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Psoriasis can affect more than the skin; it also affects self-esteem

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Susan Hammerling-Hodgers, Special to FLORIDA TODAY
Published 10:01 a.m. ET Aug. 18, 2020

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Imagine having to cover up your arms or legs all the time during the summer when it is hot outside.

Or having a special event where you want to look your best, but are self-conscious about wearing your favorite black suit or dress.

Sometimes, your rash flares up on your back or hands and becomes so sore you feel stiff and are in pain when trying to move.

August is National Psoriasis Awareness month.

Psoriasis is a common skin disease and is not contagious. Depending on the severity, it can range with minimal to severe signs and symptoms. It can present with only lesions of the skin or can involve joints and nails.

It affects people of all ages and ethnic backgrounds and can also affect self-esteem.

Various signs and symptoms that can affect patients include itching, flaking and bleeding.

Many patients struggle with having psoriasis because they are self-conscious and do not wear shorts or dresses because of the appearance of the skin lesions. They are afraid someone may ask what is wrong with their skin.

When patients only have a few skin lesions, they can be more conservative in their approach by using a topical steroid like Triamcinolone ointment or a combination of topical ointment such as Taclonex ointment.

Some over-the-counter creams, such as coal tar or salicylic acid, can help reduce the thickness of lesions.

If there is a larger surface area of skin involvement or joint pain is present, then more aggressive treatments can be explored.

In addition to topical steroids, Narrow Band phototherapy can be incorporated to the treatment plan.

For some patients, this can be inconvenient because they must attend two to three sessions per week for several months.

It also can increase the risk for skin cancers. Some patients are not candidates for phototherapy because they are on medications that can make them more susceptible to light.

Other treatment options include Otezla or Methotrexate pills. Before starting these oral medications, most providers will order baseline labs to make sure the kidney and liver are functioning properly.

Otezla is a newer medication that can be effective for the management of skin lesions. It is not a biologic but can affect your immune system. It is a pill that is taken once or twice a day. Some patients complain of side effects such as diarrhea.

Methotrexate pills have been around for a long time. It is an inexpensive treatment option. Common side effects of methotrexate are nausea, vomiting, headache, drowsiness, hair loss, fever or chills.

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Soriatane, Cyclosporine and Aspirin are other options for treatment of psoriasis.

Soriatane cannot be used in women of child bearing age.

Cyclosporine is an immunosuppressive medication which slows down the growth of certain immune cells.

NSAIDs, Aspirin and Ibuprofen help to reduce inflammation, joint pain and stiffness.

More extensive skin involvement with joint pain can be treated with biologics.

Biologics are shots that are administered that can impact the entire immune system and can increase the risk of infection.

Before starting on a biologic medication, screening for tuberculosis or other infectious diseases is required. During the treatment with a biologic, if a fever, cough or flu develops, then it is important to discontinue the medication and contact the prescribing health care provider right away.

Cosentyx is one of the newest and most popular biologics that can help psoriasis of the skin and joints. It is not recommended for patients who have GI diseases like Crohns disease or Ulcerative Colitis.

Various areas that psoriasis can affect are the scalp, arms, legs, trunk, axilla, genitals, nails and joints.

Certain classes of medications can exacerbate psoriasis such as B-Blockers like Atenolol or Metoprolol.

A positive family history can also increase the possibility of someone developing psoriasis.

If psoriasis is not able to get under control with a dermatologist, then a referral to a rheumatologist may be warranted.

When suffering with psoriasis, don’t feel like you are alone. There are many treatment options that can be offered at the dermatologist’s office.

Don’t forget to use the National Psoriasis Foundation as a resource to find a health care provider familiar with the different treatment options at www.psoriasis.org.

Susan Hammerling-Hodgers, a Member of the National Psoriasis Foundation, is a PA-C (Certified Physician Assistant) and MPAS (Master of Physician Assistant Studies) and works at Brevard Skin and Cancer at the Merritt Island and Rockledge offices.

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