PSORIASIS

Dr. Weiss is very committed to the care and treatment of individuals suffering from psoriasis. To ensure that patients with psoriasis obtain the most advanced therapy, he has created a Psoriasis Center at the Weiss Skin Institute. For the last decade, since his fellowship at the National Institutes of Health, Dr. Weiss has been actively involved in research on psoriasis. He has published and lectured extensively on the subject. During your initial visit, Dr. Weiss will take a comprehensive history to determine the treatments that you have already attempted. Then, relying on a variety of treatment methods, including topical therapies he helped to develop, biologic injectable therapy, and laser, he will structure a personalized course of therapy to clear your disease and maintain a remission.

What is psoriasis?
Psoriasis is an inflammatory skin disorder that usually manifests as inflamed, edematous skin lesions covered with silvery white scales. The most common type of psoriasis is plaque psoriasis, characterized by patches on the scalp, trunk, and limbs. It often appears between 15 to 25 years of age, however it can develop at anytime and usually continues throughout life. Between 5.8 and 7.5 million Americans have psoriasis with an annual incidence between 150,000 and 260,000.

What causes psoriasis?
Psoriasis is an immune mediated disease. Because it is a genetic skin condition, it therefore often runs in families. Patients with psoriasis also have a shortened epidermal cell cycle. This means that their skin turns-over much more quickly than in people without psoriasis - hence the thick, scaly plaques. To explain, whereas in healthy individuals the keratinocytes (skin cells) require 28 to 44 days to migrate from the basal cell layer of the epidermis (bottom) to the stratum corneum (surface), in psoriatics that process only requires 4 days.

Does anything make my psoriasis worse?
Both trauma to the skin and emotional stress can worsen your psoriasis.

Can psoriasis be cured?
Although psoriasis can be treated, there is as of yet no cure.

Topical Therapies
Topical steroids are the first line of treatment to control the inflammation. These range in potency from low potency products to be used on the face and axillae to super-high potency steroids for the body and scalp. There are many means by which to deliver the steroids depending on the extent and anatomic location of disease including ointments, creams, foams, lotions, shampoos and sprays. Dr. Weiss defines for each patient both the type of steroids and the vehicle in which it is delivered based on the extent of the disease. In addition to topical steroids, topical Vitamin D or Vitamin A analogs can be used in combination or separately.

Laser Therapy
The excimer laser emits light at the 308nm wavelength in the UVB spectrum. Although the treatment times vary depending on body surface area affected with the disease, most treatment sessions last only a few minutes. For example, an elbow lesion would take about one minute to treat. The excimer laser is usually used for mild to moderate levels of psoriasis where the lesions cover less than 5 percent of the body surface area (250 sq cm). During the treatment, the laser hand piece is moved over the affected area, focusing the light energy on the psoriatic plaques. On average, it requires between 4 to 12 sessions, but sometimes more. Treatments are usually done one to two times per week.

Systemic Therapies
More severe psoriasis, usually defined as greater than 10% body surface area, can be treated with oral immune modifiers including methotrexate and cyclosporine, a vitamin A analog called Soriatane, or biologic response modifiers including those that act on Interleukin 12/23 (Stelara) or those that act on TNF-alpha (Enbrel, Remicade, and Humira). Dr. Weiss has worked extensively with these therapies, including conducting some of the pivotal studies that led to their approval by the FDA. These therapies are often used in conjunction with topical and light therapy.

Dr. Weiss was featured on CBS news nationally to discuss the role of Stelara in the treatment of psoriasis: