For the 125 million people who suffer from psoriasis, it’s a constant struggle to keep this condition under control.
From controlling itch, managing exposure to triggers, and feeling embarrassed about one’s skin, it can have a physical, psychological, and emotional impact on an individual.
August is Psoriasis Awareness Month, and it’s high time people understand this skin disease and how to deal with it.
Keep reading to learn what psoriasis is, what the symptoms are, how it’s different from other skin conditions, what triggers you should avoid, and available treatment options, including recent research on how probiotics might help!
What Is Psoriasis?
Psoriasis is more than just a rash or skin condition. It’s actually an inflammatory autoimmune disease that changes skin cells’ life cycle, causing them to build up on the skin’s surface at an accelerated rate. Where it usually takes a month for skin cells to turnover, with psoriasis, it can happen in just a few days. This often results in raised, red (inflamed) skin with silver scaly patches that can itch, burn, or sting.
It appears equally in men and women across all age groups, but it is generally more prevalent in adults. It is a chronic, or long-lasting, condition that can be mild, moderate, or severe, and can be symptom-free for some time before flaring up again.
Psoriasis patches, called plaques, can appear on any part of the body but occur most often on the elbows, knees, legs, scalp, lower back, face, palms, and soles of feet. Fingernails, toenails, genitals, and the inside of the mouth can also be affected by the disease.
What Causes Psoriasis?
Our bodies have a type of white blood cell known as a T cell that helps protect the body against disease and infection. But in psoriasis, T cells become overactive and activate other immune responses that lead to inflammation and rapid skin cell turnover.
There is a genetic component to psoriasis, and some individuals who are diagnosed with psoriasis will also have children with psoriasis.
Different Types of Psoriasis
There are several types of psoriasis, though a person will usually have only one form at a given time. In those who have more than one form, one type of psoriasis will clear and another form may appear afterward in response to a trigger.
Different forms of psoriasis include:
Plaque psoriasis. Skin lesions are red at the base and covered by silvery scales.
Guttate psoriasis. Small, drop-shaped lesions appear on the trunk, limbs, and scalp. Guttate psoriasis is most often triggered by upper respiratory infections (for example, a sore throat caused by streptococcal bacteria).
Pustular psoriasis. Blisters of noninfectious pus appear on the skin. Attacks of pustular psoriasis may be triggered by medications, infections, stress, or exposure to certain chemicals.
Inverse psoriasis. Smooth, red patches occur in the folds of the skin near the genitals, under the breasts, or in the armpits. The symptoms may be worsened by friction and sweating.
Erythrodermic psoriasis. Widespread reddening and scaling of the skin may be a reaction to severe sunburn or to taking corticosteroids (cortisone) or other medications. It can also be caused by a prolonged period of increased activity of psoriasis that is poorly controlled. Erythrodermic psoriasis can be very serious and requires immediate medical attention.
Between 10-30% of psoriasis sufferers will also develop a form of arthritis called psoriatic arthritis which can cause joint pain, stiffness, and swelling. Like psoriasis, the disease can alternate between flare-ups and remission, and while most people develop psoriasis, joint problems can sometimes begin before the appearance of skin plaques.
How is Psoriasis Diagnosed?
Most of the time, your health care provider can diagnose psoriasis with a visual inspection. On the rare occasions where symptoms appear similar to other skin diseases, your doctor can make a diagnosis after examining a small skin sample under a microscope. In addition, scientists are developing new ways of examining the molecular processes involved in diseases like psoriasis and eczema to truly personalize diagnosis and treatment.
How is It Different from Eczema?
With some similar symptoms, many people confuse psoriasis with eczema. However, some discernible differences include:
– Psoriasis plaques are well-defined, while eczema tends to be flatter with less well-defined edges.
– Eczema usually appears in “flexor surfaces,” like the inside of the arms and the back of the knees, while psoriasis favors “extensor surfaces,” like the back of the elbows and the front of the knees.
– When biopsied, psoriasis skin appears thicker and more inflamed than skin with eczema.
People with psoriasis may notice that there are times when their psoriasis gets worse due to external factors, often referred to as “triggers.” As with any condition, triggers are not universal to all sufferers, but there are scientifically established triggers that affect a large number of individuals, and they include:
Stress. Stress can cause psoriasis to make its first appearance or exacerbate existing psoriasis. Making sure you relax and get enough sleep can help reduce flare-ups.
Skin Injury. Psoriasis can appear at the location of a skin injury or trauma. Known as the Koebner phenomenon, vaccine sites, sunburns, scratches, and bug bites can all trigger a flare-up.
Weather. Dry climates, whether during summer or winter, can dry out skin, causing a flare up; heat and sweat can also be a trigger for some individuals.
Infection. Infections, which trigger an immune response, can also trigger psoriasis. Ear infections, bronchitis, tonsillitis, or respiratory infections can often precede a flare-up, and strep throat is often associated with guttate psoriasis in children.
Medications. Some medications can trigger flare-ups, including lithium, antimalarials, Inderal (hypertension medication/beta-blocker), Quinidine (heart medication), and Indomethacin (NSAID for arthritis).
Smoking is an established trigger for some as well, and heavy alcohol consumption can both trigger a flare-up and reduce the effectiveness of certain psoriasis treatments.
Treatment of psoriasis depends on the type, location, size, and severity, as well as patient response. The most common treatments include topical treatments (where medication is applied to skin), phototherapy (light treatment), and systemic therapy (medicines taken orally or by injection).
Topical corticosteroids. These drugs reduce inflammation and skin cell turnover, and they suppress the immune system. Long-term use or overuse of potent corticosteroids can cause thinning of the skin, internal side effects, and resistance to treatment.
Vitamin D analogs. Synthetic forms of vitamin D control skin cell turnover rate. Excessive use may raise calcium in the body to unhealthy levels.
Retinoids. Topical retinoids are synthetic forms of vitamin A. Women of childbearing age must take measures to prevent pregnancy when using retinoids due to birth defect risk.
Coal tar. Nonprescription gels/ointments may be applied to skin, added to the bath, or used on the scalp as a shampoo. It may irritate skin, has a strong odor, and may stain.
Anthralin. Reduces skin cells and inflammation. Ointment, cream, or paste may be prescribed for brief periods to treat chronic psoriasis lesions. It must be washed off the skin to prevent irritation, and often discolors skin and most surfaces.
Salicylic acid. A peeling agent found in ointments, creams, gels, and shampoos, it can be applied to reduce scaling of the skin or scalp.
Bath solutions. Adding oil to the bath may help soothe skin. Scales can be removed and itching reduced by soaking in water with oiled oatmeal, Epsom salts, or Dead Sea salts.
Lubricants. Applied regularly over a long period, lubricants can calm skin. Thick formulas tend to work well as they seal water in the skin, reducing scaling and itching.
Sunlight. Sunlight is made up of different wavelengths of UV light. When absorbed into skin, UV light causes activated T cells in the skin to die, reducing inflammation and slowing skin cell turnover.
Ultraviolet B (UVB) phototherapy. UVB is light with a short wavelength that is absorbed in the skin’s epidermis, and an artificial source can be used to treat mild and moderate psoriasis. One form of phototherapy, called broadband UVB, can be used for a few small lesions, to treat widespread psoriasis, or for lesions that resist topical treatment. Treatment is given in a doctor’s office by using a light panel or light box, and some patients use UVB light boxes at home under a doctor’s guidance.
Narrowband UVB is another form of phototherapy. At first, patients may require several treatments of narrowband UVB spaced close together to improve their skin. Once the skin improves, maintenance treatment may suffice afterward. However, narrowband UVB treatment can cause more severe and longer-lasting burns than broadband treatment.
Psoralen and ultraviolet A (UVA) phototherapy (PUVA). This treatment combines oral or topical administration of a medicine called psoralen with exposure to UVA light, light with a wavelength that penetrates deeper into the skin than UVB. Psoralen increases sensitivity to this light. Sunlight must be avoided after ingesting psoralen due to the risk of severe sunburns; eyes must also be protected with UVA-absorbing glasses. Long-term treatment may increase the risk for squamous-cell and melanoma skin cancers.
Methotrexate. Methotrexate by pill or injection slows cell turnover by suppressing the immune system.
Retinoids. Oral retinoids are compounds with vitamin A-like properties that may be prescribed for severe psoriasis that does not respond to other treatments.
Cyclosporine. Taken orally, cyclosporine suppresses the immune system to slow skin cell turnover. It may provide quick relief of symptoms, but the improvement stops when treatment is discontinued.
Biologic response modifiers. Biologics are injectable drugs made from proteins produced by living cells instead of chemicals. They suppress specific immune system processes which cause the overproduction of skin cells and inflammation, but can increase risk of infection as a result.
One example is Secukinumab, a laboratory-engineered injectable antibody that targets interleukin-17A, a pro-inflammatory protein in the body linked to psoriasis; recently released clinical trial results showed that half of injected participants showed 90% improvement.
Combination therapy, where a variety of topical, light, and systemic treatments are used, can allow lower doses of each treatment and be more effective for some as well. In addition, keeping skin moisturized and cold showers and cold packs may help alleviate psoriasis symptoms.
Vitamins, Supplements & Probiotics
In addition to traditional treatments, many patients find that vitamins and supplements help keep skin clear and ease psoriatic arthritis joint pain.
Omega-3 Fatty Acids. Omega-3 fatty acids like Alpha-linolenic acid (ALA), Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) have been shown to decrease inflammation, have a positive impact on immune function, and help keep skin moisturized. ALA is found in flax seed oil whereas EPA and DHA are found in fish oil supplements.
Vitamin D. Called the “sunshine vitamin,” vitamin D is an ingredient in some topical psoriasis medications because of its ability to influence cell growth. Studies have found that it may also help counteract the body’s response to psoriasis-related inflammation. This supplement is available as a standalone supplement or is often formulated as part of a multi-vitamin like VitaMedica’s Multi-Vitamin & Mineral.
Glucosamine & Chondroitin. Glucosamine may help with cartilage formation, may help repair and inhibit inflammation, while chondroitin may promote cartilage elasticity and inhibit cartilage breakdown. Studies have shown that they can be effective for individuals with osteoarthritis, and these benefits may also potentially help those with psoriatic arthritis. These supplements are often combined and sold as a joint formula or can be sold separately.
Probiotics. Beneficial bacteria are a hot topic in medical research, particularly in relation to how they boost immune function and control allergies. A growing body of new research seems to indicate that probiotics may help with skin diseases like psoriasis, and still other studies have linked psoriatic arthritis to inflammatory bowel disease (IBD), showing that probiotics may be the key to treating this condition. VitaMedica’s Probiotic-8 is broad spectrum probiotic supplement formulated with 8 different species of beneficial bacteria to naturally replenish your stores.
If you struggle with psoriasis, it’s important to know you’re not alone. It doesn’t discriminate – famous athletes like Phil Mickelson struggle with psoriasis and psoriatic arthritis, and celebrities like Kim Kardashian and model CariDee English, whose careers are built on their beauty, have spoken out about it, too. Just know that with the right treatment and careful management, it doesn’t have to interrupt your everyday life!
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.