What is Psoriasis?
Psoriasis in an inherited condition of the skin, joints, and immune system that results in the development of red scaly skin lesions that most commonly affect the elbows, knees, and scalp, but any part of the body can be affected. Unique forms of psoriasis include palm and sole psoriasis; inverse psoriasis in which the armpits and groin are affected; pustular psoriasis characterized by disseminated pustules on the body or localized pustules to the palms and soles; erythrodermic psoriasis in which the entire skin surface is red, inflamed, and scaly; and guttate psoriasis which is characterized by widespread small scaling lesions. Nail involvement is common, and psoriasis can affect the joints causing a condition known as psoriatic arthritis.
What Causes Psoriasis?
A combination of genetic factors, together with environmental factors contribute to the development of psoriasis. Even though many patients do not have a family history of the disease, they have inherited a combination of genes that makes them susceptible to developing psoriasis. Factors such as absence of sunlight, certain medications such as lithium, antimalarial drugs, interferon, beta blockers(e.g. propranolol), and the discontinuation of systemic steroids can result in psoriasis in susceptible individuals. Infections such as strep throat are well known triggers of psoriasis. Psoriasis can also arise in skin that is irritated. The development of psoriasis in surgical scars is known as the Koebner phenomenon.
Can Psoriasis be Cured?
Because we do not yet have effective gene therapy, we do not have a permanent cure for psoriasis, but we have many excellent treatments. For patients with limited disease, topical therapy is often enough. When topical therapy isn't adequate, intralesional injections of steroids can be administered to isolated plaques of psoriasis or the excimer laser can be used.
For more extensive disease, ultraviolet light phototherapy with either broadband UVB, narrowband UVB, or PUVA can be effective. Oral medications for psoriasis include Acitretin (Soriatane®), methotrexate, cyclosporine, apremilast (Otezla®), and other therapies that are either in development or off-label such as tofacitinib (Xeljanz®).
There are now numerous injectable therapies (known as biologics) administered either at home or in the office for psoriasis and psoriatic arthritis. adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi), Infliximab (Remicade), ustekinumab (Stelara), and secukinumab (Cosentyx) are currently available. Several new injectable drugs are in development including ixekizumab, brodalumab, tildrakizumab, and guselkumab.
What Treatments are Available at Mount Sinai
We have the most advanced psoriasis treatment center in the world. The excimer laser is available at several of our campuses around New York City. Our phototherapy units (also at several of our campuses) includes every form of ultraviolet light therapy used for psoriasis, including narrow band UVB, broad band UVB, PUVA, bath PUVA, localized hand and foot units, specialized units to treat the scalp, and adjustable units to treat specific body sites. We have expertise in all of the topical and oral treatments used for psoriasis, and many of the national guidelines for those treatments were written by members of our faculty. Our Department has an infusion center for investigational treatments for psoriasis, and we have many patients treated with infliximab infusions under our supervision at Mount Sinai's centralized infusion center. All of the biologic therapies have been studied at Mount Sinai, and we have access not only to the approved medications, but most of the investigational medications are available in our clinical trials unit.
Our Department has recently opened a Dermatology/Rheumatology clinic, staffed by Board certified dermatologists and rheumatologists with expertise in psoriatic arthritis, and we have a Psychodermatology clinic staffed by Board certified psychologists, who also have expertise in the treatment of severe psoriasis.
Many members of our faculty have been at the forefront of psoriasis research. We have edited or authored hundreds of articles and numerous books on psoriasis, and pride ourselves on being able to administer the best care available for patients with this condition.