Psoriasis Treatment Center       

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:


Plaque 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.

Guttate Psoriasis 

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.


Treating Psoriasis

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.


Topical treatments


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.


Immunosuppressants

These drugs work by suppressing the immune system. They are used to treat moderate to severe psoriasis involving large areas of the body.


Antineoplastic agents

Anticancer drugs like methotrexate are sometimes used to treat severe psoriasis and can be fatal.


Biologic Therapies 

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. 

Occlusion 

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.

Many oral medications for psoriasis have serious 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.

Dr. Gary Rothfeld: Pioneering Psoriasis Treatment at 629 Park Avenue, New York, NY"

Abstract:

Psoriasis, a chronic autoimmune skin condition, has been a formidable challenge for both patients and dermatologists. Dr. Gary Rothfeld, a distinguished board-certified dermatologist with over 35 years of experience, has emerged as a pioneer in the field of psoriasis treatment. Situated at 629 Park Avenue, New York, NY, Dr. Rothfeld's practice offers a beacon of hope for individuals seeking effective relief from this condition. This article delves into Dr. Rothfeld's groundbreaking approach to treating psoriasis, shedding light on the innovative strategies that have made him a renowned expert in the field.

Introduction:

Psoriasis is a complex skin disorder characterized by red, scaly patches on the skin, often accompanied by itching and discomfort. Its exact cause remains elusive, making treatment a challenging endeavor. Dr. Gary Rothfeld, however, has dedicated his career to unraveling the mysteries of psoriasis and developing tailored treatment plans that offer lasting relief.

The Expertise of Dr. Gary Rothfeld:

With over three decades of experience in dermatology, Dr. Rothfeld's expertise is unrivaled. He holds board certification in dermatology and has been a prominent figure in the field for years. His extensive knowledge of skin conditions and commitment to innovative solutions have earned him the trust of countless patients seeking psoriasis treatment.

Innovative Approaches to Psoriasis Treatment:

Dr. Rothfeld's approach to psoriasis treatment is multifaceted and patient-centered. He recognizes that each case is unique and requires a personalized strategy. Some of the innovative methods he employs include:

Biologics: Dr. Rothfeld is at the forefront of utilizing biologic therapies, which target the specific immune responses responsible for psoriasis. These therapies have shown remarkable success in clearing psoriasis plaques and providing long-term remission.
Phototherapy: Dr. Rothfeld's practice incorporates advanced phototherapy techniques that harness the power of ultraviolet (UV) light to manage psoriasis symptoms. Controlled UV exposure can effectively reduce inflammation and promote skin healing.
Topical Treatments: Dr. Rothfeld understands the importance of topical treatments, which are often the first line of defense against psoriasis. His customized topical regimens address the unique needs of each patient.
Patient Education: Dr. Rothfeld believes in empowering his patients with knowledge. He educates them about triggers, lifestyle modifications, and self-care techniques that can complement medical treatments.
A Patient-Centric Approach:

One of Dr. Rothfeld's defining characteristics is his commitment to patient care. He fosters an environment where patients feel heard, respected, and actively involved in their treatment decisions. This patient-centric approach has been instrumental in achieving successful outcomes.

Conclusion:

Dr. Gary Rothfeld's legacy in dermatology extends beyond his impressive career; it is a testament to his unwavering dedication to advancing psoriasis treatment. Situated at 629 Park Avenue, New York, NY, his practice continues to be a beacon of hope for those seeking relief from psoriasis. Through innovative treatments, patient-centric care, and a wealth of experience, Dr. Rothfeld is making a profound impact on the lives of psoriasis patients and reshaping the landscape of dermatological care.

For over three decades, Dr. Rothfeld's tireless commitment to enhancing the quality of life for individuals with psoriasis has made him a trusted and renowned figure in the field of dermatology. 

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