Psoriasis, a chronic skin disease, affects all ages. Red, scaly patches on the body, scalp, elbows, knees are most common. The skin may itch and even be painful; sometimes there are no symptoms.Cause is unknown.
The cause of psoriasis is unknown, although more recent science is pointing to an autoimmune molecular mechanism for this (overactive immune system). There appears to be a complicated genetic predisposition, so it often runs in families. However, up to 40% of all cases don't have any family history.
There are many types of psoriasis: plaque psoriasis (the most common type, consisting of a few or many red scaly patches), hand/foot psoriasis, scalp psoriasis, guttate psoriasis (sudden onset of little patches all over the body), pustular psoriasis (when pustules occur in plaques of psoriasis) and severe or all over the body psoriasis, which can be debilitating and even serious. Some of these variations are discussed below.
Treatment for psoriasis can be managed with topical medications for milder cases. Light treatments, laser treatments (Xtrac) and oral or injectable drugs may be necessary for more extensive cases. Many new therapies for psoriasis have been advanced in recent years, so there is much hope for successful treatment of psoriasis, which is often called the "heartbreak" of psoriasis
Before treatment After treatment Psoriasis begins when certain areas of skin produce new skin cells much more rapidly than normal, causing a thickening and scaling of the skin.
Psoriasis crusts can be removed by gently rubbing cream into the crusts to soften them and then carefully peeling the crusted patches off. However, this should be done with great care so that the skin is not irritated
The scaly, red patches of skin caused by psoriasis affect men and women of all ages. They can erupt anywhere on the body, clear up for months at a time, and then reappear.
Although the exact causes of psoriasis are not known, the immune system is involved and heredity may play a role; at least 1 of 3 people with psoriasis has an immediate relative with the disease.
Psoriasis can be triggered by a strep throat infection, heavy alcohol consumption, stress, some medicines (such as beta blockers and lithium), injury to the skin, and infection with the human immunodeficiency virus (HIV).
There are several types of psoriasis:
This is the most common type. Patches appear on the trunk and limbs, especially on the elbows and knees, and on the scalp. Fingernails and toenails may become thick, pitted, and separated from their nail beds. inverse psoriasis. This is a plaque type of psoriasis that tends to affect skin creases. Creases in the underarm, groin, buttocks, genital areas or under the breast are particularly affected. The red patches may be moist rather than scaling. Pustular psoriasis This type is characterized by small pustules spread over the body.
This type causes many teardrop-sized patches that are more prominent on the body than on the face. It often develops after a strep throat infection or an upper respiratory tract infection. Among people with psoriasis, 1 in 7 develop psoriatic arthritis, an autoimmune disease that causes inflammation of the joints.
Psoriasis is a chronic condition for which there is no cure. However, there are many treatments available to help keep it from getting worse, or flaring up. Treatment depends on the type, its location, and how widespread it is.
These are treatments applied directly to the skin. They include:
Daily skin care with lubricants such as petroleum jelly or unscented moisturizers corticosteroid creams, lotions, and ointments rubbed onto plaques on the hands, feet, arms, legs and trunk, face, and elsewhere. Low-strength versions are available over the counter. Stronger versions are by prescription only. calcipotriol (Dovonex) slows production of skin scales tazarotene (Tazorac) is a synthetic vitamin A derivative coal tar salicylic acid can be used to remove scales Phototherapy
Extensive or widespread psoriasis may be treated with light (phototherapy). A treatment called PUVA combines ultraviolet A light treatment with an oral medication that improves the effectiveness of the light treatment.
Laser treatment also can be used. It allows treatment to be more focused so higher amounts of UV light can be used.
Vitamin A derivatives
These are used to treat moderate to severe psoriasis involving large areas of the body. These treatments are very powerful. Some have the potential to cause severe side effects and could be fatal so it is essential to understand the risks and be monitored closely.
These drugs work by suppressing the immune system. They are used to treat moderate to severe psoriasis involving large areas of the body.
Anticancer drugs like methotrexate are sometimes used to treat severe psoriasis and can be fatal.
Biologic drugs, or biologics, target specific parts of the immune system. They block the action of a specific type of immune cell called a T cell, or block proteins in the immune system, such as tumor necrosis factor-alpha (TNF-alpha) or inflammatory proteins known as interleukin-12 and interleukin-23. These cells and proteins all play a major role in developing psoriasis and psoriatic arthritis.
Biologics are given by injection or intravenous infusion. They include
etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), and golimumab (Simponi), all of which block TNF-alpha. ustekinumab (Stelara) targets interleukin-12 and interleukin-23, both of which are associated with psoriasis-related inflammation
Scalp and nail psoriasis can be difficult to treat. Treatment for the scalp often includes tar shampoos, corticosteroid solutions and injections, or zinc and selenium sulfide shampoos.
If you are taking topical or oral medications for psoriasis, you will need regular follow-up visits with Dr. Gary to check for possible side effects or skin cancer. You may take one medication for a while, then switch to another to reduce the chance that a serious side effect will occur.
The occlusion treatment method uses moisturizers or medicated creams or gels applied to the skin. After the products are applied, the skin is then wrapped with tape, material, cotton, or plastic. Occlusion keeps the area moist and can increase the effectiveness of medicated creams. Steroid ointment as opposed to cream works the best with occlusion treatment method for small areas, but not for more than a few days. Occlusion of large areas may cause side effects such as thinning of the skin.
Medication Choices Topical medications to treat psoriasis include:
Corticosteroids. Corticosteroids are the most common treatment for psoriasis. Calcipotriene, which contains vitamin D3. Retinoids, including tazarotene and acitretin.
Anthralin and tars.The use of anthralin and tars has decreased recently, replaced by other medications such as calcipotriene and tazarotene.
Zinc pyrithione. Zinc pyrithione (for example, Derma-Cap) is a new product available without a prescription that comes in spray, soap, or solution form. It is used to treat small patches of psoriasis and symptoms, including itching, redness, flaking, and scaling of the skin. It is also used to treat psoriasis of the scalp. For some people, it appears to eliminate scales and sores caused by psoriasis. Very few studies of zinc pyrithione have been completed. Oral medications to treat psoriasis include:
Retinoids. Cyclosporine. Methotrexate. Newer medicines, approved by the U.S. Food and Drug Administration (FDA) for treatment of psoriasis, are available. Biologics, which must be injected, modify the immune system response that produces the symptoms of psoriasis. Early clinical trials of biologic therapies for moderate to severe psoriasis have produced promising results, but the drugs are expensive and long-term effects are not known.
Alefacept (Amevive), efalizumab (Raptiva), and etanercept (Enbrel) have been approved by the FDA for treatment of moderate to severe psoriasis. Infliximab (Remicade), which is used to treat other inflammatory diseases such as rheumatoid arthritis, is beginning to be used for psoriasis with good results. Etanercept, infliximab, and adalimumab (Humira) have been approved to treat psoriatic arthritis.
In general, treatment for psoriasis starts with topical medications, such as corticosteroids, calcipotriene, and tazarotene. These medications may be used alone or in combination with cortisone injections.
If these medications are unsuccessful, phototherapy or psoralens plus ultraviolet A (PUVA) may be used.
If the above treatments are not successful, oral medications, such as cyclosporine, may be tried.
For severe cases of psoriasis, certain medications (such as tars, anthralin, calcipotriene, tazarotene, and psoralens) may be combined with exposure to ultraviolet (UV) light. Examples include combinations of:
Psoralen and UVA light (called PUVA). Tars and UVB light (called Goeckerman treatment). Anthralin and UVB light (called the Ingram regimen). Treatments that are known to be effective for psoriasis include calcipotriol (made from vitamin D) and PUVA. Other treatments, including tazarotene, etanercept, and UVB phototherapy, are likely to help, but research is less clear. While topical corticosteroids, the most common treatment for psoriasis, may be effective, they also may be harmful if not used carefully according to directions. The new biologic therapies have been shown to be effective in the short term, but no long-term results are available yet.
What To Think About People respond differently to psoriasis treatments. A treatment that worked once may not work again. A treatment that didn't work the first time may work when tried again later.
In my opinion we do not emphasize the importance of weight loss as part of a combination treatment approach to effectively treat both the skin condition and its related medical conditions in overweight patients with psoriasis
Psoriasis is a chronic inflammatory skin disease that develops when a person's immune system malfunctions and causes skin cells to grow too quickly. The new skin cells form in days rather than weeks and pile up on the skin's surface, causing scaly, painful lesions.
I have noticed that when some of my patients went on a low-calorie diet with their primary care physician and ended up losing significant weight they have reported improvements in both their psoriasis symptoms and their overall quality of life.
I have tried to emphasize to my patients with psoriasis and obesity how important it is to try to lose weight.
Obesity is a huge factor for patients with psoriasis. If you're obese with psoriasis, psoriasis is less likely to get clear. There are many reasons why excess weight can exacerbate a person's psoriasis. First of all psoriasis is an inflammatory disease, and obesity is a known cause of inflammation
When you are overweight it is going to affect how their body can heal because there is stress on the body and stress affects inflammation. By losing weight you are going to reduce the burden on their body.
Another possibility is that obesity may cause immune system responses that are very similar to those prompted by psoriasis.
On a logical approach, when you are overweight the excess skin causes skin friction as parts of the body rub against each other. When the skin rubs against skin, psoriasis exacerbates. The bottom line is friction makes psoriasis get worse.
Manyoral medicationsfor psoriasis haveserious side effects, such as liver and kidney damage or cancer. Be sure that the treatment you choose does not have side effects that are more dangerous than the condition you are treating.
You and your doctor will need to discuss how long to use treatments that have serious potential side effects. You will also need to see your doctor frequently and may have blood tests regularly while using some medications.
Many medications used to treat psoriasis are not safe during pregnancy. If you are pregnant, talk to your doctor before taking any medications.
I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. My goal is, quite simply, to provide the type of dermatologic care which I would seek for my own family. This is a very important point, since physicians often use the phrase "Doctor's Doctor" to refer to those individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their hair and skin-care concerns and offer a variety of options including a treatment plan that I believe will give them the best results
Dr Gary sees every patient himself and believes in personalized care. The Doctor does not employ any physician assistants, nurse practitioners, or other physician substitutes to do his treatment. He sees every patient himself at every visit.
It is vital to undergo a full pre assessment to ensure that your skin type is fully assessed and to be accurate about your medical history. This particular procedure might not be the right treatment for you. It is crucial that the Doctor does a full History and Physical Examination and listens to your concerns. It very important to understand the individual needs of each patient because one procedure could work on one patient and then not another.
Each patient’s condition is carefully evaluated and the best treatment(s) are chosen to ensure an optimal outcome. Treatments are performed by Dr. Gary who has extensive dermatology and cosmetic dermatology experience and training. This allows the Doctor to offer top-quality services in every area of dermatology and the cosmetic dermatology field, while ensuring patients safety and satisfaction.
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Dr. Rothfeld, recognized by the by the entertainment industry of America as one of the best dermatologists in Manhattan, has organized a comprehensive skin care center offering personalized state of the art services including medical,pediatric, and cosmetic dermatology.
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