Psoriasis Action Month in August highlights the experience of those living with psoriasis and aims to remove the stigma around the painful skin condition.
More than 8 million people in the U.S. have psoriasis, a disease caused by an overactive immune system that results in a rapid increase in skin cell production. Psoriasis leads to inflamed, scaly patches on the skin, among other symptoms, according to the National Psoriasis Foundation.
“We initially thought psoriasis was confined to the skin, but now we know it is an immune inflammatory disease that is systemic,” said Dr. Bruce Robinson, board-certified dermatologist.
Dr. Robinson, of Bruce Robinson MD in New York City, has specialized in adult and pediatric dermatology for more than 33 years, with a specific interest in psoriasis treatment. The American Academy of Dermatology, the largest U.S. dermatology organization, for which Dr. Robinson is a national spokesperson, has been at the forefront of research into many skin conditions and the improvement of the condition for those living with psoriasis.
“I see quite a number of psoriatic patients varying from all ages,” said Dr. Robinson. “The most common ages I see range between 18 to 39 with another burst of cases in patients older than 50.”
There are several different presentations of psoriatic disease, including plaque psoriasis, inverse psoriasis (affects skin folds and creases), guttate psoriasis (small tear-drop or round shaped skin spots), pustular psoriasis (pus-filled bumps on the skin), and erythrodermic psoriasis (most severe form, widespread skin redness and peeling).
Those diagnosed with the disease often have symptoms such as patches of thick, raised skin (plaques), itching, skin irritation, burning, and peeling, pustules or blisters, dry skin that cracks or bleeds, and flaking of dead skin, according to the National Psoriasis Foundation.
“The most representative form of psoriasis is plaque psoriasis, which presents with silvery, scaly raised red plaques on the elbows, knees, and scalp. 30% of patients who have psoriasis can have psoriatic arthritis, which causes inflammation of the joints,” said Dr. Robinson. “Inflammation associated with psoriasis can also led to hypertension, diabetes, obesity, increased cholesterol, and depression and anxiety in patients.”
Understanding disease triggers
Psoriasis is an autoimmune disorder that can be triggered by various factors including stress, skin injuries (such as cuts or sunburns), infections such as strep throat and HPV, medications such as lithium, beta blockers, anti-malaria drugs, hormonal challenges and more, said Dr. Robinson.
“Most dermatologists can diagnose psoriasis from a patient’s physical presentation, through the examination of the skin, but occasionally a biopsy is necessary and is submitted to a derma-pathologist, who helps determine the final diagnosis,” said Dr. Robinson.
The root cause of psoriasis is not yet fully understood by the medical community, according to the National Psoriasis Foundation. It is believed to be caused by a combination of genetics, the immune system, and the environment.
“Psoriasis is genetic, and one parent having psoriasis gives their child about a 10% of developing psoriasis, and if both parents have it, this risk develops to about 50%,” said Dr. Robinson.
Treatment options for psoriasis, aimed at reducing inflammation and slowing the disease’s rapid growth of cells, have evolved over time. Treatment formerly included only topical corticosteroids, Vitamin D and keratolytic medications (help skin exfoliate thick plaques).
“We now have wonderful medications including topical hydrocarbon receptor antagonists, that stop the cascade of inflammation, new systemic medications like biologics and JAK inhibitors, and some older effective medications like methotrexate, and cyclosporine,” said Dr. Robinson. “These new biologics have really been a game changer in terms of treating psoriasis.”
Beyond treatment options, lifestyle changes are crucial for patients to reduce the potential for psoriasis flare-ups and allow an individual to feel like they have control over their condition.
“Reducing alcohol and smoking, eating less processed foods, increasing the consumption of Omega-3 vegetables and keeping your weight down are important lifestyle modifications for those with psoriasis,” said Dr. Robinson. “It has also been seen that GLP-1 inhibitors can help patients with psoriasis manage weight and decrease metabolism.”
“Dermatologists have also suggested that sun exposure can aid in psoriasis treatment, provided a patient uses sunscreen and proper sun protection,” said Dr. Robinson. “UV light from sunlight exposure ties up a psoriasis patient’s DNA so that it doesn’t allow the cells to reproduce at a rate to cause raised plaques.”
Moving in the right direction
August is Psoriasis Action Month, in which The National Psoriasis Foundation calls on the healthcare community to educate both patients and healthcare providers on the disease while promoting steps to cure psoriatic disease.
Beyond managing psoriatic disease’s physical symptoms, many patients also face the strain of social stigma associated with the misperception of the skin condition.
“Physicians can educate patients and the public to reduce stigma and support those with visible symptoms by promoting awareness of the disease, having open communication with patients and letting them know they are not alone and that there are things that they can do lifestyle and treatment wise that can address psoriasis in a meaningful way,” said Dr. Robinson.
Dermatologists disseminate a great amount of information through their websites, podcasts, email blasts and more, said Dr. Robinson.
“The American Academy of Dermatology has a lot of influence to dispel myths about psoriasis and other diseases, but also to promote patients’ knowledge of the different treatments that are now available, which have exponentially multiplied with time,” said Dr. Robinson. “Through these resources, patients can learn how they can effectively manage their psoriasis, so they no longer have to wake up in the morning worrying if they’re going to have a flare-up.”