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 Mark Herron, MD, is board-certified in Internal Medicine and Dermatology. He has 1 year of specialized training in psoriasis. He is interested in medical treatments of skin disease.
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Psoriasis is a chronic immune disease of the skin. It affects 2.6% of the population in the United States (which is approximately 7 million people). Over 150,000 new cases are diagnosed each year. 400 people die from complications related to psoriasis each year. Psoriasis is a lifelong disease that first begins between 15 and 35 years (average 27 years). Psoriasis appears as raised red patches of skin, flaky skin, and a silvery-white scale. It occurs on the scalp, nape of the neck, genitals, elbows, hands, knees, and feet. Approximately 33% have moderate to severe psoriasis covering more than 3% of their body. Psoriasis causes itchiness and burning sensations. 50% have nail involvement, which is extremely hard to treat. In psoriasis, an excessive number of immune cells target the skin. These immune cells signal other cells to enter the skin. The cycle of increased inflammation is accompanied by abnormal growth of skin cells (thickened skin, flaky skin) and increased vascularity and blood flow in the skin. The inflammation causes itchiness and the burning sensation of the skin. The end result is development of scaly, red, itchy plaques of psoriasis.
Many people with moderate to severe psoriasis indicate that their disease is a very large problem in their life. Psoriasis forces them to alter or stop their normal daily activities. The itching is severe, and disrupts sleep and daytime activities. Many patients use clothing to cover up their psoriasis. Remission, which is complete clearing of psoriasis, is not a realistic expectation. There is no cure for psoriasis. Topical therapies are best for patients with less than 5% body surface area. They are messy, inconvenient, and less effective. Systemic treatment is reserved fot severe psoriasis that has failed topical and light therapies. The toxicities associated with systemic therapies limit the long-term usage in most cases. Biologic therapies target the immune system. The biologic agents work to interfere with immune cells associated with psoriasis.
Rosacea affects 14 million adults each year or 1% of the population. Peak age of onset is 30 to 50 years. Rosacea causes redness, swelling, blushing, flushing, pimples, pustules, and englarged blood vessels. Initially, rosacea may come and go as redness. Later, pimples and enlarged blood vessels appear. It can cause a burning and stinging sensation to the skin. Rosacea affects the cheeks, chin, forehead, nose, and eyes. The most common area is the central face. 50% have eye involvement. Oral antibiotics produce faster results than topical medications. Minocycline, doxycycline, and tetracycline are used commonly. They take months to show improvement. Steroids should be avoided. Steroids will cause "rebound" of rosacea, which is an intense flare-up. Topical gels and creams slowly improve rosacea. Topical therapy is slower, but has fewer safety concerns. Improvement may take four months. Women develop rosacea more commonly than men. Medications treat inflammation but not enlarged blood vessels and do not cure.
First step is a combination of oral and topical medications. After improvement, long-term treatment includes topical medications such as azelaic acis, metronidazole, sodium sulfacetamide/sulfur. Practicing good sun protection is key. Exposure to sunlight can worsen rosacea. A daily sunscreen of at least 15 should be applied every morning. It is absolutely important that you protect your face with sunscreen and photoprotection using hats. Protection from the sun is the most important life change you can make with rosacea. This means using sunscreen 365 days a year, which is the single most important way to control rosacea. The best sunscreen is titanium dioxide and zinc oxide.
Itching is the sensation that provokes the desire to scratch. Itching involves the nerves in the skin. Itching can be severe and lead to depression. Many times, itching may be present without any signs of rash. Pruritus is often disrupting and disabling. Itching is a common problem in the aging skin. Itching is most commonly related to dry skin. With age, the skin loses its barrier against the environment, the skin loses its subcutaneous fat, and the skin becomes damaged more easily by the sun. When the skin loses its barrier, the nerve endings become exposed to external stimuli. As we age, the skin becomes drier. This can result in itching during the cold, dry winter months. Older persons tend to use too much soap and water, which dries out the skin and damages the skin barrier. Daily baths are not necessary and may contribute to skin itching. In addition, elderly skin is more sensitive to fabric preservatives, wool, plastics, detergents, bleaches, soaps, and other irritants. Prolonged itching may lead to lack of sleep and fatigue. To prevent dry skin, using Cetaphil gentle cleanser instead of soap may help. Hot water is more irritating to dry skin than warm water. After bathing and drying off, apply a moisturizing cream or ointment immediately to seal in the moisture.
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