Hammerling-Hodgers: There may be no cure for psoriasis, but there are ways to keep it in check

Despite there being no cure, you can manage psoriasis symptoms with a doctor's help.
Despite there being no cure, you can manage psoriasis symptoms with a doctor's help.

Support local journalism. A digital subscription is incredibly affordable and makes you the most informed person around. Click here and subscribe today.

Tricia, 32, a local junior high teacher in Florida is stressed that she is going to be made fun of if her psoriasis on her arms is seen by the students.

In the past, she had people comment her skin looked gross or was asked if it was contagious. She wanted to wear a nice summer dress but is embarrassed at the scaly thick plaques.

Dave, 71, was diagnosed with high blood pressure a few weeks ago and was prescribed Atenolol, a type of Beta-blocker. After a few days, he started to break out in pink plaques on his back and scalp.

Eventually, both Tricia and Dave sought out treatment for their skin conditions and were diagnosed with psoriasis.

August is National Psoriasis Month and each year people try to learn more about this skin condition that not only affects the skin but can involve the heart and joints.

Susan's previous three columns:

According to the National Psoriasis Foundation, psoriasis is a chronic, systemic immune-mediated disease associated with inflammation throughout the body.

More than 8 million people in the U.S. and 125 million people worldwide live with psoriatic disease.

Patients with psoriasis can suffer for years from itchy, thick pink plaques on the scalp, knees, elbows and trunk.

Unfortunately, there is no cure for psoriasis but it is a treatable condition and is not contagious.

Dealing daily with cycles of flaring patches can vary with intense itching or even pain which can affect activities of daily living or sleep.

Certain triggers for psoriasis may include infections such as strep throat, trauma, smoking, heavy alcohol consumption, or certain classes of medications like B-blockers, lithium, and anti-malarial medications.  

There are a several types of presentations of psoriasis such as plaque psoriasis (most common), guttate psoriasis which can be triggered by a bacterial infection, inverse psoriasis of groin and breasts, pustular psoriasis (rare), erythrodermic psoriasis (least common) and psoriasis of the nails.

Some patients with psoriasis may experience fatigue or tenderness and swelling over tendons. The diagnosis of psoriatic arthritis involves inflammation of the joints.

It may start anytime and could affect children.

Treatment options vary depending on the severity of the psoriasis and how it affects daily activities.

If the involvement is mild, then there are several topical treatment options such as steroid creams that can’t be used for long periods of time due to skin thinning or vitamin D topicals like Dovonex, which slow skin growth.

Other creams like Tazorac or Elidel are helpful but can’t be used if pregnant or breastfeeding.

Salicylic Acid shampoos help scalp psoriasis by reducing the scaling.

Coal tar and anthralin creams can be effective but are messy and have a strong odor.

When psoriasis is more extensive and topicals are not successful in treating plaques, then natural sunlight or narrowband UVB at a dermatologist office can give relief.

At some dermatologist offices there is the excimer laser for psoriasis.

Seeking treatment with narrowband UVB or excimer laser usually involves going to the dermatologist 2-3 times per week. Most insurances cover the cost for treatment.

Otezla pills are an option if going to the dermatologist a few times a week isn’t an option due to scheduling. Some patients complain of stomach problems while taking it.

Patients turn to more aggressive treatments such as methotrexate or injectable biologics if they have severe or resistant psoriasis and joint pain.

In addition to seeking help from the dermatologist, patients may visit a rheumatologist to evaluate their joint pain.

During the height of the COVID-19 pandemic, patients became wary about starting a biologic for their psoriasis because it could lower the immune system and increase risk of infections.

There are several classes of biologics to choose from depending on their mechanism of action.

Enbrel and Humira are some of the first biologics to be on the market for psoriasis, and newer biologics are now available like Skyrizi or Cosentyx.

Make sure to discuss with your dermatologist and rheumatologist what treatment option you decide is best for you after considering various factors such as safety, side effects, cost and convenience.

If you still are confused about the various topical, oral or biologic options for psoriasis, be sure to check out the website for the National Psoriasis Foundation (https://www.psoriasis.org), which has a myriad of resources to help you be empowered with knowledge at your next appointment.

Susan Hammerling-Hodgers, a Member of the National Psoriasis Foundation, is a PA-C (Certified Physician Assistant) and MPAS (Master of Physician Assistant Studies) and works at Brevard Skin and Cancer at the Merritt Island, Titusville and Rockledge offices.

This article originally appeared on Florida Today: Psoriasis treatment has evolved greatly; here are options that can help