At Evans Dermatology Partners we offer a wide range of treatments for patients with psoriasis, including phototherapy and laser. Dr. Evans has a particular interest in caring for patients with psoriasis. Following his residency in dermatology at the University of Texas Southwestern, Dr. Evans further studied psoriasis at the St. Johns Institute of Dermatology in London, England. He is an active member of the National Psoriasis Foundation.
Psoriasis is a chronic, life-long, recurrent condition characterized by pink or red, scaly plaques on the body, frequently on the scalp, lower back, elbows, and knees. It can also occur on the hands and feet, which can sometimes interfere with working or normal activities. The severity of skin disease varies widely from patient to patient, some with only a few spots to others with nearly the entire body affected. Psoriasis is not contagious and its exact cause is unknown. Psoriasis can have a serious impact on a person’s life, including occupational or social difficulties as well as potential increased risk for depression or heart disease.
About 20-30% of patients with psoriasis on their skin will have associated joint pain, called psoriatic arthritis. Again, there is a wide range of severity. Patients often experience morning stiffness or stiffness in certain joints after long periods of sitting or rest. If untreated, some patients with psoriatic arthritis will go on to have permanent damage to the joints.
The cause of psoriasis is unknown although there is extensive research into its origin and treatment. There appears to be some genetic component, although only about one third of patients with psoriasis have a family member who is also affected. Psoriasis does appear to be an autoimmune disease, caused by the immune system (specifically a type of white blood cell called a T-cell) attacking the skin when it should not. This attack causes the skin to overproduce its cells leading to thickening, redness, and scaling. Trauma or injury seems to make psoriasis occur (called the Koebner phenomenon), so it is often seen at common sites of routine injury (such as hands, elbows, and knees) as well as in surgical or injury scars.
There are many treatments to consider for a patient with psoriasis. Our philosphy at Evans Dermatology Partners involves synthesizing the needs of the patient with the most effective medications and technologies to try to provide sustained and safe control of this disease. Each patient is different and his/her personal and medical history play an important role in choosing therapies best suited to each individual.
- Topical treatments - Most patients with psoriasis have tried various creams, gels, shampoos, or ointments on their skin. Common topical treatments include topical steroids, Vitamin D preparations, and tar shampoos. Older topicals treatments, such as anthralin, can also still be useful in certain situations. Although they can have side effects, topicals treatments are often safe and can be used conveniently at home. Unfortunately, they are not always effective enough for patients with moderate or severe psoriasis and sometimes the amount of time and mess associated with twice-daily application can make their continued use difficult.
- Ultraviolet light - Ultraviolet light has been used for decades in the treatment of psoriasis, including natural sunlight and artificial sources. Our office offers narrow band-UVB phototherapy. During the initial course of treatment most of our patients come for quick 5-15 minute sessions two to three times per week. Excimer laser, a higher energy version of the same type of energy as sunlight targeted directly at plaques of psoriasis.
- Tablets - Oral tablets have been used to treat psoriasis for decades. The three most commonly used are Methotrexate, Soriatane (also called acitretin), and Cyclosporin (also call Neoral or Sandimmune). All three can be quite helpful for skin psoriasis and Methotrexate can also help with psoriatic arthritis. These can all have significant internal side effects and require monitoring with blood tests and visits to the office to track the effectiveness and safety of treatment.
- Injectable medications - The newest class of psoriasis treatments, sometimes called “biologics,” are medications injected either at home by the patient or in a medical office and include Enbrel, Remicaide, Amevive, and Humira. Another medication in this class, Raptiva, was recently removed from the market and there are several new drugs in this category which may be available soon. All of these medications can be helpful for skin psoriasis and some also help with psoriatic arthritis. All can also have potential side effects and require monitoring to use appropriately.
Since there are many possible treatments for psoriasis and every patient is different, it is important to have good communication between doctor and patient to achieve the safest and most effective regimen possible. At Evans Dermatology Partners we strive to understand and help our patients as well as offering the latest technologies to aggressively treat psoriasis.
If you have psoriasis, or are concerned that you might, we encourage you to learn more by visiting the National Psoriasis Foundation and by calling our office at (512) 280-3939 for a psoriasis consultation appointment.