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Soothing the Angry Itch: Psoriasis

Mercy Dermatologist Dr. Oanh Lauring Provides Insights Into Psoriasis and Its Treatment as August is National Psoriasis Awareness Month

You wouldn’t think that psoriasis, a common chronic inflammatory skin disease that afflicts 5 million Americans, would have much in common with depression, high blood pressure, and even diabetes, but in fact, it does.

The connection is quality of life. For example, one study published in the British Journal of Dermatology found that children with skin conditions such as eczema and psoriasis felt their lives were as bad in the same way as kids with epilepsy, kidney disease and asthma.

Just like all of these other medical conditions, psoriasis lays a heavy burden on those who must daily face such symptoms as itching, the constant shedding of scales, joint pain, hair loss, stains on clothes, time missed form work, medication side effects and the sometimes messiness of treatment; differing doctors’ attitudes, people’s negative reactions, feeling self-conscious, having no control over the illness, and more.

There are many standard effective treatment options but they often have worrisome side effects. Oral medications such as Soriatane (acitretin) and methotrexate can effect the liver and lipid profile, as well as cause birth defects. Light therapy with PUVA or UVB, require frequent follow-up and significantly increases the risk of skin cancer development. Topical steroids can cause stretch marks, skin thinning, changes in skin pigmentation and decrease wound healing.

Fortunately, physicians are witnessing improvements in the treatment of psoriasis which are helping patients to cope. New non-steroidal topical treatments like Dovonex (calciprotriene) are safer; home ultraviolet B (UVB) phototherapy may help in giving patients a sense of empowerment in treating their disease. New laser treatments are better able at targeting plaques – the scaly psoriasis lesions – than healthy, normal skin and require patients to undergo fewer treatments. The National Psoriasis Foundation offers patients educational information and support to help patients get a better handle mentally on their illness.

In recent years, the FDA has approved new biologics like Enbrel (Etanercept) and Raptiva (Efalizumab) for the treatment of cutaneous psoriasis. Enbrel, which is an injectable medication, works by binding to the TNF-alpha receptor, thereby preventing TNF-alpha from being activated. TNF-alpha promotes inflammation and is associated with fever, pain, tenderness and swelling which is why it is used for arthritis as well.

Raptiva (Efalizumab), is a humanized therapeutic antibody designed to block the activation of T-cells that lead to the development of psoriasis symptoms. Remicade (Infliximab) is an intravenous medication that is currently awaiting FDA approval for the treatment of cutaneous psoriasis. Remicade binds to the TNF-alpha protein and acts like a sponge to absorb and remove TNF-alpha molecules.

While new drugs become available, it is important to speak with your doctor to determine not only which are best for you, but when is the best time to take them, as in the case of women contemplating pregnancy. Ideally, women during conception and pregnancy should postpone their psoriasis treatment or use only those known to be safe such as certain topicals like petrolatum jelly and mineral oil, and UVB phototherapy, to avoid birth defects. In addition, nursing mothers may wish to do the same to avoid passing on medications to their newborns. Men who have questions about how psoriasis treatments can affect fertility should see their doctor as well.

Of course, prevention remains the proverbial pound of cure. There are risk factors to keep in mind when it comes to avoiding psoriasis.

Avoid high levels of stress as stress can impact your immune system and increase your risk of psoriasis. While moderate amounts of sunlight can actually help, too much sunlight, and sunburn especially, can trigger the disease, as can exposure to toxic chemicals.

Taking certain medications, like beta blockers, anti-malarial drugs and lithium can make you more susceptible to psoriasis. People who have HIV are more likely to develop the disease or have worsened disease due to their compromised immune systems. Kids and young adults who have recurring infections, particularly strep throat, may also be at increased risk.

Family history is perhaps the biggest risk factor of psoriasis; about one in three people with the condition have a close relative with psoriasis as well, so investigate your family background thoroughly.

August is Psoriasis Awareness Month, and the National Psoriasis Foundation is trying to explode the myths about this disease. Psoriasis is a serious illness which is common, is not contagious and is more than cosmetic, but a condition that can be managed with proper treatment and understanding.