- What is Psoriasis?
- What are Psoriasis Types?
- Home Remedies for Psoriasis
- Stress Reduction
- Psoriasis Medications and Treatments
- Medical Treatment – Phototherapy (Light Therapy)
- Medical Treatment – Laser Therapy
- Medical Treatment – Systemic Agents (drugs taken within the body)
- What is the Psoriasis Diet?
What is psoriasis?
Psoriasis is chronic inflammatory autoimmune skin disease characterized by areas of thickened, inflamed, itchy, red skin, often covered with silvery scales. The body's immune system becomes overactive and attacks itself causing faster than normal skin cell turnover: about 3 to 4 days in those who have psoriasis, versus 28 to 30 days for normal skin turnover. While new skin is being produced at a rapid rate, old skin cells don't shed as quickly. This results in plaques, where the old skin builds up into thick, red, inflamed, and flaky patches.
What are Psoriasis Types?
The exact cause remains unknown. A combination of elements, including genetic predisposition and environmental factors are involved. It is common for psoriasis to be found in members of the same family. Defects in immune regulation are thought to play a major role. Despite research over the past 30 years, the "master switch" that turns on psoriasis is still a mystery.
Plaque psoriasis is the most common form of psoriasis (also called psoriasis vulgaris - vulgaris means "common") and about 80% of people with psoriasis have this type. Symptoms of plaque psoriasis include red, raised and inflamed skin lesions, covered in thick silver-white scales. The areas of the body typically affected by plaque psoriasis include the elbows, knees, scalp, and lower back. The plaque may also appear on the ears, around the belly button, on the palms of the hands and soles of the feet, or on the fingernails and toenails.
Guttate psoriasis usually occurs in children or younger adults and is the second-most common type of psoriasis. This type of psoriasis is called guttate (which means "drop-like") beacause of the spontaneous appearance of small, individual, pink, scaly spots. These spots are usually not as thick as the plaque lesions seen in plaque psoriasis. Guttate psoriasis general affects the skin on the trunk, and the arms and legs. Strep throat is a common trigger for this type of psoriasis.
Inverse psoriasis typically appears in the folds of the skin such as the armpits, groin, under the breasts, and around the genitals and buttocks. It frequently occurs in overweight and obese people in the excess skin folds. Inverse psoriasis (also called flexural psoriasis) is characterized by bright red, smooth, shiny, and inflamed lesions. Scaling is less common.
Pustular psoriasis is characterized by white pustules (blisters of noninfectious pus) surrounded by reddened skin. Pustular psoriasis is not contagious, and it affects mostly adults. This type of psoriasis tends to appear in cycles and is characterized by skin redness first, followed by pustules forming, then skin scaling. The pustules may crack. It may affect limited areas of the body or it may be generalized, covering most of the skin's surface. Generalized pustular psoriasis is rare and serious and usually requires hospitalization. Symptoms of generalized pustular psoriasis include pustules covering most of the body, fever, chills, intense itching, rapid heart rate, exhaustion, headache, nausea, muscle weakness, and/or joint pain.
Erythrodermic psoriasis (also called exfoliative psoriasis) is another rare and severe type of psoriasis, that can be life threatening. It usually affects a majority of the body's surface and is extremely inflammatory, characterized by bright red skin and a peeling rash, and shedding of scales in sheets. Flares (outbreaks) of erythrodermic psoriasis are often painful and itchy and patients should seek immediate medical care. It can be life threatening because the skin barrier is so weak it causes patients to be highly susceptible to infection (including cellulitis which can lead to sepsis, a severe infection).
Scalp psoriasis occurs in about half of all people with psoriasis. Redness and skin scaling from scalp psoriasis may affect the entire scalp, and may also extend to the forehead, hairline, the back of the neck, or behind the ears. Symptoms may be mild, or severe with thick, crusted sores that are intensely itchy and hair loss. Scalp psoriasis often can be more difficult to treat than psoriasis on other parts of the body because skin on the scalp is thicker, and hair may interfere with topical treatments.
Psoriasis of the nails also affects about half of patients with psoriasis, and it can affect the fingernails and toenails. Nail psoriasis is characterized by yellow-red nail discoloration (also called an oil drop or salmon patch), nail pitting, areas of white on the nails (leukonychia or midmatrix disease), skin thickening under the nail (subungual hyperkeratosis), nail loosening from the fingertip (onycholysis), horizontal lines across the nail (Beau lines), redness of the half moon area at the base of the nail (spotted lunula), crumbling and brittle nails, and small black lines in the nail.
Psoriatic Arthritis is a condition that causes joint pain, swelling, and stiffness, and affects about 30% of people with psoriasis. Psoriasis nail symptoms are more common and severe in patients who also have psoriatic arthritis. Joint damage can occur if psoriatic arthritis is not promptly diagnosed, treated, and managed.
Home Remedies for Psoriasis
Many patients feel natural home remedies help ease their psoriasis symptoms, or reduce the frequency of psoriasis flares (outbreaks). Ask your doctor about home remedies and discuss any herbal supplements you take as these may interact with medications you are prescribed.
Hydration of the skin can reduce symptoms of psoriasis so drinking plenty of water is important, as is moisturizing the skin. The use of skin emollients such as petroleum jelly or thick creams should be applied immediately after bathing. Other products are used to moisturize or soothe the skin and may contain jojoba or zinc pyrithione.
Herbal remedies – The National Psoriasis Foundation notes the following:
- Aloe vera gel applied to the skin may reduce redness and scaling. Do not take aloe tablets.
- Apple cider vinegar is used to help relieve scalp itch. Dilute water on a 1-to-1 ratio to prevent a burning sensation, and rinse thoroughly to prevent irritation. Do not use this is the skin on your scalp is cracked or bleeding.
- Capsaicin is often added to over-the-counter creams and ointments and may help reduce the pain, inflammation, redness and scaling associated with psoriasis. It may cause a burning sensation on the skin.
- Dead Sea salts or Epsom salts added to a warm (not hot) bath soak for 15 minutes may help remove scales and ease itching. Apply moisturizer immediately following the bath.
- Oats are used to sooth skin, and applying an oat paste or taking a bath in oats may help relieve itchy skin and reduce redness.
- Tea tree oil is believed to have antiseptic qualities and using shampoos with tea tree oil may help relieve scalp psoriasis symptoms. Use caution as many people have allergies to tea tree oil.
- Turmeric is believed to have anti-inflammatory and antioxidant properties, and some patients find it helpful in minimizing psoriasis and psoriatic arthritis flares.
- Mahonia Aquifolium (Oregon Grape) cream is effective in treating mild to moderate psoriasis. Mahonia is in a drug class called alkaloids, so should only be used under physician supervision.
Many people with psoriasis and psoriatic arthritis take vitamins and supplements. Before taking any nutritional supplement, talk to your doctor to make sure they don't interact with any medications you take. Some supplements people with psoriasis may find helpful include:
Stress is known to be a trigger for flares of psoriasis. There are numerous ways to reduce stress that may help reduce the frequency or severity of psoriasis symptoms.
- Mediation – this can help calm you, and relieve anxiety.
- Exercise – produces endorphins, which improve mood and energy.
- Therapy – talking to a therapist who specializes in stress management can
- Support groups – connecting with others who have the same issues can help you feel supported and not alone.
- Yoga – combines breathing, stretching, and strengthening to control stress
- Tai chi – similar to yoga, bit with more movement and less focus on breath – can help with psoriatic arthritis
- Acupuncture – uses hair-thin needles and may help with pain relief
- Aromatherapy – pleasant smells can enhance mood and relieve stress
Psoriasis Medications and Treatments
Topical medication such as lotions, foams, creams, ointments, gels, and shampoos applied directly to the skin is usually the first-line treatment for psoriasis. When psoriasis is more widespread and covers more than 10% of the body surface, topical medications alone may not be as practical.
- Corticosteroids: fluocinonide (Lidex, Capex, Derma-Smoothe), clobetasol propionate (Clobex, Cormax, Olux, Olux E), hydrocortisone (Locoid, Pandel, Westcort, Cetacort, Cortaid, Hytone, Micort-HC, Nutracort, Synacort), betamethasone (Diprolene, Luxiq), halobestol (Ultravate), diflorasone diacetate (Psorcon, Florone), desoximetasone (Topicort), mometasone furoate (Elocon), halcinonide (Halog) fluticasone (Cutivate), triamcinolone (Kenalog), flurandrenolide (Cordran), prednicarbate (DermAtop), desonide (DesOwen), fluocinolone (Synalar), alclometasone (Aclovate)
- Vitamin D derivatives: calcipotriene/calcipotriol (Dovenox, Taclonex), calcitriol (Vectical), tacalcitol (Curatoderm)
- Vitamin A derivatives: tazarotene (Tazorec)
- Calcium-modulating medications: tacrolimus, pimecrolimus
- Over-the-counter topicals: coal tar preparations and salicylic acid.
Medical Treatment – Phototherapy (Light Therapy)
Phototherapy, also called light therapy, exposes the skin to therapeutic doses of ultraviolet light (UVL) under medical supervision to control psoriatic skin lesions. A drawback of UVL treatments is that like all ultraviolet skin exposure it can lead to skin cancer. There are several types of phototherapy used to treat psoriasis:
- Ultraviolet B (UVB) radiation: used in patients with extensive disease, alone or in combination with topical tar.
- Narrow band UVB: an alternative to broadband, helps with plaque psoriasis
- Photochemotherapy (PUVA): treatment with either oral or bath psoralen followed by ultraviolet A (UVA) radiation
- Home ultraviolet B (UVB) phototherapy unit: prescribed by a physician. This is not the same as an indoor tanning bed. The National Psoriasis Foundation does not recommend tanning beds to treat psoriasis.
Medical Treatment – Laser Therapy
Topical targeted phototherapy using a pulsed dye laser (PDL) or excimer laser is another type of ultraviolet therapy to treat psoriasis. The advantage of the laser is that it can be very specific in treating only affected areas of skin so higher doses of UVB can be used. It usually works in fewer sessions than traditional phototherapy and is good for reaching psoriasis lesions in hard to treat areas.
Medical Treatment – Systemic Agents (drugs taken within the body)
Systemic treatments for psoriasis generally target the immune system.
Drugs in this class include:
- Phosphodiesterase 4 (or PDE4) inhibitor: apremilast (Otezla)
- Folic acid antagonist: methotrexate
- Immunosuppressant: cyclosporine
- Retinoid (synthietic form of vitamin A): acitretin (Soriatane)
A new class of systemic drug used to treat psoriasis is called biologics, which are protein-based and made from living cells. Biologics are administered by injection or intravenously (IV) and they target the parts of the immune system that cause psoriasis symptoms.
What is the Psoriasis Diet?
Dietary changes won't cure psoriasis, but a balanced diet can help you stay healthy which may mean you have fewer flares. In addition, there is evidence that obesity is a risk factor for psoriasis and psoriatic arthritis, so maintaining a healthy weight with a nutritious diet can reduce that risk factor.
One theory to support dietary changes is that psoriasis is an inflammatory disease. So is heart disease. Eating healthy helps with inflammation in heart disease so reducing inflammation with diet will help your heart, and it may help your psoriasis symptoms.
A heart healthy/anti-inflammatory diet includes the following foods:
- Cold water fish (tuna, salmon, mackerel, herring, and lake trout)
- Lean meats
- Skinless poultry
- Consume less than 1,500 milligrams of sodium daily
- Pumpkin seeds
- Fresh fruits and vegetables
Foods that increase inflammation and should be avoided include:
- Red meats
- High fat dairy
- Partially hydrogenated vegetable oils which contain trans-fat
- Limit alcohol
- Processed foods
- Fast foods
- Refined sugars
- Nightshade vegetables (including potatoes, tomatoes, and peppers)
- Eat appropriate portion sizes
Gluten-free diets are popular for a variety of ailments. Gluten is a protein found in wheat, barley, and rye, and is also found in many processed foods. Celiac disease is an autoimmune disorder in which people are intolerant of gluten, and the only treatment for them is to avoid this protein.
Psoriasis is also an autoimmune disorder, and some studies have shown that celiac disease and psoriasis have common genetic and inflammatory pathways, and up to one-quarter of people with psoriasis may be sensitive (though not intolerant) to gluten. If you suspect you have intolerance to gluten, talk to your doctor about how to start a gluten-free diet.