Psoriasis

  • Psoriasis is a chronic inflammatory disease of the immune system. It mostly affects the skin and joints, but it also may affect the fingernails, the toenails, the soft tissues of the genitals and the inside of the mouth.
  • Psoriasis and psoriatic arthritis can be associated with other diseases and conditions, including diabetes, cardiovascular disease and depression.1
  • See your dermatologist for the successful diagnosis and treatment of psoriasis.

Psoriasis Facts

  • Psoriasis is a serious medical condition.
  • Approximately 7.5 million people in the United States have psoriasis.1
  • Psoriasis occurs in all age groups but is primarily seen in adults. Up to 40 percent of people with psoriasis experience joint inflammation that produces symptoms of arthritis. This condition is called psoriatic arthritis. Psoriatic arthritis patients also experience other arthritis symptoms.2-4
  • Psoriasis usually occurs on the scalp, knees, elbows, hands and feet. Approximately 80 percent of those affected with psoriasis have mild to moderate disease, while 20 percent have moderate to severe psoriasis affecting more than 5 percent of the body surface area.1
  • The most common form of psoriasis, affecting about 80 to 90 percent of psoriasis patients, is plaque psoriasis. It is characterized by patches of raised, reddish skin covered with silvery-white scale.1
  • There are other forms of psoriasis, including inverse, erythrodermic, pustular, guttate and nail disease.1 In 2013, the total direct cost of treatment associated with psoriasis was estimated to be between $51.7 billion and $63.2 billion.5

Comorbidities Associated With Psoriasis

  • The incidence of Crohn’s disease and ulcerative colitis, two types of inflammatory bowel disease, is 3.8 to 7.5 times greater in psoriasis patients than in the general population.6
  • Patients with psoriasis also have an increased incidence of lymphoma,7-8 heart disease,9-10 obesity,11-12 type II diabetes13 and metabolic syndrome.14 Depression and suicide,15 smoking,16 and alcohol consumption17 are also more common in psoriasis patients.
  • Psoriasis can have a substantial psychological and emotional impact on patients.
  • The prevalence of depression in patients with psoriasis may be as high as 50 percent. Studies have shown that psoriasis patients experience physical and mental disability just like patients with other chronic illnesses such as cancer, arthritis, hypertension, heart disease and diabetes.18

 Treatment Options for Psoriasis

Topical treatments are helpful for mild to moderate psoriasis but do not tend to be effective for treating moderate to severe psoriasis.

Topical treatments include anthralin, coal tar, emollients, salicylic acid, tazarotene, topical corticosteroids and forms of vitamin D. These topical medications can sometimes be used together with other medications.19

Topical corticosteroids are available in many strengths and formulations.21

Psoriasis patients with moderate to severe psoriasis can be treated with traditional systemics, phototherapy or biologic agents.

In cases of more extensive psoriasis, topical agents may be used in combination with phototherapy, or traditional systemic or biologic medications.20

Phototherapy treatment includes narrowband and broadbandultraviolet B (UVB) and psoralen plus UVA (PUVA).21

Traditional systemic treatments (taken orally, or by injection or infusion) include acitretin, cyclosporine and methotrexate.20

Since biologic therapies target the immune system, it is important to prevent infections during therapy. Patients need to be monitored and evaluated periodically.22

A board-certified dermatologist can evaluate your treatment options, including new and emerging therapies, and help you determine which treatment is best for you.

 

For more information on psoriasis, visit aad.org.

 

1. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008 May;58(5):826-50.

2. National Institutes of Health /NIAMS http://www.niams.nih.gov/Health_Info/Psoriasis/default.asp (last accessed June 1, 2013).

3. National Psoriasis Foundation - http://www.psoriasis.org/about/ (last accessed June 1, 2013).

4. Gottlieb A, Korman NJ, Gordon KB, Feldman SR et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol 2008 May;58(5):851-64

5. Brezinski EA, Dhillon JS, Armstrong AW. Economic Burden of Psoriasis in the United States: A Systematic Review. JAMA Dermatol 2015; Published online January 07, 2015. doi:10.1001/jamadermatol.2014.3593.

6. Najarian DJ, Gottlieb AB. Connections between psoriasis and Crohn’s disease. Journal of the American Academy of Dermatology 2003; 48: 805-21; quiz 22-4.

7. Gelfand JM, Shin DB, Neimann AL, Wang X, Margolis DJ , Troxel AB. The risk of lymphoma in patients with psoriasis. J Invest Dermatol 2006;126:2194-201.

8. Gelfand JM, Berlin J, Van Voorhees A, Margolis DJ. Lymphoma rates are low but increased in patients with psoriasis: results from a population-based cohort study in the United Kingdom. Arch Dermatol 2003;139:1425-9.

9. Gelfand JM, Neimann AL, Shin DB et al. Risk of myocardial infarction in patients with psoriasis. JAMA 2006; 296: 1735-41

10. Neimann AL, Shin DB, Wang X et al. Prevalence of cardiovascular risk factors in patients with psoriasis. Journal of the American Academy of Dermatology 2006; 55: 829-35

11. Setty AR, Curhan G , Choi HK. Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses’ Health Study II. Arch Intern Med 2007;167:1670-5.

12. Sterry W, Strober BE , Menter A. Obesity in psoriasis: the metabolic, clinical and therapeutic implications. Report of an interdisciplinary conference and review. Br J Dermatol 2007;157:649-55.

13. Qureshi AA, Choi HK, Setty AR , Curhan GC. Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses. Arch Dermatol 2009;145:379-82.

14. Gisondi P, Tessari G, Conti A et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study. The British Journal of Dermatology 2007; 157: 68-73.

15. Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol 2010;146:891-5.

16. Herron MD, Hinckley M, Hoffman MS, Papenfuss J, Hansen CB, Callis KP et al. Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol 2005;141:1527-34.

17. Poikolainen K, Reunala T, Karvonen J, Lauharanta J , Karkkainen P. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ 1990;300:780-3

18. Rapp SR, Feldman SR, Exum ML et al. Psoriasis causes as much disability as other major medical diseases. Journal of the American Academy of Dermatology 1999; 41: 401-7.

19. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 3. Guidelines of care for the treatment of psoriasis with topical therapies. J Am Acad Dermatol 2009 April; 60(4): 643-659

20. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol 2009;61:451-85.

21. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol 2010;62:114-35.

22. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Leonardi CL, Lim HW, Van Voorhees AS, Beutner KR, Ryan C, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis Section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: Case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011 Jul;65(1):137-74