What Is Psoriasis?
Psoriasis is a common and chronic incurable but treatable skin disorder. Plaque psoriasis is the most common form and appears as elevated plaques of red skin covered with silvery scale that may itch or burn. The involved areas are usually found on the arms, legs, trunk, or scalp but may be found on any part of the skin. The most typical areas are the knees, elbows, and lower back.
Plaque psoriasis on the back. Image courtesy of Hon Pak, MD.
Psoriasis is not contagious but can be inherited. Research indicates that it is associated with a widespread defect in the inflammatory process.
Factors such as smoking, sunburn, alcoholism, and HIV infection may affect the severity and extent of the condition.
A significant percentage of people with psoriasis also have psoriatic arthritis. Individuals with psoriatic arthritis have a destructive inflammation of their joints as well as other arthritic symptoms. Occasionally psoriasis of one clinical type may evolve into another such as pustular psoriasis, erythrodermic psoriasis, or guttate psoriasis. Clinical types of psoriasis include the following:
- In pustular psoriasis, the red areas on the skin contain small blisters filled with pus.
- In erythrodermic psoriasis, very extensive and diffuse areas of red and scaling skin are present.
- In guttate psoriasis, there are many isolated small scaling bumps.
Pustular psoriasis. Image courtesy of Hon Pak, MD.
Psoriasis affects children and adults. Men and woman are affected equally.
- Females develop plaque psoriasis earlier in life than males.
- The first peak occurrence of plaque psoriasis is in people 16-22 years of age.
- The second peak is in people 57-60 years of age.
Psoriasis can affect all races. Studies have shown that more people in western European and Scandinavian populations have psoriasis than those in other population groups.
What Are Psoriasis Causes and Risk Factors?
Research indicates that the disease results from a disorder in the inflammatory system. In psoriasis, T lymphocytes (a type of white blood cell) abnormally trigger inflammation in the body. These T cells also stimulate skin cells to grow faster than normal and to pile up in raised plaques on the outer surface of the skin.
Those with a family history of psoriasis have an increased chance of having the disease. Some people carry genes that make them more likely to develop psoriasis. When both parents have psoriasis, their offspring have a 50% chance of developing psoriasis. About one-third of those with psoriasis can recall at least one family member with the disease.
Certain risk factors may trigger a psoriasis flare.
- Injury to the skin: Injury to the skin has been associated with plaque psoriasis. For example, a skin infection, skin inflammation, or even excessive scratching can trigger psoriasis at the site of the skin injury.
- Sunlight: Most people generally consider sunlight to be beneficial for their psoriasis and therapeutic phototherapy is a treatment option. However, a small minority find that strong sunlight aggravates their condition. A bad sunburn may worsen psoriasis.
- Streptococcal infections: Streptococcal sore throats may trigger guttate psoriasis, a type of psoriasis that looks like small red drops on the skin.
Guttate psoriasis. Red drop-like lesions are found on the skin. This type of psoriasis usually occurs after a streptococcal (bacterial) infection. Image courtesy of Hon Pak, MD.
- HIV: Psoriasis may worsen after an individual has been infected with HIV.
- Drugs: A number of medications have been shown to aggravate psoriasis. Some examples are as follows:
- Lithium: Drug that may be used to treat bipolar disorder
- Beta-blockers: Drugs that may be used to treat high blood pressure
- Antimalarials: Drugs used to treat malaria, arthritis, and lupus
- NSAIDs: Drugs, such as ibuprofen (Motrin and Advil) or naproxen (Aleve), used to reduce inflammation
- Emotional stress: Many people note worsening of their psoriasis when emotionally stressed.
- Smoking: Cigarette smokers have an increased risk of chronic plaque psoriasis because smoking may alter the immune system in such a way as to cause a flare of the condition.
- Alcohol: Alcohol is considered a risk factor for psoriasis. Even moderate intake of beer may trigger or worsen psoriasis.
- Hormonal changes: The severity of psoriasis may fluctuate with hormonal changes. Disease frequency peaks during puberty and menopause. During pregnancy, psoriatic symptoms are more likely to improve. In contrast, flares occur in the postpartum period.
Types of Psoriasis: Medical Pictures and Treatments
What Are Psoriasis Symptoms and Signs?
Plaque psoriasis (psoriasis vulgaris), the most common form, usually produces plaques of red, raised, scaly skin affecting the scalp, elbows, and knees. The plaques may itch or burn.
Plaque psoriasis on the elbow. Image courtesy of Hon Pak, MD.
The flare-ups can last for weeks or months. Psoriasis can spontaneously resolve only to return later.
- Plaques: They vary in size (1 centimeter to several centimeters) and may be stable for long periods of time. The shape of the plaque is usually round with irregular borders. Smaller plaques may merge, producing extensive areas of involvement.
Plaque psoriasis. Image courtesy of Hon Pak, MD.
The skin in these areas, especially when over joints or on the palms or feet, can split and bleed.
Plaque psoriasis with fissures, which are splits in the skin. Fissures usually occur where the skin bends (joints). The skin may bleed and is more susceptible to infection. Image courtesy of Hon Pak, MD.
Plaques sometimes may be surrounded by a halo or ring of blanched skin (Ring of Woronoff). This is especially noticeable after effective treatment has begun and the lesions are resolving.
- Red color: The color of the affected skin reflects the inflammation present and is caused by increased blood flow.
- Scale: The scales are silvery white. The thickness of the scales may vary. When the scale is removed, the skin underneath looks smooth, red, and glossy. This shiny skin usually has small areas of pinpoint bleeding (Auspitz sign).
- Symmetry: Psoriatic plaques tend to appear symmetrically on both sides of the body. For example, psoriasis is usually present on both knees or both elbows.
Psoriasis of the scalp. Image courtesy of Hon Pak, MD.
- Nails: Nail changes are common in psoriasis. The nails may have small indentations or pits. The nails can be discolored and separate from the nail bed at the fingertip. (See Nail Psoriasis.) This may be similar in appearance to fungal nail infections and may actually coexist with, a fungal infection.
Nail psoriasis. Note the classic pits and yellowish color in the nails. Image courtesy of Hon Pak, MD.
- Psoriasis in children: Plaque psoriasis may look slightly different in children. In children, the plaques are not as thick, and the affected skin is less scaly. Psoriasis may often appear in the diaper region in infancy and in flexural areas in children. The disease more commonly affects the face in children as compared to adults.
- Other areas: Although the most common body areas affected are the arms, legs, back, and scalp, psoriasis can be found on any body part. Inverse psoriasis can be found on the genitals or buttocks, under the breasts, or under the arms and may not show the scale typically seen in other body areas. These areas can feel especially itchy or have a burning sensation.
Psoriasis on the palms. Image courtesy of Hon Pak, MD.
When Should People Seek Medical Care for Psoriasis and Its Associated Problems?
Since psoriasis is a systemic disease of inflammation with dramatic skin involvement, most people should seek medical advice early in its course when symptoms and signs appear. Besides arthritis, people with the condition are more likely to be obese and to have coronary artery disease and/or diabetes. Psoriasis, if limited to small areas of skin, may be an inconvenience for some people. For others, it may be disabling.
Those with psoriasis commonly recognize that new areas of psoriasis occur within seven to 10 days after the skin has been injured. This has been called the Koebner phenomenon.
People should always see a doctor if they have psoriasis and develop significant joint pain, stiffness, or deformity. They may be in the reported 5%-10% of individuals with psoriasis who develop psoriatic arthritis and would be a candidate for systemic (pill or injection) therapy. Psoriatic arthritis can be crippling and cause permanent deformity.
Always see a doctor if signs of infection develop. Common signs of infection are red streaks or pus from the red areas, fever with no other cause, or increased pain.
People need to see a doctor if they have serious side effects from their medications. (See Understanding Psoriasis Medications.)
How Do Doctors Diagnose Psoriasis?
Psoriasis is typically diagnosed on the basis of a physical examination by observing the appearance of the diseased skin. Although usually not necessary, skin biopsies can support the diagnosis of plaque psoriasis although they are not always definitive.
Are There Psoriasis Home Remedies?
- Exposure to sunlight helps most people with psoriasis. This may explain why the face is so seldom involved.
- Keeping the skin soft and moist is helpful. Apply moisturizers after bathing.
- Do not use irritating cosmetics or soaps.
- Avoid scratching that can cause bleeding or excessive irritation.
- Soaking in bathwater with oil added and using moisturizers may help. Bath soaks with coal tar or other agents remove scales. Be careful in bathtubs with oil added to the bathwater since the tub can become very slippery.
- Hydrocortisone cream can slightly reduce the itching of mild psoriasis and is available without a prescription.
- Some people use an ultraviolet B (UV-B) light unit at home under a doctor's supervision. A dermatologist may prescribe the unit and instruct the patient on home use, especially if it is difficult for the patient to get to the doctor's office for light treatment.
What Are Psoriasis Treatment Options?
Psoriasis is a chronic skin condition that may worsen and improve in cycles. Any approach to the treatment of this disease must be considered for the long term. Treatment regimens must be individualized according to age, sex, occupation, personal motivation, other health conditions, and available economic resources. Disease severity is defined by the thickness and extent of plaques present as well as the patient's perception and acceptance of the disease. Treatment must be designed with the patient's specific expectations in mind, rather than focusing only on the extent of body surface area involved.
Many treatments exist for psoriasis. However, the construction of an effective therapeutic regimen is not necessarily complicated.
There are three basic types of treatments for psoriasis: (1) topical therapy (drugs used on the skin), (2) phototherapy (light therapy), and (3) systemic therapy (drugs taken into the body). All of these treatments may be used alone or in combination.
- Topical agents: Medications applied directly to the skin are the first course of treatment options. The main topical treatments are corticosteroids, vitaminD3 derivatives, coal tar, anthralin, or retinoids. There isn't one topical drug that is best for all people with psoriasis. Because each drug has specific adverse effects, it is common to rotate them. Sometimes drugs are combined with other drugs to make a preparation that is more helpful than an individual topical medication. For example, keratolytics (substances used to break down scales or excess skin cells) are often added to these preparations. Some drugs are incompatible with the active ingredients of these preparations. For example, salicylic acid inactivates calcipotriene (form of vitaminD3). On the other hand, drugs such as anthralin (tree bark extract) require the addition of salicylic acid to work effectively.
- Phototherapy (light therapy): The ultraviolet (UV) light from the sun slows the production of skin cells and reduces inflammation. Sunlight helps reduce psoriasis symptoms and signs in many people. If psoriasis is so widespread that topical therapy is impractical, then artificial light therapy may be used. Proper facilities are required for light therapy. The medical light sources in a physician's office is not the same as the light sources found in tanning salons, which are of no use for psoriasis. It must be remembered that all UV radiation has a potential to cause mutations and skin cancers. Although the incubation period for these skin cancers is quite long, UV exposures should be carefully monitored.
- UV-B: Ultraviolet B (UV-B) light is commonly used to treat psoriasis. UV-B is light with wavelengths of 290-320 nanometers (nm). Within the last 15 years, a new form of UV therapy called narrow-band UV-B (NBUVB) that has a peak energy output at about 313 nm) that seems to be very effective with less burning potential than conventional broadband UV-B. It presumably contains the most therapeutic wavelengths and avoids the more toxic ones. (The visible light range is 400 nm-700 nm.) UV-B therapy is usually combined with one or more topical treatments. UV-B phototherapy is extremely effective for treating moderate-to-severe plaque psoriasis. The major drawbacks of this therapy are the time commitment required for treatments and the accessibility of UV-B equipment.
- The Goeckerman regimen uses the application of coal tar followed by UV-B exposure and has been shown to cause remission in more than 80% of patients. Patients often complain of the strong odor when coal tar is added, and it stains clothing, towels, and sheets.
- UV-B therapy can be combined with the topical application of corticosteroids, calcipotriene (Dovonex), tazarotene (Tazorac), or creams or ointments that soothe and soften the skin.
- Laser therapy (Excimer laser): A laser that produces UV-B light in the same wavelength as full body phototherapy units can target smaller areas of psoriasis without affecting the surrounding skin. Because the light treats only the psoriasis plaques, a strong dose of light can be used, which may be useful to treat a stubborn plaque of psoriasis, such as on the scalp, feet, or hands. This is an impractical treatment for psoriasis that covers a large area and, like other forms of phototherapy, requires regular visits over several months.
- Photochemotherapy (PUVA): PUVA is the therapy that combines a psoralen drug with ultraviolet A (UV-A) light therapy. Psoralen drugs make the skin more sensitive to light and the sun. Methoxypsoralen for example is taken by mouth an hour before UV-A exposure. UV-A contains light with wavelengths of 320 nm-400 nm that activate psoralen. The activated drug then is thought to inhibit the abnormal inflammatory response in the skin. More than 85% of patients report relief of disease symptoms with 20-30 treatments. Therapy is usually given two to three times per week on an outpatient basis, with maintenance treatments every two to four weeks until remission. Adverse effects of PUVA therapy include nausea, itching, and burning. Long-term complications include increased risks of sensitivity to the sun, sunburn, skin cancer, and cataracts. Availability of the psoralen medication in the United States has been a problem, with lack of availability of the medication periodically extending for weeks or months at a time. This has discouraged its use.
Psoriasis causes the top layer of skin cells to become inflamed and grow too quickly and flake off.
Are There Topical Medications for Psoriasis?
Medications applied directly to the skin are the first line of treatment options. The main topical treatments are corticosteroids, vitamin D3 derivatives, coal tar, anthralin, or retinoids. For more detailed information on each medication, see Understanding Psoriasis Medications. Generic drug names are listed below with examples of brands in parentheses.
- Corticosteroids: Topical corticosteroids are the mainstay of treatment in mild or limited psoriasis and come in a variety of forms. Foams and solutions are best for scalp psoriasis and other thickly hair-bearing areas, such as a hairy chest or hairy back. Creams are usually preferred by patients, but ointments are more potent than any other vehicles, even at the same percentage concentration. Super potent topical corticosteroids such as clobetasol propionate (Temovate) and betamethasone dipropionate augmented (Diprolene) are commonly prescribed corticosteroids for use on non-facial, non-intertriginous areas (areas where skin surfaces do not rub together). As the condition improves, one may be able to use potent steroids such as mometasone furoate (Elocon) or halcinonide (Halog) or mid-potency steroids such as triamcinolone acetonide (Aristocort, Kenalog) or betamethasone valerate (Luxiq). These creams or ointments are usually applied once or twice a day, but the dose depends on the severity of the psoriasis as well as the location and thickness of the plaque. While it is best to use stronger, super potent corticosteroids on thicker plaques, milder steroids are recommended for skin folds (inverse psoriasis) and on the genitals. In skin folds or facial areas, it is best to use milder topical steroids such as hydrocortisone, desonide (DesOwen), or alclometasone (Aclovate).
- Drugs known as calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) have less use in plaque type psoriasis than they do with eczema but are sometimes effective on the face or occluded areas. Patients who are using one or more of the systemic agents discussed below will often still require some use of topical corticosteroids for resistant areas and "hot spots." Occasionally, when there is concern about the long-term use of a potent topical corticosteroid, pulse methods may be used with one of the vitamin D or A analogs discussed below. An example would be to use the nonsteroidal topical agent (or a milder corticosteroid) during the week and more potent steroid on the weekends.
Picture of genital psoriasis. Image courtesy of Jeffrey J. Meffert, MD. Picture of inverse psoriasis affecting the armpit. Image courtesy of Jeffrey J. Meffert, MD.
- Vitamin D: Calcipotriene (Dovonex) is a form of vitaminD3 and slows the production of excess skin cells. It is used in the treatment of moderate psoriasis. This cream, ointment, or solution is applied to the skin twice daily. Calcipotriene combined with the betamethasone dipropionate (Taclonex) flattens lesions, removes scale, and reduces inflammation and is available as an ointment and a solution. As is the case with many combination medications, it may be much less expensive to apply the individual components sequentially than a single application of a prepackaged mixture. Calcitriol ointment (Silkis, Vectical) contains calcitriol, which binds to the vitamin D receptors on skin cells and reduces the excessive production of skin cells, which helps to improve psoriasis. Calcitriol ointment should be applied to the affected areas of skin twice a day.
- Coal tar: Coal tar (DHS Tar, Doak Tar, Theraplex T, Zithranol) contains literally thousands of different substances that are extracted from the coal carbonization process. Coal tar is applied topically and is available as shampoo, bath oil, ointment, cream, gel, lotion, or paste. The tar decreases itching and slows the production of excess skin cells and is especially useful when used with or combined with a topical corticosteroid. It is messy and has a strong smell.
- Corticosteroids: Clobetasol (Temovate), fluocinonide (Lidex), and betamethasone (Diprolene) are examples of commonly prescribed corticosteroids. These creams or ointments are usually applied twice a day, but the dose depends on the severity of the psoriasis.
- Tree bark extract: Anthralin (Dithranol, Anthra-Derm, Drithocreme) is considered to be one of the most effective antipsoriatic agents available. It has the potential to cause skin irritation and staining of clothing and skin. Apply the cream, ointment, or paste sparingly to the skin plaques. On the scalp, rub into affected areas. Avoid the forehead, eyes, and any skin that does not have the lesions. Do not apply excessive quantities.
- Topical retinoid: Tazarotene (Tazorac) is a topical retinoid that is available as a gel or cream. Tazarotene reduces the size of the plaques and the redness of the skin. This medicine is sometimes combined with corticosteroids to decrease skin irritation and to increase effectiveness. Tazarotene is particularly useful for scalp psoriasis. Apply a thin film to the affected skin every day or as instructed. Dry skin before using this medicine. Irritation may occur when applied to damp skin. Wash hands after application. Do not cover with a bandage.
- Keratolytics: A useful addition to topical steroids is to add a keratolytic medication to remove overlying scale so that the steroid can reach the affected skin sooner and more effectively. Salicylic acid shampoos are useful in the scalp, and urea (either prescription strength or over-the-counter lower strengths) may be used on body plaques.
Systemic Medications for Psoriasis
Systemic Medications (Those Taken by Mouth or Injection)
- Psoralens: Methoxsalen (Oxsoralen-Ultra) and trioxsalen (Trisoralen) are commonly prescribed drugs called psoralens. Psoralens make the skin more sensitive to light. These drugs have no effect unless carefully combined with ultraviolet light therapy. This therapy, called PUVA, uses a psoralen drug with ultraviolet A (UV-A) light to treat psoriasis. This treatment is used when psoriasis is severe or when it covers a large area of the skin. Psoralens are taken by mouth one to two hours before PUVA therapy or sunlight exposure. They are also available as creams, lotions, or in bath soaks. More than 85% of patients report relief of disease symptoms with 20-30 treatments. Therapy is usually given two to three times per week, with maintenance treatments every two to four weeks until remission. Adverse effects of PUVA therapy include nausea, itching, and burning. These drugs cause sensitivity to sunlight, risk of sunburn, skin cancer, and cataracts and for this reason, the prescription of the medication for home use with natural sunlight is strongly discouraged.
- Methotrexate (Rheumatrex, Trexall): This drug is used to treat plaque psoriasis or psoriatic arthritis. It suppresses the immune system and slows the production of skin cells. Methotrexate is taken by mouth (tablet) or as an injection once per week. Women who are planning to become pregnant or who are pregnant should not take this drug. The doctor will order blood tests to check your blood cell count and liver and kidney function on a regular basis while on this medicine. After the patient has been on the medication for several years, a liver and lung examinations may be recommended to look for evidence of damage that was not apparent on routine blood tests.
- Cyclosporine (Sandimmune, Neoral, Gengraf): This drug suppresses the immune system and slows the production of skin cells. Cyclosporine is taken by mouth two or three times a day. A doctor will order tests to check your kidney function. Cyclosporine may increase the risk of skin cancer, infection, or lymphoma, and it may cause damage to the kidneys, producing high blood pressure. It is intended for short-term use.
- Acitretin (Soriatane): This drug is an oral retinoid, or a modified vitamin A molecule. It is not as effective as methotrexate or cyclosporine in the treatment of plaque psoriasis, but it works for pustular psoriasis and in other patients with predominantly hand and foot psoriasis. In women of childbearing age, acitretin must be used with caution because of the risks of birth defects. Furthermore, because of the long time needed for the elimination of acitretin from the body, even after treatment is stopped, women must continue to avoid pregnancy for three years. Regular blood tests are required while taking this medication. Side effects include dryness and irritation of the skin, lips, eyes, nose, and mucous membrane surfaces. Other adverse side effects include thinning hair, elevation of cholesterol and triglyceride levels, liver toxicity, and bone changes. Do not donate blood while taking acitretin and for two years after stopping it.
- Apremilast (Otezla): This is an oral medication that has been approved for use in psoriasis. Diarrhea is an occasional side effect of this medication. Some patients report weight loss while on Otezla. This medication does not require regular blood tests.
Biologics for Psoriasis
The following drugs are categorized under the term biologic because they are all proteins produced in the laboratory by industrial cell culture techniques and must be given either subcutaneously or intravenously. The frequency of treatment depends on the specific drug. All of these medications are very precise in that they block only one or two parts of the inflammatory reaction and are moderately immunosuppresive. Biologics are expensive and do not cure psoriasis but as a group are quite effective and reasonably safe. If it is decided to start a patient on a biologic drug, the choice will depend on the particular physician's expertise, as well as insurance coverage and payment issues.
- Etanercept (Enbrel): This is the first drug that the FDA approved for treating psoriatic arthritis. It is a manufactured protein that works with tumor necrosis factor (TNF) in order to reduce inflammation. Etanercept is given as an injection two times per week initially and then decreased to weekly in most patients. The drug can be injected at home. Enbrel affects your immune system and is especially hazardous to someone with untreated tuberculosis (TB) exposure or a history of hepatitis B. In both of these cases, patients receiving etanercept or any of the other "biologics" discussed below may experience a severe and life-threatening reactivation of their previously quiet disease. Etanercept is rarely associated with heart failure. Like other medicines of the "biologic" family, any use in patients with known or suspected multiple sclerosis (MS) or other demyelinating diseases is done only after careful consideration of other options and with very careful monitoring.
- Adalimumab (Humira): Humira is used to treat moderate to severe chronic plaque psoriasis in adults. It is a protein that blocks TNF-α, a type of chemical messenger in the immune system. In psoriasis, TNF-α overstimulates immune system cells (T cells) and causes psoriatic lesions to develop. Humira is taken by injection under the skin. The recommended dose for adults is one injection every two weeks. Side effects include severe infection, reactivation of TB or hepatitis B, rare allergic reactions, very rare serious blood disorders, lymphoma, and other cancers.
- Ustekinumab (Stelara): This drug blocks two proteins called interleukin-12 and interleukin-23, which are parts of the immune system. Interleukins-12 and 23 promote the inflammation associated with psoriasis. Stelara is injected under the skin at the start of treatment, after four weeks, and every 12 weeks thereafter. Ustekinumab may potentially increase the risk of malignancy or infection; it also may rarely cause allergic reactions, including skin rash, facial swelling, and difficulty with breathing.
- Infliximab (Remicade): This was one of the original biologic medications used for psoriasis. Advantages are that onset of action is faster than many systemic treatments. Disadvantages are that it must be administered by infusion and, over time, antibodies may develop and decrease its effectiveness.
- Secukinumab (Cosentyx): It is an antibody that acts as an interleukin 17 (IL-17) antagonist and, after a loading dose, is administered monthly. IL-17 is another substance that promotes an inflammatory reaction.
- Ixekizumab (Taltz) is an antibody that inhibits IL-17 with a similar mode of action to secukinumab.
- Brodalumab (Siliq) is another antibody that inhibits interleukin-17 receptor A (IL-17RA).
- Guselkumab (Tremfya) is another antibody that inhibits IL-23.
Are There Other Therapies for Psoriasis?
Conventional therapy is one that has been tested with clinical trials or has other evidence of clinical effectiveness. The FDA has approved several drugs for the treatment of psoriasis as described above. Some patients look to alternative therapy, diet changes, supplements, or stress-reducing techniques to help reduce symptoms. For the most part, alternative therapies have not been tested with clinical trials, and the FDA has not approved dietary supplements for treatment of psoriasis. There are no specific foods to eat or to avoid (except for alcohol) for patients with psoriasis. However, some other therapies can be found on the National Psoriasis Foundation web site. Individuals should check with their doctors before starting any therapy.
Some medications purchased online, both oral and topical, may actually contain pharmaceuticals that would normally require a prescription. This becomes a problem with unanticipated medication side effects and interactions. Caution should always be exercised in purchasing and using such products.
If one is taking a systemic retinoid such as acitretin or covering large areas with a topical retinoid (Tazorac) or a vitamin D analog (calcipotriene, calcitriol), he or she should be careful about taking "megadoses" of the same vitamins as a supplement. In rare cases, vitamin toxicity can occur.
A variety of herbal therapies have been reported in the lay press and on the Internet to help psoriasis. Some of these are oral and some topical, but none have been shown to have any predictable benefit at this time. Some, such as tea tree oil, coconut oil, and primrose oil, are known to cause contact dermatitis, which can transform a bothersome plaque into an oozing, blistering, intensely itchy one. There is no good evidence to support use of apple cider vinegar or household cleaning products either.
Follow-up After Treatment of Psoriasis
- Plaque psoriasis is a chronic disease that goes away and returns. Follow-up care depends on the severity of the disease at any given time.
- If a patient has evidence of psoriatic arthritis, a consultation with a rheumatologist (a physician who specializes in arthritis) is helpful.
Is There a Psoriasis Diet? Can People Prevent Psoriasis?
- Avoiding environmental factors that trigger psoriasis, such as smoking, and stress, may help prevent or minimize flare-ups of psoriasis. Sun exposure may help in many cases of psoriasis and aggravate it in others.
- Alcohol is considered a risk factor for psoriasis, even moderate amounts of beer. People should minimize alcohol use if they have psoriasis. This is especially important if they are taking medications such as methotrexate or acitretin.
- Specific dietary restrictions or supplements other than a well-balanced and adequate diet are not important in the management of plaque psoriasis.
- Recently, some data has supported that an "anti-inflammatory" diet that is high in fruits and vegetables and low in saturated and trans fats may help manage psoriasis, although the value in preventing its onset is less certain.
What Is the Prognosis of Psoriasis?
Psoriasis is more of an inconvenience in most cases than it is threatening. However, it is a chronic systemic inflammatory disease for which there is no true cure. The itching and peeling of skin can lead to significant pain and self-esteem issues. By far, the patient's quality of life is affected most with plaque psoriasis. Self-consciousness and embarrassment about appearance, inconvenience, and high costs of treatment options all affect one's outlook when living with psoriasis. It has recently become apparent that many patients with psoriasis are predisposed to diabetes, obesity, and premature cardiovascular disease. It is important that such patients seek good overall medical care aside from simply treating their skin disease. Anxiety, depression, or stress may worsen symptoms and increase the tendency to itch. Most patients can expect significant improvement from the treatment of their psoriasis.
Psoriasis Support Groups and Counseling
Education of psoriasis patients is one of the foundations for managing this chronic and typically relapsing disorder. Patients should be familiar with the treatment options in order to make proper informed decisions about therapy. The National Psoriasis Foundation is an excellent organization that provides support to patients with psoriasis.
Where Can People Find More Information About Psoriasis?
National Psoriasis Foundation
6600 SW 92nd Ave, Suite 300
Portland, OR 97223-7195
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
American Academy of Dermatology
PO Box 4014
Schaumburg, IL 60168-4014
Guttate psoriasis. Red drop-like lesions are found on the skin. This type of psoriasis usually occurs after a streptococcal (bacterial) infection. Image courtesy of Hon Pak, MD. Nail psoriasis. Note the classic pits and yellowish color in the nails. Image courtesy of Hon Pak, MD. Plaque psoriasis on the elbow. Image courtesy of Hon Pak, MD. Plaque psoriasis. Image courtesy of Hon Pak, MD. Plaque psoriasis. Photo courtesy of University of British Columbia, Department of Dermatology and Skin Science. Plaque psoriasis. Photo courtesy of University of British Columbia, Department of Dermatology and Skin Science. Psoriasis on the palms. Image courtesy of Hon Pak, MD. Plaque psoriasis with fissures, which are splits in the skin. Fissures usually occur where the skin bends (joints). The skin may bleed and is more susceptible to infection. Image courtesy of Hon Pak, MD. Plaque psoriasis on the back. Image courtesy of Hon Pak, MD. Severe plaque psoriasis. Note the classic red color and scales or plaque. Image courtesy of Hon Pak, MD.
Reviewed on 12/3/2018
Armstrong, April W., et al. "From the Medical Board of the National Psoriasis Foundation: Treatment Targets for Plaque Psoriasis." J Am Acad Dermatol Nov. 22, 2016: 1-9.
Burden, A.D. "Management of psoriasis in childhood." Clin Exp Dermatol 24.5 Sept. 1999: 341-5.
Feely, M.A., B.L. Smith, and J.M. Weinberg. "Novel psoriasis therapies and patient outcomes, part 1: topical medications." Cutis 95.3 Mar. 2015: 164-8, 170.
Greb, Jacqueline E., et al. "Psoriasis." Nature Reviews: Disease Primers 2 Nov. 24, 2016: 1-17.
Jensen, J.D., M.R. Delcambre, G. Nguyen, and N. Sami. "Biologic therapy with or without topical treatment in psoriasis: What does the current evidence say?" Am J Clin Dermatol 15.5 Oct. 2014: 379-85.
Kim, Whan B., Dana Jerome, and Jensen Yeung. "Diagnosis and Management of Psoriasis." Canadian Family Physician 63 April 2017: 278-285.
Mansouri, B., M. Patel, and A. Menter. "Biological therapies for psoriasis." Expert Opin Biol Ther 13.13 Dec. 2013: 1715-30.
Maza, A, et al. "Oral cyclosporin in psoriasis: a systematic review on treatment modalities, risk of kidney toxicity and evidence for use in non-plaque psoriasis." J Eur Acad Dermatol Venereol 25 Suppl 2 May 2011: 19-27.
Michalek, I.M., B. Loring, and S.M. John. "A Systematic Review of Worldwide Epidemiology of Psoriasis." JEADV 2016: 1-8.
Paul, C., et al. "Evidence-based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists."
J Eur Acad Dermatol Venereol 25 Suppl 2 May 2011: 2-11.
Sbidian, E., et al. "Efficacy and safety of oral retinoids in different psoriasis subtypes: a systematic literature review." J Eur Acad Dermatol Venereol 25 Suppl 2 May 2011: 28-33.
van de Kerkhof, P.C. "An update on topical therapies for mild-moderate psoriasis." Dermatol Clin 33.1 Jan. 2015: 73-7.
Villaseñor-Park, Jennifer, David Wheeler, and Lisa Grandinetti. "Psoriasis: Evolving Treatment for a Complex Disease."
Cleveland Clinic Journal of Medicine 79.6 June 2012: 413-423.
National Psoriasis Foundation. About Psoriatic Arthritis. 2018. 21 November 2018 .
Steven R Feldman, MD, PhD. Patient education: Psoriasis (Beyond the Basics). 20 August 2018. 21 November 2018 .
The Psoriasis and Psoriatic Arthritis Alliance. Frequently asked questions. 21 November 2018 .