Over 125 million people worldwide struggle with psoriasis. Living with this condition can be incredibly frustrating for those dealing with regular flare-ups. Although there is no cure for psoriasis, a variety of science-backed treatments and skin care solutions can help ease symptoms and prevent spreading.
Dr. Joel Schlessinger, board-certified dermatologist, Mohs surgeon and cosmetic surgeon, has been involved in clinical research on psoriasis since 1997. He has contributed to the development of nearly every new psoriasis drug available, including Otezla, Humira, Enbrel, Skyrizi, Cosentyx and many others.
He explains, “Psoriasis presents as a scaly rash on the skin, usually on the hands, knees or elbows, but it can be anywhere on the body. Sometimes it is itchy, but that isn’t always the case. It is genetically passed down and sometimes is activated as the result of an infection, cut or burn..”
“There are many treatment options available today, almost all of which were researched in my clinic prior to approval, that greatly improve symptoms and allow those with psoriasis to achieve a better quality of life,” he adds.
“I am proud that SchlessingerMD and our research arm has been involved in clinical trials of about 95% of the existing psoriasis medications. I have been published in numerous medical journals regarding this condition and the clinical trials we performed. It has been an amazing opportunity for me to contribute to the well-being of so many individuals.”
In honor of National Psoriasis Awareness Month, we’re taking a closer look at this often-misunderstood skin condition to recognize the causes, symptoms and available treatments.
What is psoriasis?
Psoriasis is a long-term, or chronic, skin disease that causes skin cells to build up resulting in itchy, scaly dry patches on the skin. This rash commonly occurs on the knees, elbows, hands or scalp. Psoriasis goes through cycles, flaring up for a few weeks or months, then subsiding for several weeks or months. Flare-ups are often brought on by triggers, which can include cuts, burns, infections, diet, allergies, stress, illnesses or certain medications. Topical and oral treatments have been proven to diminish symptoms and prevent the rash from spreading further.
What causes psoriasis?
Psoriasis is multifactorial, meaning that there are multiple causes that factor into it. At its core, though, is an overactive immune system where infection-fighting cells mistakenly attack healthy skin cells. Psoriasis results from a combination of genetic and environmental factors.
Dr. Daniel Schlessinger, board-certified dermatologist, Mohs surgeon and cosmetic surgeon, explains, “Psoriasis often runs in families, and researchers have identified genes associated with its development. These genes influence the immune system, which ‘overreacts’ to normal stresses on tissue, resulting in psoriasis.”
Environmental factors can also trigger psoriasis, and different people may have different triggers, some of which are genetically tied to psoriasis. Common triggers include gut issues like Crohn’s or colitis, infections, skin injuries like cuts, bug bites and scrapes, dry weather and certain medications. Other factors like smoking, obesity, alcohol consumption, stress and hormonal changes can also contribute to worsening or the onset of psoriasis.
Types of psoriasis
There are several types of psoriasis, each with a distinct set of signs, symptoms and treatments. Understanding what kind of psoriasis you have can help identify the best treatment.
- Plaque psoriasis: Plaque psoriasis is the most common type of psoriasis. The raised, inflamed patches of skin that occur are referred to as plaques. The plaques are composed of thick, silvery scales. They often start on the elbows or knees, belly button, shins or buttocks and are sometimes itchy.
- Nail psoriasis: Psoriatic nails can be discolored, pitted or crumbling. It can occur on the finger or toenails. Nail psoriasis and other forms of psoriasis are not contagious.
- Scalp psoriasis: Psoriasis can form on the scalp, covering it with thick, silvery scales. This type of psoriasis does not typically cause hair loss, but it can be itchy and uncomfortable.
- Inverse psoriasis: This type of psoriasis causes smooth, inflamed patches of skin in areas where the skin folds together, such as the groin, armpits or under the breasts. Unlike other types of psoriasis, the raised, red patches do not appear scaly.
- Guttate psoriasis: Guttate psoriasis primarily affects children and young adults. It’s usually triggered by a bacterial infection, such as strep throat or COVID. It creates numerous small, droplet-shaped, scaling spots on the trunk, arms or legs.
- Pustular psoriasis: This rare type of psoriasis causes tiny pus-filled blisters. It can occur in large patches on the skin or on small areas like the palms or soles.
- Erythrodermic psoriasis: This rare type of psoriasis covers 90% or more of the body’s surface area. The full-body rash resembles a burn and, in addition to being painful, can lead to chills, fever and dehydration. Erythrodermic psoriasis requires urgent medical attention.
Treatments for psoriasis
Treatments for psoriasis include topical treatments, phototherapy (which is less commonly used now) and systemic treatments such as oral or injected medications. The type of treatment depends on the type of psoriasis being treated and the severity of the symptoms.
Topical Treatments: For mild to moderate psoriasis, creams, ointments, lotions, foams or solutions are commonly prescribed. These may contain corticosteroids, vitamin D analogues, retinoids, calcineurin inhibitors or salicylic acid.
Dr. Joel Schlessinger explains, “Topical corticosteroids help by reducing inflammation, slowing skin cell production and alleviating itching. It’s important to note that potent corticosteroids should be applied only to small or thickened skin areas, as excessive use can cause skin thinning.”
He adds, “One medication that works very well and is available over-the-counter is one that my son, Dr. Daniel Schlessinger, and I developed, called FixMySkin 1% Hydrocortisone Healing Body Balm. Unlike other over-the-counter hydrocortisone treatments, it is free from irritating additives and is effective at treating a variety of skin conditions such as eczema, psoriasis, bug bites and seborrheic dermatitis.”
Phototherapy: When topical treatments are insufficient or the condition is more severe, excimer laser therapy, a type of phototherapy, may be recommended. This method involves exposing the skin to ultraviolet (UV) light. Typically, patients undergo one to three sessions per week in a light box that delivers short bursts of narrowband UVB light. Now that we have outstanding new ‘biologic’ medications such as Humira, Cosentyx and others, phototherapy is less commonly used.
Systemic Treatments: For more severe cases where other treatments have failed, systemic treatments can be prescribed. These are oral or injectable medications, including methotrexate, acitretin, cyclosporin, calcipotriol, oral retinoids, biologic drugs ranging from Cosentyx to Skyrizi to Humiras, immunosuppressants and inhibitors of phosphodiesterase 4 (PDE4) and tyrosine kinase 2 (TYK2) such as Otezla.
Dr. Joel Schlessinger adds, “At our clinic, we have performed the clinical trials for nearly every single new psoriasis drug (topical, oral, and injectable) over the last ten years. These medications are incredibly effective at controlling psoriasis by suppressing inflammation. For those with moderate to severe plaque psoriasis, these treatments often can reduce symptoms by 90-100%.”
Maintaining healthy skin
Dr. Joel Schlessinger has played a significant role in developing and testing highly effective treatments for psoriasis. At Schlessinger MD, ongoing clinical research is a priority with a dedicated clinical trials division providing access to cutting-edge treatments well before they reach the general public.
Our team at Schlessinger MD is dedicated to helping you achieve your very best skin. If you’re interested in addressing specific skin concerns, you can book a consultation with one of our providers to discuss your goals. If you’d like to speak to us directly, you can call or text us at (402) 334-7546.