Psoriasis affects more than 3% of the US population according to a 2021 study. That is more than 7.5 million adults. Psoriasis affects 3% of the world’s population, currently 125 million people.
Psoriasis is an immune mediated disease. This dysfunction of the immune system causes the skin to increase the growth of the cells. Normally skin cells are produced and shed in approximately one month duration. In Psoriasis, the rapid growth occurs in days and are not shed. They stay on the skin surface and form plaques and scales. The plaques and scales cause burning, itching and stinging sensation and are unsightly in their appearance. These lesions occur on any body part and are most commonly found on the elbows, knees and scalp areas.
Psoriasis often starts between the ages of 15 and 25 however it can start at any age. Men, women and children of all skin colors can be affected. The inflammation of psoriasis can impact other organs and tissues in the body. This causes other health conditions. One out of three people with psoriasis also develop psoriatic arthritis. This disease causes stiffness and pain and can develop permanent joint destruction and damage.
Psoriasis has no known cause, but genetics can play a major factor in the development.
Common locations for psoriatic lesions:
- Genital psoriasis- extremely common with lesions in the genital area and inner thighs. Up to 66% of patients with psoriasis have or had flare ups in this area.
- Scalp psoriasis- affects 60% of people living with psoriasis. Lesions are in the hair, neck, forehead and about the ears.
- Facial psoriasis- affecting about 50% of patients. Lesions can occur anywhere on the face, nose and lips.
- Skin folds- lesions under the arms and breasts are common and seem to be affected and irritated by friction and sweating.
- Hands, Feet and Nails- Palmoplantar psoriasis affects the palms and soles of the feet. This condition affects 16% of patients with psoriasis. Nail changes are extremely common and affect about 50% of all cases.
Types of Psoriasis
There are five common types of psoriasis.
- Erythrodermic Psoriasis- This form of psoriasis is rare affecting 2% of all cases. The skin can shed in large sheets and is associated with extreme red discoloration. This affects large areas and can be life threatening. These cases need immediate medical attention.
- Inverse Psoriasis- Signs of this type include deep red inflamed tissue without the typical scale or plaque. Commonly seen in the skin folds such as under breasts, genital area and buttock. Sweating exacerbates the intense itching of these lesions.
- Pustular Psoriasis- these lesions include pustules surrounded by inflamed reddened discolored areas. Common areas are hands and feet.
- Guttate Psoriasis- characterized by small round red discolored spots caused by the inflammation. Usually on the torso but can occur anywhere on the body.
- Plaque Psoriasis- This is the most common type affecting 80% of the cases. The plaques can occur anywhere on the body and appear as raised patches of inflamed, painful, pruritic lesions. In some cases, these lesions may have a silver like appearance with silver white scales. Other cases, these lesions have a purple like tone. Knees and elbows are very common areas, but they can occur throughout the body.
Treatment
Psoriasis treatments aim to stop skin cells from their rapid growing and to remove the scale and plaque formation. Topicals, orals, light therapy, alternative therapies may be used solely or in combination to attain a remission or control of this disease.
Topicals
Corticosteroids are the most frequently prescribed medications for treating mild to moderate psoriasis. They are available in oils, creams, lotions, gels, sprays and shampoo. The potency depends on the severity of the disease and area treated. However, long term use will thin the skin, cause systemic side effects, and may stop working completely.
Vitamin D analogues are synthetic forms of vitamin D. They work by slowing skin growth.
Calcineurin inhibitors calm the rash and reduce the scale buildup. Salicylic acid reduces the scale.
Coal tar reduce the scaling inflammation and itching associated with psoriasis. However, should not be used in pregnancy or breast feeding.
Anthralin is a tar cream that slows skin growth. It can remove scales and make the skin smoother, but it can also inflame skin. It stains clothes and must be applied and washed off.
Light Therapy
Light therapy is a first line treatment for moderate to severe psoriasis. This is usually used in combination with other treatment modalities.
- Sunlight- daily exposure may improve the lesions.
- Goeckerman therapy- combination of coal tar and light therapy. The coal tar makes the skin more responsive to UV B light.
- UVB narrow and broadband- this artificial light can be used on small patches or wider areas. The narrow band causes more side effects such as inflamed, dry itchy skin.
- Laser- applied to lesions but can cause significant blistering and inflammation.
- Psoralen plus UVA (PUVA)- a light sensitive medication is given (psoralen) and then the skin is exposed to UVA. This allows the light to deeply penetrate. The side effects include dry skin, freckles, wrinkles, sun sensitivity and increased risk of skin cancer.
Oral or Injected Medications
These drugs are usually given to refractory cases as they can have severe side effects. Most cannot be taken during pregnancy or breast feeding.
- Steroids
- Retinoids- these drugs reduce the production of skin cells.
- Biologics- As a class, they modify the immune system. In doing so, they increase the risk of severe life-threatening infections.
- Methotrexate- decreases the production of skin cells and suppresses overall inflammation. This drug has severe side effects and lab testing must be done serially. Blood counts and liver function testing must be monitored.
- Cyclosporine- another immune modulator with significant side effects where laboratory testing must be followed closely. Blood pressure and kidney function
- Must be followed closely and should not be taken for greater than one year.
Alternative treatments
Special diets, vitamins, acupuncture and herbal products may have limited benefit in treating symptoms. Aloe cream, fish oil and barberry have been shown to reduce severity.
In a recent study, 50% of patients are not satisfied with current treatment therapies.
Platelet Rich Plasma
Platelet Rich Plasma is an autologous blood derived concentrate rich in cytokines, growth factors and bioactive proteins. Due to high concentrations of these factors, PRP has been used in many fields of medicine to rejuvenate and repair damaged tissue. Various growth factors, including platelet derived growth factor, transforming growth factor, vascular endothelial growth factor and insulin derived growth factor are secreted from the alpha granules on the platelets and once activated become aggregation inducers. These factors regulate cell processes including cell migration, attachment, proliferation and differentiation and promote extracellular matrix accumulation by binding to specific receptor sites.
In psoriasis, nuclear factor kappa B, which plays a regulatory role in inflammation, is a critical mediator in the pathogenesis of psoriasis. PRP exerts an inhibitory effect on NF-kB which results in prevention of cytoplasmic shuttling. PRP reduces chemotaxis by inhibiting chemokine activation thus controlling inflammation. Patients with psoriasis, who were on methotrexate and had PRP treated plaques, had significant improvement in erythema, induration and desquamation compared to methotrexate alone.
Platelet Rich Plasma exhibited positive results on human dermal fibroblasts. Once applied, and biopsies taken for evaluation, PRP increased the expression of type 1 collagen, metalloproteinases and m-RNA in human dermal fibroblasts. This exacerbated tissue remodeling. PRP also enhances the proliferation of keratinocytes and stem cells and can stimulate the undifferentiated stem cells.
Studies
J Clin Aesthet Dermatol 2020 Aug; 13(8):28-35 PMID 33178379
Purpose: In this review, we highlight the potential efficacy and benefits of PRP with focus on skin rejuvenation, inflammatory nail disorders and psoriasis
Conclusion: PRP seems to be a promising therapeutic modality in the field of dermatology when used alone or in combination with other therapies.
Dermatol Ther 2016 Nov; 29(6): 446-450 PMID 27418241
Purpose: We evaluated the combined efficacy of platelet rich plasma and methotrexate in the management of patients with plaque psoriasis
Conclusion: Patients treated with PRP/MTX showed substantial improvement in terms of reduction in erythema, induration and desquamation at each visit and was effectively cleared off psoriasis at week 16. Combination treatment was well tolerated by all patients without any serious side effects.
Cureus 2021 Oct; 13(10): e18472. PMID 34754637
Objective: Our aim was to investigate the clinical effects of platelet rich plasma on the skin of patients suffering from plaque psoriasis or atopic dermatitis
Conclusion: Our study reveled encouraging results for both psoriasis and atopic dermatitis. The autologous treatment was safe and effective in all patients.
Semin Cutan Med Surg 2013 Mar;32(1): 41-52 PMID 24049929
Objective: To evaluate the use of LLLT in various skin conditions
Conclusion: LLLT is a proven therapeutic option in the healing and restoration of skin
J Eur Acad Dermatol Venereol 2012 Feb;26(2):219-25 PMID 21435024
Purpose: to examine the efficacy of blue light vs red light in the treatment of psoriasis
Conclusion: Blue light was more effective than red light therapy in the treatment of psoriasis but both showed improvements in double blinded applications
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits have been scientifically manufactured to provide a consistent platelet concentrate, devoid of red blood cells with a minimum number of leukocytes, critical to the regenerative process.
Juventix Regenerative Medical offers a patent pending LED Activator to activate the platelets and begin the regenerative process. This activation is a critical step in the release of cytokines, growth factors and bioactive proteins and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen.
Juventix Regenerative Medical supplies a Bio-Incubator that transforms the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different cytokines and growth factors than the original PRP. These different cytokines provide an anti-inflammatory environment. When used with the PRP, this would be a dynamic combination for plaque psoriatic lesions.
Juventix Regenerative Medical is now collaborating with Evolutional Biologics. The Evo Elixir contains a dermal fibroblast conditioned media that would be an added topical treatment for psoriatic lesions in conjunction with platelet rich plasma to further augment the overall healing and rejuvenating process.
Juventix Regenerative Medical also offers Low Level Laser Therapy and our DermaMend Device. This gives clinicians options when using various spectrums of light for the treatment of psoriasis and other skin conditions. LLLT has been proven in skin stimulating, healing and restoration. Both red and blue light are incorporated in these devices and have been proven to be efficacious in the treatment of psoriasis.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
