An Affiliate of Anne Arundel Dermatology

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For more information about skin conditions and their treatment, contact:


Gregory J. Wilmoth, MD
Eric D. Challgren, MD
Margaret B. Boyse, MD
Laura D. Briley, MD
Tracey Cloninger, PA-C

Stephanie N. Shannon, FNP-C

4201 Lake Boone Trail, #200
Raleigh, NC 27607
Telephone: (919) 782-2152


4201 Lake Boone Trail, #207

Raleigh, NC 27607
Telephone: (919) 863-0073

Inflammatory Diseases:
Immune System Out of Balance

The source of many skin issues, notes Dr. Laura Briley of Southern Dermatology and Skin Cancer Center, “is an immune system out of balance—attacking the body’s own tissues, and thus producing too much inflammation.

Dr. Briley uses the excimer laser to treat a patient.

“We treat many such inflamma-tory diseases,” she says. “Psoriasis may be the best example of this. It’s a disease that causes one part of the immune system to become hyper-active, thus producing systemic inflammation.”

Treating inflammatory diseases has always been a challenge, she notes, “because it involves the whole immune system. Years ago, for example, patients with psoriasis were given medications— such as methotrexate and soriatane—that would suppress their whole immune system. Now these are recognized as poor choices because of their side effects.

“The problem with that approach,” she says, “was that it inhibited the whole immune system—rather than treating just the one part that’s out of balance. In short, we weren’t balancing the system.

“When you totally suppress the immune system, you cause other problems—sometimes allowing skin cancers to grow because the immune system isn’t functioning properly. Today, newer biologic drugs are able to target the exact body part that’s out of balance—and only that part—and treating it more specifically.”

When Life Is Out of Balance, Health Is Out of Balance

“Many autoimmune diseases emerge when a person’s life is out of balance,” observes Dr. Briley, “when there is, perhaps, too much stress. When patients take on too many burdens and their lives tilt too much in one direction, their diseases respond by getting worse, because stress increases inflammation in the body. And inflammation is at the root of autoimmune diseases.

“Again, psoriasis offers a good example. It’s a disease that can be easy to control—in fact I’d estimate that 95 percent of my psoriasis patients are easily treated. But that remaining 5 percent of patients are probably the more challenging patients I treat—because of the co-morbidities that go with psoriasis. These patients tend to have higher than normal rates of heart disease, diabetes, obesity, depression, and substance abuse. Further, these multiple medical conditions compound one another and complicate treatment options.


Psoriasis is caused by a glitch in the natural cycle of skin cells, causing them to replicate too quickly, Dr. Briley explains. This leads to a build-up of excess skin cells forming the scaly looking plaque on the surface of the skin, which may be itchy or painful. “Sadly, a common misconception among people who don’t have psoriasis is that it’s contagious. It is not.”

Psoriasis, explains Dr. Briley, is an inflammatory disease causing one part of the immune system to become hyperactive—basically throwing the entire immune system out of balance.

“As with most things,” she says, “it’s caused by a combination of factors. Genetics are definitely a big player; there are very specific gene groups that have now been identified. But it isn’t genes alone; it’s quite multifactorial. A person can have those genes their whole life, and just like other auto-immune diseases, it doesn’t progress. However, with enough environmental hits, the genes get switched on. Then you start to have flare-ups.”

Factors that can trigger the expression of the otherwise dormant psoriasis genes may be stress, a strep-infection, thyroid disease, or obesity. “Inflammatory markers are made in fat cells,” Dr. Briley says, “so the bigger your fat cells, the more inflammation you’ll have in your body. Thus, if you gain a lot of weight and you have the genes, that can be the trigger.”

“For these few patients,” says Dr. Briley, we’ve tried most medications—old-time meds and biologics—and struggled to find the right path. And this is where an individual patient’s circumstances—their life stresses, other medical conditions, and so on—play such a big role. I have several patients who have severe depression when their psoriasis really flares up and we don’t have it under control. That’s where it gets really rough—for patient and practitioner.”

And, she continues, “as a doctor, depression is the most challenging comorbidity to deal with. Typically, you’ve known and regularly seen these patients for a very long time. Watching them struggle, crying because their psoriasis-covered hands aren’t working and they can’t function.

“On the bright side, I have found that even with these most challenging patients, we are often able—ultimately—to help them. An example is a patient I’ve seen for about nine years. She has terrible psoriatic arthritis. I treat her along with a rheumatologist, and between us, we’ve tried every medication out there. Right now, we’re fortunate because she has actually come off most of her meds and, suddenly, she’s doing better. Which makes you wonder whether there was stress that was alleviated, or some other factor going on. We’re not there yet, but I’m always researching the newest meds, hoping to make her better.”


Many conditions react to stress, notes the doctor, “including lupus as well as common skin issues such as acne and rosacea. Anything that’s inflammatory—which is a large majority of what we see on the skin—is going to get worse with stress, because stress causes inflammation.”

Hidradenitis is an example of another inflammatory skin disease that is very hard to treat, notes Dr. Briley. “It’s an under-publicized disease, more common in women, where you tend to get large sores—like boils—in the groin, under the arms, and sometimes under the breasts. It’s an inflammatory condition, there are no bacteria involved, and it has nothing to do with hygiene. It’s not talked about a lot because it mainly involves women ailing in a very sensitive area, but it’s something dermatologists and OBGYNs see a lot. I’ll see these women, who’ve been struggling with it for 20 years, and they’ll say, ‘I talked to another doctor 10 years ago and I was told there’s nothing that can be done,’ which isn’t true. There are effective treatments for this disease.

“We begin by using acne treatments like Accutane and/or antibiotics. There are a few other anti-inflammatory agents we can try, and if they don’t help, then we move on to Humira, which has had a good success rate.”