Expert Answers to Psoriasis Treatment FAQs


David Harvey, MD

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Psoriasis can be a difficult disease to manage; it can cause physical discomfort and affect emotional health. The good news? Psoriasis is very treatable. Dermatologist and surgeon David T. Harvey, MD, of Piedmont Healthcare, discusses the common questions he hears from his patients about treating psoriasis.

1. Q: What is plaque psoriasis?

A: I always liken the skin to a piece of cake. Plaque psoriasis is an autoimmune disorder affecting the icing on that cake, the epidermis. Essentially, there’s dysregulation in the immune system, which means your immune system is reacting to your body’s own tissues and causing inflammation. This same dysregulation induces your skin to produce skin cells faster than it can slough off, so what you’re left with is red, itchy, scaly raised areas referred to as “plaques.”

2. Q: How is psoriasis treated?

A: The treatment depends on the severity of the psoriasis. Management options include: topical corticosteroids, salicylic acid ointments, tars, vitamin D analogues, retinoids, UV light treatments, methotrexate, and biologic agents.

At present there is no cure for psoriasis, but it is a very manageable disease. My first priority is to make a patient comfortable and to help them function. I want them to be able to use their hands, to be able to run, and to not experience pain every time they shampoo their hair, etc. Psoriasis can be socially damaging, so I try to reduce the visibility of the plaques so that a patient is not so self-conscious.

3. Q: How do you determine what treatment is best for a patient?

A: First, psoriasis can be classified as mild, moderate or severe. The palm of your hand represents about 1% of your body’s total skin surface, so if the psoriasis condition is mild, there are only a few plaques and they affect less than 3% of the total body area. Moderate psoriasis means between 3 and 10% of the total body surface area is covered in psoriasis. In severe disease, more than 15 to 20% of the skin surface area is covered in plaques.

For mild cases, I initially prescribe a topical corticosteroid. If the disease recurs, I’ll add a vitamin D analogue or employ light treatments. I don’t utilize systemic medicines for mild cases because, in my opinion, it is just not worth the risk.

For more advanced cases, we similarly start with topical treatments, but I advise the patient that this won’t eliminate all of their plaques. Unlike in mild cases, I will prescribe an oral medication such as methotrexate, which helps to decrease the rapid skin cell turnover seen in this condition. In our experience, methotrexate works very well. Patients need to be closely monitored for liver and blood anomalies. For others with severe disease, I’ll prescribe biologic agents, which also work by decreasing inflammation and cell turnover. These medications also require close monitoring but they’re terrific for tougher cases.

4. Q: What lifestyle changes can patients make to improve their psoriasis symptoms?

A: Losing weight and exercising are important, because excess fat can contribute to psoriasis flare-ups. Patients should also stop smoking and watch their alcohol intake. Finally, stress reduction and skin hydration can also help combat psoriasis severity.

5. Q: What do you wish your psoriasis patients knew about treating their disease?

A: I want patients to know that psoriasis can be managed and to not get discouraged even if they flare, because most of the time we can control it. Patients also need to be compliant with their treatment. If you’re feeling better, one shouldn’t just stop a prescribed medication cold turkey. It’s that same medication that is helping to control your disease. My role in treatment is 40% and my patient’s role is 60%. Compliance is essential and so important to a successful outcome.

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.

David Harvey

David Harvey, MD, FAAD, FACMS

David Harvey, MD, FAAD, FACMS, is a dermatologist and Mohs surgeon with Piedmont Healthcare and the Dermatology Institute for Skin Cancer and Cosmetic Surgery.
View his Healthgrades profile >

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