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    Psoriasis is a chronic skin rash that is characterized by red scaly lesions.  The lesions of psoriasis tend to be well demarcated--you can clearly see an edge where it goes from involved to uninvolved skin.  Psoriasis has a tendency to appear in certain locations including the elbows and knees, the scalp, the lower back extending to the buttocks, the hands and feet, the nails as well as the area around the belly button.  It can affect other areas as well including the under arms, groin and other body folds (inverse pattern).  In approximately 10% of patients, there can be an associated inflammatory arthritis of the joints that can be destructive.  Psoriasis can be limited to a few areas or it can nearly cover the entire body.  Because psoriasis is mutifactorial in nature with multiple genetic and environmental factors involved, it is often difficult to predict why an individual has it or its course hence the term the "heartbreak of psoriasis". 

    Treatments of psoriasis have targeted both the scaliness (resulting from skin cells that are growing too quickly and improperly) and the redness (resulting from the underlying inflammatory nature) of the disease.  Historically, treatments have been used that probably affect both cell growth and inflammatory components; these include coal tar, ultraviolet light, Vitamin A and D based formulations, corticosteroids and methotrexate.  These tactics are tried and true and will work for most individuals, however, the lack of specificty of some of these drugs has led to variable response rates in some patients and the potential for side effects in some of the more aggressive treatments.  More recently, new medications including the biologics have focused on the ability to isolate a very specific component of the immune system that is stimulated in psoriasis.  While these treatments are not without side effects, the response rates have been historically unmatched and they offer great promise for many who have not responded to prior medications.  Overall, considerations for treatment include extent of involvement and the type/location of skin involved and whether joints are simultaneously involved.  Factors for patients with severe disease include the presence of other medical conditions that may place the patient at increased risk for side effects.  Finally, the reality of our healthcare system creates factors that limit access to some of the newer forms of treatment.  In light of these many considerations, dermatology professionals are the experts at determining which treatments are best for you.

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