Psoriasis is a chronic skin disease that affects more than 5 million Americans. It can occur at any age, including infancy and old age. No one knows exactly what causes psoriasis. Genetics plays a role and so does the immune system. It is believed that part of the immune system becomes overactive and this accelerates the growth cycle of skin cells. The rapid production of skin cells produces inflamed scaly skin lesions called plaques. In children, psoriasis is often triggered by a recent infection with Streptococcus. Some people may also develop arthritis, so let your dermatology provider know if you/your child develops any painful or swollen joints.
Psoriasis is not contagious.
Psoriasis is often found on the knees, elbows, scalp, hands, feet or lower back. Psoriasis can be limited to a few lesions or it can involve larger areas of skin. It affects each person differently.
There are several different forms of psoriasis:
· Plaque psoriasis: Red, scaly areas on the arms, legs, chest, back, abdomen, and scalp
· Guttate psoriasis: Small red, scaly dot-like areas, very common in children
· Pustular psoriasis: Redness and pustules
· Inverse psoriasis: Red areas in the creases of the body, such as the underarms and groin
· Erythrodermic psoriasis: Intense redness and peeling of the skin of the entire body
There is no cure for psoriasis. There are many different types of treatments that the doctor can prescribe. These include both topical medications, oral and injectable medications, and phototherapy. Often, people with psoriasis need to try different treatments before they find ones that work for them. Regular follow-up with your dermatology provider is very important.
The following treatments, which are available over-the-counter, may be helpful:
· Bath soaks with Cutar (6-10 capfuls per bath used daily as needed) can be helpful for itching and redness.
· Medicated shampoo such as:
o Salicylic acid shampoo (NeutrogenaT-Sal, DHS Sal)
o Tar shampoo (Neutrogena T-Gel, DHS Tar)
o Zinc shampoo (DHS Zinc, Head & Shoulders)
Your provider may prescribe one or several medications. Types of medications used to treat psoriasis include topical medications, phototherapy, or systemic medications. Please follow the instructions carefully! Your doctor may prescribe different medications for different parts of the body or for use on different days. If your child has had a recent infection with Streptoccus, use of an oral antibiotic may also be recommended.
- Topical medications include topical corticosteroids, topical vitamin D (calcipotriene), topical vitamin A (retinoid).
- Phototherapy may be recommended for persons with extensive psoriasis. Phototherapy is a type of ultraviolet light therapy that is given in a special booth. It is only available through a dermatologist. If appropriate, your dermatology provider may order a home phototherapy unit for you. You must limit exposure to sunlight when phototherapy is used, as you are more likely to get a sunburn.
- Excicmer laser is an office-based phototherapy procedure for persons with limited areas of psoriasis. It delivers ultraviolet light to selected areas of skin. Protection from sunlight is important if you are receiving excimer laser therapy as you are more likely to get a sunburn.
- Systemic therapy such as apremilast (Otezla), etanercept (Enbrel), adalimumab (Humira), ustekinumab (Stelara), secukinumab (Cosentyx), ixekizumab (Taltz), isotretinoin, acetretin, methotrexate, or cyclosporine may be recommended. It is extremely important that you take these medications exactly as prescribed. Periodic blood tests may be required and are very important. These medications may make you/your child more likely to get sick with an infection or to develop potentially serious side effects, so you must notify the office as well as you/your child’s primary care provider if you/your child develops a fever, appears ill, or develops new symptoms that may be medication-related.
It is very important that you keep your follow-up appointments so that your dermatology provider may evaluate the effectiveness of treatment, determine if any side effects are occurring, and make changes to the treatment as indicted.