What is psoriasis?

Psoriasis is one of the most common skin conditions. It’s a chronic disorder that causes skin cells to grow more quickly and build up on the surface of the skin. These extra skin cells create thick, shiny scales and itchy, dry red patches. The skin patches can be painful and can vary in size and intensity over time.

Other common symptoms of psoriasis include:

  • dry, cracked skin that may bleed
  • increased skin sensitivity
  • burning sensation on the skin
  • thickened, bumpy, or ridged nails
  • stiff and inflamed joints

Psoriasis symptoms may flare up at certain times and go away at other times. There’s no cure for the condition. Since psoriasis never really goes away, treatment is focused on slowing the growth of skin cells and offering relief from symptoms.

What types of doctors treat psoriasis?

Diagnosing and treating psoriasis requires a variety of doctors and specialists. Here’s a team of people who can help you through your treatment.

thumbs up Your psoriasis medical team
  1. Your primary care doctor can recommend topical treatments.
  2. Your dermatologist can recommend topical treatments as well as prescribe oral medications, injected medications, or light therapy.
  3. Your nutritionist can help you identify foods in your diet that are affecting your psoriasis symptoms.

Primary care physician

The first type of doctor you should see if you suspect you have psoriasis is your primary care physician. Your doctor will perform a physical examination and take your medical history. They may also take a skin sample to help confirm a psoriasis diagnosis.

If you are found to have psoriasis, your doctor will most likely recommend topical treatments to relieve symptoms. Topical treatments include:

  • Topical corticosteroids: Corticosteroids are the most commonly prescribed topical treatments for mild to moderate psoriasis. They often come in ointment form, reducing inflammation and relieving itching by suppressing the immune system.
  • Vitamin D analogues: These are man-made forms of vitamin D that typically come in ointment form. They help treat psoriasis by slowing the growth of skin cells.
  • Anthralin: This topical drug comes in cream form. It can help skin cells function normally and can smooth the skin.
  • Topical retinoids: Like anthralin, these drugs can help skin cells function properly and can decrease inflammation.
  • Salicylic acid: This drug usually comes in the form of a cream, body wash, or medicated shampoo. It helps to scrub off dead skin cells and diminish scaling.
  • Coal tar: Coal tar works to reduce scaling, itching, and inflammation. It’s available over the counter as a shampoo, cream, or oil.
  • Moisturizers: Regular moisturizing ointments don’t contain medication, but they can help reduce the itchiness and scaling caused by psoriasis.

Dermatologist

A dermatologist is a doctor who specializes in treating the skin, hair, and nails. They can offer different treatments than your primary care physician. These treatments include light therapy and oral or injected medications.

Light therapy involves using natural or artificial ultraviolet light to slow skin growth and inflammation. For natural light therapy, your dermatologist may recommend that you spend more time outside in the sunlight. They may also perform various artificial light therapies, including:

  • UVB phototherapy: This involves giving controlled doses of UVB light from an artificial source, such as a lamp, to treat psoriasis that doesn’t improve with other treatments.
  • Narrow band UVB therapy: This is a new type of psoriasis treatment that is given two to three times a week using a stronger UVB light. While it’s more effective than UVB phototherapy, it may cause more severe skin irritation and burns.
  • Goeckerman therapy: This combines UVB therapy and coal tar treatment. UVB therapy is more effective when given with coal tar, as the coal tar makes skin more receptive to UVB light.
  • Photochemotherapy or psoralen plus ultraviolet A (PUVA): This treatment involves applying a light-sensitizing medication called psoralen to the skin before being exposed to UVA light. PUVA is usually only used in severe cases of psoriasis because it can cause many side effects, such as nausea, headaches, and wrinkled skin.
  • Excimer laser: This type of light therapy is used for treating people with mild to moderate psoriasis. It involves focusing a powerful UVB light beam on only the affected areas.
  • If you have a severe case of psoriasis, your dermatologist may prescribe oral or injected medications. These medications include:
  • oral drugs such as methotrexate and cyclosporine, which can slow skin cell growth and reduce inflammation
  • biologics such as infliximab (Remicade) and adalimumab (Humira), which alter how the immune system works

Since these drugs can cause severe side effects, they’re usually only recommended for short-term use.

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Nutritionist

According to the National Psoriasis Foundation, some people with psoriasis may benefit from seeing a nutritionist. A nutritionist can help you create a diet that reduces or prevents your psoriasis symptoms and improves your overall health. For example, a nutritionist may tell you to avoid certain foods that are known to trigger or worsen psoriasis symptoms, including:

  • red meat
  • dairy
  • processed foods
  • refined sugars
  • nightshades, such as tomatoes, potatoes, and peppers

A nutritionist may also recommend vitamins or supplements if your diet is lacking certain nutrients. Filling in the holes in your diet with supplements may reduce your psoriasis symptoms.

You Asked, We Answered

  • Which psoriasis treatments tend to be the most effective?
  • It depends a lot on the severity and the kind of psoriasis you have. For example, if you have mild psoriasis, steroidal creams may be enough to relieve your symptoms. Light therapy may clear up your moderate plaque psoriasis after a few weeks of treatments. If you have moderate to severe psoriatic arthritis, you may consider a biologic treatment. Be sure to consider the side effects and the risks of taking these drugs.

    - Debra Sullivan, PhD, MSN, RN, CNE, COI