An estimated 7.5 million Americans have psoriasis, according to the National Psoriasis Foundation (NPF), making it the most common autoimmune disease in the country. Although the skin disease is prevalent, many people are still unaware of its impact. Since August is National Psoriasis Awareness Month, we should be active in educating the public and dispelling myths associated with the disease.
Psoriasis is a chronic autoimmune disease that appears on the skin.
The most common form of the disease, plaque psoriasis, appears as raised, red patches covered with an accumulation of white dead skin cells. It is a chronic skin disorder characterized by raised lesions with silvery scale that most often occur on the scalp, elbows, knees and lower back. It can range from a very mild, hardly noticeable rash to a severe eruption that covers large areas of the body. Psoriasis affects 4% of people and is not contagious, but may be inherited.
Although psoriasis appears on the skin, it is an immune system disease that is not caused or worsened by poor personal hygiene. People with the disease have a genetic tendency to develop it. There are certain things that can trigger flare ups including skin injury, stress, hormonal changes, infection and medications. Most people with the disease experience cycles of clear skin and outbreaks.
Do you have Psoriasis?
The truth is that there are many people with psoriasis who don’t even know they have it! Skin rashes are not uncommon so doctors need to rule out a list of another possible causes like allergy to food/medication and viruses. Careful visual inspection is needed for diagnosing psoriasis but sometimes there is need for a skin biopsy.
Treatment of psoriasis depends on a patient’s overall health, presence of joint pain and severity of skin involvement. In mild cases, topical corticosteroids and medications are prescribed. Psoriasis is not curable, but it is controllable. No single approach works for everyone. Therapy is individually tailored and based on your health, goals and a careful assessment of potential risks and benefits of treatment.
A dermatology resident from Affiliated Dermatology, Doctor Andrew Newman shares some facts about psoriasis.
“Psoriasis is a condition that affects about 4% of the population. Although it is typically thought to be a condition that only affects the skin, it affects the ENTIRE body. In fact, joint disease, heart disease, and depression are common features in psoriasis. It’s caused by many factors including genetic predisposition, certain medications, and some infections such as strep throat. People with psoriasis most often are regularly taken care of by a dermatologist.
The type of treatment used depends on the total body surface area involved and severity, etc.
In mild psoriasis, I think natural medicines work well. Some people find benefit from taking the natural anti-inflammatories Quentin and curcumin. Additionally, they may find that applying aloe Vera gel to the skin does wonders. Lastly, sunlight also helps with mild psoriasis. That’s right, the UV rays of the sun decrease the skin inflammation in psoriasis! In fact, this explains why myself and my colleagues see less psoriasis where we practice in the sun-rich Phoenix, Arizona, compared to areas like the the Midwest.
For more serious psoriasis, it will be almost impossible to successfully manage the disease without sophisticated prescription medicines. Usually, this will entail potent topical corticosteroids and/or certain oral or injectable medicines that help regulate the body’s immune system (which has gone haywire in psoriasis).
Importantly, if you have psoriasis (mild or severe), you should discuss the use of both natural and prescription medicines with your primary care doctor and your dermatologist.”
Another dermatology resident from Affiliated Dermatology, Doctor Mitchell Manway gave us some extra tips on what to do when you have psoriasis.
Moisturizers - which kind are the best?
“In general, the thicker or greasier the moisturizer, the better. Creams and ointments that come in a tub or jar are more effective at restoring the skin barrier than lotions or products that come in pump-dispensers. Products containing petrolatum or ceramides can be particularly effective or preferred,” says Dr. Manway.Scale softening products? What ingredients work best?
Manway says, “Products that contain lactic acid (Amlactin/Lac Hydrin), salicylic acid (Salex), or urea are more effective at removing scale and improving skin texture.”
Cold showers/cold packs or warm baths/heating pads?
According to Manway, “Ice-packs and heat may be effective at treating symptoms of itch by distracting nerve receptors, but I would avoid exposure to showers or bathing as this may promote further water-loss and drying of the skin.”
Acupuncture? Stress relief like meditation, etc?
“Studies directly involving acupuncture and treatment of psoriasis are still inconclusive, with some proposing benefit and others with no significant results. However, anything that can promote stress relief may be helpful at preventing and controlling flare-ups as stress can be a major contributor for worsening of disease,” said Dr. Manway
“Daily or weekly exercise can stimulate and regulate the immune system and decrease stress levels, and thus is an important part of disease management.”
Over-the-counter remedies like calamine lotion.
“In my experience calamine lotion is not very effective at reducing itch or pain. Topical preparations that contain pramoxine (Sarna Sensitive) or menthol (Sarna) are preferred. Surprisingly, brief periods of exposure to sunlight and UV rays can also benefit psoriasis, but limited exposure should be stressed due to the increased risk of skin cancer associated with chronic UVA and UVB damage.”
“Rx medications are by far the most effective topical treatment approach available and help to decrease inflammation at the site of disease. Potent topical steroids such as clobetasol or betamethasone are the most common medications prescribed, but other mechanisms such as vitamin D analogues and calcineurin inhibitors can provide significant and adjunct benefit towards the reduction of psoriatic plaques with less risk of long-term local side-effects. When local disease can not be maintained on topical medications or development of psoriatic arthritis is present, systemic oral medications or biologic therapy/injections are necessary.”
Is infection a possibility? When should you see your doctor?
“Infections are actually quite rare due to the fact that psoriasis itself is due to an overactive immune system. That being said, repeated scratching and excoriation can disrupt the skin barrier and facilitate bacterial invasion and is thus strongly discouraged. All patients with psoriasis should be seen at the very least annually by a dermatologist and when treatment and medications are ineffective at controlling disease severity and flares. Patients requiring systemic treatment should be seen every 3 months for check-ups while on these more sophisticated/complex medications.” Doctor Dustin Mullens another resident from Affiliated Dermatology spoke on how Psoriasis starts.
“The nervous system and stress affect a multitude of skin conditions in humans. There are many types of cells in the skin affected such as immune cells and endothelial cells, both can be regulated by neuropeptides and neurotransmitters, which are chemicals released by the skin’s nerve endings. Stress can result in the skin’s nerve endings releasing an increased level of these chemicals and when this occurs, it can lead to inflammation of the skin. This is why people often experience a flare of their inflammatory skin conditions such as eczema and psoriasis during times of stress."
What can we do? We all need to work together to improve awareness about psoriasis. Unfortunately, there are many misconceptions about the disease; for example, that it is contagious. This month we should be putting the spotlight on the disease and helping educate the public.