Psoriasis develops due to immune-mediated response in the skin.  Skin cells can multiply up to 10 times faster than normal. This rapid turnover leads to the buildup of dead cells on the skin’s surface, resulting in scaling and inflammation.

Researchers believe that genetic factors play a significant role in the development of psoriasis. Having a family member with the condition increases your risk. However, not everyone with a genetic predisposition will develop psoriasis, indicating that environmental factors also play a part.

In addition to genetics, other risk factors for psoriasis include obesity, stress, smoking, heavy alcohol consumption, and certain infections, such as strep throat. People with psoriasis are also at an increased risk of developing other health conditions, including psoriatic arthritis, eye disorders, cardiovascular disease, and depression.

While there is no cure for psoriasis, a range of treatment options can help manage symptoms and improve quality of life. Treatment plans are tailored to the individual based on the type and severity of their condition, and may involve topical creams, light therapy, oral or injected medications, and lifestyle changes. Working closely with a healthcare provider is key to finding the most effective psoriasis treatment approach.

Diagnosis and Assessment

Diagnosing psoriasis typically involves a thorough clinical evaluation by a dermatologist. They will examine the skin, scalp, and nails for characteristic signs of the condition. The appearance of red, scaly patches on the skin is often sufficient for a diagnosis, especially if they are found on the elbows, knees, lower back, or scalp.

Clinical Evaluation

During the clinical evaluation, the dermatologist will assess the extent and severity of the psoriasis. They will look at the size, location, and appearance of the plaques. The presence of nail changes, such as pitting, discoloration, or onycholysis (separation of the nail from the nail bed), can also aid in the diagnosis. The dermatologist will ask about family history, as genetic factors play a role in the development of psoriasis.

Different types of psoriasis have distinct appearances. Plaque psoriasis, the most common form, is characterized by raised, red patches covered with a silvery white buildup of dead skin cells. Guttate psoriasis appears as small, drop-shaped lesions. Inverse psoriasis causes smooth, red patches in skin folds. Pustular psoriasis is characterized by white pustules surrounded by red skin. Erythrodermic psoriasis leads to widespread redness and scaling.

Diagnostic Tools

In some cases, a skin biopsy may be performed to confirm the diagnosis. This involves removing a small sample of affected skin and examining it under a microscope. A biopsy can help rule out other conditions that may resemble psoriasis, such as eczema, seborrheic dermatitis, or fungal infections.

Additional tests may be conducted to assess for psoriatic arthritis, which affects up to 30% of people with psoriasis. X-rays, MRI, or CT scans can reveal joint damage associated with psoriatic arthritis. Blood tests, such as rheumatoid factor or anti-cyclic citrullinated peptide (anti-CCP), can help differentiate psoriatic arthritis from other types of arthritis.  Many patients with severe joint symptoms will need to be reviewed by a rheumatologist (a joint specialist)

Severity Assessment

Assessing the severity of psoriasis is crucial for determining the appropriate treatment approach. Mild psoriasis, characterized by a few scattered patches, can often be managed with topical treatments like corticosteroid creams or ointments. Moderate to severe psoriasis, which affects larger areas of the body or significantly impacts quality of life, may require more aggressive treatment with phototherapy or systemic medications.

The Psoriasis Area and Severity Index (PASI) is a tool used to measure the severity and extent of psoriasis. It takes into account the amount of body surface area affected, as well as the redness, thickness, and scaling of the plaques. A higher PASI score indicates more severe disease. Other assessment tools, such as the Dermatology Life Quality Index (DLQI), evaluate the impact of psoriasis on a person’s physical, psychological, and social well-being.

Regular monitoring is essential to track the response to treatment and adjust the management plan as needed. This may involve periodic PASI assessments, quality of life questionnaires, and evaluation of side effects from medications. Collaboration between the dermatologist, rheumatologist (in cases of psoriatic arthritis), and the patient is key to optimizing outcomes and minimizing disease burden.

Accurate diagnosis and thorough assessment lay the foundation for effective psoriasis treatment. By identifying the type and severity of psoriasis, as well as its impact on the individual, healthcare providers can tailor treatment strategies to achieve the best possible results. From topical therapies for mild cases to systemic agents and phototherapy for more severe disease, a personalized approach is essential. Ongoing monitoring and adjustments ensure that people with psoriasis can effectively manage their condition and maintain a high quality of life.

Conventional Treatment Options

Conventional treatment options for psoriasis include topical therapies, phototherapy, and systemic medications. The choice of treatment depends on the severity and extent of the condition, as well as individual patient factors.

Topical therapies are often the first line of treatment for mild to moderate psoriasis. Corticosteroids are the most commonly prescribed topical medications for psoriasis. They work by reducing inflammation and slowing down the growth of skin cells. Topical corticosteroids come in various strengths and formulations, such as creams, ointments, gels, and foams. Low-potency corticosteroids are generally used for sensitive areas like the face and skin folds, while higher-potency corticosteroids are reserved for thicker, more resistant plaques on the body. 

Topical Treatments

• Vitamin D analogs (like calcipotriene and calcitriol) regulate skin cell growth. They can be used alone or with corticosteroids. May cause irritation on sensitive areas.
• Calcineurin inhibitors (like tacrolimus and pimecrolimus) suppress the immune response in the skin. Good for sensitive areas, but less effective for thick plaques.
• Other options: Coal tar (anti-inflammatory), salicylic acid (removes scales), and anthralin (slows skin cell growth but can irritate).

Phototherapy

• UV light slows skin cell growth and reduces inflammation.
  • Narrowband UVB: Most common, can be done at home (if the psoriasis is limited or at Dermatology North Sydney, particularly if the psoriasis is widespread).

Systemic Medications (for moderate to severe psoriasis)

• Immunosuppressants:
  • Methotrexate: Reduces inflammation and skin cell production. Requires monitoring for side effects.
  • Cyclosporine: Works quickly but used short-term due to potential side effects.

             Immunomodulators:

            Apremilast: reduces activity pathway towards developing psoriasis

            Sotyktu:  reduces activity pathway towards developing psoriasis

• Acitretin: Helps normalize the growth cycle of affected skin cells. It can cause birth defects.
• Biologics: Newer drugs that target the immune system. Very effective but can increase infection risk. Examples include TNF-alpha inhibitors (like etanercept and adalimumab), IL-12/23 inhibitors (like ustekinumab), and IL-17 inhibitors (like secukinumab).

Choosing the right treatment depends on many factors, and a personalized approach is essential. Dermatologists in Australia work with patients to create tailored plans.