Psoriasis: A Highly Prevalent Yet Undertreated Condition

Psoriasis is an immune-mediated, genetic skin disease which affects 1-2% of the world’s population, 120 million worldwide and 7 million Americans. It is the result of an overactive immune system, which ultimately attacks the surface layer of the skin and leads to visible red raised, scaly plaques. Nineteen different genes are involved. It is not a contagious disease and has varying levels of severity; mild, moderate, and severe. It can also be associated with other health disorders such as obesity, heart disease, diabetes, Crohn’s disease and depression. There are certain external trigger factors associated with the disease that can cause one’s psoriasis to become active. These include stress, infections (especially strep throat in younger people), injury to the skin, and a few medications.   

Psoriasis expresses itself in different forms and occur in particular locations. One person’s psoriasis may look very different from another. Plaque psoriasis is the most common form of psoriasis and present with characteristic red thickened patches with silvery scale. Guttate (drop like lesions) psoriasis typically occur in younger individuals and are usually symmetrically located on the body and frequently associated with prior recent strep throat and respiratory infections. Inverse psoriasis occurs in body fold areas such as armpits, groin, under the breast, genitals, and buttocks and have a shiny, bright red appearance. Pustular psoriasis are small non-infectious, pus filled blisters usually occurring on the palms and soles. Erythrodermic psoriasis is a severe, inflammatory form of psoriasis, affecting the entire body. The scalp is invariably involved in 80-90% of patients and the nails in 60-70%. 

There are multiple treatment approaches dermatologists utilize in treating psoriasis. Topical agents (creams, gels, lotions, sprays, and ointments) are the first line of treatment for mild to moderate psoriasis. They include corticosteroids (most common), synthetic vitamin D3, and vitamin A. Phototherapy is available for patients with more widespread disease. Using specially constructed ultraviolet light B cubicles, Psoralen + UVA (PUVA) units, or laser machines targeting individual patches. Systemic agents are therapeutic modalities reserved for moderate to severe psoriasis patients unresponsive to topical agents and phototherapy. These oral agents include acitretin, cyclosporine, and methotrexate. Biologic treatments are a relatively new therapeutic modality that utilize a more targeted approach (ie specific components of the immune system) and as a result, have improved side effect profiles compared to systemic agents. These include Enbrel, Humira, Remicade, and Stelara. They are given by injection either by the patient themselves or in the dermatologist’s office. 

Psoriasis is currently a highly prevalent yet undertreated disease that has profound effects on a patient’s quality of life with depression not uncommon and interpersonal and work relationships invariably affected. Therefore, it is important for all physicians and patients themselves to recognize this disease and refer to dermatologists for treatment where appropriate.