As an expert in psoriasis treatment, a nationally recognized board-certified dermatologist and leader in clinical research and advanced treatments, Paul Yamauchi, M.D., turns his extensive know-how into practical treatment and management plans for chronic skin conditions. Specifically, he serves as the medical director of the Dermatology Institute & Skin Care Center of Santa Monica, teaches at the UCLA School of Medicine and promotes advanced technologies for the rejuvenation and care of skin. Below Dr. Yamauchi answers questions about treating and managing psoriasis and maintaining healthy skin.
SCN: What are the major misconceptions about psoriasis?
Dr. Yamauchi: The mostly widely held myth about psoriasis is that it’s contagious. It’s not. And it’s not a simple cosmetic skin rash, but a disorder of the autoimmune system. Psoriasis is a “systemic” skin disease because it can also affect vital organs, such as joints and the heart. Because psoriasis is misunderstood and literally covered up by clothing, people with psoriasis are often subjected to discrimination at work, in spas and pools and in salons.
SCN: What should a patient who has or might have psoriasis ask their dermatologist? Or if they’re uncertain, what can they expect a dermatologist to ask them?
Dr. Yamauchi: I ask a new patient with psoriasis several questions. 1) How long have you had it? 2) Does anyone in your family have psoriasis or other skin conditions? 3) What symptoms do you have — itching, stinging, burning?
Then I ask quality of life questions, such as 4) How has psoriasis impacted your life personally in terms of your job, your education and your social relationships? 5) What medications have you tried to treat psoriasis? Since there’s no cure for psoriasis but several treatment options, we proceed from there.
SCN: How do you guide a patient through the myriad of available medications and methods for treatment?
Dr. Yamauchi: Most have had psoriasis for a long time and tried lotions, ointments and creams, including steroids or hydrocortisone kinds of creams, vitamin A and vitamin D creams. Possibly they’ve tried light therapy or taking a pill or a shot.
But the treatments stopped working or were impractical to apply — it might take a person with extensive psoriasis covering 10 to 15 percent of body surface up to two hours a day to apply creams. So they seek new medications.
Everyone is individual and reacts differently to treatments, so we try combination therapies to see what’s the most effective. I tell them that there are greater risk factors with more aggressive treatments and that no drug is perfect.
For more severe cases, I often prescribe a biologic agent (man-made protein), given right by shot or infusion. For many, the results are worth the risk.
SCN: Are other chronic skin conditions such as eczema related to psoriasis?
Dr. Yamauchi: Eczema and psoriasis are two different conditions, although they can co-exist in the same patient. Eczema can occur from infancy, appearing as an itchy rash that tends to occur at the elbows and behind the knees, often associated with asthma.
Unlike psoriasis, eczema can be aggravated by dairy products, for example. It can be as symptomatic as psoriasis, with even greater itching that leads to scratching and infection. But it’s not systemic.
Actually, I prescribe the same creams for eczema that I do for psoriasis — steroids, moisturizers and also ultra-violet light therapy. A more advanced case of eczema can benefit from the same pills used for psoriasis. No FDA-approved biologic agent exists at the moment to treat eczema.
SNC: How do patients with psoriasis and other chronic and medical skin conditions benefit from your participation in clinical trials?
Dr. Yamauchi: By participating in clinical trials, we’re on the cutting edge of technology and know what’s on the forefront to treat various skin conditions. We understand the mechanisms of action for these drugs, know which ones work, and to an extent, their safety profiles. Any patient with or without health insurance can get medical care at no cost through participation in clinical trials.
We’ve also conducted research in advanced therapies to help treat skin cancer, acne and hair loss, as well as cosmetic studies with Botox and various fillers and treatments.
SCN: What lasers effectively treat chronic skin disorders?
Dr. Yamauchi: A pulse dye laser can help shoot down the redness of psoriasis plaques. But the gold standard therapy laser is still the narrow band UVB (ultra-violet). We use Photodynamic Therapy for acne where we apply a liquid to the patient’s skin for about one half hour, and then shine a laser on the skin for 20 minutes. This destroys the germs that cause breakouts, unclogs pores and reduces overactive oil glands.
Ninety percent of the time, we employ lasers for cosmetic use — to remove hair, tighten skin, and lessen redness from scars, stretch marks and rosacea.
SCN: What advice do you give your patients with any chronic skin condition, to help them help themselves?
Dr. Yamauchi: For a physician to treat a patient effectively, we will prescribe the proper medication so that, over a period of time, the condition, psoriasis, for example, will be under control for an extended period. That’s the goal.
But the patients have to take the medication the way it’s prescribed. Some don’t get the prescriptions filled, don’t take the medications or stop taking them. That’s one of the issues: compliance and adherence to skin regimen. Without doing what you’re supposed to, the skin condition gets worse.
SCN: How does a healthy lifestyle fit into a skin treatment plan?
Dr. Yamauchi: I tell my patients with psoriasis and skin conditions including eczema and acne to 1) Avoid stress. It plays a role in deregulating your immune system, which in turn causes a condition to get worse. Try to minimize stress through exercising, meditation, yoga and hobbies that relax you. 2) While there is no real established link between diet and psoriasis, since psoriasis is connected to heart disease and diabetes (co-morbidities), I tell patients to eat a good, balanced diet that’s good for your heart, rich in fish oils, for example.
SCN: What top five tips do you recommend for the health of anyone’s skin?
Dr. Yamauchi: 1) Wear sunscreen, hats and protective clothing to minimize exposure to the sun. 2) Moisturize your skin as much as possible, especially when it gets excessively dry. 3) Get a skin check from your dermatologist to make sure that there are no abnormal moles or skin cancers. Those with fair skin are particularly susceptible. 4) To retain youthful skin, apply something like Retin-A [a prescription retinoid]. 5) Talk to your dermatologist about your skincare concerns.
SCN:If you could be known for one achievement in the dermatological world, what would it be?
Dr. Yamauchi: I would like to be known for the fact that I made a contribution in the treatment of psoriasis, which is the disease in which I specialize. And providing education to my colleagues, to my fellow dermatologists, as well as providing the best possible care I can give to my patients with psoriasis — this would be my greatest achievement.
We want to thank Dr. Yamauchi for taking time out of his busy schedule to chat with us. We greatly appreciate you sharing your insight with Skincare-News readers.