What do Kim Kardashian, Leann Rimes and my neighbor Erica have in common? Like almost 8 million Americans they all have psoriasis. This chronic skin condition is caused by a dramatically increased speed of skin cell growth leading to red splotches coverd with silvery scales. Itchy, dry and painful it usually pops up on the torso, hands, elbows, and legs. Unlike eczema, its found on the outside rather than on the underside of joints.
Like so many health problems, doctors don’t really have a good handle on the causes of psoriasis. It seems to be genetically driven and about 30% of people with psoriasis have at least one family member with the condition. Psoriasis flare-ups have been linked to wheat, stress, weight gain, strep infection cold weather, smoking and heavy drinking. Psoriasis can also cause joint pain and swelling and up to 30% of people with psoriasis experience some degree of psoriatic arthritis.
A Bounty of Treatment Options
The three top rules for psoriasis care are moisturize, moisturize and of course moisturize. Daily care starts with a lukewarm bath with a mild soap like Dove or Aveeno Skin Relief Body Wash. Adding a handful of colloidal oatmeal to the bath will also reduce itching and inflammation. After a nice soak, gently towel dry and apply a simple but heavy moisturizer like Aquaphor. Apply a light layer, let it soak in then apply another layer.
Sunlight which is usually viewed as skin enemy #1 is actually helpful for psoriasis But easy does it. A daily 15 minute exposure will provide the benefits you want without increasing skin cancer risks.
Stepping up Psoriasis Care
Lukewarm bath, ointments and a little sunlight are the first steps in managing itchy, scaly psoriasis skin care problems. If you need more help ( and most people do) doctors “step-up” care, progressively adding treatments:
1. Topical Medications
When more than simple moisturizers are needed, salicylic acid cleansers and gels can remove scales. Steroids can also be prescribed for flare-ups, but should not usually be used long term. Tazorac ( similar to Retin A) and coal tar products can be very helpful if psoriasis affects less than 10-20% of the body.
2. Light Therapy
You can crank up the benefits of UV rays by adding a type of drug called psoralens. Either in a pill or cream, psoralens act by slowing down the turbo charged rate of cell growth that is driving psoriasis. Psoralens have problems of their own. They can cause nausea, headache and over time have been linked with an increased risk of skin cancer
3. Systematic Medications
If psoriasis still persists, doctors still have a number of powerful options in their tool box. Usually taken in pill form, methotrexate, cyclosporine, and retinoids ( like Accutane) all act by slowing down skin cell growth.
The newest categories of care are injectables that act on the molecular level to interrupt skin cell over production. Given in an injection or IV infusion, biologics like Stelera or Enbrel can be life changing if you have extensive psoriasis and/or psoriatic arthritis. Biologics are extremely powerful and require close medical monitoring. They have been linked to increased risk of infections and worsening of heart failure and multiple sclerosis. Effective but with potential side effects they are usually prescribed when other remedies have not been able to control psoriasis.
Living with psoriasis can be frustrating. All the treatments from oatmeal baths to biologic injectables need to be used in combination and it takes time and supportive health care to come up with the most effective combo plan for you. Don’t give up. The best care is out there.