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McFarland Clinic dermatologist, Dr. Stuart Kolner, discusses the medical condition psoriasis,
along with treatment options offered at McFarland Clinic to manage this condition. Psoriasis
is a multi-system inflammatory disease. When I was in training, we thought it a skin disease,
but we have come to learn that it is really due to an overactive immune system, cells
in particular called T-helper cells. These are in the skin but in other organs, and in
psoriasis, these cells are activated inappropriately. They begin to churn out chemicals that cause
inflammation, and ordinarily, this process is done in response to some infecting organism
but there's no infecting organism. So, in psoriasis, it's an inappropriate activation
of a natural immune system function that results in inflammation. It affects the skin most
prominently, but about one in ten psoriasis patients also have a very significant arthritis
that can destroy their joints and so forth. So, it can be quite a significant illness
from that point of view. What we see most often in psoriasis is, it's called a plaque.
It's a region of skin that's red and elevated and covered with a silvery type of scale.
Patients with psoriatic arthritis also have inflammation of joints, so this often occurs
in the hands. The joints can be swollen and reddened, and that can be characteristic too.
To treat psoriasis, what we call a therapeutic ladder, which means there are rungs, and the
lower rungs are simpler, safer things. And as you climb the ladder, it gets more costly
or more risky. The simplest approach is topical treatments with medicated creams, ointments,
and that sort of thing, and I would say at least 60% of psoriasis patients can be adequately
treated with that. Next, there's phototherapy, ultraviolet light therapy. We can deliver
this in our clinic, and in selective cases, the patient can acquire a home phototherapy
unit if they live a distance away and so forth. Ultraviolet light, certain wavelengths, particularly
what we call ultraviolet type B, can help clear the psoriasis cells from the skin. Next
are pills, and there's three main pills that can be used to treat psoriasis. These are
all fraught with difficulties. They have associated organ toxicities. For instance, one is toxic
to kidneys, one to the liver, and so they need to be used very carefully with blood
testing and so forth, but they can be effective. The last thing is one of the more, the newer
and more exciting areas, is called biologic therapy. These involve injectable medications
that are extremely effective, but also extremely costly. These cost on the order of $20,000
a year to use, and so even with insurance participation, there's often a copay that
can make them cost-prohibitive. The best approach to managing psoriasis is a comprehensive approach.
Skin needs to be hydrated well. Psoriasis tends to flare if skin dries out. Using the
medications that we prescribe regularly and according to the instructions is also important.
It's not letting the psoriasis get out of hand or flare up to the point where it's difficult
to control. Those are important. We try to keep it controlled at a low level of activity.
For more information about psoriasis and the McFarland Clinic Dermatology department, go
online to mcfarlandclinic.com, or call (515) 239-4492.