Psoriasis is a chronic inflammatory disorder of the skin, causing lesions called “plaques” to form in certain areas.  These plaques are red, raised areas with scaling and flaking and they are most commonly found on the scalp, elbows, knees, and lower back.  Some cases are very mild and only affect small areas of the body, but other cases are quite severe with widespread plaques, itching, flaking and discomfort.  Presently there is no cure for this disease, but in the last ten years new treatments have emerged that make it significantly more manageable.

Psoriasis – An Autoimmune Disease

Both psoriasis and psoriatic arthritis are autoimmune diseases, just like lupus and rheumatoid arthritis.  Typically your immune system protects you from illness, infection and injury by responding to certain triggers.  In patients with normal immune systems, this response is adequate for the defense that is required and once the “invader” is controlled, the immune response subsides and waits for the next attack.   However, with diseases like psoriasis the immune system is hyperactive and mounts a defensive response even when one is not required.  This leads to inflammation, swelling, and pain in the skin, joints, and other areas.

It is not well understood why some people develop this disease, while others do not.  Research is currently underway to identify substances in the body that the immune system mistakes foreign antigen, triggering this inappropriate and excessive immune response.  Tremendous progress in the understanding of psoriasis has been made, and new therapies are emerging all the time.

Psoriasis – The Role of Inflammation

Inflammation is a by-product or result of many immune system responses.  For example, if you get the flu, a type of immune cell known as a “T cell” responds to this virus and launches an inflammatory attack on the virus.  This attack is carried out with cytokines, which are proteins that modulate the immune system inflammatory response.  These cytokines cause the blood vessels to dilate and send more immune cells to different areas of the body.  In psoriasis, these cytokines cause the red, itchy and scaly plaques to form on the skin.  In psoriatic arthritis the inflammation occurs in the joints, leading to swelling and pain.

Treatments / What to Expect at Paladin

Historically, psoriasis treatments have been a variety of creams, ointments, lotions, and shampoos with the goal of reducing inflammation, hydrating the skin, and regulating cell turnover.  There are also oral medications such as methotrexate and cyclosporine that are used in psoriasis and other autoimmune diseases to modify the immune system and reduce inflammation.

Contemporary treatments for psoriasis and psoriatic arthritis specifically modify certain elements of the immune system response, thereby decreasing inflammation and associated symptoms.  Newer medications known as “biologics” target certain cell types and their cytokines to block their effects elsewhere in the body.   These medications are given by injection or IV infusion, and block the action of T cells and cytokines, such as tumor necrosis factor-alpha (TNF-a), interleukin 17-A, or Interleukins 12 and 12.  These cells and cytokines all play major roles in developing psoriasis and psoriatic arthritis.

At Paladin Dermatology we take a very personalized, individual approach to evaluating and treating psoriasis.   We utilize all forms of treatment from topical therapies to the newest biologic agents.  Our Provider Team includes nationally recognized psoriasis experts who travel the Nation to teach other dermatologist about the newest advances in treating psoriasis and psoriatic arthritis.

At your initial office visit, we will perform a full examination of your skin to determine the location of your psoriasis, the amount of skin involved, and overall severity of disease.  We will take a detailed medical history and will ask you several questions about your previous treatments and other medical problems so we can select a form of therapy that will be safe, effective and convenient.

Please understand that the evaluation of psoriasis is a lengthy process and will likely require blood tests and regular follow-up exams.  Most medications will require some type of prior authorization process by your insurance, which we will submit on your behalf.  We will also guide you through every step of the process, including benefits investigation, specialty pharmacy distribution, and injection training.

If you, a friend, or a family member has been suffering from “the heart break of psoriasis”, please call us today at 804-324-4511 to schedule a consultation.

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