- 9 Things Doctors Want You to Know About Psoriasis
- When should I see a dermatologist?
- How do I discuss my symptoms?
- How do I decide on a treatment with my dermatologist?
- Psoriasis Specialist
- What is Psoriasis?
- What are the Symptoms?
- What is Treatment Like?
They’re medicines made from substances found in living things. Doctors inject these lab-made proteins or antibodies into your skin or bloodstream. Once inside the body, the drug blocks part of your altered immune system that adds to psoriasis.
In general, biologics work on psoriasis because they:
- Curb T cells (a form of white blood cell)
- Block a substance called tumor necrosis factor-alpha (TNF-alpha), one of the main messenger chemicals in the immune system
- Stop a family of your immune system’s chemical messengers called interleukins
- Bind to proteins that cause inflammation
The patches and plaques of psoriasis come after an interaction between your skin cells and white blood cells. Biologics interfere with TNF-alpha or T cells, or they target interleukins. This short-circuits that unhealthy link. This will ease your inflammation. You’ll have less growth of thick, scaly skin, too.
Biologic medicines approved by the FDA to treat moderate to severe psoriasis include:
- Adalimumab (Humira), a TNF-alpha-blocking antibody
- Adalimumab-adbm (Cyltezo), a biosimilar to Humira
- Brodalumab (Siliq), a human antibody against interleukins
- Certolizumab pegol (Cimzia), a TNF-alpha blocker
- Etanercept (Enbrel), a TNF-alpha blocker
- Etanercept-szzs (Erelzi), a biosimilar like Enbrel
- Guselkumab (Tremfya), an antibody against interleukins
- Infliximab (Remicade), a TNF-alpha blocker
- Ixekizumab (Taltz), an antibody that binds to inflammation-causing proteins/interleukins
- Risankizumab-rzaa (SKYRIZI), an antibody against interleukins
- Secukinumab (Cosentyx), a human antibody against interleukins
- Ustekinumab (Stelara), a human antibody against interleukins
Biologics are good at treating psoriasis. In clinical trials, each of the drugs lowered psoriasis activity by at least 75% in many people.
There are some drawbacks, though. Biologics can be expensive. Though they’re safe for most people, they could raise your chances of infection, cancer, and other complications. Your doctor will need to keep close tabs on you to make sure you stay healthy.
9 Things Doctors Want You to Know About Psoriasis
Most dermatologists see patients come in with psoriasis, an itchy and sometimes painful skin condition, on a regular basis. Doctors have a wide range of effective treatments to choose from, no matter whether you have just a few patches or if it’s widespread. Here’s what three board-certified dermatologists told us about psoriasis.
Psoriasis From the Physician’s POV https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F0e%2F81%2Fc63903cb47b0af600eb9106e297b%2Fresizes%2F1500%2Fimage-gettyimages-72991422.jpg
Dr. Steve Feldman, a professor of dermatology at Wake Forest Baptist Medical Center in North Carolina says, “There’s both the typical patient and incredible variability. The average person who has psoriasis may have spots on their elbows and knees and maybe some dandruff.” But he also sees patients with much more severe cases. Michelle Pelle, a dermatologist with MedDerm Associates in San Diego, agrees. “You could have a person walk in with a patch or they walk in and 80% of their body is affected. The range is unbelievable.”
“It’s easy to recognize, but the severity varies widely.” https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/crop/4735×3168%2B0%2B0/resize/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2Fd3%2F10%2F15a5d7f0489b92509e0647b98b83%2Fimage-gettyimages-496159067.jpg
Dr. Pelle says some people’s lives “are absolutely run by their psoriasis. It’s a constant struggle to feel like you have to hide it. People are embarrassed. It’s a very uncomfortable condition, and it’s understated how itchy it is.” Ronald Davis, a dermatologist in San Antonio, Texas, adds, “If it’s on the soles, it can be a real problem for people who are on their feet all day. If it’s on the palms it can cause problems with work that requires manual labor—or even typing, if it’s affecting the fingertips.”
“We know psoriasis can be hard to live with.” https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/crop/1494×999%2B0%2B0/resize/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F60%2F1d%2F545bbb6f43a89da07ff2ef60ca4d%2Fresizes%2F1500%2Fgettyimages-913448206.jpg
If you have a mild case, you may be inclined to ignore your psoriasis. But psoriasis is linked to metabolic syndrome, a mix of health risks including obesity, high blood pressure, high cholesterol, and diabetes. It’s important to see a doctor if you think you have psoriasis. “People who have lived with it for years put up with it,” says Dr. Pelle. “Sometimes we have to talk them out of putting up with it if we think it’s better for their overall health.”
“Psoriasis can affect more than your skin.” https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F58%2Fa7%2Fbec4d20749b489008561eccb6773%2Fimage-getty-470621689.jpg
The medical arsenal against psoriasis is well stocked, including creams and liquids you put on your skin, light therapy, and biologic drugs that target the immune system. “I’ve seen the worst of the worst,” Dr. Feldman says, “but nowadays I can make almost anybody’s psoriasis better. I can get people clear or almost clear. Biologics have made a dramatic improvement in our ability to care for patients.” Dr. Pelle feels no one should have to hide because of psoriasis. “That’s not necessary anymore, because the drugs are so good now and they’re becoming safer by the year.”
“We can usually help you.” https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/crop/1490×997%2B9%2B0/resize/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2Fdc%2F6a%2F78f9c4054bd3912416a7032cc69f%2Fresizes%2F1500%2Fimage-getty-109726186.jpg
Many people think of the skin when they think of psoriasis, but psoriatic arthritis affects the joints, causing pain and damage. Dr. Feldman says, “If the patient is having joint symptoms, you address them the normal way a dermatologist should address joint disorders—by sending them to a rheumatologist. Psoriasis of the skin does not leave a permanent scar when you clear it up, but psoriatic arthritis can scar the joint, so it’s critical that you catch joint involvement early.”
“If you have psoriasis, we will ask you about your joints.” https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/crop/5421×3626%2B0%2B0/resize/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F51%2F7f%2Fd9c323b24edbac521b3d41fceec7%2Fimage-getty-609180229.jpg
Topical treatments can be messy, but your psoriasis won’t get better if you don’t use them. “One of the most resistant forms of psoriasis is scalp psoriasis,” says Dr. Feldman. “There are three reasons why it doesn’t get better with topical therapy: The most likely reason is poor compliance, the second most likely reason is poor compliance, and the third reason is poor compliance.” He says to be honest and “let the doctor know that you’re not using the treatment. That way they can take that into account when they design the next step.”
“Psoriasis patients need to do their part.” https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2F91%2F2a%2F1b76b19f44e99c2b8af0e3c667a8%2Fresizes%2F1500%2Fimage-getty-100918746.jpg
One of the questions Dr. Davis often gets is, “Is this contagious? Can I give this to my wife?” He adds, “And there can also be concern from other employees in the workplace. I stress to the patients that it is absolutely not contagious.” Dr. Pelle says, “People who don’t have it don’t realize it has nothing to do with hygiene or infection. Just like all autoimmune diseases, you inherit a gene for it and it needs to be treated just like any other inherited disorder.”
“We hear big misconceptions about psoriasis.” https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2Faf%2F73%2F0d87cd944ac28d85faad9ab55389%2Fimage-gettyimages-87418613-group-of-women-eating-out.jpg
You don’t have to feel overwhelmed by your psoriasis. “The most important thing I say today,” notes Dr. Feldman, “is to join the National Psoriasis Foundation. By doing that, you can be educated about how to deal with all the social situations which you may be faced with, you can be educated about your risks, you can be educated about the many treatment options you have.”
“Support is available for people with psoriasis.” https://d33ljpvc0tflz5.cloudfront.net/dims3/MMH/thumbnail/580×388/quality/75/?url=https%3A%2F%2Fd26ua9paks4zq.cloudfront.net%2Fdf%2F6b%2F2da161e843f792c1e0f0afaa5cca%2Fresizes%2F1500%2Fimage-getty-147271196.jpg
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A dermatologist is a doctor who specializes in the diagnosis and treatment of the skin, scalp, mucous membranes, hair and nails.
When should I see a dermatologist?
Working closely with a dermatologist is an important part of diagnosing and managing your psoriasis. If possible, the National Psoriasis Foundation (NPF) recommends that all people living with psoriasis see a dermatologist. It’s especially important to find a dermatologist who has experience treating psoriasis if:
- Your disease is flaring or you are experiencing worsening of your symptoms.
- The treatment(s) recommended by your primary care provider (also called a “PCP” or general practitioner) are not working.
- You are interested in trying treatments that your PCP is not familiar with, such as biologics, oral treatments or phototherapy.
Some people may have limited access to a dermatologist because of where they live or their insurance plan. In these situations, you should see a primary care provider to manage your psoriasis. You can also explore an option called telemedicine, the use of electronic communication, such as a smartphone or computer, to provide health care services between patients and health care providers who are at a distance.
How do I discuss my symptoms?
Psoriasis affects everyone differently. Common symptoms include the development of painful lesions, itch, fatigue and changes in the nails.
Your dermatologist will begin by asking you questions about your symptoms. To prepare, it’s helpful to track your symptoms so you can best discuss them with your dermatologist. Remember, be as clear and specific as possible!
- Be sure to explain how intense each symptom is. You may want to use a scale from 0 to 10, in which 0 is no symptom and 10 is extreme intensity.
- Discuss where you experience each symptom.
- Explain how long each symptom has been present.
- Make sure that your dermatologist understands how your symptoms change over time.
Next, your dermatologist will conduct a physical exam to look at specific sites where psoriasis can occur. This is the best way for your dermatologist to understand your unique symptoms and recommend the right treatment for you.
How do I decide on a treatment with my dermatologist?
Your dermatologist will recommend treatments based on:
- The severity of your disease
- Your health history and overall health
- Your experience with previous treatments
In 2016, the NPF Medical Board published defined psoriasis treatment targets to help you know what to expect from your treatments and assess if your current treatment is successful. You and your dermatologist can use these targets to see if your treatment is meeting your goals or determine if an adjustment is appropriate.
Remember, finding the treatment that provides the most relief may take time! Continue to work closely with your dermatologist to ensure your treatment goals are being met, as your symptoms may change over time.
What is Psoriasis?
Psoriasis is a chronic disorder causing red, scaly patches on the skin. It usually occurs on the limbs, trunk, and scalp but can show up on other parts of the body as well. It is not contagious but it can flare up causing the symptoms to get worse. The rash associated with psoriasis goes through cycles of improvement before it gets worse. Psoriasis is usually the result of a problem with the immune system. It is most likely to occur in members of the same family. At times, psoriasis can be disfiguring, uncomfortable, and even painful.
What are the Symptoms?
Symptoms of psoriasis appear as red, thickened areas of the skin with silvery scales. It most often appears on the scalp, elbows, knees, legs, arms, genitals, nails, palms, and lower back. The skin usually replaces itself after about a month. When psoriasis is present, the process speeds up and the skin is replaced in 3-4 days causing the skin cells to multiply quickly and accumulate on the surface in silvery scales. Psoriasis comes in many forms. Each differs in severity, duration, location, shape, and pattern of the scales. The most common form, called plaque psoriasis, begins with little red bumps. Gradually these become larger, and scales form.
What is Treatment Like?
Unfortunately, there is no cure for psoriasis but there are many different psoriasis treatments available that can clear the symptoms and bring relief. Your doctor may prescribe medications applied directly to the skin. These contain cortisone compounds, synthetic vitamin D analogs, retinoids, tar, or anthralin used to ease the discomfort caused by the skin patches. Other types of treatment include coal tar, Goeckerman treatment, light therapy, ultraviolet light B (UVB), PUVA, methotrexate, cyclosporine, and biologic agents. Controlling triggers that bring on bouts of psoriasis, such as stress, and taking care of your skin will help keep symptoms in control. The goal is to reduce inflammation and to control shedding of the skin. Moisturizing creams and lotions loosen scales and help control itching.
Psoriasis is a chronic skin disease that affects more than 7.5 million people in the United States. Triggered by a disorder in your autoimmune system, psoriasis looks like thick, silvery scales or itchy, dry, red patches usually found on your elbows, knees, scalp, back, face, and feet.
Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. Your symptoms may vary in severity and look different from others affected by psoriasis.
Below are some of the most common symptoms of psoriasis:
- Red patches of skin covered with silvery plates that resemble tiny fish scales
- Small scaling spots (commonly seen in children)
- Dry, cracked skin that may bleed
- Itching, burning, or soreness
- Thickened, pitted, or ridged nails
- Swollen and stiff joints
There are several types of psoriasis, each with distinctive symptoms:
- Plaque psoriasis: causes dry, raised, red skin lesions (plaques) covered with silvery scales.
- Nail psoriasis: affects your fingernails and toenails, causing pitting, abnormal nail growth and discoloration. It can even cause your nails to crumble.
- Scalp psoriasis: appears as red, itchy areas on the head with silvery-white scales.
- Guttate psoriasis: manifests as small, water-drop-shaped sores on your trunk, arms, legs, and scalp.
- Inverse psoriasis: causes smooth patches of red, inflamed skin in your armpits, the groin, under the breasts, and around the genitals.
- Pustular psoriasis: develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. It can also cause fever, chills, severe itching, and diarrhea.
- Erythrodermic psoriasis: can cover your entire body with a red, peeling rash that can itch or burn intensely.
- Psoriatic arthritis: causes painful joints that are typical of arthritis accompanied by red, inflamed, itchy skin.
Why Choose UHealth?
World-class leaders in skin care treatment. University of Miami Health System is recognized throughout South Florida and the world as a leader in caring for conditions and disorders of the skin. Backed by one of the nation’s top universities, our team uses the latest technologies and research-driven expertise to provide superior, personalized treatments for dermatologic conditions.
Compassionate care in an academic medical center. You benefit from the state-of-the-art technology and latest medical advancements developed by our researchers at the University of Miami Miller School of Medicine. You will receive the most accurate diagnosis and a detailed plan to keep your skin healthy.