man with scaly skin patches on both elbows

Psoriasis Symptoms and Treatment: What to Know

Larisa Geskin, MD

Larisa Geskin

According to the National Psoriasis Foundation, psoriasis affects around eight million Americans, and nearly 60% of individuals with psoriasis report it to be a problem in their everyday life.

To get a better idea of how psoriasis presents in the clinic and how it’s treated, we talked with Larisa Geskin, MD, professor of dermatology at Columbia University Vagelos College of Physicians and Surgeons.

Here are five take-aways from our conversation:

Psoriasis is not contagious.

Psoriasis is not something you can catch or pick up.

Psoriasis is an immune-mediated disease in which the body reacts to inflammation by making skin cells much faster than it normally would. These excess cells typically form silvery-white plaques, which can appear anywhere on the body but are most common on the arms, scalp, lower back, or knees.

Although the causes of psoriasis are not yet fully understood, we know there is a genetic component, as it often runs in families.

Anyone can get psoriasis.

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Psoriasis can affect anyone: men, women, and people of all ages. Most often, psoriasis starts early in childhood, but can sometimes start in adulthood. Psoriasis does not spare any skin type. It can appear in really pale skin or in darker skin tones, and it can look different depending on a patient’s skin color.

For some patients, the effect of psoriasis is minimal. They may have a small patch on their skin that’s not bothersome and does not require treatment, though patients need to be on the lookout for associated conditions. For other patients, psoriasis can be quite disabling; they may develop extensive patches or patches that are painful or itch. In some, psoriasis causes joint pain and arthritis. Everyone is different.

There is no cure for psoriasis. But there are many treatments to help manage a life-long disease.

While there is currently no cure for psoriasis, we can offer patients a wide variety of treatments to suit each individual case. Some of them are applied directly to the skin, including corticosteroids or non-steroidal creams and UVB light therapy.

For people with moderate or severe psoriasis, or those whose joints are affected by the disease, there are systemic therapies, which include oral medications and injectables. These therapies include the newer and more precise biologics, which actually target the part of the immune system that causes psoriasis.

When a patient is diagnosed with psoriasis, the prognosis is good. Psoriasis is a chronic disease, but it usually responds well to treatment.

Alcohol and other triggers can cause flare-ups of psoriasis.

Triggers are as individual as patients and may take some time to identify. Some common triggers are skin injuries such as cuts and bug bites, sunburn, psychological stress, excessive or frequent drinking, smoking, and cold, dry weather.

Excessive or frequent drinking is not only a trigger. It can actually reduce the effectiveness of a patient’s psoriasis treatment.

Smoking, and even being around smokers, has been shown to trigger psoriasis flare-ups. A dermatologist, along with a patient’s primary care doctor, can help a patient find a program to help them quit. We usually advise against using the nicotine patch, as it can be a trigger, too.

It’s important for psoriasis patients to understand their role in managing their disease. They must take their medication as prescribed, take good care of their skin, including daily moisturizing, and assiduously avoid those things that trigger flare-ups.

Psoriasis often comes with one or more comorbidities.

Psoriasis is a generalized inflammatory state that often causes other problems beyond skin lesions. For example, around 30% of psoriasis patients have psoriatic arthritis. The symptoms of psoriatic arthritis are joint pain and joint deformity.

For psoriatic arthritis, we recommend patients see a rheumatologist, who can prescribe systemic therapies for this disease. Novel biological therapies, which have few side effects, can be quite helpful in alleviating joint pain.

Psoriasis is also associated with depression and metabolic syndrome or obesity. A good dermatologist will be alert to these and, if appropriate and in coordination with a patient’s primary care doctor, can help a patient find a suitable specialist in these other areas.

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Larisa Geskin, MD, also is director of cutaneous oncology at Columbia University Irving Medical Center and a diplomat of the American Academy of Dermatology.