Dr. M.J. Bazos, MD.
Psoriasis is a chronic skin disorder with
frequent recurrences and remissions characterized by silvery white, scaly
plaques. Your psoriasis can vary from mild to severe, depending upon the type of
psoriasis and the extent of involvement. The exact cause is unknown. Psoriasis
is likely autoimmune (i.e., a condition in which your immune system mistakenly
attacks normal parts of the body, resulting in tissue injury or disease). This
condition is common, affecting about 2% of individuals in the United States. It
is less common in individuals of African, Asian, and Native American descent. It
affects men and women equally. It typically begins in adolescence or early
adulthood and persists throughout life. This condition is hereditary but is not
infectious or cancerous. Other members of your family may have psoriasis. Minor
injury, including scratching or rubbing, can provoke an outbreak of the lesions.
Other factors that can increase your risk for an episode of psoriasis include
stress, infections, cold and dry climates, obesity, and other autoimmune
conditions. Diagnosis is usually based upon the appearance of the skin lesions.
Your doctor may perform a skin biopsy (i.e., removal of a small piece of skin or
other tissue) for laboratory evaluation to assist in diagnosis. Psoriasis is not
curable. Psoriasis is a chronic condition in which episodes may persist for days
to months. Periods of remission occur between episodes. The severity may
decrease during pregnancy. Treatment aims to control symptoms and lessen the
severity and duration of skin lesions, but does not cure
Living With Your
Skin lesions are slightly
raised, silvery white scales with red or pink margins. The lesions can develop
painful fissures (cracks). Lesions may be single, localized to certain areas of
the body, or generalized. They are typically bilateral (i.e., involve both sides
of the body). Psoriasis can affect any part of the body. It most commonly
involves the skin of the scalp, face, elbows, hands, knees, feet, chest, lower
back, and the folds between the buttocks. Fingernails and toenails are
frequently involved. Nails often show discoloration and pitting. Itching is
common, particularly in the scalp. Joint pain occasionally occurs, especially if
psoriasis involves the fingernails and toenails. Rarely, you may have fever,
chills, arthritis, and a generalized pustular psoriasis. Secondary bacterial
infections can occur, especially if you scratch the lesions. These infections
often require antibiotic therapy. You may also experience social embarrassment
because of your skin’s appearance: “the heartbreak of
psoriasis.” Other complications include arthritis and pustular
treatment depends upon the type, location, and severity of your psoriasis, its
impact on the quality of your life, and your response to therapy. Treatment does
not cure psoriasis, but it lessens the severity of your condition and prevents
complications. Treatment includes the avoidance of precipitating factors,
general measures, and medications. Treatment of mild-to-moderate psoriasis
includes topical creams, lotions, and ointments to reduce inflammation, scaling,
and itching. Shampoos and lotions are frequently used to treat psoriasis of the
scalp. Be cautious when using topical medications because they may be absorbed
through your skin into your bloodstream, thereby causing toxic effects. Do not
exceed prescribed doses of your medicine.
1. Maintaining good skin
2. Avoiding skin
3. Avoiding excessive skin
4. Exposing your skin to moderate
amounts of sunlight.
5. Considering moving
to areas with a warmer climate.
baths to loosen scales, which can improve the appearance of your skin and
enhance the effects of topical medications. Your doctor may prescribe a variety
of medications to reduce inflammation, scaling, and itching and to lessen the
severity and duration of outbreaks of psoriasis.
1. Ointments and shampoos
containing coal tar. These medications are effective for psoriasis of the scalp
and for mild-to-moderate cases.
steroids and other topical anti-inflammatory agents. These agents are effective
in mild-to-moderate cases and as combination therapy for more severe cases.
Before using these
agents, soak the affected areas in water to
loosen and to remove scales, which increases the effectiveness of the topical
medications. Your doctor may recommend placing occlusive dressings over the
topical medications to increase their effects. Side effects include skin
atrophy, formation of abnormal, small blood vessels, and absorption of
medication through the skin into the bloodstream, which can cause toxic effects.
To decrease the risk of side effects, do not exceed the recommended dose
prescribed by your doctor.
acid in mineral oil. This helps to remove plaques, thereby maximizing the
effects of topical medications.
(combination of the medicine psoralen and exposure to ultraviolet light
wavelength A [UVA]).
5. Combination of
emollients or tar baths with ultraviolet light wavelength B
6. In severe cases,
immunosuppressive agents (i.e., medications that lessen the effects of your
immune system) such as methotrexate, isotretinoin, and etretinate. These
medications are effective but do carry the risk of toxic effects to the liver
and kidney. Therefore, your doctor will closely follow laboratory tests to
monitor your response to these medications and to check for side effects.
Isotretinoin can be toxic to a developing fetus and should not be used in women
who are pregnant or who may become
7. Antihistamines to relieve
itching. They may cause drowsiness, so use these agents cautiously when driving
or performing other activities in which you must be awake and
8. Antibiotics to treat secondary
bacterial infections. A rare form of psoriasis, known as guttate psoriasis, is
caused by a strep infection. Prompt antibiotic therapy is indicated for
individuals with this type of
• Take medications as
prescribed by your doctor.
your doctor of all other medications, including over-the-counter medicines, that
you are taking. Continue these medications unless your doctor instructs you to
• Read the labels of
medicines and follow all instructions. Consult your doctor if you have any
concerns or if you have possible side effects caused by the
• Frequently expose your
skin to moderate amounts of
• Maintain good skin
hygiene to reduce outbreaks of psoriasis and to decrease the risk of secondary
• Oatmeal baths
(one cup of oatmeal in a bathtub of warm water) loosens scales, which can
improve the appearance of your skin and enhance the effects of topical
• Consider moving to a
• Keep scheduled
follow-up appointments with your doctor; they are essential to monitor your
condition, your response to therapy, and to screen for possible side effects of
• Monitor your skin for
healing and for evidence of secondary bacterial infection. Signs and symptoms of
infection include redness around the skin lesions, purulent discharge (pus),
increased pain or swelling of lesions or lymph nodes, and
• Individuals with psoriasis
frequently become depressed or experience other psychological conditions. If you
feel depressed or are having difficulty adjusting to your psoriasis, talk to
your doctor about the best treatment options, including psychological
• Do not stop your
medicine or change the prescribed dose without consulting your
• Do not exceed recommended
doses of medicines, because higher doses can increase the risk of toxic
• Do not use potent topical
steroids on the skin of the face or genitals, because these areas are most prone
to skin atrophy.
• Do not abruptly
stop steroids or immunosuppressive therapy because you may have a rebound
worsening of your condition. In particular, do not suddenly stop steroids
because this action can have serious effects to your health. Consult your doctor
before stopping these medications.
Do not drive or perform other potentially hazardous activities when taking
medications that cause drowsiness or sedation (e.g., antihistamines and pain
• Avoid skin injuries,
including scratching, rubbing, or scrubbing, which can trigger
• Avoid skin dryness to
reduce the frequency of outbreaks.
Avoid activities that can cause infection of
To Call Your Doctor
you have any signs or symptoms of
• If you notice
that lesions are becoming worse or if new lesions appear despite appropriate
• If you notice
pustules on the skin, especially if accompanied by fever, fatigue, muscle aches,
or joint pain/swelling.
you have new or unexplained symptoms.