Kim Kardashian, Cindy Lauper, and LeAnn Rimes are just a few celebrities who have psoriasis. Psoriasis affects over 7.5 million people in the United Sates and is an autoimmune skin condition, meaning that the body’s own immune system is creating inflammation. This inflammation is systemic, meaning it affects the entire body, even though you may only have psoriasis on your knees or elbows. In psoriasis, the immune system goes into overdrive and essentially creates new skin at a rate much faster than normal. Typically, it takes about a month for us to generate new skin. During that time, old skin cells are shed and new ones come to the surface. The process is timed so well that we don’t notice it taking place. However, in psoriasis, the immune system speeds that new skin process up and shortens it to about 3-4 days. As a result, you see it all happening, and the inflammation brings about the red, scaly plaques and symptoms like burning and itch. Psoriasis does have a genetic component and can run in families. So if your mom or dad has it, it doesn’t mean you definitely will, but your risk is higher.
Psoriasis can affect any area of the skin, but common locations include scalp, knees and elbows, skin folds and palms and soles. Psoriasis can also affect the nails and cause little dents or pits in the nail as well as lifting of the nail plate (onycholysis) and a yellow discoloration. About one out of every three people with psoriasis may develop joint involvement, what is known as psoriatic arthritis (PsA). Patients with PsA often present with joint pain, swelling and stiffness. Their fingers and toes might swell up enough to look like sausages. Psoriatic arthritis is considered a destructive arthritis, meaning it can irreversibly destroy the joints and impair movement and daily activities. That’s why it’s important to diagnosis PsA early so that treatment can stop it from progressing.
What some may not realize is that psoriasis patients are at risk for other conditions, like obesity, high blood pressure (hypertension), elevated cholesterol and type 2 diabetes mellitus. If you have psoriasis, you are at higher risk of heart disease, which includes heart attack, stroke, heart failure, heart valve problems and irregular heartbeat (arrhythmia). Psoriasis patients are also at increased risk for metabolic syndrome, which is a term used to describe someone who has high blood pressure, high blood sugar, excess body fat, and abnormal cholesterol levels. Because of these increased risks, psoriasis patients should monitor their overall health more closely and follow with a primary care physician.
Treatment of psoriasis has changed significantly over the last twenty years and grown to include how it impacts a person’s quality of life. Many people think of the coal tar or phototherapy days as the only options for psoriasis patient. Phototherapy is still apart of psoriasis treatment, but there are also several medications available to treat psoriasis. For limited skin involvement or for those without psoriatic arthritis, prescription topical steroids or steroid-free topical medications are used. If someone has more extensive psoriasis with or without psoriatic arthritis, treatments include systemic medications that work on calming the immune system to reduce inflammation in the skin and joints. Some over the counter products can be useful to add into a prescription regimen to break up scale. To treat psoriasis effectively, it is also important to encourage weight loss, a healthy diet and regular exercise. In addition, reducing or eliminating tobacco and alcohol are a part of treating your psoriasis. Finally, managing stress is another aspect of psoriasis treatment. Stress has been known to trigger psoriasis flares so creating coping strategies or minimizing stress is helpful as a part of treatment. For more information on psoriasis, visit The National Psoriasis Foundation.
Trotter’s Take: Psoriasis is a skin condition with systemic inflammation that I call the 3Cs—It’s Chronic, we don’t Cure it but we work to Control it. With the therapies we have available today, psoriasis can be managed effectively and because the psoriasis patient is at risk for other health conditions, a holistic approach is needed.
Grab a cup of coffee and learn more about psoriasis in this week’s episode of Derm-It Trotter! Don’t Swear About Skincare with Dr. G. Scott Drew.
Dr. G. Scott Drew
G. Scott Drew, DO, is a medical and surgical dermatologist at Mid Ohio Dermatology Associates/Smith Clinic in Marion, Ohio since 1992. He is on the faculty of Ohio University College of Osteopathic Medicine in Athens, Ohio, and adjunct clinical faculty at Ohio State University College of Medicine in Columbus.
Dr. Drew is the author of several peer-reviewed articles in dermatology. He is a member of the American Academy of Dermatology, the Ohio Dermatology Association, the American Osteopathic College of Dermatology, and many other professional and civic organizations. He is also a consultant for several pharmaceutical companies.
In his spare time, Dr. Drew volunteers with overseas dermatology outreach missions with Power of a Nickel, Days for Girls, DO Care, and Passion to Heal.
Dr. Drew currently works at Dermatology Associates of Mid Ohio.
