Psoriasis is an systemic inflammatory disease that is caused by abnormalities in the immune system. In our practice, psoriasis commonly affects the bottom of the patient’s feet and manifests as a reddened-type rash with silvery scales or flakes of skin. The skin lesions are usually symmetrical. Psoriasis is commonly painful, itchy, inflamed, and can crack or fissure.
Psoriasis can also cause metabolic syndrome which causes patients to be more susceptible to diabetes, high blood pressure, high cholesterol and obesity. Psoriasis patients are more prone to having heart attacks and depression as well.
Psoriasis is commonly misdiagnosed as chronic athlete’s foot. Patient are commonly prescribed antifungal creams medications that do not end up working.
Psoriasis affects the toenails. The toenails will sometimes have little pits or divots. Sometimes the nails with be rough like sandpaper instead of smooth. The nails can have a tendency to come off. The nails can also have a dirty, brown appearance as if the nail was dipped in crude oil. The nails are often misdiagnosed as having fungus.
The patient will often have psoriasis in other places such as the knees, elbows, scalp and along creases in the skin folds such on the bottom or under the breasts. Oftentimes, the hands will manifest identically to the feet.
To diagnose psoriasis, a punch biopsy of the skin is most definitive. Once diagnosed, treatment can be started.
1. Topical corticosteroids – some topical steroids are very strong and some are not. Some stronger topical steroids are betamethasone, halobetasol, and clobetasol. These meds are typically only used for 1-2 weeks at the most. If they are used for a prolonged time period, it may cause the skin to become thin, develop stretch marks, and cause the skin healing to slow down. The lower dose topical steroids can be used for longer time frames.
2. Vitamin D Analogs – these medicines decrease inflammation and lessen the prominence of the skin lesions. Medications such as Dovonex and calcitriol are used twice daily. Taclonex is a combination of steroid with a vitamin D analog.
3. Topical calcineurin inhibitors – an ointment called Tacrolimus is usually combined with salicylic acid. This ointment locally affects the immune system to slow down the progression of the psoriatic lesions.
4. Keratolytics – skin creams with lactic acid, salicylic acid and urea are often used to decrease the amount of scaling and soften the hard skin.
5. Moisturizers – there is a large quantity of OTC and prescription moisturizers that can be used immediately after bathing to prevent recurrence of skin lesions and keep them at bay.
6. Topical retinoids – a medication called Tazarotene can be used once daily to decrease inflammation and decrease the amount of skin cell development at the site of the psoriatic lesions.
7. Coal tar – can decrease inflammation and itching. The downside to this product is that it has an odor, can stain the clothes and can cause sensitivity to sunshine.
8. Anthralin – research does not yet know how this product works
If you have psoriasis and desire treatment, please come see Dr. Silvers at Advanced Foot & Ankle Center in both McKinney, TX and Prosper, TX.
Call 972-542-2155 for an appointment today.