Psoriasis is a chronic autoimmune condition that causes red, scaly and often itchy patches or “plaques” on the skin. It affects millions of Americans and has been getting a lot of attention in recent years.
Many celebrities affected by the disease — such as Kim Kardashian West, Cindy Lauper and LeAnn Rimes — have gone public with their personal stories to raise awareness about psoriasis.
“The good news is that medical advances have led to more treatment options for people with psoriasis to manage their condition, improve their skin appearance and boost their quality of life,” says Erik Gilbertson, MD, a dermatologist at Scripps Clinic. “It’s important to work with your doctor to find the right treatment.”
Treatments for psoriasis include topical creams and light therapies, and both oral and injectable medications, such as biologics. Other treatment options include complementary and alternative treatments, such as herbs and vitamins, special diets and mind-body techniques.
Psoriasis occurs when an overactive immune system targets healthy skin cells and speeds up the production cycle of skin cells. The rapid buildup of these cells on the skin causes psoriasis lesions.
About eight million people in the United States have psoriasis, according to the National Psoriasis Foundation. It is more common in adults, but anyone can develop the condition, which is not contagious, but could be inherited. Certain genes have been linked to psoriasis.
Psoriasis tends to involve flares. Certain things may trigger a flare, such as:
- Weather changes that dry out your skin
- Certain medications
- Cuts, scratches, sunburns
Symptoms of psoriasis depend on which type you have. The five main types of psoriasis are:
Plaque psoriasis is the most common and appears as raised patches of inflamed, itchy and painful, scaly skin. In some, the skin may be red with silvery white scales. It often appears on the scalp, knees, elbows, belly button area and lower back.
Inverse psoriasis causes smooth, red patches in body folds, including the underarms, under the breasts, in the genital and buttocks areas.
Guttate psoriasis causes small, raised scaly red spots, many times after infection. It often appears on the arms, legs and torso.
Pustular psoriasis is a rarer form of psoriasis. It causes white, pus-filled painful blisters and inflamed or reddened skin. It may appear only in certain parts of the body, such as the hands and feet, or it may cover most of the body.
Erythrodermic psoriasis is also rare and it is an aggressive form of psoriasis. It causes red and scaly skin over much of your body and can be life-threatening.
About 30 percent of people who have psoriasis will also develop psoriatic arthritis which causes pain, stiffness and swelling in and around the joints, according to the National Psoriasis Foundation.
Finding the right treatment for psoriasis depends on the type and the severity of the condition, including how much of the body is affected.
Topical treatments, including prescription creams, typically are used for mild psoriasis to reduce swelling and slow the growth of skin cells. These include corticosteroids, coal tar products, anti-inflammatory and antifungal creams.
“These are treatments that you apply directly onto your skin,” Dr. Gilbertson says. “They come in many different forms, such as creams, lotions, ointments or sprays. They come in different strengths, from over-the-counter to prescription strength.”
Topical corticosteroids, for example, are anti-inflammatory drugs that help control the immune system.
This treatment uses natural (sunlight) or artificial ultraviolet light to help reduce scaling and inflammation. “Your doctor may prescribe phototherapy, which is also known as light therapy, either alone or in combination with other treatments,” Dr. Gilbertson explains.
“UV rays from the sun may improve psoriasis,” Dr. Gilbertson notes. “However, too much sun can also worsen the condition. It’s important to consult with your doctor about the safest way to use sunlight as treatment.”
Your doctor may prescribe systemic medications — which are drugs that work throughout the body — if you have moderate to severe psoriasis.
Oral medicine — such as retinoids, methotrexate and mycophenolate mofetil (CellCept) — may be prescribed for severe psoriasis that does not respond to other treatments. These drugs target the immune system to reduce overactivity.
“While these drugs can help make you feel better, they can cause serious side effects,” Dr. Gilbertson says. “As with any medication, they should be used with caution. The goal should always be to find the right treatments with the fewest possible side effects.”
Biologics are injectable medications that are either self-administered or done in an outpatient setting.
Biologics are strong medicines that inhibit the parts of the immune system causing inflammation. “They have revolutionized the treatment for psoriasis and psoriatic arthritis,” Dr. Gilbertson says.
Living with psoriasis can be challenging but finding the right treatment today has been made easier with a variety of new treatments.
“There are now over ten medications that for my patients have been life changing with almost complete clearance of their disease,” says Dr. Gilbertson. “The key is working with your doctor and finding the right treatment to be able to live well with psoriasis.”