Psoriasis

What Is Psoriasis?

Psoriasis is a disease characterized by red scaly plaques that result from over-proliferation and inflammation of the skin due to an intense immunological dysfunction in the skin. Not only does the skin appear abnormal, but often there are symptoms of itching, burning, and discomfort. Psoriasis is associated with arthritis in a significant number of patients. If untreated, this can be deforming and disabling. Recent data suggest that cardiac disease can be a side effect of this generalized inflammatory process and often occurs as part of a systemic metabolic syndrome.

Topical Steroids

Topical steroids are the most used product for this condition and may provide rapid improvement.* In the United States, the super-potent steroids are used commonly in adults due to the especially quick response seen with these agents. These agents suppress abnormal skin growth and inflammation.* Unfortunately, they also robustly suppress normal growth and repair which can lead to skin barrier dysfunction and later to atrophy which can be manifested as thin, easily bruised skin. Due to these side effects, it is recommended that these stronger super-potent steroids be used for 2-4 weeks and then only intermittently after that.* Unfortunately, patients and physicians often neglect this recommendation.

Laser Treatments

Phototherapy has been a useful treatment for psoriasis for 100 years.* Narrowband UVB and the Excimer laser are the most modern tools available to treat this problem.* We were the first to introduce phototherapy to Sacramento and maintain a full line of devices that can be tailored to an individual’s current needs. Dr. Tanghetti trained at the Wellman lab of Harvard University in all aspects of phototherapy and laser surgery. We also use PUVA therapy, a form of oxsoralen and UVA light, to treat more resistant forms of psoriasis and eczema, especially on the palms and soles of the feet. We also use it to treat T-cell lymphoma of the skin and Mycosis Fungoides.

Biologic/Systemic Therapies

Biologic therapies use genetically engineered drugs that target cytokines and T cells, which are essential in the pathogenesis of psoriasis. Systemic drugs like Retinoids can treat inflamed, red skin with silvery scales when combined with phototherapy.

Vitamins

Vitamin D derivatives are important partners in the treatment of psoriasis.* By themselves, they provide fair improvement over 2-3 months.* However, in combination with topical steroids and Vitamin A derivatives, they can work very well.* These agents regulate immune function, repair barrier function and, most importantly, direct differentiation.* This latter process is important in directing the regular orderly growth of the skin. Topical Vitamin A has a role in psoriasis treatment as well. Tazarotene (Tazorac), like Vitamin D, is a useful partner in the treatment of psoriasis.* This drug promotes orderly growth and differentiation of the skin.* It also has anti-inflammatory properties with its effect on toll-like receptors.* Also, this class of Vitamin A derivatives acts as a co-factor with vitamin D and other hormonal agents to orchestrate the metabolic functions of many cells.*

Tars

Tars have traditionally been used in psoriasis. Five percent crude coal tar and other tar derivatives are effective but are difficult to use in a home situation where tar easily stains clothing and other objects that it comes into contact with.* Anthralin, a tar derivative, can be used successfully by leaving it for 20-30 minutes and then washing it off.* This is referred to as “minutes” therapy and can be effective.* Unfortunately, Anthralin stain objects much like the other tar derivatives. For this reason, these products have limited use.