‘RED’ ALERT! Doctor expounds on psoriasis and its treatments


People living in Florida are often exposed to plant and sea life that causes temporary skin rashes, but if you have a persistent rash without any clear trigger such as poison ivy or a jellyfish sting, it could be psoriasis.

“Psoriasis presents itself as a red scaling rash,” said Dr. Kathryn Anderson, a dermatologist at Indian River Dermatology at Cleveland Clinic Indian River Hospital. “It’s one of the most common skin conditions, affecting 30 percent of the population in the US.

It’s most commonly seen on elbows, knees, lower back and scalps, although certain types of psoriasis will appear on hands, feet and in the under folds of skin like the armpits and back of knees.”

According to the American Academy of Dermatology, 80 percent to 90 percent of people who have psoriasis develop plaque psoriasis, which appears as patches of thick, raised skin called plaques with a dry, thin, silvery-white coating called scales. It’s common for the patches to itch but scratching only thickens the patch and worsens the condition.

“Psoriasis is an interplay between genetics and the immune system,” Dr. Anderson explained. “It tends to be hereditary but not in every case. If one parent has psoriasis, a child has about a 20-to-25 percent chance of getting it. If both parents have it, the child will have a 65 percent risk of getting it. Unfortunately, once you have it, you’ll always have it, as it’s a chronic condition. Outbreaks can last from weeks to years, and while they can be controlled, they can’t be cured.

“Psoriasis usually presents itself between the ages of 55 and 65 but we do also see pediatric patients … who will have the condition.”

There is usually a trigger that incites the immune system to start producing inflammation.

That trigger can be an infection or something as simple as the weather, stress, drinking, smoking or taking medication.

Flare-ups often occur due to stress or after getting a cut, scrape, scratch or bug bite.

Different people have different triggers. That’s why it is important for people who have psoriasis to pay attention to what triggers their flare-ups and try to avoid the triggering circumstances.

If you think you might have psoriasis, it’s wise to visit a dermatologist to have it diagnosed and treated.

“In most cases, a trained dermatologist can diagnose psoriasis with just a visual exam,” Dr. Anderson said. “If the diagnosis is unclear, we can take a sample of skin and have a pathologist look at it under the microscope to confirm the diagnosis. This is a much better time to have psoriasis than 10 or 20 years ago because there are new biologic medications that have been approved within the past 5-to-10 years that are very effective at controlling the outbreaks.

“If the rash is in a small area we’ll treat it with a topical treatment like gels, creams and liquids, both in steroid and non-steroid forms. If the rash covers more than 10 percent of the body or a smaller rash didn’t respond to topical treatment, then we’ll use internal treatments like pills or an injectable. New biologic medications target the specific immune molecule that creates inflammation in psoriasis with few side effects. There is also a treatment that uses UVB light.”

Dermatologists use UVB phototherapy for psoriasis to suppress an overly active immune system, reduce inflammation, reduce the itch and allow the skin to heal. It is generally prescribed for children, women who are pregnant or breastfeeding, and people who have a weakened immune system or ongoing infection.

The narrowband UVB phototherapy is used effectively on the scalp, ears, armpits, groin and buttocks. It is not recommended for anyone who has a medical condition or is taking a medication that makes them sensitive to UV light or anyone who has had skin cancer.

There are some over-the-counter treatments that can be helpful in mild cases of psoriasis.

“Over-the-counter hydrocortisone creams can help relieve the itch, as can psoriasis shampoos and lotions, “Dr. Anderson noted. “Many of these treatments will contain coal tar or salicylic acid, both with a track record of reducing swelling and relieving itching.”

A pharmacist can assist you in choosing an OTC product. Buying medication online may be a bit riskier, so you should talk to your dermatologist to make sure that the product you are considering has been tested and is safe and effective to use.

Psoriasis can lead to other health conditions if not treated.

“Due to inflammation in the body, it can affect other areas,” Dr. Anderson said. “Psoriasis in the joints is called psoriatic arthritis. It causes pain and stiffness in the joints, which is often worse in the mornings. You can have psoriatic arthritis without a skin rash. About a third of the patients with skin psoriasis will develop psoriatic arthritis, but there are many cases of psoriatic arthritis without the skin rash. Inflammation in the body has also been linked to heart disease, obesity, diabetes and metabolic syndrome.”

Contrary to popular belief, psoriasis is not contagious. You can’t get it from touching, having sex with or swimming in a pool with a person who has psoriasis.

Gaining control of psoriasis involves learning and avoiding what triggers flare-ups, sticking to a good psoriasis skin care routine, living a healthy lifestyle and using medication when necessary.

After earning her medical degree at Florida Atlantic University, Dr. Anderson completed her dermatology residency at Wake Forest Baptist Medical Center in North Carolina. She is accepting new patients at her office at 1155 35th Lane, Suite 202 in Vero Beach. The office phone number is 772-770-6871.

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