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For about 6.7 million adults in the U.S., psoriasis is an ongoing, painful condition with no known cure. Despite the fact that psoriasis cannot be passed from person to person, we are seeing it diagnosed more often around the world.
Studies have found that more people are reporting a diagnosis of psoriasis, up from 4.8% in 1980 to 11.4% in 2008. Researchers aren’t sure if this is because more people have psoriasis because of changes in their lifestyle and environment, or if more people are aware of the condition and seek treatment for lesions that might have been ignored 30 years ago.
Psoriasis most commonly presents as skin lesions that appear red to purple with white or silver scales. These can cause itching, stinging, and pain. It is sometimes associated with inflammation of the joints, called psoriatic arthritis. Having psoriasis increases your chances of developing a number of other serious conditions.
But there is good news! New biologic and topical treatments are highly effective and today’s patients have a better chance of finding relief from debilitating symptoms. Whether or not you’re one of the millions of people in the U.S. with psoriasis, it’s important to understand the condition and available treatments.
Symptoms of psoriasis and psoriatic arthritis.
Psoriasis cannot be passed from person to person. Doctors don’t yet know what causes the condition, but there’s some evidence that it may be passed down in families. Psoriasis results in an overgrowth of skin, which can be triggered by mild events such as trauma, sunburn, infection, some medications, and stress.
Early symptoms of psoriasis usually include:
- Itching, soreness, and burning skin
- Rash, usually shades of purple with gray scales on dark skin, or pink/red with silver scales on lighter skin. Rashes usually go away after a few weeks or months.
- Small spots of scaling, most often in children
- Skin that is dry and cracked, sometimes bleeding
Approximately 30% of people with psoriasis develop chronic, inflammatory psoriasis called psoriatic arthritis. When the joints become inflamed, it can cause symptoms such as:
- Changes in the fingernails and toenails.
- Inflammation in the knees, shoulders, fingers, toes, pelvis, and back
- Reduced range of motion
- Stiffness in the morning
- Swelling in the fingers and toes
Psoriatic arthritis can be a debilitating and irreversible condition. Symptoms often begin between age 30 and 50. If left untreated, psoriatic arthritis can lead to long-term joint damage.
Psoriasis increases the chance of other conditions.
Psoriasis is a system-wide inflammatory condition that goes beyond the skin and joints. Patients with psoriasis are at an increased risk of developing other serious conditions, including:
- Cardiovascular disease
- Celiac disease
- Chronic obstructive pulmonary disease (COPD)
- Chron’s disease
- Erectile dysfunction
- Fatty liver disease
- Parkinson’s disease
- Sleep apnea
- Uveitis (inflammation inside the eye)
- And others
If you have psoriasis, see your primary care provider regularly in addition to your dermatologist. They may conduct routine health screenings so you can act early if any of these conditions develop.
One of the greatest impacts of psoriasis is on patients’ quality of life. Skin lesions and swollen joints can be painful and restricting, making everyday life difficult. Some patients with psoriasis live private lives, fearing they will be judged or perceived as contagious by colleagues and strangers.
For all the difficulties psoriasis can cause, there are now many effective treatments that can deliver excellent results for many people.
New treatments showing excellent results.
For a dermatologist like me, this is an exciting time—we have more tools than ever to help patients with psoriasis.
Some of the most exciting of these are biologics, which are antibodies derived from living organisms. These medications target specific parts of the immune system. Biologics have been shown to be a safe and effective way to treat moderate to severe psoriasis.
The newest type, inhibitors of an immune system messenger called IL-23, are marketed under the names Tremfya, Ilumya, and Skyrizi. Studies have shown that after 16 weeks of these types of biologic treatment, 70% of patients showed at least 90% improvement in their psoriasis.
Biologics are taken by injection, so MedStar Health patients get training from a nurse in how to administer the injection themselves. Doses can be taken weekly to every three months, depending upon the individual treatment plan.
New topical treatments that can be applied to the skin are also showing excellent results. These treatments are excellent options for patients who seek improvement from symptoms without injections or pills.
Roflumilast cream, for instance, can be applied directly to the skin. Studies have shown nearly 50% of patients reported their psoriasis symptoms were clear or almost clear after eight weeks. Another topical cream that is showing benefits for my patients is Vtama. Studies have shown 40% of patients who used this cream for 12 weeks reported at least 75% clearer skin.
Topical treatments are particularly effective at relieving symptoms like itching and can be applied to skin that is otherwise difficult to reach. It’s important to note that topical medications are intended to treat skin lesions and are not felt to decrease inflammation throughout the body like systemic treatments.
The latest advance in oral (pill) therapy for psoriasis is called Sotyktu. Studies have shown this treatment’s single daily dose reduced the severity of patients’ psoriasis symptoms and improved their quality of life better than a placebo some earlier medications.
I have seen many cases in which patients’ skin-level psoriasis has been nearly or entirely cleared by use of these new medications, which is a significant advance in our ability to provide treatment.
Today there are many effective treatments for psoriasis. Talk with your doctor at the first sign of symptoms. The earlier we can provide treatment, the better your chances of avoiding serious long-term problems.