Dr. Pranav Sheth Answers Common Psoriasis Questions

Sometimes disguised as dandruff or eczema, a psoriasis outbreak can occur at any age, any time.

While psoriasis is a chronic condition, Pranav Sheth MD, FAAD, a dermatologist at Group Health – a TriHealth Physician Partner, answers common psoriasis questions and reminds you it is controllable.

What is Psoriasis?

Psoriasis is a common skin condition that causes patches of skin redness and flaking, and typically falls into one of the following categories:

  • Plaque – The most common type, which appears as thick, red patches of skin, covered by flaky, silver-white scales (usually on the scalp, elbows or knees)
  • Guttate – Drop-like, small, pink-red spots seen more commonly in kids (often can develop after an infection, like strep throat)
  • Inverse – Redness and irritation that occurs in the folds of the skin (in areas like the armpits and groin)
  • Erythrodermic – A rare type that covers a large area (sometimes almost 100 percent of the body surface is covered)
  • Pustular – Red patches with yellow-brown pus bumps or blisters in the center

The onset of psoriasis can occur at any age, but it is most common in people between ages 15 and 35.

What Causes Psoriasis?

Psoriasis is often passed down through genetics, or is the result of an autoimmune condition that occurs when the body mistakenly causes inflammation in the skin.

Environmental or lifestyle triggers may include:

  • Bacterial infections, like strep throat
  • Cold weather
  • Injury to the skin, including cuts, burns and insect bites
  • Certain medicines such as lithium blood pressure medicine
  • Stress
  • Too little sunlight
  • Too much sunlight (sunburn)
  • Too much alcohol

“Colder, drier climates have more psoriasis than warmer, more tropical or equatorial areas,” Dr. Sheth explains. Similarly, he says people who live in areas that experience four seasons tend to have psoriasis flare-ups during the fall and winter months.

The presence of nail psoriasis may indicate the increased risk of psoriatic arthritis.

How Can Psoriasis Impact Someone’s Life?

psoriasis on knuckle

The presence of nail psoriasis
may indicate the increased risk
of psoriatic arthritis.

The first issue Dr. Sheth addresses in psoriasis cases is how the condition affects your physical, psychological and social health. “The patient's quality of life can be impacted, depending on where the psoriasis is located … but, a higher concern for disability comes if they have inflammation of the joints,” he points out.

This may be psoriatic arthritis, which can lead to joint destruction, if not treated properly. For this reason, it is also important to evaluate whether you are experiencing joint pain, swelling or stiffness. In cases where symptoms of arthritis are evident, Dr. Sheth would refer you to a rheumatologist.

On the other hand, psoriasis can cause significant issues for an individual’s psychosocial health. If you have moderate to severe psoriasis, you are more likely to experience depression, anxiety, obesity, heart disease and metabolic syndrome – among other health issues.

While Dr. Sheth says the medical field has not determined if there is a direct relationship between psoriasis and incidences of certain conditions, like heart disease and obesity, he points out: “One of many theories is that patients with psoriasis – especially moderate to severe psoriasis – may end up being less active outdoors or in athletic settings because of their shyness about their skin."

Similarly, psoriasis could also hinder your ability to feel comfortable in social settings. Physical discomfort or embarrassment with your skin can lead to poor eating or drinking habits as well.

What Types of Treatment Options Are Available?

Treating psoriasis depends on its severity, which is categorized as mild, moderate, severe or very severe. The level of severity depends on several things:

  • Body surface area covered
  • Thickness of the skin plaques and symptoms
  • Part of body covered with psoriasis
  • How it impacts a patient’s quality of life  

For example, “a patient may have only 3 percent of their skin surface covered … however, let’s say the 3 percent is their scalp and face – it might be affecting their social life, their work life,” Dr. Sheth explains. “So with them, we might need to be more aggressive.”

Topical Treatments

In less severe, more localized cases, psoriasis is treated with topical therapies – usually steroids – which come in the form of lotions, ointments, creams and shampoos. Long-term use of topical steroids can increase your risk for stretch marks, rosacea, acne, and thinning or discoloration of the skin, and for this reason, they are usually only prescribed for short-term or intermittent use.

Phototherapy

“Group Health is one of the few medical practices in our region that does the full complement of light therapies,”
– Pranav Sheth MD, FAAD

When psoriasis covers a larger surface area of the body, phototherapy may be used as treatment option. Phototherapy is a medical treatment in which your skin is carefully exposed to ultraviolet light. “Medical phototherapy is not the same as a tanning bed, and is not sunlight,” Dr. Sheth warns.

Phototherapy is offered at the following Group Health locations: Clifton, Kenwood and Mason.

A variation of phototherapy, excimer laser, is high-intensity UV light used for localized or limited psoriasis.

“Group Health is one of the few medical practices in our region that does the full complement of light therapies,” he explains. These therapies are typically more time-intensive:

  • Phototherapy – to attempt clearance, you attend three appointments, each week, for an average of three months
  • Laser – two appointments each week, for an average of two months

Oral Treatment

Pills that affect the body’s immune response may be administered for more severe psoriasis cases. Individuals on an oral treatment require blood tests to monitor for side effects. The three most common oral drugs include methotrexate, acitretin and cyclosporine.

Injectable Therapy

Injectable drugs, called biologic therapies, are a newer type of treatment option for psoriasis patients, and for this reason, are the most expensive. These drugs include Enbrel, Humira, Remicade and Stelara. Like oral treatment, these are administered if you have moderate to severe psoriasis.

Can Lifestyle Changes Help Manage Outbreaks?

Stress, an unhealthy diet, smoking and poor sleeping habits all negatively affect the immune system, and therefore, may aggravate psoriasis. Dr. Sheth suggests:

  • Developing ways to cope with stress
  • Maintaining a healthy weight
  • Eating a nutritious diet, high in bright and dark-colored vegetables and fruits
  • Reducing intake of red meats and fried foods
  • Exercising
  • Quitting smoking

Prognosis: Is there a Cure?

Unfortunately, doctors have not found a cure for psoriasis. Still, Dr. Sheth reminds his patients that it can be controlled. “First and foremost, the patient has to get appropriately educated on it and find the right physician, who’s going to customize the treatment to them.”

Tags: Skin Health

Last Updated: February 22, 2014