McFarland Clinic dermatologist, Dr. Stuart Kolner, discusses the medical condition psoriasis, along with treatment options offered at McFarland Clinic to manage this condition. Psoriasis is a multisystem inflammatory disease. When I was in training, we thought it a skin disease, but we have come to learn that it is really due to an overactive immune system, cells in particular called Thelper cells. These are in the skin but in other organs, and in psoriasis, these cells are activated inappropriately. They begin to churn out chemicals that cause inflammation, and ordinarily, this process is done in response to some infecting organism.

But there’s no infecting organism. So, in psoriasis, it’s an inappropriate activation of a natural immune system function that results in inflammation. It affects the skin most prominently, but about one in ten psoriasis patients also have a very significant arthritis that can destroy their joints and so forth. So, it can be quite a significant illness from that point of view. What we see most often in psoriasis is, it’s called a plaque. It’s a region of skin that’s red and elevated and covered with a silvery type of scale.

Patients with psoriatic arthritis also have inflammation of joints, so this often occurs in the hands. The joints can be swollen and reddened, and that can be characteristic too. To treat psoriasis, what we call a therapeutic ladder, which means there are rungs, and the lower rungs are simpler, safer things. And as you climb the ladder, it gets more costly or more risky. The simplest approach is topical treatments with medicated creams, ointments, and that sort of thing, and I would say at least 60 of psoriasis patients can be adequately.

Treatment for Psoriasis at McFarland Clinic

Treated with that. Next, there’s phototherapy, ultraviolet light therapy. We can deliver this in our clinic, and in selective cases, the patient can acquire a home phototherapy unit if they live a distance away and so forth. Ultraviolet light, certain wavelengths, particularly what we call ultraviolet type B, can help clear the psoriasis cells from the skin. Next are pills, and there’s three main pills that can be used to treat psoriasis. These are all fraught with difficulties. They have associated organ toxicities. For instance, one is toxic to kidneys, one to the liver, and so they need to be used very carefully with blood.

Testing and so forth, but they can be effective. The last thing is one of the more, the newer and more exciting areas, is called biologic therapy. These involve injectable medications that are extremely effective, but also extremely costly. These cost on the order of $20,000 a year to use, and so even with insurance participation, there’s often a copay that can make them costprohibitive. The best approach to managing psoriasis is a comprehensive approach. Skin needs to be hydrated well. Psoriasis tends to flare if skin dries out. Using the.


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