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Psoriasis

What is Psoriasis?


Psoriasis is a chronic inflammatory disease resulting from immune system dysregulation. There are many different clinical presentations of psoriasis, but the most common type is plaque psoriasis which has well-defined pink or red “plaques” with silver scale.  Other forms of psoriasis include guttate (raindrop-like), pustular, hand-foot, intertriginous (affecting the skin folds), nail, and joint (psoriatic arthritis) psoriasis.  People affected by psoriasis may have more than one form. 

What causes psoriasis?


 

The cause is believed to be multifactorial.  People with psoriasis have a higher likelihood than non-affected individuals of having one or more family members with psoriasis.  Psoriasis may develop after an infection, with exposure to some medications, or after a surgery.  In most cases it develops with no identifiable trigger.

 

Diet may play a role in psoriasis although evidence is not conclusive. What is known is that being overweight is common among people affected by psoriasis and there is good evidence that being overweight makes the disease more resistant to many treatments.  Some evidence exists that the following recommendations are helpful for psoriasis:

 

Dietary Recommendations for Psoriasis

Recommendations

Avoid or Minimize

Leafy green vegetables

Alcohol

Regular exercise

High fat foots

Fish

Processed & packaged foods/junk foods

Legumes and nuts

Animal meat rich diet

Limited fruit

Sweets

Balanced diet

Extreme diets

Treatment of Psoriasis


In general, treatment options are directed by many factors including the extent of psoriasis involvement on the skin and/or joints, location of psoriasis involvement, co-existing medical factors, social and psychological considerations, as well as the limitations caused by the disease and/or medications used to treat.

Topical medications (corticosteroids, Vit D3 analogs, tazorotene, calcineurin inhibitors, coal, tar, anthralin, salicylic acid, and lactic acid):  May be used as solo therapy for limited involvement of skin psoriasis or in combination with other treatments.

Narrow Band UVB- light treatment using part of the sun’s light spectrum in a controlled intense stetting.

PUVA – Psoralen (a photosensitizing agent) used with light treatment

Xtrac Laser treatment –Very intense light treatment for localized plaque psoriasis

Traditional Systemic Agents (e.g. Methotrexate, Cyclosporin, Acitretin, Sulfasalazine, Hydroxyurea) – Often effective alone or in combination with other treatments.  Dose may be limited by side effects.  May require laboratory monitoring.

Biologic Medications (e.g. TNF inhibitors, IL-12/IL-23 inhibitors, IL-17 inhibitors, and others coming soon) – Injected medications that bind and block key inflammatory mediators that drive psoriasis.  Required screening and monitoring and may increase the risk of infection, some cancers, and other possible side effects.

Nonbiologic immunomodulatory agent – Oral agent affecting the inflammatory balance of immune cells.

Patient Considerations


It is important to be upfront with your doctor about how psoriasis symptoms are affecting you physically, mentally, socially, and sexually.  All of these factors may affect treatment considerations.  Psoriasis symptoms may change over time.  Almost 1/3 of people with skin psoriasis may start to develop psoriasis in the joints also.  Keeping your weight down, regular exercise, good health habits are all important as is monitoring for morning stiffness or pain in the joints after prolonged inactivity.  Compliance with general good health habits, medical monitoring and medications are the best strategies for controlling this and other chronic conditions.