Easing the Challenges of Psoriasis

A common chronic inflammatory skin condition, psoriasis can be incredibly frustrating and challenging to live with. Brought on by an overactive immune system that speeds up the life cycle of skin cells, causing them to build up rapidly on the surface of the skin, psoriasis causes thick, scaly, red patches on the skin’s surface.

Most common in adults between the ages of 15 and 35, psoriasis can appear at any age with the severity varying dramatically between individuals. There are five types of psoriasis but most people (90%) develop plaque psoriasis.

The term plaque in plaque psoriasis refers to the raised, inflamed, and scaly patches of skin that the condition creates. On Caucasian skin, plaques may appear as red patches with a silvery white buildup of dead skin cells or scale on the surface. On skin of color, plaques often appear thicker and darker—think dark brown, purple, or even gray. 

Regardless of skin color, plaques can appear anywhere on the body, although they most often appear on the elbows, knees, lower back, and torso, typically appearing symmetrically, or on both sides of the body at once. Plaques can also develop on the scalp, face, fingernails, genitals, hands, feet, and anywhere the skin folds.

For many people with psoriasis, certain conditions or events can trigger flare-ups—a worsening of symptoms for a period of time. Not all triggers lead to flare-ups for all people, but common triggers include:

Stress: Periods of intense stress can trigger psoriasis flare-ups in many people.

Skin injuries or conditions: Cuts, scrapes, sunburns, scratches, bug bites, or other skin trauma can trigger psoriasis at the site of injury about 10-14 days later.

Infections: Strep throat, colds, and other infections can trigger psoriasis flares by activating the immune system.

Stopping or starting medications: Certain medications like blood pressure medicine, anti-inflammatories, heart drugs, anti-malarial drugs, certain antibiotics, and mental health medications can trigger or worsen psoriasis.

Weather: Cold, dry weather often worsens psoriasis symptoms. Conversely, some people may experience flares from excessive sun exposure or sunburns.

Alcohol: Heavy drinking can trigger psoriasis flares in some individuals.

Smoking: Tobacco use may increase the risk of developing certain types of psoriasis and can worsen symptoms.

Diet: While it varies by individual, some common food triggers may include red meat, dairy, eggs, gluten, processed foods, and nightshades.

Hormonal changes: Puberty, pregnancy, and menopause can affect psoriasis in some people.

Obesity: Excess weight can increase the risk and severity of psoriasis.

Certain skincare products: Harsh soaps or fragranced products may irritate the skin and trigger flares.

While there's no cure for psoriasis, there are various treatments available to manage the symptoms and improve quality of life. Treatment options include:

1. Topical Treatments: These include corticosteroids, vitamin D analogues, and salicylic acid, which help reduce inflammation and slow down skin cell turnover.

2. Phototherapy: Also known as light therapy, this treatment involves exposing the skin to ultraviolet light under medical supervision.

3. Systemic Medications: For moderate to severe cases, oral or injected medications can target the underlying immune response.

4. Biologics: These are newer medications that target specific parts of the immune system and are often used when other treatments fail.

5. Lifestyle Changes: Maintaining a healthy weight, eating a balanced diet, keeping your skin well moistened, avoiding triggers like smoking and excessive alcohol, and managing stress can significantly improve symptoms.

Living with psoriasis can be challenging. It's important to work closely with your healthcare provider to find the most effective treatment plan for you. Remember, psoriasis treatment is often a process of trial and error, and what works for one person may not work for another.

The National Psoriasis Foundation also provides support in the form of a peer-support group called One to One, which connects sufferers with another individual living and thriving with the condition.

Other organizations offering online support and resources include:

• The Psoriasis Association
• The Arthritis Foundation support group for psoriatic arthritis
• Inspire’s psoriasis community forum

Lixia Ellis, MD, PhD is a board-certified dermatologist at SVMC Dermatology.