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Psoriasis: A Skin Condition That’s More Than Skin-Deep

Do any of these (somewhat unusual) names sound familiar to you? Humira, Stelara, Cosentyx, Embrel and Otezla?

It’s probably because you’ve seen ads for them. With so many commercials (and celebrities) talking about “clear skin” you might think everyone needs it!

The skin condition those medications, and many others, are designed to treat is psoriasis. It affects 3% of the population, so while we don’t all need it, millions of American suffer from it. It’s considered an “immune-mediated disease,” which means a disease with an unclear cause related to the dysfunction of the immune system, according to the National Psoriasis Foundation®. 

Normally, skin cells grow and then fall off in about a month. Snakes shed their skin all at one time—with humans it’s constant and invisible. When you have psoriasis, the immune system doesn’t work properly, causing T-cells to attack the body and prevent skin cells from shedding. Instead of coming off, they pile up in raised “plaques” or scales on the skin.

“Skin is a major target, as are the joints,” said Robert Greenberg, M.D of Golden State Dermatology in Livermore in San Ramon. “When it affects the joints, it’s called psoriatic arthritis. If you only see the commercials, you might think it’s about only about clearing up your skin, but in fact psoriasis is linked to associated conditions including an increased risk of diabetes, stroke, and heart attack. That’s because of its connection to the immune system.”

Dr. Greenberg has become a leader in this field and has taken part in many studies involving psoriasis, as well as other conditions like eczema (often confused with psoriasis), acne, and rosacea. He also lectures on those topics, using an interactive technique that helps his audience understand and engage.

“We want to educate our patients about this, because it’s not just an unpleasant rash,” said Dr. Greenberg. “Anything tied to the immune system needs to be more thoroughly understood and treated appropriately.”

Don’t Be Fooled by Appearances: The Many Types of Psoriasis

If you think red, itchy, or flaky skin is psoriasis, it might be. But in fact, many skin conditions look similar. That’s why getting an exam from a dermatologist is the quickest way to the best treatment (versus buying an over-the-counter treatment that may or may not treat the outward symptoms).

No matter how unpleasant any of these may sound, know that none of these are contagious. Here’s a list from the American Academy of Dermatology:

Plaque psoriasis

This is what most of us picture: raised, thicker skin in patches, which looks as if it’s covered with a scale (like a fish scale). They can show up anywhere, but you’ll see these typically on the scalp, elbows, knees, or back.

Scalp psoriasis

When it’s on the scalp, the psoriasis can be thin or thick. It can spread to nearby areas like the ears or neck.

Nail psoriasis

You may not see patches on your skin, but instead it can show up as yellow-brown spots on the nails. Or the nails may look as if they have tiny potholes, they may be weak or even separate from the skin.

Guttate psoriasis

Children can get this type after an infection, like strep throat. It shows up as multiple small, scaly spots, versus large, thick patches.

Inverse psoriasis

Possibly the one that people mistake for something else the most often, it shows up where skin touches skin, like under the arms or in the groin. You will see shiny, smooth patches, which can be red and painful.

Pustular psoriasis

As you can guess from the name, this type involves painful pus-filled blisters as well as thicker, scaly skin. It shows up on hands and feet.

Generalized pustular psoriasis.

This one is rare, thankfully, because it’s also serious and needs immediate medical intervention. It shows up as dry, red, and tender skin, followed quickly by pus-filled blisters appear.

Erythrodermic psoriasis

If you notice sizeable areas of skin that look burned – even though you know you haven’t burned yourself – get help right away. This kind of psoriasis can be life-threatening, but again, is relatively rare.

What Causes Psoriasis?

While the specific cause is unknown, medical professionals agree it’s genetic. If someone in your family has it, your chances of getting it too are higher. As with many health conditions, you can have a genetic predisposition but never “trigger” the disease itself.

What are some known triggers to avoid if you have psoriasis in your family?

  • Stress
  • Injuring the skin (cuts, sunburn)
  • Infection
  • Certain medications, including lithium, prednisone, and hydroxychloroquine.
  • Smoking or chewing tobacco.
  • Heavy alcohol use
Psoriasis Treatment Options

The good news is that progress has been made in treating psoriasis! In fact, as recently as 2020, the National Psoriasis Foundation (NPF) partnered with the American Academy of Dermatology (AAD) and others to develop new psoriasis treatment guidelines.

“The treatment goal is to get patients clear or almost clear, in terms of how the skin looks and feels,” said Dr. Greenberg. “It’s also important to treat psoriatic arthritis as part of the approach. Fortunately, these new targeted therapies are extremely effective and have excellent safety records.”

Treatments (all offered by Golden State Dermatology) include:

  • Topical medications
  • Injections of biological medications
  • Oral therapy with immunomodulators and anti-inflammatory medications
  • Phototherapy
  • Laser treatment

“We now have a much broader, more effective range of treatments,” says Dr. Greenberg. “And I think we’ll get to the cause of it, too, as we learn more about the genome and the immune system. Until then, I always tell patients if they see something on their skin that wasn’t there before, it’s worth checking it out.”


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