LCHM Summer 2017 - 20


Psoriasis can be controlled, but is not yet
curable. There are certain avoidable (and some
unavoidable) risk factors that may bring on a
flare of psoriasis. These include infection, stress,
certain medications, skin injury, alcohol, and
nicotine. Psoriasis may also be more severe in
people with compromised immune systems due
to infection, autoimmune disease, or medications.
It is a chronic condition that requires vigilant
patient care in order to maintain a strong skin
barrier. The skin barrier is vital to protecting
the body against bacterial and viral infections.
Treatment regimens should be tailored to the
extent of disease. For all people with psoriasis,
good moisturization routines are extremely
important. People with limited skin involvement
may benefit from moisturization with over the
counter creams alone, but even mild disease often
requires topical prescription medications. Topical
corticosteroids, which decrease inflammation in
the skin, are a common first line therapy. Topical
corticosteroids come in various potencies and
formulations including foams, solutions, gels,
lotions, creams, and ointments. Other topical
medications frequently used in the treatment of
psoriasis include coal tar products, salicylic and
lactic acid containing products, vitamin-D analog
containing products, and certain topical retinoids.
More severe disease often requires treatment
with oral agents that work to dampen the
immune system. These medications work systemically from the inside out, rather than the topicals
which work on the skin directly. Some of the
medications that have been used to treat psoriasis
for many years include methotrexate, acitretin,
cyclosporine, azathioprine, and mycophenolate
mofetil. Although they work in different ways,
they all serve to suppress the immune system to
slow down the inflammation and cell turnover
that are responsible for psoriasis.
Many new and exciting treatment options
for psoriasis have emerged over the last decade.
Their use as intervention is now being assessed
and emphasized as dermatologists and researchers
discover the larger impact that psoriasis may
have on patients and their overall health. These
treatments are great examples of using specific
targets to control disease. Research showed that
certain pro-inflammatory molecules are increased
in patients with psoriasis. This allowed for the
20 Lehigh County Health & Medicine | SUMMER 2017

invention of medications that act on these specific
molecular targets. As a group, these medications
are commonly known as biologic agents, or
biologics. New agents are being developed at a
very fast pace as our knowledge about psoriasis
increases. The more well-known medications in
the group of biologics include etanercept (Enbrel),
adalimumab (Humira), infliximab (Remicade),
ustekinumab (Stelara), secukimumab (Cosentyx),
and ixekizumab (Taltz), among others.
Although psoriasis was once regarded as
purely a skin disease, research has shown that
the inflammation of psoriasis can affect other
organ systems as well. Up to 40% of patients
with psoriasis may have associated psoriatic
arthritis, or joint inflammation, that can be
debilitating. Furthermore, there is now a
known association between psoriasis and heart
disease. There is a greater emphasis now than
ever about initiating treatment for psoriasis
early on to protect patients from disease that
involves organs other than just the skin. This is
because patients with psoriasis have an increased
incidence of lymphoma, heart disease, obesity,
type II diabetes, and metabolic syndrome.


Overall, it is important that our knowledge
about psoriasis continues to grow. Through
diligent research efforts, medications have
emerged that are very effective in the treatment
of this condition. It is also essential for people
who think they may have psoriasis to be evaluated
by a dermatologist or primary care physician to
confirm the diagnosis. This allows for important
monitoring of other organ systems that may be
affected in the setting of psoriasis. Psoriasis is a
condition that can be managed effectively. There
are many great resources for people with psoriasis,
including the National Psoriasis Foundation
which provides a community for all of those
affected by psoriasis.
Dr. Kelly Quinn is a 2nd year Dermatology
resident at Lehigh Valley Health Network. She
received her Bachelor of Science in Vertebrate
Physiology from The Pennsylvania State University,
Main Campus. She went on to her graduate studies
at Lake Erie College of Osteopathic Medicine in
Bradenton, Florida. Following medical school,
she completed a Transitional Year internship at
Lehigh Valley Hospital where she has continued
her Dermatology training.

Table of Contents for the Digital Edition of LCHM Summer 2017

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