Dealing with Psoriasis – Treatment Tips from a Certified Dermatologist

Reuters Health recently reviewed a survey of psoriasis patients which showed a significant patient dissatisfaction level with the current treatments available. This research study conducted by the National Psoriasis Foundation between 2003 and 2011 surveyed more than 5,000 participants in the United States who either had psoriasis or psoriatic arthritis.

Participants answered questions regarding prescription medications they use and overall satisfaction with their treatment. Just more than half of the survey respondents were dissatisfied with their treatment. In fact, 42% of respondents indicated that they discontinued their medication stating that they either did not work or caused too many negative side effects.

The Reuters article and the National Skincare Month in September were the inspiration for this article to highlight the need for dermatologists and patients to work together to treat this disease.

What is psoriasis? Psoriasis is a chronic, non-contagious, and often painful skin disease that causes the cells of the dermis, or skin, to reproduce more rapidly than normal. The condition causes reddish, round scaly skin patches to develop on the knees, hands, feet, elbows and scalp.

The normal skin cell life cycle is 28 to 30 days. During this time the cell matures and sloughs off the body’s surface. A psoriatic skin cell has a three to four day maturation process. Once mature, instead of falling off the body the skin cells pile up and form the lesions or patches described above. There are several types of psoriasis:

• Plaque psoriasis - the most common form of psoriasis characterized by reddish patches of skin with silvery scale;

• Guttate psoriasis - characterized by smaller lesions appearing as dots;

• Pustular psoriasis - involves weeping lesions and more intense scaling;

• Inverse psoriasis - characterized by intense inflammation of the skin;

• Erythrodermic psoriasis - characterized by intense shedding and redness around the lesions.

Approximately 20% of patients with psoriasis develop a form of arthritis called psoriatic arthritis. Psoriasis sufferers are also at an increased risk of depression and diseases like heart attack, stroke and other cardiovascular disease.

Psoriasis treatment options
Current available treatment options contain symptoms, but do not address the cause of those symptoms. These include oral and topical medications, as well as newer intravenous or injectable biologic treatments which work to block the activation of the cells that trigger psoriasis.

Why is psoriasis so difficult to treat?
There are several issues that make treatment of mild to severe psoriasis difficult. First, a lot is still not known about psoriasis. Further research is required to develop a full understanding of the disease.

Psoriasis also manifests itself differently from person to person, making a one-size-fits-all solution impossible. To make matters worse symptoms of the disease may occur in certain locations on the body, like the scalp, the nails and in various folds of the skin (intertriginous) that are difficult to treat.

Finally, many insurance plans have been hesitant to cover expensive biologic agents that cost as much as $25,000 annually. Financial issues were a main factor cited in the Reuters study.

Tips for working well with your dermatologist:

1. Find a dermatologist who you trust and who has experience with the disease. Referrals from other medical professionals or friends and family are useful.

2. Keep in constant communication with your dermatologist about what is working and what is not. Raise any and all concerns you may have, including mental health-related concerns.

3. Consider trying forms of treatment other than medication including diet (fasting periods, low energy diets and vegetarian diets have improved psoriasis symptoms in some studies). Studies have also shown that symptoms may be influenced by lifestyle habits related to alcohol, smoking, weight, sleep, stress and physical activity.

Final Thoughts Until better treatments become available, it is important to fully understand your individual psoriasis condition. Working with a licensed dermatologist will make minimizing your symptoms and discomfort easier.

About the Contributor: Lisa Rhodes, MD practices medical dermatology at Westlake Dermatology & Cosmetic Surgery. Dr. Rhodes also currently a volunteer faculty member at the University of Texas Southwestern Dermatology Program.