Psoriasis is an autoimmune disorder, in which white blood cells, called T-lymphocyctes, cause inflammation on the skin and other areas. In particular, skin cells multiply too rapidly, causing a scaly plaque to grow on the skin.
Some therapies are directly applied to the skin, while more systemic therapies are injected or taken orally. Topical corticosteroids are anti-inflammatory drugs that help control the immune system. Over time, however, these treatments can lose effectiveness. Another option is Vitamin D analogues, which help slow skin cell growth.
Phototherapy, or light therapy, can also be helpful. The UV rays in the sun actually destroy T-lymphocytes. However, too much sun can also worsen the condition. There are more controlled versions of phototherapy, such as narrowband UVB therapy.
There is a whole new class of systemic therapies, called biologics, that target a protein called tumor necrosis factor (TNF), which is largely responsible for the inflammation and rapid cell growth associated with psoriasis. Products like Enbrel and Humira are injected every week or every two weeks.
These drugs can be very effective. I have patients who were covered from head to toe who are now completely cleared. However, it’s important to note that these drugs do come with side effects, some of them severe. Pharmaceutical companies are currently working on a new generation of biologics that will, hopefully, have fewer side effects and require less frequent injections.
We are also learning that people who suffer from psoriasis are at higher risk for other conditions, such as cancer, cardiovascular disease, arthritis, diabetes and depression. These risks must be factored in as we treat the whole patient.
This Scripps Health and Wellness tip was provided by Erik Gilbertson, MD, a dermatologist at Scripps Clinic in San Diego.