Articles - Psoriasis

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What Skin Condition do
Kim Kardashian & Phil Mickelson have?

"…skin condition that affects about 2% of the US population."

Ashley Hamstra, MD
Advanced Dermatology & Skin Surgery
Board Certified Dermatologist
Board Certified Dermatopathologist

Ashley Hamstra, MD

Psoriasis is a common skin condition that affects about 2% of the US population. It can present for the first time at essentially any stage in life, from a little newborn to someone in his seventies!

What does psoriasis look like?

Psoriasis is a chronic and recurrent disease. Someone may not always have an active rash, but he will always have psoriasis and the rash will eventually come back. Unfortunately there is no cure for psoriasis, but there are effective treatments for controlling the psoriasis.

The rash is typically made up of red, scaly, well circumscribed, raised bumps (doctors often call these “lesions” or “plaques”). The scale often has a dry, silvery appearance. These plaques can range in size from pinpoint to covering entire surfaces, such as the scalp. Psoriasis is usually symmetric and commonly involves the scalp, elbows, knees and lower back. However, psoriasis can show up just about anywhere, including the tongue! It can sometimes be frustratingly itchy or painful.

What causes psoriasis?

There is a large genetic component to psoriasis, but it is polygenic, meaning multiple different genes are involved. The immune system also plays a big part, which is why different environmental triggers can impact when psoriasis flares up. Known triggers include medications, infections and trauma. Streptococcal infections (e.g. strep throat) are common triggers. Also stress, in and of itself, can worsen psoriasis.

Is psoriasis just a rash?

No, psoriasis is more than just a rash. In 20-30% of patients, psoriasis involves the joints, which can cause permanent, debilitating damage. This is called psoriatic arthritis.

People with psoriasis are more likely to develop lymphoma, a kind of blood cancer. They are also more likely to have obesity, hypertension and diabetes mellitus (metabolic syndrome) as well as cardiovascular disease due to increased inflammation throughout the body.

How is psoriasis treated?

There are several ways that psoriasis can be treated. The treatment plan is very patient specific. It depends on how much of the skin is involved, where the plaques are, how thick the plaques are, if the joints are involved and also patient preference. It is important to find a plan that is sustainable for the long-term. There is no quick fix for psoriasis.

If the psoriasis is limited, it can often be controlled with medicated creams and ointments. These medications are most commonly topical steroids and vitamin D3 analogues. If the psoriasis is extensive or is not responding to topical medications, light treatments, pills (Methotrexate or Otezla) or injections (Enbrel, Humira, Stelara, Taltz and Cosentyx) may be necessary. Medication in the form of pills and injections are called systemic medications. These medications are stronger than creams or ointments, but require lab work and regular office visits.

What does the future hold for psoriasis patients?

There is growing evidence that the systemic medications may not only help with psoriatic arthritis, but also with the metabolic conditions (hypertension, diabetes mellitus) and cardiovascular events as well.

Thankfully new medications are continually entering the market. The newest systemic medications (Taltz and Cosentyx) have the highest success rates yet and fewer known side effects.

by Ashley Hamstra, MD