What is Psoriasis and how is it Treated?

If you have itchy flaky skin with red bumps and silvery or white scales of skin on your hands, elbows or other parts of your body, you may have a skin condition known as psoriasis. 

Psoriasis is a chronic autoimmune condition that may be genetic.  It is a systemic inflammatory disease, but it is still not fully known what the single cause of the development of psoriasis is.  The American Academy of Dermatology Association (AAD) states “When a person has psoriasis, something goes wrong in the immune system, so T-cells also attack the body’s skin cells. This attack causes the body to make new skin cells more often. The extra skin cells pile up on the surface of the skin, and you see psoriasis.”

Facts about psoriasis from the American Academy of Dermatology Association (AAD)

• Psoriasis is not contagious
• Psoriasis occurs in all races and genders
• Approximately 2% of the people living in the United States have psoriasis

What are the symptoms of Psoriasis?

Raised, inflamed, itchy, bumpy, red skin with silvery or white scales is the obvious symptom of psoriasis.

Psoriasis can occur anywhere on the body, including the legs and torso, but the most common areas are the elbows, hands and knees.

What are the different types of Psoriasis?

Plaque Psoriasis – This is the most common form, with symptoms that include raised, red patches of skin with silvery and white scales of skin.

Guttate Psoriasis – This form of psoriasis often appears after a strep infection.  Symptoms include small lesions that look like little dots.  It is the second most common form of psoriasis, affecting about 10% of those with psoriasis.

Inverse Psoriasis – This form of psoriasis appears as dark red lesions in the folds of the body such as the armpit, behind the knee or in the groin.

Pustular Psoriasis – This form of psoriasis is characterized by little white blisters or pustules containing pus. It is not contagious, and usually appears on the hands and/or feet.

Erythrodermic Psoriasis – This severe form of psoriasis can be life-threatening.  It is a widespread, very red, itchy and painful psoriasis which may cause skin to come off the body.  While it is rare, it occurs in approximately 3% of those who have unstable plaque psoriasis.

What is Psoriatic Arthritis (PsA)?

More than 8 million Americans have psoriasis, according to the National Psoriasis Foundation.  Between 10-30% of these people will develop psoriatic arthritis. 30% of individuals with psoriasis have psoriatic arthritis.  Psoriatic arthritis is a chronic, inflammatory disease affecting the joints and locations where ligaments and tendons attach to the bones. Left untreated this disease can cause permanent joint damage resulting in a loss of range of motion.   Patients suspected of having PsA will most often be referred to a rheumatologist to find an effective treatment plan.

What can cause Psoriasis to appear?

Certain conditions may cause psoriasis to appear for the first time or cause existing psoriasis to flare up. Some known triggers of psoriasis include:

• Stress
• Cold, dry weather
• Strep throat or other infections
• Bad sunburns and other skin injuries
• Certain medications such as prednisone,  hydroxychloroquine, or lithium
• Tobacco and alcohol use

How is psoriasis diagnosed?

Your doctor will be able to tell you if you have psoriasis. However, often doctors will refer patients with skin conditions to a certified dermatologist, who will create a full range treatment plan to help manage and treat your psoriasis and help prevent uncomfortable flare-ups.

During an examination your doctor or dermatologist will examine your symptoms and ask about other related symptoms such as joint pain and/or swelling.  They will often ask if any other members of your family have this condition and if you have recently had any stress or illnesses.  Often a small sample of skin is removed for examination to determine and confirm if you have psoriasis.

How is Psoriasis treated?

Psoriasis is treated according to several factors, including:

• Severity
• Location on the body
• Type of psoriasis
• Other medical conditions you may have
• Other medications you may be taking.

While psoriasis cannot be cured, there are treatments available including light treatments and prescription medications such as Otezla® (apremilast).

How does Otezla® (apremilast) treat Psoriasis and Psoriatic Arthritis?

Otezla® (apremilast) is in a class of drugs called phosphodiesterase 4 (PDE4) inhibitors.  It works by helping relieve and decrease pain and swelling in psoriatic arthritis and may improve the swelling and flexibility in joints that are affected.   It also helps calm and reduce redness and scaling, as well as the thickening of the skin that occurs with plaque psoriasis.

How do you take Otezla® (apremilast)?

This medication is taken by mouth, usually twice a day. However, the dosage does depend on your individual condition, so your doctor will prescribe Otezla® (apremilast) according to your needs.

This medication needs to be taken as directed and, for best results, taken at the same time every day. Do not chew or crush this medication.

The active ingredient in brand-name Otezla® is apremilast.

Brand-name Otezla® – 30 mg tablets

What are the side effects of Otezla® (apremilast)?

Many medications have side effects that may be a nuisance and clear up on their own, while others may persist.  Speak to your doctor if any side effects continue or become worse.   Some side effects of Otezla® (apremilast) may include:

• Diarrhea
• Nausea/Vomiting
• Headache
• Loss Of Appetite
• Headache

This is not a complete list of side effects.  Refer to the medication information that comes with your prescription and/or discuss other possible side effects with your pharmacist.

Psoriasis is an uncomfortable condition affecting close to 124 million people worldwide, according to the World Psoriasis Day consortium.  With treatment and understanding, there is hope for better treatment and management.  If you would like to learn more about psoriasis, visit the National Psoriasis Foundation at www.psoriasis.org.