One of the most common dermatological conditions seen here at Kayal Dermatology is psoriasis. Psoriasis is a chronic, inflammatory condition characterized by well defined, red scaly plaques; however, it can vary in presentation in each individual. Most of the time it occurs on the elbows, knees, and trunk, but it can also be seen on the scalp, around the eyes, on the palms and soles, and in the groin and buttocks. It is caused by an increased rate of skin reproduction that is autoimmune related. This results in an inflammatory reaction to the skin which causes the thicken plaques that itch.
There is a genetic predisposition, so if a family member has psoriasis, an individual may be more prone to develop it. In addition, there is an increased risk of developing other autoimmune conditions such as arthritis, ulcerative colitis or Crohn’s disease so your healthcare provider will ask about other areas of the body that may not see related. Typically, individuals will begin seeing their psoriasis in their 30’s to 40’s but it still can present at any age.
The management and treatment of psoriasis requires a multidimensional approach involving topicals and possibly newer biologic medications. How your healthcare provider will determine the best treatment plan will be based upon how severe the psoriasis is, how much body surface area it covers, and what areas of the body it effects. Most patients will start their therapy by applying topical steroids and vitamin D derivative called calcipotriene with a good moisturizer added in. If the psoriasis effects the scalp or palms and soles, intralesional steroid injections can be a great option as well.
If your healthcare provider determines you are a good candidate, a biologic medication will be prescribed. Almost all of these medications are delivered via injections except for one that is in a pill form. Humira is the oldest biologic medication and has over 20 years of safety data. It is an injection in which you inject every other week. Stelara is another option that has a favorable dosing period of one injection every 3 months. Three newer biologics are Taltz, Cosentyx and Tremfya. These have shown very high efficacy rates and have the ability to allow many patients to achieve 100% clearance. Taltz and Cosentyx are dosed one injection every month and Tremfya is an injection every other month. For females who are of child bearing potential and are pregnant or plan to become pregnant, Cimzia is an excellent option. It can be used safely because it does not cross the placenta barrier. It is dosed once a month.
Psoriasis can now be very manageable and patients now have the opportunity to have complete clearance although it is a chronic, incurable condition. We can now treat it so the patient may not have any more symptoms. If you believe you have psoriasis or would like to discuss further treatment options, please schedule an appointment today.