Americans spend over $71 billion a year on lottery tickets - and scratch-off games are a huge favorite. But that's nothing compared with the $112 billion that's spent annually to deal with the itchy skin condition psoriasis and its associated health problems, such as arthritis, depression and cardiovascular disease.

Fortunately, these days the chronic inflammatory skin disorder can be controlled. But fully 50 percent of patients say they're dissatisfied with the treatment they receive! Well, that's made the National Psoriasis Foundation itch to improve sufferers' lives. So they've defined, for the first time, targeted treatments for plaque psoriasis that specify what improvement you should expect to see from proper treatment.

-At minimum, an acceptable response to three months of treatment should see skin lesions reduced to 3 percent or less of the body's surface area, or an overall improvement of 75 percent from baseline.

-The optimal goal of three months' treatment should have skin eruptions confined to 1 percent or less of the body's surface; and an evaluation every six months should reveal that this level is maintained.

If you have psoriatic plaques, don't gamble with your health and happiness. Make an appointment with a dermatologist and discuss your treatment options, including topical corticosteroids, retinoids, salicylic acid and vitamin D analogues; anthralin (it normalizes DNA activity in skin cells); phototherapy (there are many versions); and oral or injected immune modulators and biologics, such as methotrexate and etanercept. And keep exploring what works for you until you hit those treatment targets! You can do it!