Many people think dermatology is just for people with acne, rosacea or skin cancer, or those who want Botox injections. However, a specialized dermatologist does a lot more. It's a very advanced field of medicine that requires its doctors to focus on one of many specific skin disorders, such as psoriasis, pyroderma gangrenosum or scleroderma. Today's specialized dermatologists often combine efforts with primary care physicians, rheumatologists or oncologists.
Auto-immune disorders and dermatology
Psoriasis is an auto-immune disorder, meaning that the body's own immune system attacks itself. Plaque psoriasis is the most common form of psoriasis. This disease forms when the immune system causes skin cells to grow faster than the body can naturally shed them. They then build up on the surface of the skin, forming thick patches of scales on the body called plaques. These patches are very painful. The skin often cracks and bleeds. Approximately 7.5 million Americans suffer with psoriasis, with roughly 150,000 cases diagnosed every year. It is usually diagnosed between the ages of 15 and 30.
The teen and young adult years are very difficult as it is without having a severe health issue. If you are suffering with psoriasis, it is important to begin treatment instead of hiding your skin, hoping it will go away. There are many forms of treatment out there, and specialized dermatologists can find one that will work for you.
As with most auto-immune diseases, there is a genetic cause. However, research shows that there are many things in the environment that turn on the immune system and cause it to go into overdrive and begin to attack the body. Strep throat is one such trigger that many patients report. Many people say that stress is a major cause of flares.
A specialized dermatologist will sometimes consider co-treating with a rheumatologist. Many patients later develop psoriatic arthritis--around 30 percent. The joint damage is severe and affects the body like rheumatoid arthritis.
Current forms of treatment
Over the last 10 years, treatments for auto-immune disorders such as psoriasis have advanced greatly. Before the biologic group of medicines came out, most treatment focused on the skin only. The first line of treatment is topical creams such as Clobetasol, Protopic or Dovonex, which is a synthetic Vitamin D. There are many other categories of topical creams.
The drawback to such treatments is that they are messy and can stain clothing. If you have children, you will want to wait until the cream is dry before touching them.
Phototherapy is the most common treatment for moderate to severe psoriasis. Light is helpful in clearing some psoriasis plaques. The simplest form of light therapy is getting daily sunlight. Other forms of light therapy include the use of artificial lights by themselves or with other medications. These treatments are given as often as five days a week for up to six weeks. After you go into remission, you will start to have fewer treatments.
The last type of treatments is oral or injected medications. These come in several forms. Retinoids, a type of vitamin A, can slow down the speed that skin cells produce, which keeps plaques from forming. After stopping treatment, the disease will return. Women should especially be cautious, as it can cause severe birth defects. In fact, doctors recommended that women do not get pregnant for three years after stopping this medicine.
Two other drugs are methotrexate and cyclosporine. They both work by suppressing the immune system. Methotrexate can slow arthritis development in some patients. It is well tolerated in lower doses, but can cause upset stomach, loss of appetite and general malaise. Doctors need to check for liver damage and your white cell count often during treament. It comes in pill and shot form. Most people taking methotrexate need to take folic acid supplements while on this drug.
Cyclosporine can cause nausea, upset stomach, and headaches. It can increase your risk of infection and other health problems, including cancer, acute kidney failure and high blood pressure. These risks increase as dosage and treatment time increases. Doctors suggest that cyclosporine is not used for more than two years straight. Usually this drug requires tapering as you come off it, especially if on high doses.
The last class of drugs is the most recently developed. These are the monoclonal antibodies. Remicade was the first released, in August 1998. It can also be used to treat psoriasis and the related arthritis. You have probably seen commercials for medicines such as Enbrel, Humira and Stelara. These medicines work on specific cells in the immune system. Enbrel, Humira and Remicade are TNF-alpha inhibitors.
TNF (tumor necrosis factor) is a specific immune cell that destroys certain viruses and fights against tumor growth. This is an important immune function, but in those with auto-immune disorders TNF is overproduced, which leads to severe inflammation. This severe inflammation causes diseases such as psoriasis, psoriatic arthritis, Crohn's and ulcerative colitis.
Stelara is another biologic. It is an interlukin inhibitor. It specifically targets interleukins 12 and 23, which are proteins in the body that control the immune system and cause inflammatory disorders. These drugs are given by injection. Stelara is given at your dermatologist's office. They help with both psoriasis and psoriatic arthritis. They are not without side effects, though, and the most common side effects are sinus and upper respiratory infections.
With drugs like Stelara and Cyclosporine, more serious complications do occur, such as increased cancer risks, especially lymphomas, and a rare but life-threatening disorder called reversible posterior leukoencephalopathy syndrome (RPLS). Signs of this disorder are severe headache, seizures, confusion and vision problems. If detected and treated quickly, most people recover. Before beginning treatment with any of these biologics, your specialized dermatologist will check you for tuberculosis.
Whatever you chose, your dermatologist will help you find the best course of treatment and watch for any developing issues. Search Kudzu to find a dermatologist in the Atlanta area.