Psoriasis is a common skin disorder affecting roughly one in 40 Americans. It is an “itchy flaky rash” that causes the development of raised, scaly, thickened patches of skin referred to as “plaques.” These can be seen almost anywhere on the body, but by far the most common locations are the elbows, knees, scalp, and buttocks areas. In more severe cases, the patches can cover large areas of the body. As the disorder becomes more severe, the plaques become thicker, more heavily covered with crust and scale, and more likely to crack and bleed. Involvement of the hands and feet can become so severe that walking and using the hands become extremely difficult. Similarly, scalp involvement can be difficult to manage and miserable to live with.
It is now recognized that psoriasis is fundamentally an “autoimmune” disease. This means that the cause of the disease is actually the body itself. Many diseases are now recognized as being the result of a misguided attack by the body’s immune system. Normally, the immune system protects us from infections by attacking and destroying viruses and bacteria. If, however, the system becomes confused, it can begin to attack itself. Depending on where the target of attack is, different diseases result: rheumatoid arthritis if the joints are being attacked, multiple sclerosis if the nerves are the target, Type I diabetes if the insulin-producing cells in the pancreas are destroyed. In the case of psoriasis, the target of attack is the skin, and the thickened, red areas are the result of the skin trying to heal from this continuous attack.
In milder cases, treatment of psoriasis has typically involved topical medications, which are generally very safe to use. These include topical cortisone creams as well as Vitamin A and D derivatives, tar-based products, and several others. In the past, more severe cases were managed with powerful ultraviolet light treatments or potent oral medications like methotrexate, a chemotherapy type drug that can cause liver damage.
Recent advances in our understanding of the cause of psoriasis have led to the development of new and improved treatments. Injected drugs like Enbrel and Humira have revolutionized our ability to manage the most severe cases of psoriasis. The new drugs are both more effective and significantly safer than the older options. Psoriasis continues to be a hotbed of research, with numerous new compounds in the testing phases. These advances promise a future with even better treatments for more and more psoriasis sufferers.