What to Expect When Treating Moderate to Severe Plaque Psoriasis

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According to the American Academy of Dermatology, 7.5 million people have plaque psoriasis in the United States. Recently, high profile patients like Kim Kardashian and Art Garfunkel have given the disease more attention in the public sphere. A disease that causes red, scaly and often painful plaques on the skin, psoriasis occurs when your body’s immune system makes skin cells grow too quickly. This condition can be both physically debilitating and emotionally exhausting for those with moderate to severe cases. Psoriasis can appear at any age, but in my clinical practice I see a range of patients from age 20 to age 60 struggling with the condition.

Diagnosing Moderate to Severe Psoriasis

Psoriasis is an immune-mediated inflammatory disorder, or a disease in a group of conditions with unknown origins that are characterized by inflammation. There are as many as five clinical variants of psoriasis distinguished by location on the body and the kind of rash they produce. Plaque psoriasis is by far the most common, affecting 80 to 90% of psoriasis patients. The disease is usually diagnosed by a full-body skin exam or a biopsy of the affected skin. Psoriasis outbreaks on the skin can vary in severity depending on how extensive the lesions are and how red, scaly and thick they become. Typically, mild plaque psoriasis covers less than 3% of a patient’s body surface area, moderate psoriasis covers between 3 and 10%, and severe psoriasis covers more than 10% of a patient’s body surface.  

Understanding Psoriasis

Patients should feel empowered to let those they interact with know that psoriasis lesions are never contagious by contact. I also believe it is important that patients understand that, while we have not developed a cure for this disorder, we have many treatments available.

Treatment Options for Plaque Psoriasis

Fortunately, there are some very successful drugs and treatment methods used to fight psoriasis. The extent of body surface area affected by psoriatic lesions will determine what course of treatment to take. For example, patients with mild psoriasis, or those with less than 3% of their skin affected, who don’t have joint issues, can be managed primarily with combinations of topical medicines.

But patients with moderate to severe psoriasis typically turn to oral drugs, light therapy and then biological drugs, or biologics. Biologics are drugs developed using genetically engineered proteins from the human gene to target specific components of the immune system. These drugs successfully suppress the disease in most cases, but because biologics are so expensive, I typically recommend them only if your condition failed to improve on all other forms of therapy. Some drug companies offer payment plans or financial aid to help people afford biologics, but some insurance companies will make patients try all other options before covering the drugs. However, if you have severe psoriasis, where plaques cover more than 10% of your body surface, then I bring biologics into the conversation earlier.

Both oral medications and biologics require prescreening exams to determine if you are a good candidate for that particular treatment. Biologics can increase your risk of developing infections, so these exams screen for tuberculosis, hepatitis B and hepatitis C, since biologics would make it harder for your immune system to fight these serious conditions. Some common side effects for biologics include respiratory infections, flu-like symptoms and reactions at the injection site.

Psoriasis: Not Just a Skin Disorder

If you’re diagnosed with psoriasis, it is important to know that psoriasis is not just a skin disorder. Rather, it is now viewed as a chronic condition that can affect much more than your body’s surface. For example, up to 30% of psoriasis patients also develop psoriatic arthritis, a condition in which the disease spreads into your joints and causes pain and swelling. I work closely with my colleagues in the rheumatology department to treat these patients.

Another example is the fact that psoriasis can also be linked to stress. When I first meet with a patient, I try to discern what might have led to the disease’s onset. I have had several patients who were considered healthy in other aspects of their lives until a stressful event occurred, such as the loss of a loved one or intense emotional strain; it seems the first symptoms of the disease surfaced as a result of this increase in stress levels. That’s why it’s so important to practice stress reduction techniques if you have psoriasis—developing coping skills for stressful situations can help you avoid flare-ups and stay in control of your disease.

Infections and smoking can also trigger flares, so making lifestyle changes like quitting smoking and being careful not to contract infections are other ways you can control your psoriasis.

Plaque buildup and psoriasis-induced inflammation can also affect cardiovascular health. We now know that psoriasis patients are at an increased risk for metabolic syndrome, a group of symptoms that can lead to heart disease, and atherosclerotic cardiovascular disease, a condition caused when plaque builds up in your arteries. For this reason, I advise all my patients to be aware of the risk of heart issues with psoriasis, especially younger patients who haven’t yet shown any other medical problems.

Looking Ahead

With new medications like biologics and a growing body of research, we are making big strides in our understanding of the disease and how to treat it. I have even seen some of my patients completely cleared of their symptoms. If you have psoriasis, know there are options for you and your physician can tailor treatment to your needs.

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THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.
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