Psoriasis can be managed with proper treatment

By Erik Gilbertson, M.D. 6 a.m.Jan. 9, 2014

This column is written by experts in the medical field and provides health-care insights to help educate consumers.

Psoriasis is a chronic autoimmune disorder in which white blood cells, called T-lymphocyctes, cause inflammation on the skin. In particular, skin cells multiply too rapidly, causing red raised patches and a scaly plaque to grow on the skin.

Psoriasis is the most prevalent autoimmune disease in the United States. According to the National Psoriasis Foundation, approximately 7.5 million Americans have the condition. It generally develops in the 20s or 30s, although it may develop in later life as well. About 50 percent of people who have psoriasis have some family history of the disorder.

Psoriasis can range from mild cases that cause a few spots on the elbows and knees, to severe cases that cover most of the body. It can have a significant psychosocial impact, as people with the disorder are often very self-conscious and reluctant to pursue personal relationships. Even work can be affected. For example, people with psoriasis on their hands are not allowed to work in food service.

Because psoriasis is a chronic inflammatory condition, patients may have a higher incidence of heart disease, high blood pressure, diabetes, or other concerns. Studies show that between 10 and 30 percent of people with psoriasis also develop psoriatic arthritis, which causes pain, stiffness and swelling in and around the joints. It is very important for psoriasis patients to have a full physical evaluation and mention any arthritis symptoms to their physicians.

For mild cases, the first lines of treatment are topical creams applied to the skin to slow the rate of cell reproduction and decrease inflammation. Steroid creams are used most often, but topicals that contain vitamin A or synthetic vitamin D may also be recommended. These are generally available only by prescription. Creams that contain aloe vera, neem oil and other natural substances also may help soothe symptoms and are available over the counter.

Patients who do not get results from topical treatments, have moderate to severe psoriasis, or also have psoriatic arthritis may be treated with systemic medications that work throughout the body to reduce inflammation. Oral systemic drugs include retinoids, which are synthetic forms of vitamin A, and methotrexate, a low-dose chemotherapy medication that can greatly reduce psoriatic arthritis symptoms. Immunosuppressants like cyclosporine and CellCept (mycophenolate mofetil), which slow the growth of immune cells, may be used for up to a year in qualified patients.

A newer class of systemic therapies called biologics target a protein that is largely responsible for the inflammation and rapid cell growth associated with psoriasis. Products like Enbrel (etanercept), Humira (adalimumab) and Stelara (ustekinumab) are injected every week or every two weeks and can be very effective in treating both psoriasis and psoriatic arthritis. However, these drugs do come with potentially severe side effects, including lowered immunity and an increased risk of serious infections.

Patients must be screened for tuberculosis before starting biologics therapy. Clinical studies are under way to explore a new generation of biologics that will ideally have fewer side effects and require less frequent injections.

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Psoriasis can be managed with proper treatment