Thursday, March 13, 2014

Living with Psoriasis

By: Dr. James Krell with Total Skin and Beauty Dermatology Center
Psoriasis is a common chronic disease that affects almost 7.5 million Americans. It can range from mild disease (just a few spots on the scalp, elbows or knees) to severe disease covering 30-40% of the total body. It is estimated that 25% of patients with psoriasis have severe disease.

Psoriasis can start at any age, but the most common age of onset is in the mid-20s. The cause of psoriasis is unknown, but about 30% of patients have inherited it from one of their relatives. The most common type of psoriasis is plaque psoriasis, but a frequent type of psoriasis is called guttate psoriasis and occurs in young people (often under the age of 20) as a result of a strep infection.

Psoriasis is frequently associated with itching and can often affect daily life activities such as walking (especially when it is on the feet), standing or sitting for long periods of time, sleeping and even one’s sexual life.

There is also a strong association with depression, and about 30% of patients with psoriasis have a type of arthritis called psoriatic arthritis that is associated with pain and swelling of the feet, fingers, wrists and back. It is also associated with stiffness in the morning.

Recent studies have shown that psoriasis is associated with a higher risk of cardiovascular disease. This data comes from several sources, but the main source is the large database in the United Kingdom.

The cardiovascular risk is highest in patients who are young and have severe psoriasis. Nonetheless, the risk exists in all patients with psoriasis. Dermatologists continue to ask the question as to whether treating the psoriasis reduces the cardiovascular risk in those patients.

A study of 2,400 patients in Denmark published in 2012 begins to answer that question. In the study, the authors found that patients who were treated with biologic medications (Enbrel, Humira, Stelara) and Methotrexate had a lower incidence of stroke, heart attack and death.

We recommend that all patients with psoriasis have a primary care doctor who can look at their cardiovascular health on a regular basis. We suggest reducing cardiovascular risk factors when possible. In particular, we suggest weight loss and that patients not smoke.

At Total Skin & Beauty, we treat psoriasis aggressively in our practice with phototherapy, topical therapy, laser therapy, oral medications and new biologic injectable medications to get most patients’ disease under good control.

Dr. Krell is considered to be a national expert on psoriasis and has lectured extensively in the United States and internationally on this frustrating disease.

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