As the largest organ in your body, your skin has a number of very important functions, including acting as a barrier to protect from infection, helping regulate temperature, and shielding you from the cellular damage caused by the Sun’s ultraviolet rays. Despite this, it is not uncommon to see instances when these functions break down and cause problems – such as skin infections, excessive sweating, overheating, skin cancer, et al.
However, less understood, and certainly less commonly explained, there is a multitude of other problems that can affect the skin. As the body’s ‘largest organ’, your skin is susceptible to every other issue and abnormality that your other organs are susceptible to, however, there are a number of conditions that express themselves uniquely when they affect the skin. Of these, those involving the immune system’s interaction with the skin tend to be the most significant and problematic for patients (autoimmune skin disease). The most notable and common of these immune conditions are eczema, lupus, and psoriasis.
Psoriasis is essentially the manifestation of one’s own immune system attacking the skin and causing it to become inflamed and thicker, for unknown reasons. Psoriasis affects an estimated 7.4 million Americans. Despite extensive and ongoing research, we still have no idea exactly what the initial trigger is. That said, however, we are daily learning so much more about the cellular and molecular pathways that drive psoriasis, which has led to our current ‘golden age’ of new treatments for psoriasis.
Although they are not mutually exclusive and much overlap exists, there are overall 5 main types of psoriasis:
- Plaque psoriasis is the most common form. It causes red, inflamed, scaly patches on various areas of the skin, most commonly, the elbows, knees, and scalp.
- Guttate psoriasis is more common in childhood and young adults and causes widespread small pink scaly spots. Often, this type can be precipitated by an infection elsewhere.
- Inverse psoriasis causes bright areas of red, inflamed, often weeping patches in the body’s skin folds, such as under armpits, under breasts, the groin creases, and genitals.
- Pustular psoriasis is a severe form of the condition that develops white pustules within angry red skin patches. It can be limited to localized areas like palms and soles, or even be widespread. Sometimes it can even affect the body as a whole and cause flu-like symptoms.
- Erythrodermic psoriasis is rare, but overall is the most severe form of the condition, generally involving most of the skin’s surface. The symptoms can be so severe that hospitalization may be necessary and is potentially life-threatening if not treated.
What Causes Psoriasis?
As noted, psoriasis is the result of the body’s immune system acting abnormally to attack the skin. This attack essentially results in skin cells being produced much faster than normal and are unable to undergo the natural skin shedding process, which results in skin continually building up thicker and thicker. Additionally, these same immune system cells produce inflammatory chemicals that cause redness and tenderness. However, while we now understand much about these processes, we still don’t know what exactly triggers psoriasis, and this remains THE big question researchers are still searching to solve. That said, however, there are certain factors we believe play key roles in the development of psoriasis. Some of these include:
- Some Infections (such as strep throat or skin infection)
- Certain medications (including lithium, iodides, beta-blockers, antifungals, among others)
- Physiologic stressors (such as other chronic medical conditions, obesity, smoking, heavy alcohol consumption, emotional stress and depression, vitamin deficiency, among many others)
While there is no cure for psoriasis, there are many treatments of various types that can help to manage it. In general, the goal of most all psoriasis treatments is to calm down the immune system and inflammation that is the driving force resulting in the abnormal skin. A detailed discussion of treatments is beyond the scope of this article, however the main categories of treatments are listed below:
- Topical Medications: these are medications that are applied on top of the skin, as the name implies. These are considered first-line treatments in all types of psoriasis and are also used as adjunct therapy, even when other treatment methods are used. Examples include topical steroids, vitamin D analogues, some retinoids, among others.
- Systemic Medications: as opposed to topical medications, these are medications that go inside the body, and include any of a number of oral or injected medications. In general, these are not considered first-line therapy due to a higher potential of side effects or adverse events. Older medications include methotrexate, cyclosporine, or acitretin. Newer medications include Otezla and the “biologics” (e.g. Humira, Stelara, Cosentyx, among others), many of which may be familiar from extensive advertising on TV. These newer treatments tend to target very specific areas in the cascade of events causing psoriasis and are complex to produce, therefore, unfortunately, they are generally very expensive.
- Light Therapy: this involves exposure of the affected areas of skin to ultraviolet light, very similar to a tanning booth. In the same way, natural sunlight is sometimes recommended. The light spectrums used are UVA and UVB due to their inherent ability to calm down overactive immune response in the skin. This treatment type is generally performed in-office, although it has become less and less common over the years due to the numerous regular visits necessary to achieve improvement, potential for causing skin cancer (!!), and the many more effective newer medications that have been developed in recent years. Presently, this treatment is mostly available only in academic centers.
Recently a definite link has been established between other health problems (e.g. obesity, diabetes, high blood pressure, high cholesterol, and heart disease) and onset or worsening of psoriasis. Additionally, stress of all types makes psoriasis flare or more difficult to control. Controlling these conditions and improving overall health can not only improve psoriasis, it could even cause it to go into remission.
Psoriasis Care in Lake Worth, Texas
If you have psoriasis and want an experienced dermatologist to help you take control of the condition, make an appointment with Dr. Matthew A. Mittelbronn at Lakeview Dermatology. He will not only diagnose and treat your psoriasis, but will also guide you on how you can live most comfortably with your condition. To schedule an appointment with Dr. Mittelbronn, please call our office at (817) 752-5256 or use our convenient online request form.