Psoriasis
Psoriasis is a chronic, non-contagious skin disease of scaling and inflammation that affects about 2 percent of the US population, or as many as 7.5 million Americans. Psoriasis most often appears on the scalp, elbows, knees, and torso but can develop anywhere. Up to 30% of people with psoriasis will develop psoriatic arthritis, or painful, inflamed, stiff joints.
Impact of Psoriasis on Quality of Life
Individuals with psoriasis may experience significant physical discomfort and some disability. Psoriasis of the hands and feet can prevent individuals from working at certain occupations. Many people with psoriasis feel self-conscious about their appearance and have a poor self-image. The psychological distress can lead to significant depression, alcoholism, and social isolation.
Treatment of Psoriasis
There is no cure for psoriasis, but many different treatments, both topical and systemic, can help clear psoriasis.
Topical Therapy
First line treatment for psoriasis.
- Salicylic acid – helps remove scale and is often combined with topical steroids.
- Steroids – reduce inflammation and are effective in controlling mild to moderate psoriasis; potential side effects include thinning of the skin.
- Dovonex (calcipotriene) – a form of synthetic vitamin D3. Taclonex contains both calcipotriene and a potent steroid in one product.
- Tazorac – a vitamin A derivative that works to normalize skin turnover. Can be irritating.
Light Therapy
Sunlight, ultraviolet B (UVB) phototherapy, and psoralen plus ultraviolet A (PUVA) phototherapy can all be helpful in psoriasis. The multiple treatment schedule can be inconvenient, however, and sunlight and PUVA are associated with an increased risk of skin cancer.
Systemic Treatment
Appropriate for more severe psoriasis.
- Methotrexate – slows cell turnover by suppressing the immune system. Can be effective for both psoriasis and psoriatic arthritis, but long-term use can cause liver damage.
- Soriatane – mechanism of action is unknown, but in general retinoids help control how cells multiply. Because of the risk of birth defects, not used in women of child-bearing potential.
- Cyclosporine – slows cell turnover by suppressing the immune system. Acts quickly, but long-term use may impair kidney function or cause high blood pressure.
- Biologics – an exciting new group of drugs. Biologics work by blocking the action of certain immune cells that play a role in psoriasis and psoriatic arthritis. Because biologics have a more targeted impact on the immune system, they are potentially a safer option than older drugs. Biologics approved for moderate to severe psoriasis and/or psoriatic arthritis include Amevive, Enbrel, Humira, Raptiva, and Remicade.
