Medical Dermatology / Conditions
Psoriasis is an inflammatory autoimmune condition that manifests itself in the skin and joints. It affects at least 7.5 million Americans. The exact cause of psoriasis is unknown but is likely influenced by environmental and genetic factors. Approximately one third of those afflicted by psoriasis have a family member with the condition. It may appear at any age, and is found in all ethnic groups.
Plaque psoriasis is the most common type of skin manifestation. It produces patches of red, raised, scaly skin that may also be itchy or painful. Classic locations would be the elbows, knees and scalp, though nearly any area of the body may be affected. Guttate psoriasis is most common in childhood and young adulthood. It appears as scattered, scaly red dots and is known to appear after strep bacterial infections. When psoriasis appears in folds of skin in the underarms, crease of the leg, or crease of the buttock, it may have a smooth, pink appearance. This is called inverse psoriasis. Less common types of psoriasis would be pustular psoriasis, and erythrodermic psoriasis, which covers most of the body surface.
Psoriatic arthritis causes inflammation and pain in the joints. The risk of development of this form of psoriasis, in addition to the skin disease, is about 30% over an individual’s lifetime. It is important to treat this type of psoriasis as it can lead to permanent joint destruction, deformity, and disability. There is some overlap between treatments of skin psoriasis and psoriatic arthritis, though a rheumatologist will commonly be involved in the treatment of psoriatic joint disease.
Currently, there is no cure for psoriasis, but there are many effective treatment options available, with many more in development. When a relatively small area of skin is involved, the condition can often be well managed with topical corticosteroids, topical vitamin D derivatives, injected corticosteroids, or Excimer laser. With increasing surface area, it may be necessary to consider UVB light therapy or systemic treatment options such as methotrexate, acitretin, cyclosporine, Otezla, or injectable biologics. With the most recent advances in medical treatment, psoriasis therapy is becoming safer and more effective. There is no reason why any individual should be forced to suffer with this embarrassing and uncomfortable disease.
For more information about psoriasis, you may visit the National Psoriasis Foundation website.
Allergic Contact Dermatitis
Contact dermatitis is a rash that occurs after an offending chemical comes into contact with the skin. This allergic reaction is something our immune system “learns” to do. If an individual is repeatedly exposed to a chemical, their immune system may begin to recognize it as an invader. When this occurs, any future exposure to the chemical will cause the same allergic reaction to flare. Symptoms can range from mild irritation or itching, to severe red rash with blistering and weeping of the skin.
Most people are familiar with the contact dermatitis caused by poison oak or poison ivy, but there are countless other potential allergens in our environment; some common ones include fragrances, dyes, preservatives, cosmetics, soaps, latex, topical antibiotics, metals, and various plant-derived substances. It is a common misconception that only a new exposure can cause contact dermatitis, as repeated exposure is required for sensitization.
The vast majority of the time, the offending agent is not apparent simply based upon the appearance of the resulting rash. At the Center for Dermatology and Laser Surgery, we use an extended series of patch testing to evaluate an individual’s sensitization to over 70 of the most common chemicals, metals and botanicals (this is different from skin prick testing, which is performed by an allergist). We also use the Contact Allergen Management Program (CAMP), which is a valuable allergen avoidance resource for our patients. CAMP translates patch test results into an easy to navigate list of products that are free from an individual’s particular allergens. It contains product information for personal care products, household products, industrial products and more.
If you think you may be suffering from allergic contact dermatitis or want to learn more about patch testing, please schedule an appointment with one of our medical providers.
Vitiligo is an autoimmune disorder in which an individual’s immune system begins to recognize and attack the melanocytes, the pigment-producing cells in the skin. This produces light colored or completely white patches of skin in the affected areas, the most common of which would be the face, arms, hands, feet and genitals. It may be difficult to recognize this depigmentation in a light-skinned individual, but in those with darker skin, the contrast can be quite noticeable. Vitiligo is not life threatening or contagious, but it is often a source of distress for those who are afflicted by the condition.
There is no cure for vitiligo, and while it may be difficult to restore pigment to affected skin, there are several ways in which the condition may be treated. Topical and oral anti-inflammatory medications can target the immune cells responsible for the depigmentation. UVB light therapy and Excimer laser can be effective in re-pigmenting skin over time as well. Often a combination approach has the greatest chance of success. In rare cases, when there is a very large affected area of the body, and especially in light-skinned individuals, complete depigmentation with a topical lightening agent may be the treatment of choice. At any stage of the disease, it is vital to practice strict sun protection as areas of skin without pigment are extremely sensitive to sunburn, sun damage, and the development of skin cancer later in life.
To learn more about vitiligo, or to connect with others who have vitiligo, visit the American Vitiligo Foundation website.