Overpowering Plaques

Treatments clear skin after psoriasis outbreaks.

For Adam*, an outbreak of psoriasis can occur at any time. The semi-retired architect and New England native has struggled with the unsightly and disheartening skin disorder for years. Just over a year ago, though, he experienced a particularly severe episode that his doctors were unable to effectively treat.Stock photo from istockphoto.com.
“I had red blotches on my skin that increased in size,” he describes. “The blotches looked like blemishes, and when I didn’t treat them, my skin got scaly like plaques. They really itched. Many people’s plaques are in different locations on their bodies, but the predominant area for mine was on the backsides of my upper legs.”
Adam’s years of service in the United States Army National Guard earned him coverage through the Veterans Administration Medical Center. Doctors at the VA treated his latest outbreak of psoriasis with little success. His VA facility didn’t have a dermatology department, so they referred Adam to Blue Ocean Dermatology in Port Orange.
At Blue Ocean Dermatology, Adam met Alina Collins, ARNP, advanced registered nurse practitioner. Alina works alongside Jason L. Welch, MSN, NP-C, and Nitra H. Welch, MSN, NP-C, certified nurse practitioners specializing in dermatology, and Lawrence G. Blasik, Jr., MD, who is board certified in both dermatology and internal medicine. Alina was assigned to follow Adam through his treatment process.
“Adam came to the office with some resistant areas of psoriasis on his legs and backside,” notes Alina. “He had been seen at the VA, where they gave him different creams that didn’t work for him. I prescribed a combination of creams he hadn’t tried before.
“I sent him home with those prescriptions and gave him instructions on how to use them. Adam came back a month later, and his psoriasis plaques were significantly improved.”
“The treatment regimen I followed was two different ointments to get the psoriasis under control,” confirms Adam. “I opted to do the ointments rather than have injections. I also used some anti-itching medication, which worked quite well.”

Plaque Suppressants

Psoriasis is an autoimmune reaction of the skin that affects about three percent of the population. The skin reacts to immune system stimulation by overproducing skin cells. The cells stack up on each other, creating the thick, itchy plaques on the skin.
People can get psoriasis anywhere on their bodies, says Alina, but it often occurs in areas of friction, most frequently on the elbows and knees. Itching is the most common symptom, but depending on where the plaques are found, they can also be painful.
“If the plaques are on the head, they can cause pain in the scalp,” she reports. “People can get psoriasis of the nails where the nails become pitted or become very brittle and break off. Plaques can also be located in the private areas and cause burning pain.”
The first step in determining a treatment plan is completing a thorough health history. Initial treatment depends on the location of the plaques and whether the patients have had their psoriasis treated before or if it’s a new diagnosis. Typically, the medical staff at Blue Ocean Dermatology begins by prescribing topical steroid creams for the plaques. But that’s not their only option.
“We also use a group of topical medicines called calcineurin inhibitors, which suppress the immune system,” informs Alina. “Usually, we use them in a combination, as we did with Adam.

“I used the ointments every day, and they took care of my psoriasis. The plaques went away, and I got relief from the itching.”-Adam

“Dermatology providers generally have more success using topical medicines because we better understand the different ways to use ointments and creams. We’re also aware of nuances in dosing that physicians who don’t use ointments every day may not know.”
Alina notes that treatment also depends on how much of the body is affected by the psoriasis. If it’s located on just the knees and elbows, that’s a relatively small surface area, so a combination of topical creams should be sufficient treatment.
“If it’s on a larger body surface area or scattered throughout the body, we can use narrowband UVB therapy, a type of phototherapy,” she acknowledges. “We treat patients using a safe UVB light source, which blocks many of the inflammatory mediators that cause psoriasis, and it improves symptoms.”

Relief at Last

Adam saw improvement in his psoriasis plaques early on using the medications Alina prescribed. He continued to follow his treatment regimen and, over time, experienced excellent results.
“I used the ointments every day, and they took care of my psoriasis,” marvels Adam. “The plaques went away, and I got relief from the itching.
“I saw improvement pretty quickly, but my understanding is you can’t cure psoriasis. It’s a constantly reoccurring thing, there for the rest of your life. Still, I was very happy with my treatment results.
“Blue Ocean Dermatology has a good staff, and Alina is very conscientious,” he reports. “Blue Ocean is also very convenient, as it’s close to where I live, about four miles away.
“I’m completely satisfied with the treatment I received from Blue Ocean!”

*The patient’s name was withheld at his request.
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    • Blue Ocean Dermatology

      Blue Ocean Dermatology provides outstanding medical and aesthetic dermatology to people of all ages. All services are performed with integrity and honesty, and with high regard to humane concerns.... Read More

    • Lawrence G. Blasik, Jr., MD

      Lawrence G. Blasik, Jr., MD, earned his undergraduate degree from Valparaiso University in Valparaiso, IN. He was awarded his medical degree from the University of Illinois College of Medicine in Chicago. Dr. Blasik is board certified in dermat... Read More

    • Nitra H. Welch, MSN, NP-C

      Nitra H. Welch, MSN, NP-C, received her Bachelor of Science degree in Nursing from Troy State University in Troy, AL. She was an ICU nurse for eight years. She earned her Master of Science degree in Nursing and her family nurse practi... Read More

    • Jason L. Welch, MSN, NP-C

      Jason L. Welch, MSN, NP-C, received his Bachelor of Science degree in Nursing from Florida State University in Tallahassee.  He was an ICU nurse for seven years. He earned his Master of Science degree in Nursing and family nurse pract... Read More