“Dr. Basuk is a fabulous doctor. I travel from south New Jersey (Swedesboro) (3 hours) to see her about my psoriasis. Dr. Basuk keeps my psoriasis under control, & she is a caring Dr. which is hard to find these days. Thank you Dr. Basuk.” – Michael Riegler
Psoriasis often appears on elbows
Psoriasis is a persistent skin condition affecting 1% to 3% of the population. The disease is lifelong and can be chronic and recurrent, although one can have remissions where the skin clears for a long period of time. Some cases of psoriasis are so mild that some people don’t even know they have the disease. In more severe cases, the joints can also be affected resulting in a type of arthritis. The presence of arthritis in patients with psoriasis varies between 10-30%; the arthritis can even occur before skin symptoms develop. Psoriasis can begin in childhood but most commonly starts between the ages of 15 and 35. It can be emotionally and physically disabling: you may have heard the term “heartbreak of psoriasis”. Dermatologists can help patients with psoriasis even in very severe cases.
Psoriasis can occur on any part of the body and can be associated with other health conditions, such as diabetes, heart disease and depression.
The most common types of psoriasis are:
- Plaque Psoriasis: raised, red patches which can have a white buildup of dead skin cells, called scale. It’s most common type of psoriasis: 80% of patients have this type. It typically appears on the elbows, knees, scalp, nails, and lower back.
- Guttate Psoriasis: scaly papules (small raised spots) on the trunk and extremities, but not on the hands and feet; it may appear on the scalp and face. It may be itchy (pruritic). Guttate psoriasis can appear quickly and can disappear over weeks to months. It usually affects children and young adults. It often starts with a sore throat and commonly occurs after a strep infection.
- Pustular Psoriasis: white pustules (pus-filled lesions that look like blisters) surrounded by inflamed skin and tends to develop on palms and soles. The pus is filled with white blood cells. Pustular psoriasis is most commonly found on the hands and feet.
- Inverse Psoriasis: usually occurs in skin folds such as the armpit, under the breasts, and in the groin or buttocks. It appears as smooth red lesions and not much scale is evident.
- Erythrodermic Psoriasis: widespread and is the most severe and serious type of psoriasis. The skin is red and one can have intense itching or pain in the affected skin areas.
What causes psoriasis? It can be transmitted genetically, although the immune system may also play a major role in its development. Most researchers agree that the immune system is somehow mistakenly triggered, which speeds up the growth cycle of skin cells. It usually takes one month for a normal skin cell to mature and fall off (shed) from the skin surface. In psoriasis, a skin cell takes only 3 to 4 days to mature and instead of shedding, the cells pile up on the surface of the skin, forming psoriasis lesions. Psoriasis may develop after a certain trigger in the environment like stress, injury to the skin (after surgery or after a fall), certain medications, or strep infections like those that cause a sore throat.
Psoriasis in any form is not contagious, and the pus from pustular psoriasis is not contagious.
How is psoriasis diagnosed? Usually, a dermatologist can diagnose a patient by performing a full skin exam. A skin biopsy may be necessary to confirm the diagnosis in some cases.
Treatment
There are numerous therapies to managing and treating psoriasis, due to the large number of types and varying levels of severity in patients. The skin and joints can become inflamed because the cells reproduce too rapidly, and therapy may be different if arthritis is also present.
Simpler therapies may involve creams or ointments and more extensive therapies may involve exposure to the sun and systemic medications. For example, creams, moisturizers, or petrolatum applied directly to the plaque may soften and remove scaling, possibly clearing areas of the skin. The use of such products helps to reduce inflammation and normalize skin production, thereby alleviating symptoms. Topical therapies may include topical steroids, vitamin D preparations, topical retinoids, anthralin, tar preparations, and varyious scalp therapies.
Ultraviolet light (both UVA and UVB) or sunshine can help alleviate the symptoms of psoriasis but must be used with caution due to side effects of exposing your skin the ultraviolet rays. This therapy slows the rapid growth of skin cells. But careful monitoring of the skin is important to check for possible skin damage that might occur with this treatment method.
Other therapies that help psoriasis are targeted at the immune system using systemic and biologic therapies. There are several oral medications that may be recommended based on the location, type, and severity of the condition. In the past several years, new injectable medications called biologics have been designed to suppress the immune system. These medications can be given by injection or infusion. What makes these drugs unique is that they target the precise immune responses involved in psoriasis. Newer biologic drugs are being discovered every year and a lot of new research is working in this field of psoriasis treatment. For patients who might warrant biologic treatment, an intensive discussion with a physician is appropriate.
There are many treatment options for patients with psoriasis. The challenge for both physician and patient is to find what works most effectively for the individual. In many cases, a physician may choose to combine two or more treatments for the best outcome.
Diet
Because people vary tremendously with regard to eating, lifestyle habits, and genetics, no general suggestions about diet can be expected to work for everyone. That said, those who are affected by psoriasis may be interested in medical information about diet that might very well help. As mentioned above, the body’s immune system is involved in psoriasis. There are changes that can be made to your diet to reduce inflammation and, hopefully, reduce your psoriatic symptoms.
For the last few decades, it has been very popular to attempt to reduce intake of fats. But humans do require some fat intake; we need certain fatty acids, but can’t make them. These fatty acids are called “essential fatty acids” or EFAs (http://en.wikipedia.org/wiki/Essential_fatty_acid). The two we need are often called “omega-3” and “omega-6”. Studies suggest that prehistoric people evolved with a diet with approximately the same intake of omega-3 and omega-6 fatty acids. Due to our ability to get a fantastic variety of foods all year round from local supermarkets, our typical diet has changed that ratio to a comparatively tremendous imbalance: we now take in far more omega-6 than omega-3. Omega-6 helps us with inflammatory response (like psoriasis!), while omega-3 helps us with anti-inflammatory response. So if the goal is to reduce your inflammatory response – and that’s the goal in reducing psoriasis – you should try to ingest at least as much omega-3 as omega-6.
Increasing your omega-3 food content is not enough, you must also decrease your omega-6 intake. That’s because these essential fatty acids are processed inside us with a certain enzyme, and there’s a limited amount of that enzyme. If you take in lots of omega-6 fatty acids, those enzymes will be busy processing the omega-6, and not the omega-3.
Foods with high omega-3 content:
- fish and fish oil
- flax seed (except for Linola) (c.f. http://en.wikipedia.org/wiki/Flax)
Foods with high omega-6 content:
- fresh fruits and vegetables
- meats
- eggs
Suggested diet summary:
Increase the amount of fish and/or flax seed and decrease your fruits, vegetables, meats and eggs in your diet.