Psoriasis is more than just dry or itchy skin. Psoriasis is a chronic disease that manifests in thick, inflamed, itchy, and scaly patches of skin known as plaques. The plaques are caused by abnormally rapid and excessive proliferation of keratinocytes, the cells that comprise the outermost layer of the skin.
Up to 2.6% of the U.S. population of all ages suffers from psoriasis, with a heavier prevalence in Caucasians than in other ethnicities. Fortunately, psoriasis outbreaks can be managed with expert evaluation and care by the board-certified dermatologists at Old Metairie Dermatology in New Orleans.
What are the Symptoms of Psoriasis?
Psoriasis most commonly affects the scalp, knees, and elbows, causing a distinctive scaly rash. In more extensive cases, any area of the body can be involved, including the fingernails and toenails. A variant of psoriasis that affects up to 30% of patients is psoriatic arthritis, a potentially debilitating inflammation of the joints. This scaly rash has also been linked to obesity, high blood pressure, diabetes, high cholesterol, fatty liver, and cardiovascular disease with a three-fold increased risk of heart attack.
What Causes Chronic Itchy, Scaly Skin?
In psoriasis, skin cells work overtime proliferating at a faster rate than normal. This causes skin cells to pile up on the surface of the skin instead of piling up leaving thick flaky, itchy patches. The exact etiology of psoriasis is unknown, but the most prevalent current theory is that it is an autoimmune disease, in which the body mistakes its own cells for a foreign invader and attacks them. Strengthening this hypothesis is the overlap of symptoms and signs that psoriasis shares with other autoimmune disorders, such as rheumatoid arthritis, inflammatory bowel disease, and lupus, and the fact that some scaly rash sufferers develop arthritis as part of their disease. Recent research has shown there may be some genetic basis for the condition as well.
Scaly rash outbreaks can be triggered by a number of stressors although whether these relationships are causal or secondary is still unknown. The most common triggers that have been identified so far include infections, skin injuries, sunburns, cold weather, psychogenic stress, alcohol consumption, cigarette smoking, weight gain, and certain medications, such as lithium for bipolar disorder, beta-blockers for high blood pressure, antimalarials, and iodides.
The Psychological Distress of Scaly Skin
In addition to the physical symptoms of psoriasis, such as itching and pain, many patients suffer from social rejection and/or self-consciousness due to the appearance of their plaques. Patients with a scaly rash are often shunned because people mistakenly believe that their disease is contagious.
While no cure for psoriasis has yet been found, at Old Metairie Dermatology in New Orleans, Dr. Patricia K. Farris and Dr. Mamina Turegano offer a variety of therapies to treat various levels of severity. We also encourage patients to make lifestyle and dietary changes that can help them build up their immune systems and control their outbreaks.
The goal of psoriasis treatment and management is to slow down the rapid turnover of keratinocytes, remove the unsightly, scaly plaques, and soothe the skin.
Dr. Farris and Dr. Turegano are known for their holistic approach to treating patients. Because psoriasis is considered to be an autoimmune disorder, our physicians encourage patients to strengthen their immune system with good nutrition, obtaining adequate vitamin D levels, and addressing other lifestyle changes, such as stress management through meditation and other positive coping strategies.
A healthy exercise program can help strengthen the immune system. Exercise can also aid in warding off the depression that many psoriasis patients suffer owing to the psychological distress and social ostracizing that comes from dealing with a chronic and highly visible disease.
Topical corticosteroids are anti-inflammatory agents that quell inflammation and itching and slow down skin cell turnover. For mild cases of psoriasis, steroids may be sufficient to control the disease. Corticosteroids also come in a variety of strengths to treat more severe cases of psoriasis and can be combined with other medications and therapies.
Other Topical Treatments
There are a number of topical psoriasis treatments that can control itching and pain while helping to resolve the psoriatic plaques. Topical vitamin D analogs, anthralin, topical retinoids, calcineurin inhibitors, salicylic acid, and coal tar have all been demonstrated to be effective, especially in milder cases.
Read more about topical medications for chronic itchy, scaly skin at WebMD.com.
Oral or Systemic Medications
More severe or resistant cases of psoriasis may require oral or injectable medications. Because these drugs are potent, they may need to be used in the short-term only or in alternation with other therapies. This class of drugs may include retinoids, methotrexate, cyclosporine, biologic agents (e.g. Humira, Enbrel, Stelara, Cosentyx, Taltz), and immunomodulators (e.g. Biologics, Otezla, etc.)
Phototherapy, or light therapy, is one of the earliest treatments for psoriasis. Limited exposure to sunlight’s ultraviolet rays can slow keratinocyte turnover, reduce inflammation, and ameliorate scaling. Too much sunlight, however, can trigger an outbreak or worsen the condition.
There is no one psoriasis treatment that will work for everyone. During your consultation at Old Metairie in New Orleans, Dr. Farris and Dr. Turegano will discuss your symptoms and make recommendations that can help you find relief.
Psoriasis is an itchy, scaly condition that can affect the scalp, knees, and elbows. In more extensive cases any area of the body can be involved including the nails. Some patients with psoriasis develop a unique variant of arthritis called psoriatic arthritis. Psoriasis is not contagious but can be a significant cosmetic concern for those who suffer with it.
Treating chronic scaly, itchy skin depends on the extent of involvement and how much it affects your daily life. Mild cases of psoriasis can be controlled with topical medications but more extensive cases may require more aggressive therapies. Light treatments, oral medications, and injectable biologics may be necessary to control severe cases of psoriasis. Nutrition, stress management, and lifestyle changes may also be helpful for managing psoriasis.
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