Psoriasis

Integrated care: Working side-by-side with River City Rheumatology, we collaborate to improve and expedite outcomes for patients battling both psoriasis and psoriatic arthritis. Feeling like a ping pong ball being bounced back and forth between specialists but ultimately not going anywhere? Our integrated care was created for you.

Urgent new patient visits for Psoriasis:

• If you are a new patient and are experiencing a psoriasis flare, we will expedite your new patient appointment.
• Appointments available in as little as a few days after we receive your referral.
• We take pride in giving you the urgent care and attention your psoriasis needs.

Urgent work-in visits for established patients: If you are an established patient and are having a psoriasis flare, we can work you into the schedule to address it.

Screenings for psoriatic arthritis at every visit: The signs of psoriatic arthritis can start very subtly. If left uncontrolled, it can be a very debilitating and mutilating disease. Early identification, through proper screening, is vital to catching psoriatic arthritis in the early stages.

Sophisticated treatments tailored to meet your goals.

Psoriasis is a disorder of the immune system that affects more than 7.5 million adults in the US. This immune system dysfunction leads to excessive inflammation in the body that targets the skin. The skin responds by becoming inflammed (creating redness) and rapidly growing (creating plaques). Psoriasis is a whole body disease that has a skin presentation. It is not a contagious disease.

The root word for psoriasis is the greek “psora” which means “itch”. Psoriasis can be very itchy, especially depending on location. Other symptoms include, but are not limited to: pain, change in color, warmth, and swelling.

There are many types of psoriasis and patients can have multiple types over the course of their lifetime, or multiple at once.

Plaque Psoriasis: The most common form is plaque psoriasis, also called psoriasis vulgaris. This is characterized by inflamed, raised, plaques with scale. Changes in skin color on spots of psoriasis to darker (hyperpigmentation) or red (erythema) can occur. 

Guttate Psoriasis: This form of psoriasis can occur at any age, but most commonly affects younger individuals, often as the very first presentation of the disease. The word “Guttate” is latin for “drop-like”, and guttate psoriasis appears like little raindrops of psoriasis patches throughout the skin. It can be triggered by an infection, commonly strep throat.

Pustular Psoriasis: This type of psoriasis involves white or yellow pus-filled bumps called “pustules” located on the plaques. This type of psoriasis tends to be painful. Even though this type has pus-filled bumps, this is not an infection. There are two main types of pustular psoriasis: Generalized Pustular Psoriasis, and Palmoplantar Pustular Psoriasis. 

• Generalized Pustular Psoriasis (GPP) is a type of pustular psoriasis can present very rapidly all over the body. GPP can be life-threatening and patients can require hospitalization for stabilizing. Symptoms include: fever, chills, changes in heart rate, pain and itch, fatigue and muscle weakness. If you experience these symptoms, please contact your healthcare provider immediately. 
• Palmoplantar Pustular Psoriasis is a form that presents mostly on the palms of the hands and/or the soles of the feet. It is commonly associated with cigarette smoking and can be especially painful. It tends to take a longer time than psoriasis vulgaris to respond to any treatment. 

Inverse Psoriasis: Inverse psoriasis, also known as intertriginous psoriasis, involves smooth shiny plaques without scale in the skin fold areas (armpits, groin, between the buttocks). It can be especially painful as the lesions are under constant friction. It is often misdiagnosed as a yeast infection. 

Erythrodermic Psoriasis: Erythrodermic psoriasis is a rare complication of psoriasis. It happens when the skin swells, becomes incredibly warm, and can result in the top layer of skin peeling off. It can look like a severe sunburn and can be misdiagnosed as an infection of the skin called cellulitis. This condition leads to shivering, inability to control body temperature, and can disrupt the fluid balance of the body leading to serious complications. Patients with erythrodermic psoriasis often require hospitalization. If you believe you are experiencing erythrodermic psoriasis, contact your healthcare provider immediately.

Psoriasis involving special areas of the body:

• Nail psoriasis: This type of psoriasis involves the nail matrix, resulting in pitting or even breakage or lifting of the nail. It is a potential indicator of psoriatic arthritis, so patients with nail psoriasis must be screened regularly. This type of psoriasis tends to take the longest to respond to even the best treatment, sometimes up to years for full results. 
• Scalp psoriasis: Scalp psoriasis is classically itchy. It can hide just behind the ears, or cover the scalp. In severe cases, it can lead to hair loss as the hair follicles cannot grow through the thick scale of the plaques. Patients with scalp psoriasis are at greater risk of developing psoriatic arthritis and should be screened regularly. 
• Palmoplantar psoriasis: This type of psoriasis affects the palms of the hands and/or soles of the feet. It can take a long time to see the full benefits from treatment. It is often misdiagnosed as eczema. 
• Genital psoriasis: This is a form of inverse psoriasis affecting the genital areas. It can be especially painful for patients and can result in lack of physical intimacy. This is the least commonly identified form of psoriasis, but not the most uncommon. It is also associated with an increased risk of psoriatic arthritis. If you think you may suffer from genital psoriasis, please inform your healthcare provider so they can properly address your needs.

Psoriatic Arthritis: This is a chronic inflammatory disease involving pain, stiffness, and swelling of the joints. It occurs in up to 30% of patients with psoriasis. Proper screening and early intervention are essential to halt the progression of this destructive disease. Our partner, River City Rheumatology, are experts at inflammatory joint diseases. Symptoms include:

• Fatigue

• Tenderness, pain and swelling over tendons called enthesitis

• A random swollen finger or toe called dactylitis or sausage digits

• Reduced range of motion

• Morning stiffness

• Nail psoriasis

• Eye inflammation called uveitis

If you think you may have psoriatic arthritis, please contact your healthcare professional.

Inflammatory Bowel Disease (IBD): IBD involves inflammation in the lining of the digestive tract and can present with bloody diarrhea. Patients who also have psoriatic arthritis are at even greater risk of IBD. 

Cardiovascular Disease:

• Non-alcoholic fatty liver disease

• Diabetes

• Metabolic syndrome

• Obesity

• Depression

• Cancer: including skin cancer

 

While the root cause of psoriasis is genetic dysregulation of the immune system, certain things can trigger a new onset of psoriasis, or worsening of existing psoriasis. These include:

• Stress: One of the most common triggers is stress. Stress stimulates our immune system, which thus stimulates our immune disease causing worsening of psoriasis. This worsening of psoriasis can, in turn, cause us more stress. It is a vicious cycle. Stress is not always manageable, but being mindful of stress and using healthy coping mechanisms can help. 
• Physical injury: Injuring the skin promotes inflammation, which draws the immune system to the site of injury to fight any potential infection and promote healing. This is normally a good thing. However, when we have an immune disease, this also draws the disease to the area of injury. This is called Koebner phenomenon. 
• Infection/illness: Anything our immune system needs to fight will kick it into high gear, bringing our immune disease along for the ride. There are some infections that are more prone to triggering psoriasis than others. Strep throat is a common cause of guttate psoriasis and is often the first onset psoriasis in children. 
• Weather/Seasons: Weather/Season change from summer to fall/winter can trigger flares of psoriasis. Lack of sunlight and drier weather all contribute. Sunshine can improve psoriasis in limited doses. Too much sunlight will have the opposite effect, causing a burn, worsening psoriasis, and increasing risk of skin cancer. 
• Others: Certain medications, alcohol consumption, and others can trigger flares. Keeping track of activities surrounding flares can help identify your specific triggers. 

The treatment options for psoriasis have never been more diverse, effective or sophisticated.  These include:

• Topicals: Mediations such as lotions, creams, and ointments that are applied to patches of psoriasis. Traditional ones include topical steroids, and more sophisticated options include many non-steroid agents.

• Phototherapy: this is where a narrow band of UVB light is directed onto the skin to reduce psoriasis. It mimics the benefits of the sun in a controlled setting.

• Oral small molecules: These range from older medications that act more broadly on the immune system (Methotrexate, Cyclosporine, and others) to newer, more targeted agents. 

• Biologics: The most sophisticated treatments ever created for psoriasis, these are injectable medications that can often deliver 90-100% improvement in psoriasis plaques.

To discuss treatment options with our provider, please schedule a visit.