"We understand the physical and emotional impact psoriasis has on a patient's psychological well-being. "

The Psoriasis Center is a state-of -the-art facility providing the latest in treatments for psoriasis. We understand psoriasis and psoriatic arthritis are both physically and mentally distressing chronic conditions for patients, and require specialized treatment regimes tailored to the individual patient. The Psoriasis Center offers our patients novel therapies including the new "biologicals," full-body and hand/feet narrow-band ultraviolet B phototherapy, and other traditional oral and topical medications. In addition, we provide our patients educational videos and the opportunity to participate in FDA-approved clinical trials of current and upcoming treatments for psoriasis and psoriatic arthritis.

How do you recognize psoriasis?
Psoriasis is a common immune-mediated chronic skin disease that comes in different forms and varying levels of severity. Most researchers now conclude that it is related to the immune system, often called an "immune-mediated" disorder.

It generally appears as patches of raised red skin covered by a flaky white buildup. In certain kinds of psoriasis, it also has a pimple-ish, or burned discolored appearance. Psoriasis can also cause intense itching and burning.

It is not contagious. In general, it is a condition that is frequently found on the knees, elbows, scalp, hands, feet or lower back. Many treatments are available to help manage its symptoms. More than 4.5 million adults in the United States have it.

Between 10 percent and 30 percent of people with psoriasis also develop a related form of arthritis, called psoriatic arthritis.

How is it caused?
Researchers believe the immune system sends faulty signals that speed up the growth cycle in skin cells.

Certain people carry genes that make them more likely to develop psoriasis, but not everyone with these genes develops psoriasis. Instead, a "trigger" makes the psoriasis appear in those who have these genes. Also, some triggers may work together to cause an outbreak of psoriasis; this makes it difficult to identify individual factors.

Possible psoriasis triggers are emotional stress, injury to the skin, some types of infection, and a reaction to certain drugs.

Once the disease is triggered, the skin cells pile up on the surface of the body faster than normal. In people without psoriasis, skin cells mature and are shed about every 28 days. In psoriatic skin, the skin cells move rapidly up to the surface of the skin over three to six days. The body can't shed the skin cells fast enough and this process results in patches also called "lesions" forming on the skin's surface.

How is psoriasis diagnosed?
There is no blood test for psoriasis. At the VuCARE Clinic we diagnose it by examining the affected skin. Sometimes, to remove a small piece of skin affected by the psoriasis and examine it under a microscope.

Who gets psoriasis?
Psoriasis is a genetic disease. A family association exists in one out of three cases.
It often appears between ages 15 and 35, but it can develop at any age.
About 10 percent to 15 percent of those with psoriasis get it before age 10, and occasionally it appears in infancy. Psoriasis is not contagious-no one can "catch" it from another person.

How serious is psoriasis?
Psoriasis is measured in terms of its physical and emotional impact. Physically, if less then 2 percent of the body is involved, the case is considered mild. Between 3 and 10 percent is considered moderate, and more than 10 percent is severe. (The palm of one hand equals 1 percent.)

Psoriasis also is measured by its impact on quality of life. When psoriasis involves the hands and feet, it may also be considered severe because of how it affects a person's ability to function. Or, if a person's psychological or emotional well-being is considerably affected, the psoriasis may also be considered severe.

Different types of psoriasis:
Typically, people have only one form of psoriasis at a time. Sometimes two different types can occur together, one type may change to another type, or one type may become more severe. For example, a trigger may convert plaque psoriasis to pustular.
Although the reasons for the changes are not well understood, some triggers may include abrupt withdrawal of medications; an allergic, drug-induced rash that brings on the Koebner response (psoriasis appearing on the site of skin injuries); and severe sun burning.

The different types of psoriasis not only have different appearances, but also may require different types of treatment. It is very important that you talk with your physician about what course of action to take with your type of psoriasis.

Plaque Psoriasis
The most common form is called plaque psoriasis which is characterized by well-defined patches of red, raised skin. About 80 percent of people with psoriasis have this type. Plaque psoriasis can appear on any skin surface, although the knees, elbows, scalp, trunk and nails are the most common locations.

Guttate Psoriasis
A condition mostly characterized by small, red, individual drops on the skin.

Inverse Psoriasis
Smooth, dry areas of skin, often in folds or creases, that are red and inflamed but do not have scaling.

Erythrodermic Psoriasis
This condition is often periodic, widespread, with a fiery redness of the skin.

Pustular Psoriasis
Palmo-plantar pustular psoriasis involves either generalized, widespread areas of reddened skin, or localized areas, particularly the hands and feet.

What are the most irritating locations for psoriasis?
Scalp
Scalp psoriasis occurs in at least half of all people with psoriasis. It can range from very mild with fine scaling to very severe with thick, crusted plaques.

Genitals
Genital psoriasis acts similar to other affected parts of the body. But because of the sensitivity of the skin, this type may require special considerations.

Hands and Feet
Pustular psoriasis can impair a person's ability to work. Plaque psoriasis can dry out the skin and cause cracking and bleeding.

Nails
Nail changes occur in about half of those with psoriasis and 80 percent of those with psoriatic arthritis. The nails may have small holes or pitting, a changed or deformed shape, separation from the skin and some degree of discoloration.

Types of Psoriatic Arthritis:
Symmetric Arthritis
Asymmetric Arthritis
Distal Interphalangeal Predominant (DIP)
Spondylitis
Arthritis Mutilans

Treatments for Psoriasis
Psoriasis and psoriatic arthritis have no cure, but people have a wide range of treatment options to help them gain control over their disease. Many different therapies can reduce, or nearly stop, the symptoms of psoriasis and psoriatic arthritis. No single treatment works for everyone, but something is likely to work in most cases. Individuals may need to experiment before they find a treatment that works for them.

It is important for people who seem to be developing severe psoriatic arthritis to begin appropriate treatment. Early treatment can help slow the disease, and preserve function and range of motion. Some early indicators of severe disease include onset at a young age, spinal involvement and the results of certain blood studies.

Drug Categories for the Treatment of Psoriasis:
Nonsteroidal anti-inflammatory drugs / NSAIDs:
This includes over-the-counter medications such as aspirin and ibuprofen as well as prescription products; the main purpose of these medications is to decrease the symptoms of psoriatic arthritis, including inflammation, joint pain and stiffness.

Disease-modifying antirheumatic drugs / DMARDs:
These medications relieve more severe symptoms and attempt to slow or stop joint and tissue damage and progression of psoriatic arthritis.

Biologics:
These are new drugs that block the immune system from producing the inflammation that may lead to joint and tissue damage.

Other Approaches:
Heat for stiffness, warm water soaks; ice for swelling; exercise programs and physical therapy also are used in the treatment of psoriatic arthritis.

Treatments for psoriasis can be divided into three basic categories. They include topical or external treatments; phototherapy using artificial ultraviolet light, or a combination of ultraviolet light and medications; and systemic medications taken by pill or injection.

Topical Treatments:
The Psoriasis Center offers the following topical treatments. These are used after determining the extent of the disease, location of disease, disability produced by the disease and person's age. Topical treatments are usually the first line of defense in treating psoriasis. Many effective treatments are in this class.

Steroids
Steroids are a class of topical medications. Also called "corticosteroids," they are among the most commonly prescribed therapies for mild to moderate psoriasis. Steroids are man-made (synthetic) drugs that resemble hormones (cortisone, for example) that occur naturally in the body. They are available in many different forms, including ointments, creams, lotions, solutions, sprays, foam and tape.

Coal tar
Topical coal tar preparations have helped treat the scaling, inflammation and itching of psoriasis for hundreds of years. Tar can be used by itself, and it is often combined with ultraviolet light B (UVB). Coal tar may make the skin more sensitive to ultraviolet light. Because of this, it can cause greater sensitivity to burning when combined with UV therapy or sunlight.

Calcipotriene
Calcipotriene (brand name Dovonex) is a synthetic (man-made) form of vitamin D3 that is used to treat mild to moderate psoriasis. . It slows down the rate of skin cell growth. It works best at flattening psoriasis lesions and removing scales.

Anthralin
Anthralin is a prescription topical medication. It has been used to treat psoriasis for more than 100 years. It is derived from Goa powder, which is from the bark of the araroba tree. It is available in cream form and as a solution for scalp psoriasis. Physicians and pharmacists can create stronger levels of the medication as needed. Anthralin can be very effective for mild to moderate psoriasis. It is often used with ultraviolet light B (UVB) treatments for more severe psoriasis.

Salicylic acid
Salicylic acid is a chemical that helps remove scale. Removing scale is important, because it allows topical medications to reach and penetrate the skin. Salicylic acid is found in keratolytic products (scale lifters) that loosen scale. There are keratolytic products that include shampoos, soaps, lotions and gels. These products usually contain salicylic acid, lactic acid or urea.

Salicylic acid is called "sal acid" for short. It can be made stronger with a prescription, but is usually found in over-the-counter (OTC) products. The U.S. Food and Drug Administration has approved salicylic acid as an over-the-counter treatment for psoriasis in strengths of 1.8 percent to 3 percent. It is often combined with other topical medications to make them more effective.

Tazarotene
Tazarotene is a prescription topical retinoid (vitamin A derivative) approved for treating mild to moderate plaque psoriasis. It is available as either a topical gel or cream. It can be used on most parts of the body, including the face, hairline and scalp. It commonly makes the plaque very red before the psoriasis clears. If the plaque is painful, the doctor may prescribe a lower dose of medication.

Other topicals
People with psoriasis can also reduce redness and itching by keeping their skin lubricated. Moisturizers, bath solutions and nonprescription medications, including coal tar and salicylic acid, can help skin heal by keeping it flexible.

The VuSkin System line of skin care products has many nonprescription preparations to treat your skin and relieve many symptoms associated with psoriasis.

Phototherapy:
Phototherapy involves exposing the skin to wavelengths of ultraviolet light under medical supervision. This is a standard treatment for patients with moderate to severe psoriasis who have not responded to topical therapies. It also may be used for patients whose psoriasis is extensive or disabling.

Ultraviolet Narrow Band (UVB) Phototherapy
This type of treatment involves exposing the skin to a particular wavelength of ultraviolet light called narrow band (UVB). UVB is an effective treatment for psoriasis. It is present in natural sunlight. It is a common, safe and very effective (for many patients) treatment for moderate to severe psoriasis or localized areas of stubborn plaques.

There are two types of UVB treatment: broad-band UVB and narrow-band. At our Psoriasis Center we use narrow-band UVB which emit a more specific range of UV wavelengths than broad-band. It may be effective with only one or two treatments per week, whereas broad-band may require more frequent treatments. Narrow-band may also be an alternative to PUVA (the medication used with UVA light) because it is easier to undergo and possibly safer; narrow-band may be less likely to contribute to skin cancer, for example.

UVB treatment is used for adults and children. It is effective in at least two-thirds of patients who have thin plaques with moderate to severe disease, and who respond to natural sunlight. It is often used when topical treatments are not successful. Some patients have had success by combining UVB with calcipotriene, tazarotene, anthralin or coal tar. Methotrexate and acitretin may also improve UVB's effectiveness.

Systemics:
Systemic medications usually are reserved for psoriasis that becomes extensive or disabling. They are system-wide (affect the entire body) treatments for moderate to severe psoriasis that isn't responsive to topical medications or ultraviolet light treatments. However, in cases where the psoriasis affects a person's quality of life or is disabling, the patient and doctor may decide to use a stronger treatment right away after weighing the treatment's side effects and effectiveness.

Biologics
Several of the new treatments available to treat psoriasis and psoriatic arthritis, called "biologics," are made from living sources, such as viruses, animals and people. Unlike other systemic drugs, biologics must be injected or infused into the body, rather than taken orally. These new drugs target very specific parts of the immune response. In theory, they could have fewer side effects than existing drugs.  We currently prescribe Enbrel, Raptiva, which the patient self-injects weekly into the skin, or Remacaide an IV treatment given once every 6 weeks in our infusion center.  

Cyclosporine
Cyclosporine is a prescription systemic medication used to treat psoriasis. It has been available since 1995 to help prevent organ rejection in transplant patients. It can be taken by adult patients with severe, difficult-to-treat psoriasis. In 1997, the U.S. Food and Drug Administration (FDA) approved Cyclosporine as a psoriasis treatment.

It suppresses the immune system and prevents actions of certain immune cells. By preventing this immune activity, cyclosporine slows the growth of skin cells.

It is available in either capsule or liquid form, which must be diluted for use. The dose is usually kept low until the patient sees improvement. In severe psoriasis, the doctor may start with a high dose and gradually reduce it.

Patients may see some improvement in symptoms after two weeks of treatment; however, it may take longer (12 to 16 weeks) to reach a more complete level of control. When cyclosporine is stopped, most patients experience the reappearance of their psoriasis. This relapse typically occurs between 6 and 16 weeks.

Methotrexate
Methotrexate is a prescription medication usually sold as a generic. Initially used to treat cancer, methotrexate was discovered to be effective in clearing psoriasis in the 1950s and was eventually approved for this use in the 1970s. It is called "systemic" because it affects the entire body. In psoriatic arthritis, it acts as a disease-modifying antirheumatic drug (DMARD) to reduce the painful symptoms and in some cases stop the destruction of joints. Methotrexate is often prescribed for severe plaque psoriasis, erythrodermic psoriasis and acute pustular psoriasis.

Methotrexate binds to an enzyme involved in the rapid growth of cells, and also slows down skin-cell growth in psoriasis. Methotrexate also affects normal cells, including fetal cells, bone marrow and sperm cells.

Methotrexate usually is taken once per week orally; it may also be used by injection. A patient takes a "test dose" for tolerability. It usually improves the skin within four to six weeks. More than 80 percent of patients see some improvement within two or three months of starting methotrexate. After the first clearance, the dose is reduced as much as possible.

Methotrexate may be combined with other treatments, including cyclosporine, or narrow band UVB to clear the remaining lesions or to reduce side effects. The physician will use blood tests to make sure the drug is correctly metabolizing.

Soriatane
Soriatane is an oral retinoid, which is a synthetic form of vitamin A. Synthetic retinoids were introduced as experimental drugs in the mid-1970s and were approved for use in most countries, including the U.S., in the 1980s. Soriatane is the only oral retinoid currently approved for psoriasis treatment. It is a prescription medication.

The precise mechanism of how Soriatane works to control psoriasis is unknown. In general, retinoids affect how cells regulate cell behavior, including how quickly they grow and shed from the skin's surface.

Doctors may use Soriatane with phototherapy to clear lesions faster than Soriatane would alone. It may also be prescribed in sequence or rotation with other systemic medications, such as cyclosporine or methotrexate.

Soriatane has been used to clear symptoms of severe psoriasis both in the short term and long term (more than a year). Lesions usually improve within 2 to 3 months.

Combination therapy
When psoriasis is resistant to one therapy, it may be more effective to combine treatments. This creates an "individualized" treatment program that can result in a quicker response and may reduce side effects. At the VuCARE Psoriasis Treatment Center all possibilities are discussed with the patient during their consultation with Dr. Vujevich.

Rotational therapy is slightly different from combination therapy in that therapies are prescribed for a certain time period, and then exchanged for others. For example, one treatment may be used for 12 to 36 months, and then another is used, and so forth.

All of the treatments for moderate to severe psoriasis have risks and side effects. By rotating treatments, patients may minimize their exposure to toxic properties and avoid becoming resistant to certain treatments.