Psoriasis
Between 1-2% of the population may develop psoriasis. It is genetically based although only 25% of people with psoriasis will have a family history.
How do I know it’s psoriasis?
Many times, psoriasis can be simply diagnosed, by a Board Certified Dermatologist, by the way it looks and where it is located. Sometimes a biopsy can help, but this is typically not needed. Psoriasis takes many forms and affects any area of the skin and nails. Most patients will have “plaque” type psoriasis which is red, flaky, and well-demarcated (clear and abrupt definition between normal and inflamed skin).
How did I get it?
Genetics play a large role in psoriasis. Based on our current understanding, people have a genetic risk for psoriasis
and then have an exposure – such as a common cold or strept throat – and then they develop psoriasis. Many times, the “exposure” is not discernable.
Unfortunately, there is not a known cure for psoriasis.
How do you treat it?
There are many great treatment options. The ones that are right for you will depend on your health history, the type and location of the psoriasis, your doctor’s experience with certain medications, and unfortunately – your insurance companies’ willingness to support coverage for a particular medication.
The good part is that the number and effectiveness of medications for psoriasis has exploded in the last 10-20 years so there are many great options. As with any disease process, the medications recommended will balance the risk and benefit of each treatment and the severity of the patient’s disease. Common treatments are:
Topical creams/ointments/solutions – Topical steroids, topical calcineurin inhibitors, Topical Vitamin D analogs, and Vitamin A analogs
Oral (tablet) medications – Apremilast, Oral vitamin A analogs, traditional immunosupressants (MTX, cyclosporine)
Biologics – Injected medications – there are many options here and range from injections once per week to every 12 weeks. The right biologic for you will depend on your type of disease, medical history and coverage by your insurance. Most insurance companies cover these medications if your disease is severe enough, however, they typically have specific ones that are covered first (tier system of approved medications). Don’t worry though, your doctor will work with you and your insurance to find the right one for you.
It is important to understand that there is no known
medication that will remove all psoriasis and prevent it from re-appearing. As a dermatologist, I hope every patient has 100% effectiveness. However, 75% reduction in the rash is a more realistic goal. However, if the patient continues to struggle with itch or other quality of life issues even with 75% reduction in rash then discussion of changing a regimen is very reasonable.
What else?
Remember that psoriasis is not only a disease of the skin but also inside the body. Most notably the joints. If you have joint pains that are increasing, discuss these with your dermatologist or rheumatologist.
Having psoriasis also increases your risk for heart attack and stroke. So consider eating healthier, taking part in regular exercise, and stopping unhealthy habits like smoking.
Psoriasis is a complex issue and I encourage you to learn more through the websites below to create a more fruitful conversation with your dermatologist.
Source: American Academy of Dermatology (link - https://www.aad.org/public/diseases/psoriasis)
National Psoriasis Foundation (link - https://www.psoriasis.org/)
For Physicians only (or patients of Dr. Contestable) – “Psoriasis – Patient Handout”