Your Complete Guide to Living With Psoriasis
Psoriasis is a skin condition that most often appears between the teen years and middle age, although it can affect people of all ages. This chronic autoimmune disease is equally common among men and women.
Because of the characteristic reddish, scaled patches of skin and uncomfortable symptoms of itching and burning, psoriasis can be distressing. About 60 percent of people with the disease say it’s a large problem in their lives, with moderate to severe forms of the disease causing the most trouble. Women and young children seem to be affected more by the psychological aspects of the condition.
If you suffer from psoriasis, it doesn’t have to hold you back. Education is the first step toward a proper treatment plan. You can get the disease under control by managing triggers, reducing symptoms and making lifestyle changes.
What Is Psoriasis?
All forms of psoriasis are associated with an overactive immune system. According to the American Academy of Dermatology, the most common symptom of psoriasis is raised patches of thick, inflamed skin on the scalp, knees, elbows, hands or feet. These red, itchy patches, covered in silvery scales, form when skin cells divide about five times faster than is normal and build up on the skin’s surface. Instead of taking four weeks to reach the top layer of skin, these cells travel up in just a few days, intermingling with the dead cells and causing the characteristic inflammation and redness we associate with psoriasis.
- Scalp psoriasis causes itchy, dry patches on the head
- Nail psoriasis results in weakening and discoloration of nails
- Psoriatic arthritis develops in 10 to 20 percent of cases and causes joint pain, stiffness and swelling
- Guttate psoriasis, seen most often in children and young adults, is associated with bacterial and viral infections
- Inverse psoriasis is triggered by fungal infections and appears in areas where skin folds
- Pustular psoriasis is a rare form of the disease with a quick rate of onset and higher severity of symptoms
- Erythrodermic psoriasis can appear over the entire body and may be triggered by certain medications
As a chronic autoimmune disease, psoriasis can be persistent and currently has no cure. However, many treatment options are available.
In most psoriasis cases, a primary care doctor is in charge of diagnosis and treatment. If your physician suspects you have the condition, the first step is a physical exam focusing on the skin. A detailed medical history will be gathered to identify potential genetic links.
Because some symptoms are also associated with other conditions, your doctor may order a skin biopsy to confirm a psoriasis diagnosis. If symptoms of psoriatic arthritis are present, your doctor might want to take X-rays or do bloodwork to rule out other types of arthritis.
Causes, Triggers and Risk Factors
As with many autoimmune diseases, the exact cause of psoriasis is unknown. Both genetic and environmental factors appear to play a role, and additional risk factors and triggers contribute to the onset and severity.
Researchers have identified about 25 genes in people with psoriasis that differ from those in healthy individuals. Having a combination of these genes can increase your risk for developing the disease, although which genes have the biggest impact isn’t yet clear.
The mechanisms behind psoriasis appear to involve T cells and neutrophils, cells that are active as part of your immune system. T cells are defense cells, trained to recognize foreign substances known as antigens. When working correctly, T cells identify invaders and help other immune cells remove them from the body. Sometimes, however, the system goes awry, causing T cells to see your own tissue as an intruder.
In psoriasis, the unintended target is your skin cells. When T cells overreact, they can trigger not only an immune response, but also the excess production of skin cells and neutrophils. The PubMed Health Glossary describes neutrophils as part of your body’s first line of defense against infections. These cells travel to the areas T cells flag as being affected by outside attackers. This causes characteristic psoriasis symptoms, including swelling, redness, and pus.
This immune response gone wrong may explain why some cases of psoriasis are touched off by medications or infections. Your gut and the bacteria living in it are largely responsible for training your immune system. Infections may cause immune cells to go on high alert, and many medications throw off the balance of gut bacteria, leading to miscommunication between cells and possibly triggering an autoimmune condition.
Although this link hasn’t been proven, several factors are known to be associated with the onset of psoriasis:
- Skin injury or trauma
- Bacterial, viral or fungal infections
- Excessive alcohol consumption
- Vitamin D deficiency
- Cold, dry weather
- Some medications, including lithium, beta blockers, antimalarial drugs and iodides
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Hormonal changes, such as those associated with puberty, pregnancy and menopause
Genetics help to determine whether or not you will wind up with psoriasis. You’re at an increased risk if one parent has the condition. If both have it, your risk is even higher. Being obese or suffering from recurring infections may also lead to the onset of psoriasis.
Stress is another big factor. Being under chronic stress or experiencing a traumatic event negatively affects your immune system and can interfere with the communication between your gut and immune cells. If your immunity is already compromised, due to HIV or a similar condition, you’re more likely to develop psoriasis.
Conditions and Behaviors Commonly Linked with Psoriasis
People with psoriasis have a greater risk of developing other health conditions and behaviors, known as comorbidities:
- Crohn’s disease
- Smoking and alcohol use
- Cardiovascular disease
- Polycystic ovary syndrome (PCOS)
Definite links haven’t yet been established, but some strong correlations exist. For example, psoriasis sufferers are up to 50 percent more likely to have depression.
Signs and Symptoms
Psoriasis symptoms go through phases, getting better or worse, or even going into remission for a time. The most common symptoms include:
- Patches of itchy, scaly skin
- Raised, thickened areas
- Red or deep pink discoloration
- Silvery-white scales over affected areas, often appearing smaller in younger patients
- Stinging and/or burning
- Dry, cracked, bleeding skin
- Thickened, pitted or discolored nails
- Nails separating from nail beds, known as onycholysis
Different forms of the disease have the potential to manifest additional symptoms, such as:
- Pustular psoriasis presents with small pus-filled blisters and may also cause fever, chills, diarrhea and problems with the kidneys or liver
- Psoriatic arthritis causes joint pain, stiffness and inflammation, a loss of range of motion and changes in the condition of the nails
It’s important to visit your doctor if you observe any unusual changes in your skin. Get an appointment as soon as you can if you experience severe discomfort or pain, have trouble with normal daily tasks or are in emotional distress over the appearance of your skin. Symptoms of psoriatic arthritis should be addressed quickly to prevent the disease from becoming debilitating.
Although uncommon, you may require emergency care if you develop an infection related to psoriasis. A high fever, the appearance of red streaks or pus, or the onset of extreme pain should be treated by a medical professional right away.
When you have psoriasis, you’re at a higher risk for a number of other conditions:
- Cardiovascular disease, including high blood pressure, irregular heartbeat, high cholesterol, arterial plaques and strokes
- Chronic obstructive pulmonary disease (COPD)
- Emotional distress and mood disorders
- Eye diseases, such as conjunctivitis, blepharitis and uveitis
- Kidney disease
- Metabolic syndrome
- Nonmelanoma skin cancers
- Other autoimmune diseases, including celiac, Crohn’s and sclerosis
- Parkinson’s disease
- Pregnancy difficulties, including premature birth
- Type 2 diabetes, with the National Psoriasis Foundation noting severe psoriasis cases have as much as a 30 percent increase in risk
Scientists don’t yet know the exact reasons behind these associations, but it’s likely inflammation plays a role. Many of the diseases linked to psoriasis involve an inflammatory reaction in the body. The chronic inflammation associated with autoimmunity could play a role in the development of other conditions.
Psoriatic arthritis comes with the risk for further complications. These include fatigue, painful and swollen joints, uveitis, swollen extremities, deformities, hearing loss and degradation of bone in the fingers and toes.
Worldwide, about 3 percent of the population suffers from psoriasis. This represents approximately 125 million people in all countries. In the U.S., about 2 percent of the population is affected, with 7.5 million people currently dealing with the disease and 150,000 new cases appearing every year, according to MG217, a manufacturer of healthcare products.
The severity of psoriasis is determined by how much of the skin’s surface is affected:
- Mild: less than 3 percent
- Moderate: 3 to 10 percent
- Severe: 10 percent or more
Mild to moderate cases are most common, affecting 80 percent of people with the disease. The 20 percent with moderate to severe cases tend to experience worse quality of life. The overall impact of the condition on daily living is also taken into account when gauging severity.
The American Academy of Dermatology reports direct and indirect costs of psoriasis in the U.S. were estimated to be between $51.7 to $63.2 billion in 2013. This includes an average of 26 work days missed by 60 percent of people with the condition and the 3 million related doctor’s office and hospital visits made each year, according to Healthline. Dermatologists handle about 80 percent of these serious cases.
Traditional Medical Approach and Treatment
The goal of traditional psoriasis treatment is to slow down the rate at which affected cells multiply. After you are diagnosed with psoriasis, you and your doctor will discuss the best course of treatment for the type and severity of your condition.
Over-the-counter and prescription creams are a common form of treatment. These include:
- Thick moisturizers to trap your skin’s natural moisture
- Preparations made with retinoids to encourage the shedding of excess cells
- Preparations containing vitamin D
- Salicylic acid to remove scales
- Corticosteroids to slow cell growth and reduce inflammation
- Coal tar to slow cell growth
Moderate to severe cases of psoriasis may require alterative or additional treatments. Phototherapy, in which an excimer laser is used to apply targeted UVB light to affected skin, is a common option. Psoralen plus ultraviolet A (PUVA), a procedure combining light-sensitive medications with UVA exposure, may also be an option.
Because of the potential for unpleasant side effects, prescription drugs are used only in specific cases. These include:
If your psoriasis doesn’t respond to other treatment types, your doctor may recommend biologic drugs. These work by suppressing your immune system to block proteins associated with the disease and can raise your risk for infections and cancer. Other drugs, known as calcineurin inhibitors, can also address the symptoms of psoriasis.
With a physician’s guidance, you may have to switch between treatment types to avoid irritating your skin and to prevent potentially serious side effects.
Complementary and Integrative Health Treatment Options
If you prefer a more holistic method to address psoriasis, you may wish to look into natural and integrative treatments. These options focus on the root causes of the disease, especially inflammation. They have few or no side effects and can lower your risk for other conditions.
Some of the foods you eat every day could be promoting inflammation and making your psoriasis worse. The first step in a dietary approach is to eliminate these foods, including:
- Animal products
- Processed foods
- Artificial sweeteners, colorings and additives
- White flour
- White sugar
- Anything to which you have an allergic reaction
Switch your focus to whole, unprocessed fruits, vegetables, grains, beans, legumes, nuts and seeds. These choices provide phytonutrients to combat inflammation and cell damage and increase your fiber intake, to support a healthier gut environment. However, some people find nightshade vegetables, such as tomatoes, peppers, potatoes and eggplants, aggravate their symptoms. If you’re eating a healthy diet but still struggle with your psoriasis, eliminate these foods to see if your symptoms begin to ease.
According to Dr. Michael Greger, an American physician and author of numerous health and lifestyle books, changing your diet also improves the function of your adrenal glands, resulting in a better balance of natural glucocorticoids and creating a healthy system of checks and balances in your body’s inflammatory response. The high levels of potassium found in many plant foods, including avocados, spinach, sweet potatoes, dried apricots, broccoli and sunflower seeds, may also aid in reducing the symptoms of psoriasis.
Alternative Skin Treatments
Natural ingredients in creams and supplements may provide relief without the negative effects of prescription topical preparations. WebMD and the National Psoriasis Foundation recommend trying these treatments when you’re dealing with a psoriasis flare-up:
- Aloe vera cream with 0.5 percent aloe
- Tea tree oil, especially for scalp psoriasis
- Oat extracts or oatmeal baths for itching and redness
- Epsom salt baths for scales and itching
- Omega-3 fatty acids from foods like flaxseed or in supplements derived from algae
- Oregon grape herb to lower inflammation
- Turmeric supplements with black pepper for maximum anti-inflammatory effects
- Apple cider vinegar to reduce scalp itching or burning
- Capsaicin cream to ease pain, redness, inflammation and scaling
- MSM, a sulfur compound, to reduce inflammation
If you struggle with multiple autoimmune diseases or inflammatory conditions, you may find it helpful to work with a knowledgeable practitioner to address potential gut issues. Multiple courses of antibiotics, chronic stress, poor eating habits and other factors can all result in a damaged gut and potentially worsen psoriasis symptoms.
When developing a treatment plan, the severity of your psoriasis is an important factor. Doctors usually prefer to start with the mildest possible option and increase the intensity as needed. Exceptions include psoriatic arthritis and erythrodermic psoriasis, both of which need systemic treatment from the start.
Your doctor will also consider the proper balance of treatments, whether to combine traditional and alternative options and when and how to cycle courses of treatment. Side effects, including skin thinning, irritation, weakened hair, hair loss and reduced effectiveness, must be addressed and weighed against the benefits of each treatment option.
Treatment is always monitored for effectiveness and the appearance of complications. The Psoriasis Crisis website warns that some forms of psoriasis have the potential to cause emergency situations, including protein loss, cardiac failure and edema. Although these symptoms are rare, treatment in these cases must be tailored to prevent the condition from becoming severe.
Making simple changes in the way you address common problems and go about your daily routine can make a big difference in the level of discomfort caused by psoriasis.
The best place to start is with stress relief. Stress represents one of the biggest dangers to health in modern society. Whether you have psoriasis or another chronic condition, being under stress has a negative effect on your immune system and your hormones. Identify the stressors in your life, then do what you can to eliminate as many of them as possible. For those factors you can’t control, consider adopting stress-busting practices, such as:
- Getting together with easygoing friends
- Stretching or practicing yoga
- Getting a massage
- Reading a favorite book
- Listening to calming music or white noise
- Engaging in a craft like coloring, knitting or sewing
Many people also find it helpful to join a support group, so that they always have someone to talk to who understands the frustrations and limitations associated with psoriasis. Your doctor may be able to recommend a local group.
To directly address potential triggers and minimize environmental factors involved in flare-ups, you can:
- Carry moisturizer with you to be applied as necessary
- Use a humidifier to keep indoor air moist
- Protect your skin in cold, dry weather
- Use an effective insect repellant during summer months
- Stop using skin care products containing harsh chemicals and fragrances
- Choose clothes with minimal potential for chafing
- Avoid very hot water when bathing or showering
- Limit or eliminate alcohol
- Quit smoking
- Avoid scratching as much as possible
- Talk with your doctor about alternatives to medications with the potential to aggravate symptoms
Getting small amounts of unprotected exposure to the sun may also be beneficial, but be smart about how long you go without sunscreen. Sunburn traumatizes the skin and can cause your psoriasis to flare, in a reaction known as the Koebner phenomenon.
Choosing a Doctor
To get an accurate diagnosis and receive the best treatment for your psoriasis, team up with a dermatologist specializing in or having experience with the condition. Ask your primary doctor for recommendations, and research the reputations of their practices. Call your top choices and ask:
- How quickly you can be seen
- How long they’ve been treating psoriasis
- How familiar they are with current treatments, including natural options
- If they’re familiar with designing comprehensive treatment programs
- If you’ll have a single doctor assigned to your case
- If they rely on research to direct treatment
- If their services will be covered under your health insurance plan
Keep in mind you may also need to work with other professionals, such as a rheumatologist if you have psoriatic arthritis, or a therapist if your psoriasis affects your mood. Use the same methods to find reliable practitioners in these fields so that you have a strong, competent team, capable of providing comprehensive support.
By working closely with your doctor and a team of specialists, you can control your psoriasis and take steps to prevent it from becoming worse. As you move forward with your treatment plan, keep in touch with a support group to ensure you stay on track. The more support you have from friends, family, medical professionals and others who understand the condition, the greater your chances of success with treatment.
Continue to explore options and alternatives with your doctor. As science and technology advance and more studies are performed, new treatments are likely to become available. The right combination of medications, lifestyle changes and alternative approaches can give you relief and let you focus on your life, instead of your psoriasis.