Relief for Psoriasis
With proper treatment, symptoms can be reduced or eliminated
You first noticed them on your elbows – itchy, sore patches of thick, red skin with silvery scales—and wondered if the markings could be psoriasis. For people suffering from the skin disorder, the patches can also appear on your knees, scalp, back, face, palms, and feet, but they can show up on other parts of your body.
Psoriasis has been recognized for centuries; however, there has been a revolution in the understanding of the condition.
“At its core, psoriasis is an autoimmune disease caused by an immune system that overproduces skin cells,” says Michael Shapiro, M.D., FAAD, ACMS, a board-certified New York dermatologist. “The most up-to-date treatments for severe psoriasis do not treat the skin but rather target the immune system. Since it is an inflammatory skin disease, it is now known to be associated with internal cardiovascular inflammation.”
“Psoriasis is a chronic condition,” says Noe Baker, public relations manager for the National Psoriasis Foundation (NPF).
Up to 30 percent of people with the disease develop psoriatic arthritis, and recent studies indicate that patients with moderate to severe disease are also at increased risk for other associated health conditions, including heart disease, heart attack, diabetes, high blood pressure, obesity, depression, and hypertension.
“A dermatologist will diagnose the condition and provide the most effective care for individual patients. With effective treatment, many people find that their psoriasis will clear. However, it can reappear at any time,” Baker cautions.
“Once patients understand that their psoriasis is not contagious, they seem to be relieved,” according to dermatology specialist Joshua Fox with Advanced Dermatology, PC.
“They are comforted to know that there is help for their symptoms. Psoriasis can be painful and can make everyday actions uncomfortable for adults and children,” adds Fox. “The disease carries a stigma that can lead to a loss of self-esteem, depression, and other health complications.”
“Psoriasis occurs across all races and climates and has a bimodal age distribution,” Shapiro says. “One peak occurs in children and the other in middle-aged adults. Psoriasis improves with natural sunlight, and thus may be seen in more severe forms in northern climates where sun exposure is less.”
Scientists believe that at least 10 percent of the general population inherits one or more of the genes that create a predisposition to psoriasis, according to Baker. However, only 2 to 3 percent of the population develops the disease.
Researchers believe that for a person to develop psoriasis, the individual must have a combination of the genes that cause psoriasis and be exposed to specific external factors known as triggers.
Triggers are not universal, and what may cause one person’s psoriasis to become active may not impact another. Common triggers, according to the NPF website, include:
Stress: Stress can cause psoriasis to flare for the first time or aggravate existing psoriasis. Relaxation and stress reduction may help prevent stress from impacting psoriasis.
Injury to skin: Psoriasis can appear in areas of the skin that have been injured or traumatized. This is called the Koebner [“KEB-ner”] phenomenon. Vaccinations, sunburns, and scratches can all trigger a Koebner response. The Koebner response can be treated if it is caught early enough.
Infection: Anything that can affect the immune system can affect psoriasis. In particular, streptococcus infection (strep throat) is associated with guttate psoriasis. According to Baker, strep throat is often associated with the first onset of guttate psoriasis in children.
“You may experience a flare-up following an earache, bronchitis, tonsillitis, or a respiratory infection, too,” she adds. “It’s not unusual for someone to have an active psoriasis flare with no strep throat symptoms. Talk with your doctor about getting a strep throat test if your psoriasis flares.”
Lithium: Used to treat manic depression and other psychiatric disorders.
Antimalarials: Plaquenil, Quinacrine, chloroquine, and hydroxychloroquine may cause a flare of psoriasis, usually two to three weeks after the drug is taken.
Inderal: This high blood pressure medication worsens psoriasis in about 25 to 30 percent of patients with psoriasis who take it.
Quinidine: This heart medication has been reported to worsen some cases of psoriasis.
Indomethacin: This nonsteroidal anti-inflammatory drug used to treat arthritis has worsened some cases of psoriasis.
“Psoriasis is treated with topical agents, including topical steroids and non-steroid agents, such as vitamin D derivatives. It is also controlled with oral medications that alter the immune system,” says Shapiro, “as well as more sophisticated injectable medications called biologic medications.”
Psoriasis is also commonly treated with narrow-band ultraviolet light B and PUVA (psoralen, a sensitizing agent, combined with ultraviolet light A). The latter light treatments are generally administered in the dermatologist’s office, but home units are also available.
Phototherapy, or light therapy, involves exposing the skin to ultraviolet light on a regular basis and under medical supervision. Treatments are done in a doctor’s office or psoriasis clinic or at home with a phototherapy unit.
“Phototherapy is not the same as tanning,” says Baker. “The National Psoriasis Foundation does not support the use of tanning beds as a substitute for phototherapy treatment.”
New oral treatments improve symptoms of psoriatic disease by inhibiting specific molecules associated with inflammation. Unlike biologics, which are derived from living sources and must be administered via injection or infusion, these treatments can be effectively delivered as tablets taken by mouth.
“Treating your psoriasis is critical to good disease management and overall health. Work with your doctor to find a treatment—or treatments—that reduce or eliminate your symptoms,” says Baker. “What works for one person with psoriasis might not work for another. So it’s important to know the different treatment options and keep trying until you find the right regimen for you.”
Women and Psoriasis
Studies show that the emotional and social effects of psoriasis and psoriatic arthritis are more significant for women than men.
“Treating psoriasis and psoriatic arthritis in women requires extra considerations,” says Baker. “If you are planning to become pregnant, you may wonder how psoriasis could affect you and your baby. If you are nursing, you may have questions about the safety of treatments.”
How to Manage Psoriasis
- Moisturize. Use a non-irritating, fragrance-free moisturizer. Thick ointments are best for locking in moisture and repairing the skin barrier.
- Limit bathing. Take warm (not hot) baths not more than once per day. Pat the skin dry with a towel (do not rub) and apply moisturizer immediately following.
- Choose a mild, non-irritating soap. Use sparingly.
- Use a humidifier indoors. The ideal range is 45-55 percent humidity.
- Wear loose, soft clothing. Choose cotton over wool, denim, or other harsh fabrics. Wear gloves and scarves outside to protect exposed skin.
- Avoid sweating. Sweat can trigger flare-ups. Wear wicking fabrics and change out of damp or snowy clothes as soon as possible.
- Keep fingernails short. This decreases the likelihood that scratching will tear the skin and lead to infection.
- Hydrate. Drink plenty of water.
- Reduce stress. Stress can trigger flares.
- Identify and eliminate possible triggers. Some common triggers include wool, soaps, fragrance, pet fur, cosmetics, and household cleaners. Some patients have found relief by altering their diets.
Baker encourages readers to visit www.psoriasis.org/about-psoriasis/women-and-psoriasis to learn more. BW
Claire Yezbak Fadden is a Pennsylvania-native freelance writer. Follow her on Twitter @claireflaire.
Courtesy of Joshua L. Fox, M.D., F.A.A.D. and Levine Robert Levine, D.O., F.A.O.C.D. www.advanceddermatologypc.com