Outbreaks are often unpredictable and capricious, depending upon the individual
By: Lorraine Seabrook and Jerry Bagel, M.D.
Psoriasis is a chronic skin disease, characterized by small or large red patches, which affects over 3 million Americans. While researchers have yet to develop a cure, treatment methods can be quite effective.
Jerry Bagel, M.D., board-certified dermatologist on staff at University Medical Center at Princeton, answers the following commonly asked questions about the condition.
What is psoriasis?
Psoriasis is an immunologically mediated disease where the skin’s epidermis grows too quickly, resulting in scaling, flaking and itching skin.
Seventy-five percent of people with psoriasis have localized disease appearing on their elbows, knees or scalp, as well as around their fingernails or toenails. The other 25 percent of people have moderate to severe psoriasis, affecting up to 100 percent of the skin. Outbreaks are often unpredictable and capricious, depending upon the individual. Psoriasis can range from mild to moderate to severe to disabling. Thirty percent of people with psoriasis have arthritis known as psoriatic arthritis.
Is this condition contagious?
Absolutely not. However, those who have psoriasis often report that they are ostracized by strangers, co-workers and even family members who are disgusted by the presence of the lesions. For these people, the negative reactions of others can have a strong psychological impact causing sufferers to feel embarrassed, angry and anxious. Acknowledging that this happens and offering hope and support are important parts of any psoriasis therapy.
What causes psoriasis?
Psoriasis is a T-cell mediated disease with T-cells referring to a type of white blood cell. The role of T-cells is to circulate through the body and detect any foreign substances such as a bacterium or a virus, at which point the T-cell is activated and sends signals to the immune system to respond. For those afflicted with psoriasis, part of the immune system backfires and the activated T-cells end up in the skin. Modern research focuses on understanding why the immune system’s activation leads to skin lesions.
How do you treat psoriasis?
No one treatment works consistently for all people. Localized psoriasis (characterized by psoriasis on less than 10 percent of the body surface area) often responds well to topical therapy such as ointments, creams and emollients containing steroids, tars and salicylic acid; Anthralin; Vitamin D derivatives containing Calcipitriol, and intralesional cortisone injections.
Ultraviolet B light (UVB) and/or narrowband UVB phototherapy is the treatment of choice for people with moderate psoriasis (characterized by psoriasis on 10 percent or more of the body surface area) that have not responded to topical modalities. UVB, in combination with home moisturizing, benefits patients within 20 or 30 treatments, resulting in remission about 70 percent of the time.
PUVA (Psoralen plus Ultraviolet A) therapy utilizes a medication called Psoralen which absorbs UVA light, resulting in a decrease in the proliferation of epidermal cells. It is extremely effective in treating moderate psoriasis, though its relative risks require thorough evaluations prior to initiation of therapy.
Psoralen is taken orally, followed by a UVA light treatment 75 minutes later. Treatments are given two to three times per week, and an average of 20 treatments usually will clear the condition. PUVA results in a longer remission than UVB; however, there is a slight increase of skin cancer associated with PUVA therapy.
What are the newer treatments that are available?
In the past two years, three new biological medications have been approved by the Federal Drug Administration (FDA) for the treatment of psoriasis.
Amevive is an intramuscular injection given once a week for 12 weeks in the physician’s office and can result in a six-month remission. Raptiva and Enbrel are subcutaneous injections (similar to insulin injections) that people administer to themselves at home.
Presently we’re doing research with oral medications that have beneficial effects. These medications work as well as the newer biologic agents thus eliminating the discomfort that accompanies injections.
What advice do you have for psoriasis sufferers?
Don’t assume that psoriasis is a condition that you have to live with. Seek treatment immediately and work with your physician to determine a treatment that works for you. Know that the search for a cure is ongoing.