is known as Goeckerman therapy. The two therapies together are more effective than either alone because coal tar makes skin more receptive to UVB light.
   

• Anthralin: Anthralin (another tar product) is a cream used to slow skin cell growth. It can also remove scales and make skin smoother. It should not be used on the face or genitals. Anthralin can irritate skin, and it stains almost anything it touches. It's usually applied for a short time and then washed off.
   

There are also different light therapy treatments used, such as:

• Sunlight: Brief, daily exposures to sunlight (heliotherapy) might improve psoriasis. Before beginning a sunlight regimen, ask your doctor about the safest way to use natural light for psoriasis treatment.

• UVB broadband: Controlled doses of UVB broadband light from an artificial light source can treat single patches, widespread psoriasis and psoriasis that doesn't improve with topical treatments. Short-term side effects might include redness, itching and dry skin. Moisturizing regularly can help ease your discomfort.

• UVB narrowband: UVB narrowband light therapy might be more effective than UVB broadband treatment and in many places has replaced broadband therapy. It's usually administered two or three times a week until the skin improves and then less frequently for maintenance therapy. Narrowband UVB phototherapy may cause more-severe and longer lasting burns, however.

• Psoralen plus ultraviolet A (PUVA): This treatment involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.

This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.

• Excimer laser:  With this form of light therapy, a strong UVB light, targets only the affected skin. Excimer laser therapy requires fewer sessions than does traditional phototherapy because more powerful UVB light is used. Side effects can include redness and blistering.
   

There are also oral or injected medications, you can take as well.  (For a brief period) They are:

• Steroids: If you have a few small, persistent psoriasis patches, your doctor might suggest an injection of triamcinolone right into the lesions.

• Retinoids: Acitretin (Soriatane) and other retinoids are pills used to reduce the production of skin cells. Side effects might include dry skin and muscle soreness. These drugs are not recommended when you're pregnant or breast-feeding or if you intend to become pregnant.

• Methotrexate: Usually administered weekly as a single oral dose, methotrexate (Trexall) decreases the production of skin cells and suppresses inflammation. It's less effective than adalimumab (Humira) and infliximab (Remicade). It might cause upset stomach, loss of appetite and fatigue. People taking methotrexate long term need ongoing testing to monitor their blood counts and liver function.

Men and women should stop taking methotrexate at least three months before attempting to conceive. This drug is not recommended when you're breast-feeding.

• Cyclosporine: Taken orally for severe psoriasis, cyclosporine (Neoral) suppresses the immune system. It's similar to methotrexate in effectiveness but cannot be used continuously for more than a year. Like other immuno-suppressant drugs, cyclosporine increases your risk of infection and other health problems, including cancer. People taking cyclosporine need ongoing monitoring of their blood pressure and kidney function.

These drugs are not recommended when you're pregnant, breast-feeding or if you intend to become pregnant.

• Biologics: These drugs, usually administered by injection, alter the immune system in a way that disrupts the disease cycle and improves symptoms and signs of disease within weeks. Several of these drugs are approved for the treatment of moderate to severe psoriasis in people who haven't responded to first-line therapies. The therapeutic options are rapidly expanding. Examples include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), secukinumab (Cosentyx) and ixekizumab (Taltz). These types of drugs are expensive and may or may not be covered by health insurance plans.

Biologics must be used with caution because they carry the risk of suppressing your immune system in ways that increase your risk of serious infections. In particular, people taking these treatments must be screened for tuberculosis.

• Other medications: Thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are medications that can be used when other drugs can't be given. Apremilast (Otezla) is taken by mouth twice a day. It's especially effective at reducing itching. Talk with your doctor about possible side effects of these drugs.
   

Alternative medicine

A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs.  Some alternative therapies are deemed generally safe and might reduce itching and scaling in people with mild to moderate psoriasis. They are:
 

• Aloe extract cream: Taken from the leaves of the aloe vera plant, aloe extract cream may reduce redness, scaling, itching and inflammation. You might need to use the cream several times a day for a month or more to see any improvement in your skin.

• Fish oil supplements: Oral fish oil therapy used in combination with UVB therapy might reduce the amount of affected skin. Applying fish oil to the affected skin and covering it with a dressing for six hours a day for four weeks might improve scaling.

• Oregon grape:  Also known as barberry, this product is applied to the skin and may reduce the severity of psoriasis.

If you're considering dietary supplements or other alternative therapy treatments to ease the symptoms of psoriasis, consult your doctor first.
 

You can also try some home remedies as well, such as:
 

• Take daily baths. Bathing daily helps remove scales and calm inflamed skin. Add bath oil, colloidal oatmeal and Epsom salts to the water and soak for at least 15 minutes. Use lukewarm water and mild soaps that have added oils and fats.

• Use moisturizer. After bathing, gently pat dry and apply a heavy, ointment-based moisturizer while your skin is still moist. For very dry skin, oils may be preferable — they have more staying power than creams or lotions do. If moisturizing seems to improve your skin, apply it one to three times daily.

• Cover the affected areas overnight. Before going to bed, apply an ointment-based moisturizer to the affected skin and wrap with plastic wrap. When you wake, remove the plastic and wash away scales.

• Expose your skin to small amounts of sunlight. Ask your doctor about the best way to use natural sunlight to treat your skin. A controlled amount of sunlight can improve psoriasis, but too much sun can trigger or worsen outbreaks and increase the risk of skin cancer. Log your time in the sun, and protect skin that isn't affected by psoriasis with sunscreen with a sun protection factor (SPF) of at least 30.

• Apply medicated cream or ointment. Apply an over-the-counter cream or ointment containing hydrocortisone or salicylic acid to reduce itching and scaling. If you have scalp psoriasis, try a medicated shampoo that contains coal tar.

• Avoid psoriasis triggers. Notice what triggers your psoriasis, and take steps to prevent or avoid them. Infections, injuries to your skin, stress, smoking and intense sun exposure can all worsen psoriasis.

• Avoid drinking alcohol. Alcohol consumption may decrease the effectiveness of some psoriasis treatments. If you have psoriasis, avoid alcohol. If you do drink, drink in moderation.

• Strive to maintain a healthy lifestyle. In addition to quitting smoking and drinking moderately, if at all, you can manage your psoriasis by being active, eating well and maintaining a healthy weight.

 

Source: Mayo Clinic

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-Dietra Myers