Spectrum Of Treatment Options
Although psoriasis presents differently on various skin types, color doesnât necessarily determine treatment options. Patients should consult with their health care providers to personalize their treatment plans. Creams, ointments and topical steroids are typically the first line of defense against psoriasis, while more severe cases require more aggressive therapies.
âWhen people of color present with psoriasis, especially African-American patients, they often have more hyperkeratotic, or thicker-scaled lesions,â says McMichael. âThat means the lesions are going to take a longer time to control, with medication at higher potency levels.â
If creams donât help, phototherapy can be very effective for people with darker skin pigment, she says, noting the lack of research on treatment for skin of color, as most studies predominantly feature white patients. That situation is changing, however. In 2017, the Patient-Centered Outcomes Research Institute awarded an $8.6 million contract to one of Takeshitaâs colleagues, Joel Gelfand, M.D., a board-certified dermatologist whose clinical work focuses on general dermatology and psoriasis. The PCORI contract is for a clinical trial called LITE. The purpose of LITE is to study the effectiveness and safety of 12 weeks of home-based versus office-based phototherapy for the treatment of psoriasis, and the effects of phototherapy across skin tones.
Aimee Perez
Shingles: A Rash And Severe Pain That Lingers
Shingles is another viral infection that shares some symptoms with psoriasis. Like psoriasis, shingles can make your skin burn and itch and produces a red, blistered skin rash. Shingles is caused by the same virus that first brings on chickenpox. The virus stays in your body and can come back years later to cause shingles, especially during times of stress or infection. The skin rash of shingles follows the course of a single nerve, usually on the trunk. In some cases, severe pain lasts long after the burning, itchy rash disappears. Shingles is more common in people over age 50.
Ringworm: Fungal Infections Of The Skin And Nails
Tinea is a type of fungal infection that resembles some symptoms of psoriasis. Psoriasis can cause the thick fingernails symptomatic of fungal nail infections, and both can cause red, itchy skin rashes. When tinea grows on your skin, it can cause a scaly, red skin rash that clears in the middle, called ringworm . Fungal infections of the skin and nails can be hard to treat. Antifungal medications work, but you may need to take them for a long time.
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Consider Laser Treatment If You Have Any Scarring
If you have scars or pigment changes from psoriasis flares that dont improve with time and treatment, ask your dermatologist if youre a candidate for laser treatment. In some cases, we will use fractional or vascular lasers to treat scarring, says Kassouf. The laser sends signals to that area of skin to tell it to keep remodeling, which can encourage those scars to get closer to normal.
Additional research by .
How Is Guttate Psoriasis Treated
Treatments for guttate psoriasis depend on the severity of the case. For milder cases, the following are usually recommended:
- Creams that treat itching and inflammation, especially those containing cortisone or other corticosteroids .
- Creams and lotions that have coal tar in them.
- Medications containing vitamin D or that contain vitamin A .
- Over-the-counter or prescription-strength dandruff shampoo .
Severe cases may be treated using the following:
- Immunosuppressant medications: Like chronic psoriasis, guttate psoriasis also responds to medications that reduce your bodys immune response.
- Biologic medications: These medications target specific parts of your immune system and block them. This can reduce psoriasis symptoms.
- : Ultraviolet light , either on its own or combined with a medication taken by mouth or applied to your skin, can treat guttate psoriasis. Laser therapy may also be used when guttate psoriasis becomes chronic plaque psoriasis.
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Itching Psoriasis Plaques Can Cause Scars
Scarring from psoriasis isnt common, but it can happen. Scarring doesnt typically occur unless people scratch or manipulate their plaques, says Michelle Pelle, MD, a dermatologist in San Diego. This can cause trauma to the skin and result in linear scarring . Plaque psoriasis can also cause skin to become dry, then crack and bleed, which can sometimes lead to scarring.
In some cases, psoriasis treatments can contribute to the problem. Overuse of topical steroids, for example, can thin the skin and cause changes to its collagen structure. This can lead to an atrophic scar or even stretch marks, notes Dr. Kassouf.
While can be an effective treatment for plaque psoriasis, it stimulates the skins pigment cells, which can make discoloration caused by plaques more noticeable, and occasionally permanent. This was more of a problem with older forms of light treatment, Kassouf notes. “Newer, narrow band UVB therapy has significantly minimized the risk of permanent pigment changes, but there is still some risk.
Your Nails Look Better
For some people, changes to their nails are the first sign a flare-up is occurring. You may notice your finger and toenails are pitted, discolored, or growing abnormally. Psoriasis can also cause your nails to become loose and break. If your psoriasis is going into remission, you may notice your nails returning to a normal color and becoming stronger, with less pits present.
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What You Need To Know About Psoriasis Do Psoriasis Scars Go Away
Is Your Stomach to Blame?
Who would have thought that a severe psoriasis outbreak could start because of something going wrong inside of your stomach and intestines? Yet, new research developed by psoriasis expert Edgard Cayce shows a distinct link between a leaky gut and a scaly psoriatic episode. According to Cayce, the primary source of psoriasis can be found in the intestinal tract, where toxins are leached into the body. This causes the immune system to react by thickening the skin. At the same time, the skin tries to purge the toxins through its layers, which can cause scabs and sores to form.
Could Arthritis Be the Cuplrit?
The intestines arent the only link to psoriasis found by researchers arthritis seems to also contribute to it. As many as one-third of all psoriasis patients eventually develop some form of psoriatic arthritis. Unlike normal forms of arthritis, those with psoriatic arthritis do not exhibit a rheumatoid factor when their blood is tested. This indicates that the arthritic condition comes solely from either the psoriasis itself or the underlying cause of the skin affliction.
Could a Virus Be the Cause?
Arthritis has been linked to certain virus and so have other auto-immune disorders. This leads some researchers to think that psoriasis too may start with a virus, which is what kicks the immune system into overdrive.
Psoriasis Doesn’t Have To Be A Life
Peter Amento avoided shorts and short sleeves for most of his life, no matter how warm the weather. When he did wear them, People would comment: What have you got? Poison ivy? Thats how bad my psoriasis would look, says the 61-year-old husband and father of three from Hamden.
Weve worked together to find the best treatment for his condition. Its a great partnership.Keith Choate, MD, PhD
The skin disorder appeared when Amento was 15, and over the years he tried everything to make it go away. I started with sunlamps, which was the way to go back then, he says. It didnt do much. He moved on to ointments, slathering them on the red patches on his arms, legs and torso, then covering the areas with plastic wrap to help the medication seep in. Theyd go away for a couple of weeks, then youd have to repeat the whole process.
Later, he would fly to Florida and sunbathe on the beach until his skin was crisp. The sunburn killed me for a couple of days, but it got rid of the psoriasis for a month, he says.
Amento assumed he would struggle with the condition for the rest of his life. Then his local dermatologist referred him to Yale Medicine, where physicians had a new approach.
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How Long Does A Psoriasis Flare
People with psoriasis often have flare-ups . Flare-ups, or flares, are often the result of specific triggers, such as cold and dry weather, infection, illness, stress, dry skin, skin injuries, and the use of some medicines.
A psoriasis flare can last from a few weeks to a few months. Flares are usually followed by periods in which symptoms subside or go into remission.
A psoriasis flare-up is marked by red, dry, and thick skin patches. These patches sometimes contain silvery-white scales that itch or burn. The skin might become cracked and bleed. Psoriasis plaques frequently appear on the scalp, low back, knees, skinfolds , and genitals.
Additional symptoms of a psoriasis flare include:
- Nail changes: Pitting, thickening, ridges, crumbling, discoloration, and nail bed separation
- Emotional effects: Including depression and anxiety
- Joint symptoms: Including stiff, swollen joints if you have psoriatic arthritis, which affects up to 30% of people with psoriasis
When To See Your Doctor
You should always see a dermatologist for a rash that doesnt go away with over-the-counter medicine. Dr. Fernandez stresses. Typical treatments include:
- Topical cortisone, especially if you have a mild case.
- Immunosuppressive drugs for more moderate to severe cases.
Its also important to know that eczema can prompt a secondary infection. To prevent this, your doctor may use topical and systemic antibiotics to remove bacteria and calm the inflammation.
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How Psoriasis Is Diagnosed
A GP can often diagnose psoriasis based on the appearance of your skin.
You may be referred to a specialist in diagnosing and treating skin conditions if your doctor is uncertain about your diagnosis, or if your condition is severe.
In rare cases, a small sample of skin called a biopsy will be sent to the laboratory for examination under a microscope.
If your doctor suspects you have psoriatic arthritis, which is sometimes a complication of psoriasis, you may be referred to a doctor who specialises in arthritis .
You may have blood tests to rule out other conditions, such as rheumatoid arthritis, and X-rays of the affected joints may be taken.
Are There Complications Of Psoriasis
In some people, psoriasis causes more than itchiness and red skin. It can lead to swollen joints and arthritis. If you have psoriasis, you may be at higher risk of:
- Use medicated shampoo for scales on your scalp.
Other steps you should take to stay as healthy as possible:
- Talk to your healthcare provider about lowering your risk for related conditions, such as heart disease, depression and diabetes.
- Lower your stress with meditation, exercise or seeing a mental health professional.
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What Happens If Psoriasis Is Left Untreated
Aside from causing you long-term pain, scarring, and unhealthy skinuntreated psoriasis could also lead to more serious health complications in some cases. One kind of psoriasis in particular, called psoriatic arthritis, tends to lead to more severe issues when left untreated. This kind of arthritis causes joint problems in addition to skin issues, and when left untreated, could cause permanent joint damage. People who have this kind of psoriasis could be at risk for long-term, debilitating joint pain.
Can Psoriasis Be Treated
Yes, there are many forms of treatment for psoriasis, which range from those you apply to the skin to tablets, and more recently injectable therapies, See Treatments for Psoriasis.
Many people who have psoriasis find that the sun and artificial ultraviolet light helps to improve their skins appearance. For some the change is dramatic. Be aware that exposure to the sun and artificial UV therapy can cause damage to the skin. See Psoriasis and the sun and Psoriasis and phototherapy
For some people, talking therapies such as cognitive behaviour therapy can also help them understand the psychological impact of psoriasis and provide a safe therapy which may help them cope with psoriasis. See our free online CBT programme
Your general practitioner or dermatologist will be best placed to advise you and keep you informed of all current and new treatments available and to recommend the best treatment programme for you personally.
Remember: Your treatment can only be as good as you allow it to be – that means if the treatment takes six weeks, you have to follow it as instructed for six weeks and no ducking out! Adherence to treatment instructions is an essential part of managing your psoriasis.
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Moisturize At Least Twice A Day
Using emollients especially creams with exfoliating acids such as lactic, glycolic, or salicylic acid is key to reducing itching and scaling. It should be done in addition to whatever therapy is prescribed by your doctor, Dr. Pelle says. Apply moisturizer twice a day for the best results. You can also use it to soothe itchiness and help you resist the urge to scratch.
What Causes Psoriasis
Psoriasis is an immune system problem. Your immune response overreacts, causing inflammation, which leads to new skin cells growing too fast.
Typically, new skin cells grow every 28 to 30 days. But in people with psoriasis, new cells grow and move to the skin surface every three to four days. The buildup of new cells replacing old cells creates the silvery scales of psoriasis.
Psoriasis runs in families. There may be a genetic component. Parents may pass it down to their children.
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Can Psoriasis Go Away
Psoriasis is a skin disease that develops due to changes in genetic makeup, and most often, it is passed from your parents . It may also occur due to changes in the immune system, autoimmune response, in which your own antibodies start attacking the cells of your body.
Psoriasis is a chronic inflammatory condition that has no definite cure and only the symptoms can be managed. At times, treatment can make psoriasis symptoms disappear and give you clear skin for a while.
This symptom-free period is referred to as remission. A remission is followed by the reappearance of the symptoms and this period is known as relapse.A remission can last for months or years ranging from one to 12 months.
The course of psoriasis is unpredictable, varying considerably among patients, so it’s impossible to know if you will have a remission and how long it will last.
What Are The Types Of Psoriasis
In children, common types of psoriasis include:
Plaque psoriasis. This is the most common type of psoriasis. It causes plaques and silvery scales, usually on the knees, elbows, lower back, and scalp. They can be itchy and painful and may crack and bleed.
Guttate psoriasis. This type often shows up after an illness, especially strep throat. It causes small red spots, usually on the trunk, arms, and legs. Spots also can appear on the face, scalp, and ears.
Inverse psoriasis. This causes smooth, raw-looking patches of red skin that feel sore. The patches develop in places where skin touches skin, such as the armpits, buttocks, upper eyelids, groin and genitals, or under a woman’s breasts.
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What Happens If You Stop Treating Psoriasis
If a person stops treating psoriasis, progression of the disease is possible, and the condition will worsen with time. Psoriasis inflammation can also progress, which increases your risk for complications that affect the rest of the body.
According to The American Journal of Managed Care , untreated moderate-to-severe psoriasis can develop into PsA. PsA can be painful and disabling, and AJMC reports people with psoriasis and PsA have a more significant disease burden .
Additional complications of untreated psoriasis the increased risk for:
- Cardiovascular disease: Including heart attack, stroke, heart valve problems, and heart failure
- Metabolic syndrome: A combination of different metabolic disorders, including insulin resistance, elevated blood sugar, high cholesterol, high blood pressure, and abdominal obesity
- Type 2 diabetes: Condition in which the body does not correctly regulate and use sugar as fuel
- Anxiety and depression
- Inflammatory bowel disease: Inflammation of the gastrointestinal tract, including ulcerative colitis and Crohn’s disease
- Kidney disease: Condition in which the kidneys cannot filter blood normally, resulting in fluid and waste staying in the body
- Some cancers: Including squamous cell carcinoma, lymphoma, and basal cell carcinoma
- Serious and life-threatening infections
Is Psoriasis The Same As Eczema
Psoriasis and eczema are two different skin conditions. They differ in where the disease appears on the body, how much it itches and how it looks. Eczema tends to appear more often behind the knees and inside the elbows. Eczema also causes more intense itching than psoriasis. Many people, especially children, can get both eczema and psoriasis.
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What Else Should I Ask My Healthcare Provider
If you have psoriasis, ask your healthcare provider:
- How can I prevent outbreaks and control symptoms?
- What medication will work best for me?
- What else should I do to improve symptoms?
- What are my options if creams dont work?
- Will psoriasis ever go away?
A note from Cleveland Clinic
Psoriasis, an itchy skin condition, can come and go throughout your life. Its related to an overactive immune response and is not contagious. If you have skin changes that arent going away, talk to your healthcare provider. There is no cure for psoriasis, but psoriasis treatments can improve symptoms. Your provider may prescribe a special cream or moisturizer or medications. Other therapies are available if creams or medicines dont work. Maintaining your overall health will also help improve symptoms.
Last reviewed by a Cleveland Clinic medical professional on 10/17/2020.
References
An Itching Or Burning Feeling On The Skin
Although psoriasis patches arent usually irritating, some people do report itchiness. People who have psoriasis of the scalp can report its very itchy or dry, says Anthony Rossi, MD, FAAD, a board-certified dermatologic surgeon at Memorial Sloan Kettering Cancer Center and assistant professor of dermatology at Weill Cornell Medical College.
The itching and pain can interfere with basic daily activities including self-care, sleep, and even walking.
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