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SOUTHERN DERMATOLOGY & SKIN CANCER CENTER

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THE DERMATOLOGY & SKIN CANCER CENTER

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

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

 

THE SKIN RENEWAL CENTER AT SOUTHERN DERMATOLOGY

4201 Lake Boone Trail, #207

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

The Trauma of Psoriasis

“Our whole understanding of psoriasis has changed over the last several years,” says Dr. Laura Briley of Southern Dermatology and Skin Cancer Center in Raleigh. “Whereas we once just considered it as a skin disease, we now understand that psoriasis is really a systemic issue—often involving many co-morbidities. Today we have a much firmer understanding of how important it is to look at the big picture when treating these patients.”

Dr. Briley prepares a light treatment for a patient with psoriasis.

When considering the effects of trauma to the skin, psoriasis is a particularly interesting topic, Dr. Briley continues. “When the skin is traumatized—when you get a cut for example—a psoriasis patient will get a flare-up of the disease in that traumatized area in the form of thick, itchy scales or plaques. This is true of anything that causes even minor injury to the skin or body, including excessively dry skin, and stress. Stress is something we don’t often think of as trauma, but truly it is.

“We see on an every-day basis how stress complicates and exacerbates many skin problems, but for psoriasis this is particularly true,” she continues. “The patient with psoriasis will have a sudden flare-up with the loss of a beloved pet, during a stressful time at work or school, or when there is stress at home. Often just explaining and reminding patients of the mind-body connection is quite helpful in understanding how the trauma of stress can manifest in a physical sense, and it’s not unusual for a patient to correlate life events with a skin eruption: ‘Well, I did lose my mother three weeks ago, and my rash has been much worse since her death,’ a patient might tell me. Itching is often a sign of stress—I see a strong correlation between the two.

“Obviously I am a dermatologist and not a psychiatrist,” Dr. Briley notes with a smile, “but I do feel it’s part of my job as a health care provider to offer support when it is clear a patient is being affected by a significant life event—especially one that is having an additional adverse effect on their physical health—and guide them towards the help of a professional counselor or psychiatrist if that is what is needed. These can be difficult conversations to have, but they can also be necessary ones.”

The Systemic Issue

Psoriasis patients tend to have higher rates of heart disease, diabetes, obesity, depression, and substance abuse, Dr. Briley points out. “The troublesome reality of psoriasis is that while it manifests most obviously on the skin, these things all sort of flow into each other: Depression often develops from feelings of embarrassment about one’s physical appearance and leads to not fully participating in a healthy social life. Substance abuse develops secondarily to depression, both of which cause decreased physical activity and contribute to worsening obesity. Obesity causes psoriasis to get worse due to increased production of inflammatory markers from increased fat cells. And so it goes, round and round.

“So really, we have to take a holistic approach to treatment. We need to make sure these patients are seeing a primary care provider to address major medical concerns. We need to treat the skin of course, and we also need to make sure we are watching out for complications like joint health—because psoriatic arthritis is believed to be severely under diagnosed.”

Treatment

Drugs have come a long way in the treatment of this difficult disease. Whereas 10 years ago minimal symptom relief was about all a psoriasis patient could hope for, today new drugs, like Taltz, are changing the name of the game for practitioners and patients.

“These new medications—which are in a class called biologics drugs—are marketing themselves as producing patients with what’s called a PasiScore of 100 percent, meaning 100 percent clear of psoriatic lesions,” Dr. Briley says. “Now, generally, if you are able to get a psoriasis patient 75 percent clear, or in some cases just 50 percent clear, they love you. So this idea of 100 percent clearance is amazing to me.

“Biologic medications are designed to treat psoriasis and psoriatic arthritis by targeting or ‘going after’ overactive immune cells in the body,” she explains. “Some biologics target a type of immune cell called a T cell, while others target the chemical messengers released by activated T cells. T cells are called the ‘generals’ of the immune system because they normally recognize bacteria and viruses and coordinate the immune response to eliminate these foreign invaders.

“In psoriasis, however, certain T cells are mistakenly activated and migrate to the skin. Once in the skin, they begin to act as if they are fighting an infection or healing a wound, which sets off a chain of events that leads to the rapid growth of skin cells, causing lesions to form. Certain biologic medications treat psoriasis by preventing the activation or migration of T cells, or by reducing the number of psoriasis-involved T cells in the body.”

An added benefit of these newer drugs is the positive effect they have on some of the co-morbid conditions as well. “As these biologics drugs work to lower the inflammatory markers contributing to psoriasis, inflammation is being lowered in the blood vessels at the same time, therefore decreasing the rate of heart disease, and hopefully the rate of heart attacks in these patients.”

In addition to heart disease, other complicating factors are also addressed by the increased treatment success seen with biologic medications. As patients achieve a higher rate of skin clearance, they are more interested in resuming a healthy social life and being physically active, thereby lowering rates of depression, substance abuse, and obesity.

Psoriasis is a strongly genetic disease that affects millions of people in the United States. It may appear in childhood, or not until much later in life. “The youngest I have seen, I think, was four years-old, and the oldest first-time flare-up was around 80 years old,” Dr. Briley says. “A strep infection is a really common issue to cause that initial flare-up, as well as weight gain. The good news, however, is that while psoriasis is a life-long struggle, appropriate management of this disease can mean living a healthy, happy, normal life.”