What is Psoriasis, and Do I Need A Dermatologist?

Winter is here — bringing with it cold, dry air that may affect our skin. Not only is the outside air cold and dry, but the atmosphere is also dry inside your workplace and home. As a result, many people experience itchy skin as the days get shorter and the air becomes colder and dryer.

It’s not uncommon for people to develop a rash in the winter. So how do you tell if your rash is a simple winter rash from dry skin or if it’s eczema or psoriasis?

What is Psoriasis?

Psoriasis is an inflammatory skin condition; however, psoriasis isn’t just a skin problem. Psoriasis is a chronic, immune driven skin disease that affects the skin, joints and other organ systems.

Psoriasis can begin during childhood, but that’s relatively uncommon. Usually, psoriasis develops in people during their twenties. Some of the most common areas affected are the elbows, knees and scalp.

How Does the Condition Look?

• Signs/symptoms. 
  • The most common symptom is red skin plaques covered by silver scales. You might also have thick, ridged, or pitted fingernails or experience joint pain.
• How is it different from eczema? 
  • Eczema is characterized by leathery, scaly patches of skin that are crusty or oozing, while psoriasis usually has silver-covered red plaques.
• Diagnosis. 
  • Your doctor will ask about your symptoms, perform a physical exam, and may take a sample of your skin to biopsy.

What are the Different Types of Psoriasis?

Types of psoriasis include plaque psoriasis, scalp psoriasis, nail psoriasis, psoriatic arthritis, and palmoplantar psoriasis. Plaque psoriasis presents with well-defined pink plaques with silvery scale on the elbows, knees, scalp or anywhere on the body. You might also develop inverse psoriasis in your armpits, beneath your breasts, or in your groin. This type of psoriasis is usually a bright pink color without scale.

Psoriatic arthritis is another type of psoriasis with joint pain, inflammation, and skin plaques.

Are there more serious types? 

Dr. Carl Barrick explains, “There is one called erythrodermic, which is head to toe, covering most of their body. So, 80% is the definition. If 80% or more of their body is covered, they can get sick. Sometimes they have to be hospitalized because when your skin barrier is not intact, you’re losing a lot of fluids, and you may need to be hospitalized. That’s the most serious one, for sure.”

Are care and treatment different for the different types of psoriasis? 

Mild cases of psoriasis are usually treated with topical ointments, either steroidal or Vitamin D analogs. Patients with more severe psoriasis may benefit from oral medications such as methotrexate, Otezla or other immunosuppressants. In addition, biologics help regulate the immune system and help patients with severe psoriasis or patients who haven’t responded to other treatments.

How Does Someone Develop Psoriasis?

People develop psoriasis because their immune system doesn’t function properly and causes inflammation in the body. As a result, the immune system becomes overactive and causes our body to produce new skin cells too quickly. Typically, our skin cells grow and shed every 30 days, but new cells are created with psoriasis every 3 or 4 days.

• Can you “catch” it? 

No — psoriasis is not contagious, and touching someone who has psoriasis won’t cause you to get it.

• Is it hereditary? 

Psoriasis sometimes runs in families. But not everyone in a family will develop psoriasis.

• Does your environment have any impact or cause psoriasis? 

Certain things may “trigger” a flare: cold weather, stress, sunburn, strep throat, or even some foods.

Psoriasis can’t be prevented. However, dermatologists suggest that patients keep a diary of things that trigger a flare to help them avoid or lessen the severity of a flare.

How is Psoriasis Diagnosed and Treated?

Psoriasis is diagnosed with a complete medical history and a physical exam. The location of plaques on your body helps dermatologists diagnose psoriasis. The appearance — thickening of skin cells and white/silvery plaques — also leads to the diagnosis.

Dr. Elise Craig clarifies, “There’s a couple of different skin conditions that can cause ‘erythroderma,’ full-body redness… frequently we need to use a biopsy to determine exactly which skin condition is causing a full-body rash.”

What medications or treatments are needed? 

Topical treatments, ointments applied to the skin are effective for some patients. But if a patient doesn’t respond, oral anti-inflammatory medications can be very effective. In addition, some types of psoriasis may require injections of biologic medicines, which work well for certain patients. Unfortunately, psoriasis is a chronic condition that patients can control with medication and avoid behaviors and situations that cause flares.

Dr. Craig explains how the biologic medications work, “Biologics are injectable medicines that regulate your immune system. They don’t suppress your immune system, but they regulate, and they modulate your immune system to the point where this regulation that we talked about in your skin cells is being corrected, or it’s being reversed a little bit. So it’s good because we can almost clear people at this point, whereas before, we haven’t been able to before these medicines became available.”

Why is it important to be treated right away? 

Psoriasis isn’t just a simple skin rash. It’s an autoimmune disease that can potentially affect other body parts. Psoriasis most often can affect the joints — sometimes reasonably quickly. Left untreated, the joint damage caused by psoriasis could cause some patients to lose the use of a hand or the ability to walk. If psoriasis affects the armpits or areas under the breast, those areas could crack, become infected, and become very painful. Psoriasis is also associated with obesity, so a patient needs to be aware that their dietary habits might contribute to their psoriasis flares.

Can I Take Care of Psoriasis Myself, or Should I See a Professional?

Patients sometimes come to our office and tell us that they’ve tried to treat their scaly scalp or the plaques on their elbow or knees with OTC (over-the-counter) remedies. But these OTC ointments, creams, and shampoos don’t address the cause of psoriasis. Their skin problems are caused by their immune system, which can’t be fixed at home. In addition, some of those at-home remedies might make their skin condition worse.

Some patients seek help from their family doctor, but most primary care physicians refer people with psoriasis to a dermatologist.

Contact Dermatology, Surgery and Cosmetics of NE Ohio Today!

Dermatologic Surgery Center of Northeast Ohio has locations in Medina and Canton. Call us today at 330-239-4350 to treat psoriasis or any other skin problem. You can also contact us via our website to schedule an appointment.