Psoriasis
Psoriasis is a chronic inflammatory condition that can affect the skin and joints. In the skin, psoriasis produces red, scaly lesions. These lesions usually appear the elbows, knees, and scalp, but can appear anywhere on the body. The disease is chronic, meaning that symptoms often come and go over time. This is the most common form of psoriasis.
Less common forms of psoriasis affect the palms, soles of the feet, armpits, groin, fingernails, and toenails. Some rare types of psoriasis are:
- Pustular psoriasis produces small bumps filled with yellow material form on the palms and soles or over the entire skin surface.
- Guttate psoriasis causes small, drop-like red lesions with scale to form over large parts of the skin surface.
- Erythrodermic psoriasis is when the entire surface of your skin becomes red and scaly.
- Psoriatic arthritis is a form of arthritis caused by psoriasis. It mainly affects the joints of the hands, but can affect other joints as well. About 30 percent of people with psoriasis of the skin also have psoriatic arthritis.
Psoriasis is caused by a combination of genetic and environmental factors. Even if none of your relatives has the disease, you may carry genes that leave you at risk to develop it. You can also get psoriasis because of an infection (such as strep throat), certain medications (such as lithium, antimalarial drugs, interferons, and beta-blockers), and abruptly stopping use of steroids. You can also develop psoriasis when your skin is irritated or traumatized. We call this the Koebner phenomenon.
Psoriasis increases your risk of developing heart disease, diabetes, insulin resistance, obesity, metabolic syndrome, depression, and alcoholism. We usually diagnose psoriasis by physical exam and medical history. We might also do a skin biopsy to determine the exact type of psoriasis you have.
Treatments We Offer
There is no cure for psoriasis. However, we can treat its symptoms. If you have a mild case, we can often treat you with topical therapy. Topical treatments include corticosteroids, vitamin D analogues, anthralin, retinoids, calcineurin inhibitors, salicylic acid, coal tar, and moisturizers.
We can also use intralesional injections of steroids and Excimer laser, a type of light therapy that treats only the involved skin, not the surrounding areas.
For more extensive disease, treatment options include ultraviolet light phototherapy or systemic medications. Ultraviolet light therapy uses broadband or narrow-band ultraviolet light B (UVB), or psoralen and ultraviolet light A (PUVA). We can use this approach by itself or in combination with topical or systemic medications.
Oral medications for psoriasis include acitretin (Soriatane®), methotrexate, cyclosporine, and apremilast (Otezla®). There are other medications in development.
Injectable medications, also known as biologics, can be very effective. These include adalimumab (Humira®), etanercept (Enbrel®), golimumab (Simponi®), infliximab (Remicade®), ustekinumab (Stelara®), secukinumab (Cosentyx®), ixekizumab (Taltz®), brodalumab (Siliq®), guselkumab (Tremfya®), and tildrakizumab (Ilumya®). We can administer these medications in our office, or you can use them at home. There are also a number of new injectable drugs currently in development.
Why Mount Sinai?
At the Mount Sinai Health System, we offer advanced psoriasis treatments. Our faculty members have developed many of the national treatment guidelines for topical and systemic psoriasis therapies. We continue to research new treatments, which means our patients have access to many drugs that are still being studied.
In addition, we offer every form of ultraviolet light therapy including narrow-band UVB, broadband UVB, PUVA, and bath PUVA. We also provide excimer laser, which treats specific body sites such as the scalp, hands, and feet. For severe, psoriasis we offer psychodermatology services with psychologists who have expertise in psoriasis.