September 4, 2010 Lawrence Jaeger is a Board Certified Dermatologist practicing in New York. With over twenty-five years of experience treating patients with Psoriasis he is considered an expert in this field. A recent study in the Journal of the American Academy of Dermatology found that “adalimumab is consistently efficacious in the treatment of moderate to severe psoriasis across patient subgroups, and there are no significant differences in the risk of serious adverse events between adalimumab- and placebo-treated patients across weight categories.” It was also found that those patients who were more overweight had “somewhat reduced responses.” Further, it was found that “subgroup analyses of REVEAL showed that although adalimumab demonstrated considerable efficacy in the treatment of patients with moderate to severe psoriasis, patients of greater weight and obese BMI experienced only modestly lower PASI 75 score responses at week 16 compared with patients of lesser weight and BMI.” According to Lawrence Jaeger, Psoriasis is a persistent, long-lasting (chronic) disease. There may be times when your symptoms get better alternating with times it worsens. The primary goal of treatment is to stop the skin cells from growing so quickly. While there isn’t a cure, treatments may offer significant relief. Lifestyle measures, such as using a nonprescription cortisone cream and exposing your skin to small amounts of natural sunlight, also may improve your symptoms. Lawrence Jaeger notes that signs and symptoms can vary from person to person but may include one or more of the following: Red patches of skin covered with silvery scales Small scaling spots (commonly seen in children) Dry, cracked skin that may bleed Itching, burning or soreness Thickened, pitted or ridged nails Swollen and stiff joints patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. Several types of psoriasis exist. These include: Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques itch or may be painful and can occur anywhere on your body, including your genitals and the soft tissue inside your mouth. You may have just a few plaques or many. Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. The nails may become loose and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble. Scalp psoriasis. Psoriasis on the scalp appears as red, itchy areas with silvery-white scales. The red or scaly areas often extend beyond the hairline. You may notice flakes of dead skin in your hair or on your shoulders, especially after scratching your scalp. Guttate psoriasis. This primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped sores on your trunk, arms, legs and scalp. The sores are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes. Inverse psoriasis. Mainly affecting the skin in the armpits, in the groin, under the breasts and around the genitals, inverse psoriasis causes smooth patches of red, inflamed skin. It’s worsened by friction and sweating. Fungal infections may trigger this type of psoriasis. Pustular psoriasis. This uncommon form can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips. It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea. Erythrodermic psoriasis. The least common type, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely. Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discolored nails and the swollen, painful joints that are typical of arthritis. Symptoms range from mild to severe, and can affect any joint. Although the disease usually isn’t as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity. Doctor Lawrence Jaeger is Chief Medical Director at Advanced Dermatology Associates and Central Park Medical Associates in New York City.