By Sarah Churton, MD, FAAD

Psoriasis is a chronic, immune-mediated, systemic inflammatory disorder. The immune system sends faulty signals that cause cell turnover to speed up, resulting in red, itchy, scaly, raised plaques on the skin. Psoriasis affects as many as 7.5 million Americans. The exact cause of psoriasis is unknown, but there are genetic and environmental influences that play a role. An environmental insult can trigger the immune system to release inflammatory cytokines resulting in psoriasis in those with a genetic predisposition. Triggers include stress, injury to the skin, weather, infections, certain medications, alcohol, smoking, and obesity. Psoriasis can appear on any part of the body, but common locations include the scalp, elbows, knees, buttocks, hands, feet, and nails. Psoriasis is not contagious. It can develop at any age but often starts between ages 15-35. Psoriasis can run in families, but many people do not have a family history of psoriasis when they are diagnosed.

Beyond the Skin
Nearly one third of people with psoriasis develop psoriatic arthritis which causes joint pain, stiffness, and swelling. Having psoriasis increases the risk for developing multiple other serious medical conditions, called comorbidities (1). Some of these conditions are listed below:

• Atherosclerosis (hardening of the arteries)
• Heart attack
• Stroke
• High blood pressure
• High cholesterol
• Diabetes and Metabolic syndrome
• Fatty liver disease
• Obesity
• Cancer
• Chronic pulmonary disease
• Depression and Anxiety
• Alcoholism

It has been proposed that overlapping mechanisms of systemic inflammation contribute to the link between psoriasis and cardiovascular disease. Those with severe psoriasis have a higher risk of comorbidities, such as cardiovascular disease-related conditions. Research shows that even pediatric patients with psoriasis have an increased risk of cardiovascular comorbidities including obesity, high blood pressure, and diabetes. Recent evidence suggests that some psoriasis treatments improve cardiovascular risk (2). Because of the possibility of developing comorbidities associated with psoriasis, I recommended that people with psoriasis see a dermatologist for skin exams as well as their primary care physician for regular physicals. Patients with psoriasis who have joint pain may be referred to a rheumatologist to evaluate for psoriatic arthritis.Psoriasis and

Quality of Life
Psoriasis can have a negative impact on personal and health-related quality of life. Physically, psoriasis can be itchy and uncomfortable, and mentally, psoriasis can impact people socially and psychologically. Psoriasis patients are over 1.5 times as likely to develop depression and have a higher risk of anxiety. Reaching out to a mental health professional is important for anyone who is feeling depressed or hopeless.

Dietary and Lifestyle Modifications
Some studies have shown that losing weight may help improve psoriasis symptoms. Excess abdominal fat causes inflammation that is similar to the inflammation in psoriasis and several studies have shown a correlation between body mass index and psoriasis severity. Losing weight may also increase the effectiveness of some psoriasis medications. Studies on elimination diets and dietary supplementation for the treatment of psoriasis have provided conflicting results. Psoriasis is an inflammatory disease, so following an anti-inflammatory diet could reduce symptoms of psoriasis. A gluten-free diet can help in patients with psoriasis who also have celiac disease. With the increased risk of cardiovascular disease and metabolic syndrome, patients with psoriasis should strive to follow a healthy diet.

Psoriasis Treatments
There is no cure for psoriasis, but there are many different treatment options. Treatments include topical medications, phototherapy, systemic medications, and biologics. New therapies have been approved in the past few years and there are more medications currently being studied for psoriasis and psoriatic arthritis. Biologic medications are derived from proteins and work by blocking immune cell interactions. Biologics can be infused or injected in the home or office, depending on which treatment is chosen. Treatment regimens are individualized for each patient depending on the severity of psoriasis and one’s other medications and medical conditions. When working closely with a dermatologist, it is possible to control the symptoms of psoriasis and psoriatic arthritis. Treating your psoriasis, living a healthy lifestyle, and being aware of the comorbidities associated with psoriasis can lead to a better quality of life.

You can learn more about psoriasis by scheduling an appointment at The Woodruff Institute.

Dr. Churton specializes in psoriasis and completed a 3-year Psoriasis Research Fellowship at Case Western Reserve University at University Hospitals Cleveland Medical Center. During her research fellowship, she studied the correlation between psoriasis and cardiovascular disease and was an investigator in multiple clinical trials for psoriasis.

References
1. Churton, Sarah E.; Doud, Kristen; Korman, Neil J. Comorbidities of psoriasis. Expert Review of Dermatology. 2013 Jun;8(3):277-290.
2. Churton, Sarah E.; Brown, Liza; Shin, Thuzar; Korman, Neil J. Does treatment of psoriasis reduce risk of cardiovascular disease? Drugs. 2014;74(2):169-182.

With the more nutrition-conscious society that we have become, we are often asked if there are any foods to avoid for patients with acne.

So far, no specific dietary changes are generally recommended in the management of acne. However, while the answer is not yet clear-cut, a few possibilities have emerged. Most importantly for some of us, we can breathe a sigh of relief to know that chocolate has not been shown to cause acne!

Presently, the data suggests that high glycemic index foods may be associated with acne. The glycemic index measures how a carbohydrate-containing food raises blood sugar. Examples of high glycemic index foods

Examples of high glycemic index foods include: white bread, instant oatmeal, shortgrain white rice, crackers, pretzels, and popcorn.  Examples of low glycemic index foods include: whole wheat, oat bran, barley, sweet potato, peas, legumes, lentils, most fruits, and non-starchy vegetables. In addition, limited evidence suggest that skim milk may aggravate acne. No association was found with cheese or yogurt.

If you or your family member has an acne problem, our dermatology providers at The Woodruff Institute would be happy to help you! We have same-day appointments available.

PRP (Platelet-Rich Plasma) skin rejuvenation may be just what you are looking for!

What is PRP? (Platelet-Rich Plasma)

PRP has become a highly sought-after non-surgical procedure used in several fields of medicine to promote healing and cell growth.  PRP is a therapy that utilizes a patient’s own blood to stimulate new cell growth, helping to improve your complexion, skin texture and to restore lost facial volume. PRP can also be used to treat thinning hair and hair loss, particularly female and male pattern baldness. As the procedure uses a patient’s own blood, it has been referred to as the “Vampire Facelift” or Dracula therapy. Since PRP utilizes the beneficial functions of a patient’s own blood, there is no risk of allergy or rejection of the treatment.

How do you harvest PRP? 

PRP is a natural product created from your own body. A small amount of blood is drawn from you and placed in a sterile tube that is spun down in a centrifuge to separate the different components of the blood. Red and white blood cells are divided from the platelets and the plasma (the clear fluid). This plasma now contains a higher than normal number of platelets and is called platelet rich plasma, or PRP.

How do platelets rejuvenate?

In the last 20 years we have learned that when activated in the body, platelets release healing proteins called growth factors. There are many growth factors with varying responsibilities, however cumulatively they accelerate tissue and wound healing. Therefore, after extracting these platelets we can inject a powerful cocktail of growth factors that can dramatically enhance the improvement skin color, elasticity, tone and collagen production.

How does PRP therapy differ from other injections or fillers?

Hyaluronic acid fillers, like Juvederm and Restylane, are solid substances injected into the dermis of the skin to help provide volume and fullness to areas where natural aging causes volume loss or wrinkles. Common areas of treatment include the nasolabial folds (“parentheses” lines), “marionette” lines along the lower face and around the mouth, and mid-face (cheeks). They usually last from 6-18 months. Repeated treatments are usually needed to fill the areas again. PRP stimulates your own collagen to grow for total facial rejuvenation rather than individual wrinkle improvement.

How do I prepare for PRP treatment? 

Smoking, illegal drug use, and excess alcohol should be avoided.  Aspirin and anti-inflammatory drugs (such as ibuprofen, aleve) should be stopped for two weeks before and six weeks after treatment. Supplements with omega 3 fatty acids (such as fish, krill or flax seed oil) should also be avoided during the same period, as they can increase bruising. If you are taking blood thinning medications (e.g. Warfarin, Pradaxa or Xarelto), you may also experience greater bruising. Drink plenty of water and eat healthily prior to the treatment. Please note that some people experience mild bruising and swelling in treated areas. This is normal and should subside in a few days.

What to expect during and after the PRP procedure

A nurse will take your blood (like a normal blood test).  The blood is then spun in a centrifuge to isolate the PRP which contains a large concentration of growth factors and platelets integral to healing and regeneration.  The area to be treated is washed and local anesthetic cream is applied. The PRP is then injected directly into the area to be treated.  This process takes approximately 45-60 minutes.

Combining PRP With Micro-needling For Even Better Results

Micro-needling is a procedure that stimulates healthy tissue growth through the creation of controlled channel wounds. The instrument used in micro-needling is a pen-like device with tiny needles that can puncture the skin to a depth of up to three millimeters, creating tiny channels in the skin. PRP is often combined with micro-needling by rubbing on the skin before, during and after the procedure. The platelets, which contain growth factors, help to stimulate healthy tissue growth. We highly recommend this cosmetic procedure to our clients who come to us with questions about non-surgical methods for restoring healthy skin.

Is PRP safe?

Since the autologous Platelet-Rich Plasma (PRP) is produced from your own blood, there is virtually no risk of an allergic reaction or rejection.  If you have a rare condition such as thrombocytopenia (low platelet count), hypofibrinogenemia, chronic liver disease or an active blood or skin infection, PRP therapy is not recommended.

To find out if you can benefit from laser treatments at The Woodruff Institute…

Please call our toll free number at 844.485.0104 for a consultation at one of our offices in Naples, Bonita Springs/Estero, or Fort Myers. 

Have you ever noticed waxy brown or gray bumps that look “stuck on” or “pasted on,” as if you could peel them?

These may be seborrheic keratoses (SKs), which are benign, age-related skin lesions. Patients have many names for SKs, like age spots, wisdom or maturity spots, barnacles, or even liver spots (even though they do not have anything to do with the liver).

SKs may be found anywhere on the body and appear gradually over time. They are usually not bothersome but sometimes may feel itchy. Some people may have a lot of SKs, which may be hereditary. If many such lesions appear at once, make sure to have them evaluated by your dermatology provider.

SKs will occasionally become itchy or painful, especially those that rub on clothing. Some insurances may cover the removal of SKs to help relieve the symptoms. Treatment is most commonly done with liquid nitrogen, a very cold liquid, among other methods. Multiple treatments may be necessary to completely remove the SKs, as frequently they do not resolve with only one treatment.

If SKs are not symptomatic, treatment is usually not covered by insurance since it would be considered cosmetic/elective.

SKs may look like other skin growths, sometimes concerning lesions. Therefore it is important to have your dermatology provider evaluate and diagnose your skin lesions. If you have any new, changing, bleeding, growing, or itchy lesions, make sure to visit your friendly dermatology provider at The Woodruff Institute for Dermatology & Cosmetic Surgery for an evaluation. We are offering same-day appointments.

Have you ever noticed whitish or discolored scaly spots on the body?

If these spots come and go, one of the possibilities may be a condition called tinea versicolor (TV), or also known as pityriasis versicolor. TV is caused by yeast that is commonly present on the skin, which normally doesn’t cause problems with the skin.

Some factors may promote the growth of this yeast on the skin, including:

*hot and humid weather
*excessive sweating
*oily skin
*a weakened immune system
*hormonal changes

You may try over-the-counter dandruff shampoo as a body wash daily in the shower. Wear loose fitting clothing as freqently as possible. If that does not work after a couple of weeks, make sure to visit your dermatology provider for evaluation and treatment. In general, there are various other possible diagnoses for such rashes, from benign common ailments to concerning disorders. We are here for you, and are offering same day appointments.

Call 239-498-DERM or request an appointment online.

Now that Hurricane Irma has subsided, SWFL residents should be on the lookout for potentially serious skin conditions while trying to resume their day-to-day lives.

These tips should help keep your skin as healthy as possible when you find yourself in post hurricane conditions.

Parasites and Bacteria 
People should avoid wading in or drinking floodwater. Floodwater may contain heavy and sharp wreckage and contaminated sewage, soil, and other debris. Wading in floodwater exposes skin to parasitic or bacterial infections like E. coli, Salmonella, Norovirus, Rotavirus, and Cryptosporidium. While many of these infections are quickly treatable by your dermatologist, the young or old and those suffering from dehydration will have a harder time fighting them off. So stay hydrated and avoid standing water.

Wound Infections
Injuries are common while people work to clean up a storm’s damage. Developing a fungal or bacterial infection is very common due to standing in water or wet clothing for extended periods of time. Wound care involves cleansing the area with clean water and mild soap and applying plain Vaseline or Aquaphor with a bandage. The area must remain out of flood water. Whether the wound is big or small, it should be evaluated as soon as possible by a dermatologist.

Intertrigo
Intertrigo is a type of rash that involves the skin folds, such as armpits, inner thighs, groin, or other areas where there is prolonged skin to skin contact. In hot environments, like homes without air conditioning, moisture gets trapped within these folds and becomes moist, irritated and inflamed. Without ways to cool off after a hurricane, intertigo becomes a common problem. Try using moisture absorbent powders and see a dermatologist if the condition does not subside.

Eczema
Eczema tends to flare up with changes in heat and cold, so for those individuals who tend to get this itchy, irritating rash, high heat and humidity have the potential to make their lives much more miserable. Absorbent powders, loose cotton clothing, and over-the-counter 1% hydrocortisone creams (if itching occurs) will help until you can be evaluated by your dermatologist.

Mosquitoes
Lastly, the standing water and floating trash make for the ideal breeding ground for mosquitoes. With an influx of hatching eggs as the waters recede, West Nile Virus (WNV) becomes a concern as it is commonly spread to people by mosquito bites. According to the Center for Disease Control (CDC), “there are no vaccines to prevent or medications to treat WNV. Fortunately, most people infected with WNV do not have symptoms. About 1 in 5 people who are infected develop a fever and other symptoms. About 1 out of 150 infected people develop a serious, sometimes fatal, illness.” People should stay indoors at night. You can further reduce your risk of West Nile Virus by using insect repellant and wearing protective clothing to prevent mosquito bites.

Our offices are open and offering same day appointments. Call 239.498.DERM or Request An Appointment Online.