My Doctor Online The Permanente Medical Group

Symptoms

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Psoriasis can be mild, with small areas of rash, to moderate or severe, with inflamed skin and raised red areas topped with loose, silvery, scaling skin. In severe cases, skin may itch and be tender. Large patches of skin with psoriasis can be uncomfortable and embarrassing.

Psoriasis may affect the fingernails and toenails, causing the nail to pit, change colors, and separate from the nail bed. Swollen, stiff joints may be a sign of psoriatic arthritis.

Diagnosis

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We diagnose psoriasis by looking at the patches on your skin. Usually, no special tests are needed. Severity is indicated by the amount of redness and scaling, thickness of the plaques (large areas of raised skin patches), and percentage of skin affected.

Occasionally, we remove a skin sample (biopsy). We may order X-rays if joint pain is present or take a skin test to rule out a fungal infection.

In the case of guttate psoriasis symptoms, we may check for strep throat.

Causes

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The cause of psoriasis is unknown. The tendency to develop psoriasis may be inherited since one-third of people with psoriasis have family members with the condition. We believe that the immune system may also be a factor. Other factors contributing to development of psoriasis include:

• Cold, dry weather
• Injury to the skin
• Stress
• Certain medications (nonsteroidal anti-inflammatory drugs, or NSAIDs, beta-blockers, and lithium)
• Infections such as strep throat

Risk Factors

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The following factors may increase your risk of developing the disease or increase the severity of the disease:

• Family history
• Emotional or physical stress
• Other medical conditions, including HIV and strep throat in children
• Smoking
• Obesity that causes skin creases and folds
• Alcohol consumption

Home Remedies

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While you cannot prevent psoriasis, skin care at home may help improve your appearance and ease the discomfort of damaged skin. These tips will improve symptoms or reduce flare-ups:

• Keep skin moist by taking daily baths and using ointment-based moisturizer while your skin is still moist.
• Follow instructions for skin products and prescribed medication.
• Soften psoriasis crust with cream.
• Use over-the-counter medicated tar shampoos like selenium sulfide, pyrithione zinc, salicylic acid, tar, and ketoconazole to reduce the itching of scalp psoriasis.
• Avoid becoming sunburned because it can cause psoriasis flare-ups and skin cancer.
• Be aware of and avoid medicines that make your psoriasis symptoms worse.
• Avoid cool, dry climates.
• Avoid scratching or picking at plaques and avoid skin injuries. Keep your nails trimmed.
• Avoid stress and anxiety, which appear to bring on psoriasis flare-ups.
• Avoid infection that can cause guttate psoriasis.
• Do not smoke.
• Limit your intake of alcohol.

Treatments and Medications

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Psoriasis treatment focuses on slowing the rapid growth of skin cells and reducing inflammation and plaque formation. Removing scale and soothing the skin are also part of treatment. There are 3 main types of treatment:

Topical medications

• Topical corticosteroids slow down cell turnover by suppressing the immune system. This reduces inflammation and itching.
• Vitamin D compounds slow down the growth of skin cells. They may be used alone or in combination with phototherapy.
• Anthralin, a topical cream, slows skin cell growth and removes scale, making the skin smoother. It may stain your skin and clothes, so we recommend that you use it only for short periods and then wash the affected skin.
• Topical retinoids slow skin cell growth and may decrease inflammation. Common side effects are skin irritation and sensitivity to sunlight.
• Tar products.

Light therapy or phototherapy

These therapies involve the use of natural or artificial ultraviolet light for the treatment of psoriasis.

• Sunlight slows skin cell turnover and reduces scaling and inflammation. Exposing your skin to controlled amounts of natural sunlight may improve psoriasis.
• UVB phototherapy can be used to treat single patches, widespread psoriasis, or psoriasis that resists topical treatments. Side effects include redness, itching, and dry skin.

Oral medications

We may recommend prescription medication for moderate or severe psoriasis or if topical medicines and phototherapy are not working for you.

• Methotrexate decreases the production of skin cells and suppresses inflammation. It cannot be used by women who are pregnant or planning to become pregnant. Men whose partners are planning to become pregnant should also avoid this medication. Long-term use can lead to serious liver damage and decreased production of blood cells.
• Retinoids reduce the production of skin cells. They do not weaken the immune system and thus are sometimes used for children and people with other conditions such as HIV. Side effects are dry skin and mucus membranes, itching, and hair loss. Retinoids can cause birth defects, so women of reproductive age should discuss taking this medication with us.
• Cyclosporine suppresses the immune system. It increases your risk for infection and other health conditions including cancer. Cyclosporine may increase your susceptibility for kidney problems and high blood pressure as well.
• Biologics are given by intravenous infusion or injection. These medicines act on specific parts of the immune system to decrease the inflammation associated with psoriasis. Biologics may be effective and may be safer for the liver and kidneys, but long-term safety is unknown.

Alternative Medicine

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Complementary therapies include the use of herbs, vitamins, certain diets, and stress reduction. These therapies may relieve symptoms in some people:

• Aloe vera. This cream may decrease redness, scaling, itching, and inflammation.
• Capsaicin cream. An extract from chili peppers, capsaicin cream may decrease itching and severity of psoriasis. You may experience a burning sensation the first few times it is used.
• Fish oil. Omega-3 fatty acids, which can be obtained in fish oil supplements, may reduce the inflammation associated with psoriasis.

Coping and Support

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Psoriasis can cause complications such as low self-esteem, depression, stress, anxiety, and social isolation. Psoriatic arthritis can be debilitating and painful, interfering with daily activities and causing erosion in joints. To cope and feel more in control:

• Become educated about your disease and treatment options.
• Find a support group.
• Use coverups, clothing, or cosmetic coverup products.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might contact me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we may discuss your medical and family history and I will examine the patches on your skin. Usually, no special tests are needed. Occasionally, we do a skin biopsy, order X-rays if joint pain is present, or conduct a skin test to rule out a fungal infection. If we suspect guttate psoriasis, we may check for strep throat. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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