A Common Skin Disease That Is Often Misunderstood

August is Psoriasis Awareness Month. In this week’s Medical Monday, Anetta Reszko, M.D., Ph.D., a dermatologist and dermatologic surgeon in New York City, explains the symptoms and treatments for Psoriasis — one of the most common skin diseases afflicting about 2 percent to 3 percent of the population. 


“What did you do to your hands? Did you apply some chemicals to remove your fingerprint lines?”

These words greeted my husband and me at Miami International Airport, when we flew back from our vacation in St. Martin.

“I have palmoplantar psoriasis, a skin condition that causes my skin to become red, dry and flaky,” replied my husband, whose psoriasis was first diagnosed when he was 16 years old.  “Sometimes my fingers even crack and bleed.  It is not contagious.  It is autoimmune.  My wife here is a dermatologist.  She can explain it better.”

After four hours of interrogation and questioning  by the Homeland Security and immigration officers, which caused us to miss two flights, followed by an emergency landing in Baltimore, we landed at La Guardia Airport and our vacation from hell was finally over.  La Guardia never looked more welcoming.

Psoriasis is one of the most common skin diseases afflicting about 2 percent to 3 percent of the population. It is polygenetic in transmission, meaning that multiple genes contribute to the development of the disease.

Current estimates indicate that 10 percent of people inherit one or more of the genes that could eventually lead to psoriasis. Researchers believe that for a person to develop psoriasis, that person must have a combination of the genes and be exposed to specific external trigger factors.

Clinically psoriasis is characterized by patches of red, itchy and scaly skin. Symptoms may vary in severity from small and localized to covering a large body surface area. Occasionally hands, feet, nails (pits and nail color changes) and joints (psoriatic arthritis) can be involved. Symptoms often worsen during winter and with certain medications, like beta blockers or NSAIDs. Infections, especially streptococcus (strep), and psychological stress may also play a role in development and worsening of the disease.

Even though certain infections may trigger psoriasis, it is not contagious.

There are five main types of psoriasis: plaque (most common, over 90 percent of all cases), guttate, inverse, pustular, and erythrodermic. Most cases present as red patches with fine white scales on the body. The areas of the body most commonly affected by the disease are the back of the forearms, shins, around the navel, intergluteal fold (between buttocks) and the scalp.

Currently there is no cure for psoriasis. However, various treatments can help control the symptoms. These treatments may include steroid creams, vitamin D3 cream, ultraviolet light, and immune system suppressing medications, like methotrexate, and newer generations of drugs known as biologics, like TNF alpha blockers, and various monoclonal antibodies that modulate the inflammatory pathway leading to psoriasis. About 75 percent of cases can be managed with creams alone.

Psoriasis is also associated with other conditions, with an increased risk of psoriatic arthritis, lymphomas, cardiovascular disease, Crohn’s disease, and depression.  Psoriatic arthritis (painful joint swelling of especially small joints) affects up to 30 percent of individuals with psoriasis.

The psychological impact of psoriasis cannot be underestimated.

Psoriasis has a negative impact on the quality of life of both the affected person and his or her family members. Depending on the severity and location of outbreaks, individuals may experience significant physical discomfort and some disability. Itching and pain often interfere with sleep. Participation in certain activities and occupations can become difficult activities for those with psoriatic plaques and fissures located on their hands and feet. Plaques on the scalp can be particularly embarrassing, as flaky plaque in the hair can be mistaken for poor hygiene and dandruff.

Psoriasis has been associated with low self-esteem, social isolation and depression. Children with psoriasis may encounter bullying.

I hope that this post will increase public awareness of the condition, and increase understanding of its genetic/autoimmune cause. Every person with psoriasis should be able to live a full, vibrant and active life unburdened by social stigma. Please help us spread the word!


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