Psoriasis

Psoriasis is a chronic, scaly skin condition that affects at least 4 million people in the U.S.  A recent study demonstrated a clear link between smoking and development of psoriasis. Genetic predisposition seems to play an important role in who gets psoriasis.

Psoriasis can involve any area of the skin including the palms, soles, and scalp.  It can be limited to one small patch or it can involve nearly the entire skin.  When the disease is extensive, it can be very difficult to treat and may require newer chemotherapy-like drugs for control, the tumor necrosis factor blockers.  Widespread disease is also more likely to be associated with other serious problems like arthritis or heart disease.  Psoriasis is directly linked to the "metabolic syndrome" which includes hypertension, diabetes and heart disease.  Improvement in both conditions can be seen by following a low carbohydrate diet.  Supplementation with oral Vitamin D3 may also be beneficial in psoriasis especially if Vitamin D blood levels are low.

Psoriasis, limited to a few patches on the body or scalp, can be treated successfully by your dermatologist with a combination of prescription Dovonex (Vitamin D analog) cream and a topical cortisone cream in about three months.  It's important to stop smoking if you have been diagnosed with psoriasis since this disorder can improve slowly if smoking is curtailed.

Young children or teenagers sometimes develop a form of psoriasis called guttate psoriasis in which small oval, scaly, tan patches suddenly appear on the chest, back and arms.  This presentation of psoriasis usually follows a respiratory infection or Strep throat and a course of prescription antibiotic can sometimes result in a cure.  However, most of these young people have a strong family history of psoriasis and it is likely to recur in the usual plaque form later in life.  It has also been shown that children exposed to cigarette smoke develop psoriasis at an increased frequency.

Psoriasis may mimic the appearance of nail fungus.  If the psoriasis is limited to the nails, a nail culture may be required to distinguish the two conditions. 

If your dermatologist has prescribed Dovonex and a topical cortisone cream, the following recommendations give the best results:

For the first month, apply Dovonex cream and the cortisone cream twice a day to all plaques, morning and night.  Application after bathing and before the skin is dry is beneficial.  Dovonex scalp solution and a cortisone lotion will be prescribed if you have psoriasis in the scalp.  These are also applied twice daily for the first month.

At the end of one month or when plaques have gotten flat and red: Continue Dovonex twice a day, every day but reduce the cortisone cream to twice daily on Saturday and Sunday only.   Use the Dovonex on the weekends also along with the cortisone cream.

When the plaques become flat and pink, no longer red, discontinue the cortisone cream but continue twice daily applications of Dovonex until plaques are no longer pink.  When the plaques are tan or normal skin color, the Dovonex can be stopped.

Warning: Do not use cortisone cream on the face or in the groin area since this can lead to atrophy of the skin.

If you have questions, consult your physician regarding these recommendations.