Frequently Asked Questions About Moderate To Severe Psoriasis
Even though psoriasis affects millions of Americans, there's a lot people don't know about the condition. Between the stigma of psoriasis and the number of different treatments available, many patients might not know where to begin. Dermatologist Paul Yamauchi, MD, answers some of the most common questions he hears from psoriasis patients.
1. Q: What is moderate to severe psoriasis?
A: Psoriasis is an inflammatory skin condition characterized by red, itchy plaques on the body. I like to tell my patients psoriasis basically means their immune system is in overdrive, which creates the psoriatic lesions. There are several different levels of severity in psoriasis based on how red and thick the plaques are, which areas of the body are covered and how much of the body is covered. Think of the palm of your hand as 1% of your body’s surface. If 1 to 3 palms worth of your skin, or 1 to 3% of your body’s surface, is affected by psoriasis plaques, it’s considered mild. If 3 to 10% is affected, your psoriasis is considered moderate, and if more than 10% of your body is covered, it’s considered severe.
Your psoriasis may also be considered more severe if it’s in areas that tend to be harder to treat, like the scalp, genitals or hands and feet -- even if it’s only on 3% of your body. Finally, you can assess the severity of psoriasis based on treatment. Typically, if topical cream alone is not working to relieve your psoriasis, it’s considered more moderate or severe.
2. Q: Who is at risk for developing moderate to severe psoriasis?
A: It can affect people of every age. I’ve treated infants with psoriasis, and I’ve treated people in their 80s and 90s. However, in many patients, symptoms begin around 20 years of age, or after 50. In the US, psoriasis affects about 7.5 million Americans, or about 2% of the population. Because it’s such a visible, stigmatizing condition, patients may be too embarrassed to see a doctor about it -- especially if it’s in areas that are generally covered by clothing.
3. Q: What are the different treatment options for moderate to severe psoriasis?
A: There are four ways to treat psoriasis: topical therapy, phototherapy, oral medications and biologic agents. Topical therapy includes things like creams, gels, foams and ointments that are applied directly to psoriatic lesions to reduce the itchiness, and thickness of the plaques. Phototherapy, or light therapy, is usually used in patients with more moderate or severe psoriasis. Phototherapy uses ultraviolet light to alter certain immune system functions. The biggest drawback to phototherapy is the time commitment -- patients have to receive phototherapy three times a week at their doctor’s office, and with work or school, that’s nearly impossible.
The next line of treatment for psoriasis is oral medications like methotrexate, cyclosporine which are essentially broad-based immunosuppressants and Soriatane which is a vitamin A derivative. While effective, these agents require routine frequent blood testing because they can affect your liver and kidneys.
Lastly, there are biologic agents, which completely revolutionized the way we treat psoriasis.
4. Q: What are biologics?
A: I tell my patients that biologic agents work by normalizing your immune system and restoring it to a better balance, rather than totally suppressing your immune system. Since the introduction of biologics, we’ve seen vast improvements in patients, and the best part is there’s an extremely low rate of side effects.
Biologic agents target the specific inflammatory pathways involved with psoriasis. There are three classes of biologics: Tumor Necrosis Factor-Alpha (TNF-Alpha) inhibitors like Humira (Adalimumab), Interleukin-12/23 (IL-12/23 inhibitors) like Stelara (ustekinumab), and IL-17 inhibitors like Cosentyx (secukinumab) and the newly FDA-approved Taltz (ixekizumab). In fact, ixekizumab is the only biologic thus far to have achieved a Psoriasis Area and Severity Index (PASI) score of 100% clearance in some patients, and a large majority of patients will see at least 75% clearance of their psoriasis.
THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.
Paul Yamauchi, MD, is a clinical assistant professor in the division of dermatology at the David Geffen School of Medicine at UCLA, and has been practicing dermatology for 16 years. View his Healthgrades profile >
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