Psoriasis is a common autoimmune skin condition. It affects as much as 3 to 4% of the population. In the most frequently seen form of psoriasis, people can develop red scaly plaques in various areas on their body especially over pressure points, such as the elbows, knees, low back, and scalp. This type of psoriasis is specifically called chronic plaque-type psoriasis. In the case of psoriasis, as an autoimmune disease, a cascade of steps by the immune system leads up to inflammation triggering the skin spots.
Psoriasis Background Part 1
Over the past few decades, we have come to understand that psoriasis can be much more than just a skin-limited condition. Around one-third of patients with psoriasis may also have associated inflammation in their joints, known as psoriatic arthritis. Some of the common signs of psoriatic arthritis are joint pain and stiffness that is especially problematic in the morning or after periods of rest. On top of all that there is mounting evidence in the last few years that psoriasis can in fact affect other organ systems. As an example, we know that in individual people with more severe psoriasis there is an increased risk of vascular disease, including heart attack, stroke, and blood clots.
Taking all these things into consideration, it is more important than ever to effectively treat psoriasis. There is also evidence that in cases of moderate or severe psoriasis, effective systemic treatment may reduce a person’s risk of other associated complications such as those mentioned (vascular disease).
The best dermatologists know to look at a handful of different factors when determining how to treat psoriasis. Simply put, the most noteworthy factor to take into consideration is the percentage of body surface area coverage (BSA). An easy “rough-in” way to do this is to look at the front surface of your hand—your palm and fingers. That is roughly 1% of your BSA. The cut-off points for mild to moderate and moderate to severe psoriasis are 3% and 10% – patients with less than 3% (or 3 handprints) of psoriasis covering their skin have mild disease whereas those with more than 10% (10 handprints) have severe disease. Everyone else in-between is considered moderate. Hands-down, most patients who will need systemic treatment which includes certain prescription pills or injectable medications, will have severe disease.
The presence or absence of psoriatic arthritis is the next most important criterion that we look at when determining treatment options. Not only can arthritis cause substantial symptoms, but it may also cause permanent damage and disfigurement to the joints. This is even more reason that in these cases systemic treatment may also need to be considered.
Some of the final factors that are weighed when considering treatment options are the specific areas of the body that are affected and the severity of symptoms. Surprisingly many patients with psoriasis do not have any symptoms, though some can have quite a severe itching or discomfort. As is clear-cut, the more severe the symptoms the more likely we are to select more aggressive treatment options. Involvement in certain areas of the skin may also affect our decisions. This is particularly true with involvement on the face, hands, and feet, or genital area. For various reasons, patients who have involvement in those areas may also tend to need more aggressive treatment.
Advanced Dermatology of the Midlands | Best Dermatologist Omaha & Council Bluffs, IA | Board Certified Dermatologists
If you or someone you know suffers from psoriasis, look out for our follow up a blog which will be published next week about what’s new in treatment for severe psoriasis. In the meantime, if we may be of any assistance please reach out to us to schedule a consultation with any of our dermatology providers at Advanced Dermatology of the Midlands. We all have extensive training and experience in helping patients with psoriasis. Please contact us to schedule a consultation. in any of our clinics in Omaha, Council Bluffs or the surrounding communities.
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