Learning About Psoriasis

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August is Psoriasis Awareness Month — time to understand a common condition.

Get some of your questions answered about psoriasis, a disease affecting around 2 to 4 percent of the population worldwide.

Dr. Kenneth A. Katz

What Psoriasis Is

Psoriasis is a disease that causes a rash on the skin and, in some people, arthritis in the joints. It’s caused by inflammation resulting in skin cells developing at an abnormally fast rate. It often first appears in people ages 15 to 35.

What activates the immune system in psoriasis sufferers is not fully understood, but it’s likely that both genetics and environmental factors play a role. In some cases, psoriasis runs in families. And environmental triggers such as infections, medicines, and cold weather can bring on psoriasis or make it worse.

While skin rashes in people with psoriasis can become infected, it’s important to note that psoriasis itself is not contagious.

Its Symptoms

The hallmark of psoriasis is its characteristic skin rash, which is often red, scaly, and can be itchy or painful. The most common kind of psoriasis, called plaque psoriasis, typically shows up on the outside of the elbows and knees, and in the scalp.

Up to 30 percent of people with psoriasis will develop arthritis, also due to inflammation. Symptoms of that condition — called psoriatic arthritis — include pain and swelling over tendons, stiffness and tenderness in joints, morning stiffness, and swollen fingers and toes that can have a sausage-like appearance.

The skin and joint manifestations of psoriasis can vary greatly in severity, ranging from very mild to quite severe.

Ramifications

The physical and emotional toll of psoriasis varies greatly. For people with more severe psoriasis, the impact on quality of life is often like that seen in people with other chronic diseases.

In the past 15 years we’ve learned that psoriasis is associated with serious diseases, possibly because of increased inflammation in the body. People with psoriasis are at higher risk for cardiovascular diseases, diabetes, obesity, and inflammatory bowel disease, for example.

On the skin, psoriasis can be quite visible, both to the person who has it as well as to others. That can lead to feelings of embarrassment or shame, depression and stress, and poor self-esteem.

Getting Help

If your skin is bothering you, or you have questions about a rash, ask your doctor. The first step is making a diagnosis. Because psoriasis can look like other skin conditions, talk to your doctor to better understand what’s going on in your skin and to develop a treatment plan.

Treatment

The range of treatments available for psoriasis has really expanded over the past 2 decades. They now include newer medicines that target very specific components of the immune system that are involved in psoriasis, as well as older medicines that remain very effective, are often less expensive, and have well understood side effects.

We often talk about a “treatment ladder” for psoriasis, in which each rung of the ladder represents a type of treatment. Lower rungs — moisturizers; prescription and nonprescription creams, ointments, and shampoos; and light therapy — represent treatments that can be effective and have a lower chance of side effects. As we move to higher rungs, which include oral or injected medicines that affect the whole body, effectiveness increases, but with it so does the chance of side effects.

Closing Thoughts

Unfortunately, as for many other inflammatory diseases, there is no cure for psoriasis. But with an increasing range of treatments available, psoriasis can be a very controllable condition for most people.

Dr. Kenneth A. Katz is a dermatologist at Kaiser Permanente’s Mission Bay campus in San Francisco.

Discussion7 Comments

  1. What are some of the best lotions and hair products out there (shampoo, conditioner, heat protectant) for folks who have psoriasis? Thank you in advance!

    • Lynn Mundell

      It often depends on the patient and the particular presentation of psoriasis. There are many shampoos (and no conditioners or “heat protectants”) that are good specifically for psoriasis. I’d recommend discussing with your doctor.

      Ken Katz, MD
      Dermatologist
      Chief, Outpatient Pharmacy and Therapeutics Kaiser Permanente – San Francisco Medical Center

  2. Fascinating. I appreciate the article AND the comments. I’d be curious to see if people were tested for celiac prior (or post) psoriasis diagnosis. Autoimmunity disorders/disease are complex — diet can be all or part of the solution, some of the time. Thank you all for posting!

  3. Suffering from psoriasis, I have worked with my doctors to research the triggers through various allergy and elimination tests. My psoriasis, asthma, eczema, alopecia, acne, and geographic tongue were all linked to these known allergies: Propylene glycol (it’s in everything), wheat, rice, dairy, corn, barley, malt, and corn syrup. Once I removed the triggers, I no longer suffer unless they are reintroduced into my diet. I know, it’s not easy, but worth it. Smaller waistline and no more flakey, embarrassing skin. Good luck, y’all!

  4. Along with gluten, dairy can also be a culprit. My friend had it so bad for many many years before he tried removing dairy. He is so much better and happier now!

    • True. Five years ago, I stopped eating foods with dairy proteins (whey & casein). I used to drink a glass of milk daily. 30+ years I experienced daily head aches, joint pains, upper & lower back pains and high cholesterol. Had to use pain medicine to help me get through the day.

      I haven’t had above issues since I stopped consuming foods with dairy proteins and my health is so much better! My cholesterol is always normal even without exercise!

      After stopping dairy, I cut down on gluten to weekends only. And now trying to cut down on caffeine to once a week.

  5. For me it was anything that had gluten in it, even small amounts. My nails, and skin around nails, would break down and bleed. It looked awful and was very painful. I also had severely dry, flakey, and itchy scalp. Growing up I just lived with it using remedies, medicine, and special shampoo. Three years ago, I read about how some foods harm our body so I decided to remove foods with gluten. Took a week to see improvements, but it worked! No more issues! Because of gluten I had suffered 30+ years of psoriasis.

    Gluten is addicting so it took me a few weeks to reduce my cravings. Now I only eat foods containing gluten on weekends. My weekdays are gluten-free. Overall health became better, too.

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