Psoriasis

Patients who have psoriasis experience chronic symptoms that include red, itchy and scaly skin. These symptoms can be uncomfortable, interfering with your quality of life and self-esteem. At Silver Falls Dermatology, our providers have the experience and knowledge necessary to help psoriasis patients determine an effective treatment option. While psoriasis cannot be cured, treatment options are available to reduce or cope with symptoms. Silver Falls Dermatology includes a network of over 20 convenient locations across Oregon and Washington. 

What is Psoriasis?

Psoriasis is a common chronic skin disease. Patients with psoriasis experience patches of red, itchy or scaly skin, most commonly on the knees, elbows, scalp or torso. These patches may come and go in cycles, with flare-ups lasting for weeks or months. There are several types of psoriasis, which include:

• Plaque psoriasis
• Nail psoriasis 
• Guttate psoriasis
• Inverse psoriasis
• Pustular psoriasis 
• Erythrodermic psoriasis
• Psoriatic arthritis 

What Causes Psoriasis?

Psoriasis is believed to be a condition caused by immune system dysfunction. Patients with psoriasis have skin cells which regenerate at a faster than normal rate. This is what results in the thickened or scaly red patches. Certain risk factors can increase your likelihood of developing psoriasis. This includes a family history of psoriasis, smoking or stress. 

Psoriasis flare-ups are often triggered by a range of environmental or other factors. Some common psoriasis triggers include:

• Infections
• Injury
• Heavy alcohol consumption
• Cold or dry weather 
• Medications including lithium, blood pressure medication or antimalarial drugs
• Smoking and secondhand smoke
• Stress
• Withdrawal of oral or systemic corticosteroids

Psoriasis Symptoms 

Not all patients will experience the same psoriasis symptoms. Typically, patients will see symptoms flare periodically, with flare ups lasting weeks or months followed by several weeks of symptom-free remission. The most common symptoms are red patches of itchy or inflamed skin which are often covered in thick gray scales. These patches often itch, bleed or crack. Patches may also be referred to as “plaques.” Psoriasis patients may also experience swelling or stiffness in the joints as well as thickened, pitted or ridged nails. 

Psoriasis may increase your risk of other complications including eye conditions, obesity, type 2 diabetes, cardiovascular disease, high blood pressure or other autoimmune conditions including celiac disease or sclerosis. 

Psoriasis Treatment Options 

In some cases, a biopsy may be required or recommended to make an accurate psoriasis diagnosis. This involves removing a small skin sample which can then be examined in a lab. 

After making a psoriasis diagnosis, your provider may recommend a variety of treatment options which can include topical therapies, light therapy (phototherapy) or oral and injected medications. Your treatment will generally begin with the mildest possible treatments before progressing to stronger treatments as needed. This typically means beginning with topical creams such as corticosteroids and light therapy to help relieve symptoms including swelling, redness, dryness or itchiness. Your provider will help you determine the treatment option which best slows cell turnover and reduces your symptoms while preventing unnecessary side effects. 

Topical therapy options include:

• Corticosteroid creams, gels, ointments, foams or shampoos. These can include hydrocortisone for more sensitive areas including the face. 
• Vitamin D analogues to slow skin cell growth. This treatment is often used alongside topical corticosteroids.
• Retinoid gels or creams
• Calcineurin inhibitors to reduce inflammation and plaque buildup
• Salicylic acid shampoos to reduce scaling on the scalp
• Coal tar, or other tar products, to reduce scaling, itching and inflammation

Oral or injected medication options include:

• Steroid injections
• Retinoid pills such as acitretin 
• Methotrexate (Trexall)
• Adalimumab (Humira)
• Infliximab (Remicade)
• Cyclosporine (Neoral)
• Biologics such as etanercept (Enbrel), infliximab (Remicade), ustekinumab (Stelara), secukinumab (Cosentyx) or ixekizumab (Taltz). 

In addition to these treatment options, your provider is likely to suggest at-home routine options that can help you best prevent future psoriasis flares. This can include habits such as bathing daily, moisturizing effectively and frequently, covering plaques and otherwise affected areas and exposing the skin to small amounts of sunlight. Your provider may also recommend avoiding alcohol and maintaining an overall healthy lifestyle, prioritizing a balanced diet and routine exercise. Finally, identifying your psoriasis triggers and avoiding them to the best of your ability will help prevent future flares. Your provider can help you begin to identify any possible triggers. 

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