Psoralen Plus Ultraviolet A
For this treatment, you’ll first be given a tablet containing compounds called psoralens, or psoralen may be applied directly to the skin. This makes your skin more sensitive to light. Your skin is then exposed to a wavelength of light called ultraviolet A . This light penetrates your skin more deeply than ultraviolet B light.
This treatment may be used if you have severe psoriasis that hasn’t responded to other treatment. Side effects of the treatment include nausea, headaches, burning and itchiness. You may need to wear special glasses for 24 hours after taking the tablet to prevent the development of cataracts. Long-term use of this treatment isn’t encouraged, as it can increase your risk of developing skin cancer.
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How Can I Manage My Psoriasis
- Take care of your skin: Apply emollients, lubricants, or moisturizing creams to your skin regularly. Apply these while your skin is still damp when you bathe. Stop using them if they sting or irritate your skin. Use mild soaps and add bath oils to soothe your skin when you bathe.
- Protect your skin from sun exposure: When you get sun exposure for short periods of time, it can help your psoriasis. Too much sun exposure or a sunburn can make your psoriasis worse. Talk to your dermatologist or healthcare provider about how much sun exposure is right for you.
- Manage stress: Stress can trigger a flare-up. Find healthy ways to manage stress, such as deep breathing or meditation.
- Watch for symptoms with new medicines or herbal supplements: Some medicines, including herbal supplements, may trigger a psoriasis flare-up. Ask if any of the medicines you take may be making your psoriasis worse. Always check for skin changes when you take your medicines.
- Do not smoke: Smoking can trigger a flare-up of psoriasis. If you smoke, it is never too late to quit. Ask for information about how to stop.
- Avoid triggers: Injury to the skin, cold weather, and heavy alcohol use are other things that can trigger psoriasis flare-ups.
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What Causes Psoriasis Outbreaks
Psoriasis outbreaks differ from person to person. No one knows exactly what causes flare-ups. Common psoriasis triggers may include:
- Skin injury .
- Streptococcal or other infection that affects the immune system.
- Certain prescription medications .
- Cold weather, when people have less exposure to sunlight and humidity and more to hot, dry indoor air.
Home Treatment For Psoriasis
There are some home remedies that may help minimize outbreaks or reduce symptoms of psoriasis:
- Exposure to sunlight.
- Apply moisturizers after bathing to keep skin soft.
- Avoid irritating cosmetics or soaps.
- Do not scratch to the point you cause bleeding or excessive irritation.
- Over-the-counter cortisone creams can reduce itching of mild psoriasis.
A dermatologist may prescribe an ultraviolet B unit and instruct the patient on home use.
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What Are The Types Of Psoriasis
Chronic plaque psoriasis: Raised, red, scaly patches mainly occurring on the limbs and the trunk, especially on the elbows, knees, hands, around the navel, over the lower back and on the scalp. The nails may be affected so that they become thickened and raised from their nail beds, and the surface of the nail may be marked with small indentations . This is the most common type of psoriasis, affecting approximately 9 out of 10 people with psoriasis.
Guttate psoriasis : So named because it manifests itself over the body in the form of scaly, droplet-like patches. Numerous small, red, scaly patches quickly develop over a wide area of skin, although the palms and the soles are usually not affected. It occurs most frequently in children and teenagers, often after a throat infection due to streptococcal bacteria. Some people who have had guttate psoriasis will go on in later life to develop chronic plaque psoriasis.
Scalp psoriasis: Raised, red, thick, scaly plaques on the scalp and around the hairline. It is common and approximately 1 out of 2 of all people with psoriasis have it on their scalp. The reason it deserves special mention is that it can be particularly difficult to treat and usually requires specifically formulated medicines. It is awkward to treat with creams and ointments because the hair gets in the way. See Scalp psoriasis for more information
Medical Treatment Topical Agents
The first line of treatment for psoriasis includes topical medications applied to your skin. The main topical treatments are corticosteroids , vitamin D-3 derivatives, coal tar, anthralin, and retinoids. These drugs may lose potency over time, so often they are rotated or combined. Ask your doctor before combining medications, as some drugs should not be combined.
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Scratches Bites And Skin Injury
If you have a bug bite, cut, or scrape, or youve experienced any kind of skin injury, you may notice new psoriasis lesions near the affected area. These types of injuries can even occur during everyday activities, such as shaving or tending to a garden.
Skin injury can only trigger psoriasis lesions in people who already have psoriasis.
Tips For Psoriasis Sufferers Planning To Try A Dairy
If you think there is a connection between your psoriasis flare-ups and dairy, you might want to experiment with a dairy-free diet to see if it improves your symptoms. But, as always, it is best to talk to your doctor or a qualified nutritionist before starting a new diet to make sure you won’t be missing out on any nutrients. What’s more, if you think you might suffer from a true dairy allergy , you could also ask your doctor to perform an allergy test.
If you decide to go on a strict dairy-free diet, you will have to avoid all types of dairy products, including milk, cheese, butter, yogurt, cream and ice cream. Also keep in mind that many packaged foods have hidden dairy, so read the labels carefully.
When adopting a dairy-free diet, psoriasis sufferers should also be aware that some alternatives to cow’s milk and dairy products may also be problematic. For example, some psoriatics cannot tolerate gluten, which makes many grain-based milk alternatives a non-option. There have also been concerns that beans might be bad for psoriasis sufferers, and if that is true, then psoriasis sufferers might also have to avoid vegan milks made from beans, such as soymilk, as well as other soy-based dairy alternatives such as soy yogurt.
References: A. Bordoni et al . Dairy Products and Inflammation: A Review of the Clinical Evidence. Critical Reviews in Food Science and Nutrition, 19:0 .
For More on Diet & Psoriasis
Guide to Healing Psoriasis
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Not Going Outside Enough In The Sun
Unfortunately for most people our busy lifestyles leave little time to enjoy the outdoors. Vitamin D is essential to control psoriasis. Sunlight helps your body to naturally generate Vitamin D. In addition, the UVB rays provided by the sun can help slow the over productive skin cells that cause plaques on your skin. Getting as little as an hours worth of sunlight each day can be extremely beneficial. Try going for a walk during your lunch break and soak up some wonderful sunshine.
Unhealthy Coping Mechanisms Can Make Psoriasis Worse
People with psoriasis also should limit behaviors that can amp up stress. Alcohol and recreational drugs, for instance, may intensify rather than relieve stress, Petronic-Rosic says. A study published online in August 2019 in Psoriasis Auckland suggests that alcohol might make psoriasis worse.
Theres a lot to be said about managing these addictive behaviors, says Petronic-Rosic. Stress-induced behaviors, such as alcoholism and smoking, aggravate psoriasis and correlate directly to the severity of the psoriasis. A study published in January 2019 in Expert Review of Clinical Immunology found that smoking can make psoriasis treatments less effective and suggested that people with psoriasis be encouraged to enroll in smoking-cessation programs.
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Stress Can Be Part Of Daily Life With Psoriasis
Its impossible to avoid all stress in our lives, says Colby Evans, MD, a retired dermatologist in Austin, Texas, who had served as the chairman of the board of trustees of the National Psoriasis Foundation.
Psoriasis itself can cause stress, and that can make managing the condition more difficult.
Psoriasis is a stigmatizing disease for many people because its so visible, says Dr. Petronic-Rosic. For example, you may be anxious about exposing psoriasis plaques and choose to wear long sleeves on a hot day. Feeling self-conscious or worried about signs of disease increases stress, which can cause psoriasis to flare even more a vicious cycle.
Doctors believe that that the first step in helping patients feel less stressed about their psoriasis is providing them with treatment that works. You cant just tell a patient, Dont stress and the psoriasis will improve, says Petronic-Rosic. First, try to get the disease under control. When the skin feels and looks better, then move on to doing other things that are beneficial for well-being.
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Learning To Manage Stress Has Long
Psoriasis will get better or worse, go into remission or flare, but its probably going to be there for the rest of your life, says Petronic-Rosic.
Psoriasis patients should strive to develop healthy coping mechanisms, she says, so theyre not constantly stressing themselves out because they have this disease.
Additional reporting by Beth W. Orenstein.
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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
When To See A Doctor
If you have any reason to suspect that you have psoriasis, you should call a dermatologist. Regardless of where psoriasis appears or to what degree it appears, it needs to be treated properly, Dr. Siegel says. Treating all degrees of psoriasis can improve a patients quality of life significantly.
On top of that, the Mayo Clinic notes you should talk to your doctor if your psoriasis becomes more severe or widespread, causes you discomfort or pain, leads to joint problems like pain and swelling, or doesnt improve with treatment.
Even if you think its not that bad, you deserve relief. “We oftentimes dont prioritize skin, but its the largest organ in your body and its a big deal, says Dr. Cather.
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What Kind Of Doctor Treats Psoriasis
There are several types of doctors who may treat psoriasis. Dermatologists specialize in the diagnosis and treatment of skin disorders, including psoriasis. Rheumatologists specialize in the treatment of joint disorders, including psoriatic arthritis. Family physicians, internal medicine physicians, rheumatologists, dermatologists, and other medical doctors may all be involved in the care and treatment of patients with psoriasis.
What Triggers Psoriasis Flare
While the underlying cause of psoriasis stems from your body’s immune system, certain triggers can make symptoms worse or cause flare-ups. These psoriasis triggers include:
- Cold and dry weather. Such weather can dry out your skin, which makes the chances of having a flare-up worse. In contrast, hot, sunny weather appears to help control the symptoms of psoriasis in most people.
- Stress. Having psoriasis can itself cause stress, and patients often report that outbreaks of symptoms come during particularly stressful times.
- Some medications. Certain drugs, such as lithium , drugs for malaria, and some beta-blockers , can cause flare-ups of psoriasis symptoms.
- Infections. Certain infections, such as strep throat or tonsillitis, can result in guttate or other types of psoriasis two to three weeks after the infection. Psoriasis symptoms may worsen in people who have HIV.
- Trauma to the skin. In some people with psoriasis, trauma to the skin — including cuts, bruises, burns, bumps, vaccinations, tattoos, and other skin conditions — can cause a flare-up of psoriasis symptoms at the site of the injury. This condition is called “Koebner phenomenon.”
- Alcohol. Using alcohol may increase the chances of psoriasis flare-ups.
- Smoking. Some experts think that smoking can worsen psoriasis symptoms.
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Beware Of Insect Bites
Psoriasis sufferers are vulnerable to suffering from the Koebner phenomenon, where symptoms get worse after the skin is damaged.
An insect bite will break the skin and could set this reaction off, so it’s well worth taking care during the warmer months.
If you’re worried, it’s a good idea to cover up with long-sleeved tops and long trousers to prevent insects from getting close to your skin.
You should also invest in an effective insect repellent. However, bear in mind that one of the key ingredients in these products, DEET , can react badly with your psoriasis and cause plaques to get worse.
Choose a product with low levels of DEET and never spray insect repellent directly on patches of irritated skin or open sores.
What Type Of Psoriasis Treatment Will I Need
Several treatment options can relieve psoriasis. Creams or ointments may be enough to improve the rash in small areas of skin. If the rash affects larger areas, or you also have joint pain, you may need other treatments. Joint pain may be a sign that you have arthritis.
Your provider will decide on a treatment plan based on:
- Severity of the rash.
- Vitamin A or retinoid creams.
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Steroid Creams Or Ointments
Steroid creams or ointments are commonly used to treat mild to moderate psoriasis in most areas of the body. The treatment works by reducing inflammation. This slows the production of skin cells and reduces itching.
Topical corticosteroids range in strength from mild to very strong. Only use topical corticosteroids when recommended by your doctor. Stronger topical corticosteroids can be prescribed by your doctor and should only be used on small areas of skin or on particularly thick patches. Overusing topical corticosteroids can lead to skin thinning.
How Is Psoriasis Treated
Psoriasis is usually treated by a dermatologist . A rheumatologist may also help with treatment. Treatments can include:
- ultraviolet light from the sun or from home or office treatments. But in some people, sunlight can make psoriasis worse.
- creams, lotions, ointments, and shampoos such as moisturizers, corticosteroids, vitamin D creams, and shampoos made with salicylic acid or coal tar
- medicines taken by mouth or injected medicines
A doctor might try one therapy for a while and then switch to another. Or a doctor may combine different therapies. It’s all about finding one that works for each person.
Sometimes what works for a while might stop working. This is one reason why it’s important to work closely with a doctor. Trying out new treatments can get a little frustrating, but most people eventually find one that works.
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Is There A Test For Psoriasis
To see if you have psoriasis, your doctor usually examines your skin, scalp, and nails for signs of the condition. They may also ask questions about your health and history.
This information can help the doctor figure out if you have psoriasis, and, if so, identify which type. To rule out other skin conditions that look like psoriasis, your doctor may take a small skin sample to look at under a microscope.
Injuries Or Damage To Your Skin
Though a minor cut or scrape may not seem like a big deal, it can potentially lead to a flare-up according to Dr. Feinberg, who says that skin lesions are a common source of local flares.
“Almost anything that causes damage to an area of skin can cause psoriasis to come out when we’re dealing with an overall flare-up of the disease,” he explains. “It can be any type a small cut or injury.”
Getting a sunburn can also be the cause of flares. As AAD points out, “even a mild sunburn can worsen existing psoriasis and cause new psoriasis to form.”
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Can Diet Affect My Psoriasis
A healthy diet is important for wellbeing and can reduce your risk of many long-term illnesses. However, there is no clear link between what you eat and the severity of psoriasis symptoms.
- The British Nutrition Foundation suggests eating at least 300g of oily fish per week for general health .
- Aim to eat more green leafy vegetables, nuts, seeds and wholegrain cereals, which also contain important essential fatty acids.
- Cut back on saturated fats and vegetable oils and use more olive oil and rapeseed oil products.
- Eat fresh, homemade foods rather than pre-packaged convenience food.
- Excessive amounts of alcohol can make psoriasis worse and can also interfere with certain drug medications, for example methotrexate.