While psoriasis is not just a skin-deep issue (despite all appearances to the contrary), a dermatologist can make all the difference in dealing with an affliction that impacts 7.5 million Americans and is characterized by skin that, depending on the severity, could be itchy, scaly, cracked or bleeding in spots, and joints that might be swollen or stiff.
There is no known cure for psoriasis, but it is treatable with various medications (whether oral, topical or injectible), as well as different types of light treatments. A dermatologist can determine what treatment might be most effective, as such a specialist can ascertain in the course of an examination the manner and severity of the affliction from which a patient might be suffering.
A dermatologist can also determine whether psoriasis has led to other health issues, not the least of which is arthritis, which afflicts 30 percent of those suffering from psoriasis. The affliction also results in an increased risk of cardiovascular disease, liver disease and even depression.
While scientists don’t know the exact cause of psoriasis, they have honed in on genetics and immune-system issues. Researchers have discovered that the disease runs in families, while at the same time finding that it’s possible to never develop psoriasis, despite having a genetic profile that would appear to make one predisposed to it. That’s why scientists also believe that triggers such as stress, infection, tobacco or heavy drinking might lead to the affliction’s manifestation.
For reasons that remain unclear, psoriasis results when white blood cells, a crucial part of your immune system, attack skin cells. That leads to the body producing more skin cells, and they collect on the outside of the body. The condition is not contagious, but as mentioned, neither is it curable. Those suffering from psoriasis have it for life; while it will likely go into remission at various times, it is also likely to flare up again. Again, those triggers are frequently the cause.
Dermatologists can, at least, deal with the symptoms, and reduce the risk of the most serious manifestations of the disease, as well as the aforementioned side effects. They can leave their patients with clearer skin and reduce pain and itching.
- Corticosteroids: Used in mild cases, or in combination with other medications in severe cases. Minimal chance of side effects (thinning skin, spider veins, stretch marks) if used properly.
- Coal Tar: Featured in many products, particularly those geared toward plaque psoriasis, the most common form of the disease. Some concerns have been raised about it increasing the risk of cancer, but scientists dismiss that, finding that it is most likely among those who work with industrial coal tar.
- Synthetic Vitamin D: Particularly effective against nail psoriasis (i.e., the form of the disease that alters the appearance of toenails and fingernails) and scalp psoriasis, this drug has been in use for nearly 30 years.
- Tazarotene: A synthetic form of Vitamin A, this is considered a safe treatment for anyone suffering from psoriasis except pregnant women, as it can cause birth defects.
- Apremilast: While effective in controlling inflammation in the immune cells, this medication has also been shown in some cases to lead to depression and suicidal thoughts. The most common side effects (diarrhea, headache, nausea, etc.) were far more mild, however.
- Biologics: Used in moderate to severe cases, biologics — 12 of which have been given FDA approval — target the immune system and have proven to be effective in curtailing not only psoriasis but psoriatic arthritis.
- Cyclosporine: This medication, first used to prevent the body from rejecting a transplanted organ, has been found to be effective in particularly severe cases of psoriasis.
- Methotrexate: Also used in severe cases, this medication, which has likewise proven effective against juvenile rheumatoid arthritis, has many potential side effects (vomiting, nausea, mouth sores, etc.). Patients using it, as a result, are closely monitored.
- Off-Label Medications: Under this practice — which is legal, and actually quite common — doctors may prescribe a drug that has not been approved to treat psoriasis, but rather some other condition. These medications include Topical Calcineurin Inhibitors (TCIs), which are most often used for eczema.
- Oral Retinoids: Derived from Vitamin A, these medications are unlike others in that they do not suppress the immune system, and as a result can be used by patients who test HIV-positive. There is, however, a danger of developing high cholesterol from using oral retinoids.
Certain over-the-counter medications are also available, but certainly dermatologists represent a great resource for those facing this condition.