Treating Plaque Psoriasis – Morning Sign Out at UCI

Written by Daria Sysoeva and Edited by Mehr Kaur Bawa

Photo by **Karolina Grabowska** from **Pexels**

Approximately eight million people in the United States in 2014 are affected by an inflammatory skin condition called psoriasis, with similar estimates for current times [1]. Although the cause of psoriasis is still being studied, studies have shown the association of the condition with a dysfunctional immune system [2]. Specifically, psoriasis involves T-helper cells and cytokines. T-helper cells are immune cells that release cytokines, small signaling proteins that initiate immune system responses. In the case of psoriasis, the immune system triggers an overproduction of cytokines in T-helper cells, resulting in a cascade of inflammatory responses in the body. One of those inflammatory responses affects the skin, as the overproduction of cytokines accelerates the cycle of normal skin growth from a month to a couple of days [3]. This rapid skin cell growth leads to a buildup of skin in certain areas, which results in the development of thick, red patches. These red patches of skin characterize plaque psoriasis—the most common type of psoriasis [3]. A variety of treatments are available to treat this condition with popular methods of topical treatments, UV therapy, and systemic treatments.

The most commonly prescribed medication for psoriasis are corticosteroids. Corticosteroids are topical treatments, ointments that can be applied directly to the skin. This medication reduces inflammation by suppressing the immune system [4]. On a molecular level, corticosteroids control inflammation by suppressing genes that encourage inflammation when being passed on to the next generation of cells [5]. Ultimately, how well corticosteroids are able to treat psoriasis depends on their strength. Class one corticosteroids are the strongest type of medication, while class seven are the weakest. Because class seven corticosteroids are relatively gentle, this class of corticosteroids is suitable for sensitive areas such as the face. On the other end, class one corticosteroids is best for areas with thicker skin such as the bottom of feet. However, a possible concern with corticosteroids is tachyphylaxis, referring to a drug’s declining effectiveness on the body after continued use [6].

Ultraviolet (UV) therapy is another effective course of treatment for patients who have more severe cases of psoriasis. UV light is shone on the affected portions of the skin to decelerate the skin growth cycle and reduce the immune system’s inflammatory responses [7]. The most common type of UV therapy is narrowband UVB, in which the wavelengths of the light used are kept short to reduce side effects of UV exposure but still be effective enough to treat psoriasis [7]. However, a common concern with UV therapy is the risk of skin cancer. Narrowband UVB phototherapy is generally associated with lower risk of skin cancer compared to other UV therapies, but the relationship is still being studied [7].

For severe cases of psoriasis, systemic treatments, like biologics, may be the most effective option for treatment. Biologics work by targeting specific components of the immune system responsible for the inflammatory response behind psoriasis [8]. For example, Orencia is a biologic that blocks the activities of helper T-cells. Inhibiting the function of helper T-cells helps prevent and reduce the inflammatory response of psoriasis. However, this course of treatment may make the body more easily susceptible to infection, since biologics suppress the immune system in general [8]. Overall, with every medication for psoriasis, studies have shown both risks and benefits, which further research hopes to elucidate more treatment options of treating psoriasis.

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