Orit Markowitz, MD, a board-certified dermatologist from New York City, has been treating psoriasis patients for over 17 years. The biggest misconception among patients who pass through her office is that psoriasis is nothing more than a skin problem, she said. “People think that the only thing they need to worry about is their skin, and that if it doesn’t bother them that much, then they’d rather just deal with it than treat it,” she says.
Instead of going to a dermatologist for help, she saw people trying to cope with their psoriasis on their own, trying to scrape off or pumice the typical thickened red scales. This not only worsens the condition of the vulnerable psoriatic skin, but also completely ignores the root cause of the problem. “Psoriasis is a chronic condition that affects your immune system, and as with any chronic condition, you will always need a comprehensive 360-degree treatment,” says Dr. Markowitz.
Over the past few years, advances in psoriasis treatment technologies have greatly simplified the search for such treatments. Read on for the ones Dr. Markowitz recommends.
What is psoriasis?
Before diving into the most effective treatments for psoriasis, it’s important to first understand what it really is. Psoriasis is an overgrowth of the top layer of skin cells in the epidermis caused by an overactive immune system. Textbook examples are usually denoted by a demarcation rash with silvery scales. Elbows, knees, buttocks, scalp, and nails are most commonly affected and can vary in severity.
However, the more severe your psoriasis is, the more it can affect other systems in your body, so it’s important to think of it as more than “just a skin problem,” says Dr. Markowitz. “If it affects more than 10 percent of your body surface, it can cause heart disease, heart attacks and permanent joint damage,” she says. “The reality is that if you have it, it becomes a part of you, but treatment can help you keep it in check and manage.”
What treatments for psoriasis really work?
Historically, treatments for psoriasis have ranged from “ineffective” to “dangerous” (think: intense phototherapy and excessive exfoliation). However, thanks to new technological innovations, dermatologists agree that now is a good time for people with psoriasis because therapies are becoming more and more advanced. “The more innovation we have and the more technology we have, the better these holistic therapies become,” says Dr. Markowitz. “But not all patients have the same genetic markers for psoriasis, so while the treatment needs to be 360, it also needs to be tailored and individualized.”
If you are dealing with psoriasis (especially if it is severe), you is always want to work with a board-certified dermatologist to figure out the best course of action. Although psoriasis is incurable, are procedures that she believes are particularly effective when used under the guidance of a professional.
“In terms of prescriptions, there are many drugs and different formulations that are phenomenal for psoriasis,” says Dr. Markowitz. “When it gets a little more aggressive or starts to affect more systemic things like our heart and joints, there are a lot of systemic drugs that reduce the inflammatory response.”
These include biologics that use antibodies to suppress the immune system in the psoriatic pathway, but do not affect the rest of the body, so the side effects are minimal. They work by stopping the part of the immune system that is responsible for the proliferation of skin cells and allowing the rest of the immune system to function properly. They are prescribed by a doctor but are administered at home (usually four times a year).
“With new drugs for severe cases of any inflammatory disease – especially an inflammatory disease such as psoriasis – it all depends on which parts of the pathway you block and where you can block your body’s response to reduce disease and any unwanted systemic side effects.” says Dr. Markowitz. “These new drugs work farther and farther down this path, and the further along the path they work, the more specific the response and fewer side effects you will get.”
2. Light therapy.
Unlike the dangerous PUVA therapies (incredibly intense phototherapy methods that are now classified as hazardous in the dermis) that were used in the past, doctors now prescribe what is called narrow band UVB therapy. “It’s a completely different spectrum of ultraviolet light that is much less harmful,” says Dr. Markowitz. A 2011 study found that this type of light therapy helps suppress part of the immune pathway that leads to overgrowth of the skin, and other studies have shown that it does not come with the same risk of skin cancer as previous UV treatments.
3. Trending topics
Dr. Markowitz notes that if you have mild psoriasis, there are certain over-the-counter topical treatments that can help make your life more comfortable. “The mild oatmeal washes have been helpful, and the coal tar shampoo can definitely help relieve psoriasis,” she says. “There are also some alternative anti-inflammatories, such as safflower oil, tea tree oil, and certain cannabis formulations that may be helpful as well.” However, since these ingredients only target leather element of psoriasis, it is still important to consult a doctor such as a dermatologist, rheumatologist or autoimmune specialist to make sure nothing more serious is happening below the surface.
4. Changes in lifestyle.
Regardless of which treatment plan your dermatologist prescribes, maintaining a healthy lifestyle is one of the most important things you can do to control your psoriasis symptoms. Although lifestyle habits are not cause psoriasis (if you are genetically predisposed, it will manifest on its own), things like binge drinking, smoking, and weight fluctuations are known to trigger flare-ups.
“If my patients, who have cured psoriasis, have an exacerbation of the disease, I first ask them the following questions:“ Are you experiencing increased stress? Have you recently eaten less healthy foods than usual? and the answer will always be yes, ”says Dr. Markowitz. “Reducing stress and living a healthy lifestyle can help you cope with any chronic disease, including psoriasis, so in the long run you will see the benefits of living a healthy lifestyle.”
What is the future of psoriasis treatment?
As therapies continue to improve, there are more innovations that are exciting. Dr. Markowitz is currently working on a study that uses non-invasive imaging to explore the nuances of changes that psoriasis medications cause very early in the process. This process will not only help dermatologists predict when and to what extent psoriasis will go away with a given treatment plan, but it will also make it easier to determine when a treatment is not working so that treatment can be changed.
“These are all really innovative ways to fight the disease,” says Dr. Markowitz. “We now have topical, oral and injectable drugs that we didn’t have before, and [treatment] really can be adapted exactly to what the patient needs. “
To learn more about psoriasis (and what the dermis says about treating it), watch the video below.
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