Autoimmune Attack

Psoriasis occurs when your immune system, which normally fights disease, goes into overdrive. Instead of protecting the body, it launches an inflammatory attack against it, causing your skin cells to reproduce too rapidly. The out-of-control skin cells “stack up,” creating patches, lesions or bumps. In healthy skin, cells replace themselves every month; with psoriasis, they reproduce every three to five days.

Doctors don’t know exactly what activates this backwards immune response, but according to Foy Cox, M.D., a dermatologist with Sutter Health Advanced Dermatology and Laser Center in Yuba City, “it’s clear that there’s a genetic factor.”

“Psoriasis tends to run in families,” Dr. Cox explains. In addition, “environmental events can trigger it. For instance, you might have a strep infection and an immune response to that bacteria sparks the disease,” he says. “Stress also brings it on.”

According to the American Academy of Dermatology, 4.5 million Americans suffer from psoriasis. It affects men and women equally and occurs in all races, most commonly Caucasians. Although you can get psoriasis at any age, first onset often occurs between 15 and 35 years of age. It is not contagious.

Unpredictable, Varied and Serious

Psoriasis bouts show little pattern over a lifetime. “It waxes and wanes,” Dr. Cox says. “You could have symptoms forever, or they could come and go on their own. You could get treated until symptoms are gone, but then they flare up again.” Physical and emotional stress often cause recurrences.

Two types of psoriasis—pustular and erythrodermic psoriasis—are particularly difficult to manage. Pustular psoriasis shows up as reddish skin with pus-filled bumps, usually on the palms of the hands and soles of the feet.

Erythrodermic is the rarest, but also the most dangerous, form of psoriasis. It turns large areas of the skin bright red, like burns. In addition, “you can’t control your body temperature, which can lead to shivering,” Dr. Cox says. “You shed large amounts of skin and suffer fluid and protein loss, which can lead to severe illness.” Left untreated, this kind of psoriasis may become fatal.

Up to 40 percent of people with psoriasis also develop painful psoriatic arthritis when the inflammation moves into the joints.

Treatment Choices

Even though psoriasis has no cure, there are options to treat and control it. Talk with your doctor to develop a plan that works for you.

If you have mild to moderate psoriasis, you may get relief from topical creams and ointments that incorporate healing ingredients such as coal tar, anthralin, tazarotene, corticosteroids and salicylic acid.

Also investigate phototherapy, or light therapy; exposure to UV rays from a light panel sometimes alleviates psoriasis symptoms. Pursue this treatment only under a doctor’s care, however, and not by visiting a tanning booth, which can further damage your skin and lead to cancer.

If you have more severe psoriasis, oral medications such as methotrexate, acitretin and cyclosporine may slow the immune system response. However, these drugs can have serious side effects, so consult your physician.

Promising New Options

Because of medications’ downsides, some doctors now recommend biologics, also known as immunotherapy. These targeted agents block your immune system response earlier in its pathway, so treatment doesn’t inadvertently affect as many other parts of the body. That means better results with fewer side effects.

In the recent past, biologics had to be administered with a shot and needed close monitoring because they impacted the entire immune system. Today, newer oral immunotherapy medications don’t require as much observation. These new drugs tend to be expensive, but with growing interest in biologics, Dr. Cox believes less pricey versions may be available before 2020.

In fact, the future looks bright for beating this common and painful disease. “Psoriasis remains a highly active area of genetic research and drug development,” Dr. Cox says, “so additional medications will be available in coming years. Don’t feel hopeless; seek treatment.”