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Psoriasis Skin Disease Information

Written by Megan Kinder, with some information gathered from Healthline.com and SFGate.com. [email protected]

Psoriasis skin disesase's effects on the body go far deeper than skin deep.

The chronic condition, considered the most common autoimmune disorder, leads to itchy, painful patches on the skin, but the inflammation associated with the disease is also linked to a higher risk of heart attacks and strokes.

"Patients don't realize it's not just a skin disease. It's an autoimmune disease that affects the whole body," said Sonia Kalil, community development manager for the Northern California division of the National Psoriasis Foundation, which formed the chapter in Oakland last year. "There are a lot of patients affected by the disease, and oftentimes they are not getting treated."

But in recent years, new treatments for moderate to severe psoriasis have been introduced, and more promising options are in the pipeline. They add to the growing number of biological drugs that have been made available in the past decade to treat a disease that can be painful and debilitating, both physically and emotionally.

Psoriasis afflicts about 7.5 million Americans, including more than 450,000 Northern Californians who have the more common skin psoriasis or also psoriatic arthritis, a type of inflammatory arthritis that can develop in those who have skin psoriasis.

The roots & causes of of psoriasis skin disease

With psoriasis skin disease, the body's immune system - which creates inflammation as a natural defense against bacteria, fungus, trauma and other invaders - goes haywire, sending out faulty signals that speed up the growth of skin. This typically causes red, scaly patches that not only cause pain and itching, but also can lead to psychological trauma and depression.

"In psoriasis, people have inflammation all over their body for no good reason," said Dr. John Koo, director of UCSF's Psoriasis, Phototherapy and Skin Treatment Clinic, who is both a dermatologist and a psychiatrist. "It's like the immune system is paranoid and reacts when it's not supposed to react."

The severity of the disease determines treatment. There is no cure for psoriasis, but it can be controlled. People with mild to moderate disease often rely on topical creams, most commonly steroids, coal tar creams or those that derive from vitamin A.

Phototherapy, or exposure to ultraviolet light, is also an option in combination with the creams, but the therapy can require daily sessions for a period of time.

"It was like a full-time job just treating their psoriasis," said Dr. Peter Marinkovich, Stanford associate professor of dermatology.

For more severe cases, systemic treatment is needed. Older immunosuppressant chemotherapy drugs, such as methotrexate and cyclosporine, can be effective, but also damage the bone marrow or cause harm to major organs like the kidney or liver.

Types of Psoriasis Skin Disease

There are several different types of psoriasis skin disease, distinguished by (a) the affected area of the body, and (b) the type of patches. They include:

Scalp Psoriasis skin disease

This type involves plaques on the scalp that typically can be confused as dandruff. About half of all people with any type of psoriasis also have scalp psoriasis.

Plaque Psoriasis skin disease

Found anywhere on the body, plaque psoriasis is the most common form of psoriasis. Small red bumps spread and dead skin cells easily flake from those areas.

Inverse Psoriasis skin disease

This type of psoriasis involves smooth inflamed lesions in areas where the skin folds or flexes, such as the armpits, groin, or under the breast.

Erythrodermic Psoriasis skin disease

This kind causes severe disruption to the body's chemical balance, affecting the majority of the body, and causes symptoms such as severe scaling, pain, and itching to the point where the skin looks as though it has been burned. It can also cause severe illness.

Pustular Psoriasis skin disease

Characterized by puss-filled blister-like lesions, this kind can be contained to a small area or widespread. It can be a precursor to plaque psoriasis or develop in those who already have it.

Palomar-plantar Pustulosis skin disease

A type of pustular psoriasis, it causes pustules to form at the sides of the heel or base of the thumb that turn brown and peel.

Guttate Psoriasis skin disease

This involves small, red dots that enlarge rapidly and often develop scales in the scalp, arms, legs, and torso. They can clear up without any treatment, but may appear later as plaque psoriasis. 

Nail Psoriasis skin disease

This form of psoriasis affects the fingernails and toenails with pitting, discoloration, flaking, or possible separation from the nail bed.

So, for the Psoriasis Skin Disease, what are the New treatments available?

Several new drugs have been approved in recent years. A newer class of biologics blocks TNF, which stands for tumor necrosis factor and is part of a group of proteins that play a key role in inflammation. These drugs have fewer severe side effects than the older immunosuppressants.

The main drugs in this class are Enbrel, first approved to treat psoriatic arthritis in 2002, and the newer Humira, approved in 2005. Remicade, another anti-TNF drug, is also used. But these injectable drugs come with potentially serious side effects, including lymphoma and other cancers.

"We don't have long-term experience with many of these biologics," Marinkovich said. "What we don't know is, 20 years down the road, whether we will have even more incidence with cancer."

The newer treatments are expensive, ranging in cost from $20,000 to $60,000 a year, depending on the drug and the dose.

UCSF's Koo said the benefits can far outweigh the drugs' risks. Studies have shown that controlling the disease and the associated inflammation helps reduce the risk of heart attack and stroke.

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