The Business of Skin: Treating Psoriasis

Watch an hour of television and chances are good that you’ll see a commercial for a medication to treat psoriasis, an autoimmune disease affecting the skin of an estimated 7.5 million people in the U.S.

But exactly what is psoriasis? How is it treated? Is it curable?

August is Psoriasis Awareness Month, a great opportunity to talk about a disease that affects the skin, the body’s largest and fastest-growing organ.

According to the National Psoriasis Foundation (NPF) psoriasis is caused by a dysfunction in the body’s immune system in which an overactive system speeds up skin cell growth. While normal skin cells grow and fall off in a month, the skin cells of someone with psoriasis do that in just three or four days. But instead of falling off, the skin cells pile up on the skin, creating inflamed, sometimes itchy and burning raised plaques and scales on the skin’s surface.

The NPF says psoriasis is most commonly found on the elbows, knees and scalp, though it can appear anywhere on the body. Symptoms often start between ages 15 and 25 but can start at any age, the foundation says. Men, women and children of all ethnicities can develop psoriasis, of which there are five different types. Treatment plans vary based on type and severity.

Psoriasis is not contagious.

High-profile people affected by psoriasis include musicians LeAnn Rimes, Cyndi Lauper and Art Garfunkel, Olympic swimmer Dara Torres and comedian Jon Lovitz. Novelist John Updike, who died in 2009, also had psoriasis.

Inflammation from psoriasis can affect other parts of the body, the NPF says. One in three psoriasis patients may also develop psoriatic arthritis, marked by swelling, stiffness and pain in the joints and areas around the joints. Famed professional golfer and three-time Masters champion Phil Mickelson is one notable person managing psoriatic arthritis. A rheumatologist can help manage the inflammation, which is important because untreated psoriatic arthritis can lead to permanent joint damage.

There is no cure for psoriasis, but there are scores of FDA-approved medications to manage the disease. These include topicals, phototherapy and systemic prescription drugs such as cyclosporine.

In more recent years, biologics have emerged as a treatment option, and they are typically the therapies currently featured in television and other advertising. Biologics, given by injection or IV infusion, target specific parts of the immune system, unlike systemic drugs, which do not. Biologics can block certain proteins or immune cells.

The NPF recommends that anyone considering a biologic should discuss short- and long-term side effects and risks with their clinician. Biologics can increase the risk for infection.

There are things that can trigger psoriasis flare-ups, including stress, diet, skin injuries, illness and weather. Each person is unique and no two people with psoriasis will have the same triggers. Tracking and managing flare-ups are important in managing the disease.

Your primary care clinician also can play a key role in helping to manage psoriasis and related conditions and can refer you to a dermatologist if appropriate.