Psoriasis is an itchy skin condition that appears as patches and plaques of dry, scaly skin located most commonly on the elbows, knees and scalp. Psoriasis, however, can occur anywhere. Sometimes it can be very mild with just a couple of spots, and in other cases it can be quite severe and widespread. Psoriasis can also make your fingernails and toenails rough and discolored with small pits.

Why  should I care  about 

psoriasis?

Psoriasis is extremely common, and approximately five percent of all people have this skin disease. Psoriasis has associations with arthritis, heart disease, diabetes and dental disease.

What causes psoriasis?

The exact cause of psoriasis is poorly understood; however, we do know that there is a genetic basis for psoriasis and it can run in families. There are probably several genes responsible for causing psoriasis.

How is psoriasis diagnosed?

Psoriasis is diagnosed by board-certified dermatologists based on its classic clinical presentation. There are some rare forms of psoriasis where a biopsy may be required. Some versions that occur only on the hands and feet may also present as painful

Psoriasis before and after treatment

pustules on the palms and soles.

Can psoriasis be prevented?

Because psoriasis is a genetic condition, it cannot be prevented. However, flare-ups can be minimized. Certain medications, heavy smoking, and heavy drinking are triggers that can be avoided to minimize flare-ups of psoriasis. Following a carefully developed treatment plan from your dermatologist will also help tremendously.

How is psoriasis treated?

There are many great treatments for psoriasis. Unfortunately, a recent survey demonstrated that almost 90 percent of patients with psoriasis are unhappy with their current treatment program. If you have psoriasis and are unhappy with your current treatment, this is something that needs to be discussed with your dermatologist.

Treatments for psoriasis include topical moisturizing creams, topical anti-inflammatory prescription creams and ointments, oral medications, special phototherapy/light treatments, and a new class of medications called injectable biologic medications. Many dermatologists will combine several of these for optimal results.

Because 25 percent of patients with psoriasis can also develop psoriatic arthritis, it is important to mention to your doctor if you’re having any joint pain, especially in your hands and feet in the morning lasting more than 20 minutes. This is an early sign for psoriatic arthritis; it’s important to note that arthritis can occur before, during, or years after psoriasis of the skin is diagnosed.

Action steps for anyone with psoriasis

See your dermatologist and develop a progressive treatment plan for your arthritis.

Let your dermatologist know if you’re having any joint pain.

Be sure to also ask your dermatologist about phototherapy treatments.

Schedule a regular general medical examination every year with the appropriate tests for your age and sex.

Let your primary care doctor know that you have psoriasis and are also concerned about arthritis, diabetes and heart disease.

Because psoriasis can also affect your teeth, make sure you have yearly dental examinations.

Remember, there are great treatments for psoriasis, and if your current program is not working, talk to your dermatologist to modify and/or change your current treatment program.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.

Long-term data from study results have shown that Apremilast improves the signs and symptoms of psoriatic arthritis in about 60% of patients at 52 weeks. Apremilast is an oral drug for psoriatic arthritis that is being developed by Celgene. It inhibits phosphodiesterase-4, a molecule thatmodulates a network of pro-inflammatory and anti-inflammatory mediators within cells.

The findings were derived from the PALACEtrials, several trials that have studied the safety and effectiveness of Apremilast for psoriatic arthritis.Results from PALACE1, which were reported last year, revealed thatat the 16-week point 31% of psoriatic arthritis patients treated with 20 mg. Apremilast and 40% of those treated with 30 mg. Apremilast achieved ACR20 compared to 19% who were given placebo. Patients who failed to achieve ACR20 at 16 weeks and who were originally assigned placebo were randomly assigned 20 or 30 mg. Apremilast for a continuaton of the trial. Patients who originally were given Apremilast but didn’t achieve ACR20 at 16 weeks continued with their dose. At the 24-week point, the rest of the placebo group was randomly assigned 20 or 30 mg. Apremilast. Study participants were evaluated at the 1-year point in the study.

The effectiveness seen at 52 weeks is promising, as are positive results from PALACE 1, 2, and 3. Based on the findings, Celgene is expected to file for FDA approval of Apremilast for psoriatic arthritis. The drug is also being studied as a possible treatment for psoriasis, ankylosing spondylitis, rheumatoid arthritis, and Behcet’s disease.

• 52-week Results From PALACE1 (6/12/13)
• Endpoints Achieved in PALACE3 (6/13/13)
• Endpoints Achieved in PALACE4 (5/6/13)
• Benefit Seen From PALACE1, 2, 3 (9/6/12)
• Endpoint Achieved in PALACE1 (7/12/12)

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• Psoriatic Arthritis Screening Quiz
• Test Your Knowledge – Psoriatic Arthritis
• Recognize Signs and Symptoms of Psoriatic Arthritis
• 10 Things You Should Know About Psoriatic Arthritis

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