Psoriasis in genital area

What to Do About Genital Psoriasis

When it comes to uncomfortable and embarrassing conditions, genital psoriasis would make most people’s lists. But that doesn’t need to be the case.

“Many people with genital psoriasis go undiagnosed for a long time. People may be too embarrassed to tell their doctors about their symptoms. Doctors may be too embarrassed to look,” says Jeffrey I. Ellis, MD, a dermatologist for Northwell Health at Glen Cove Hospital in Glen Cove, New York. “This is especially true when genital psoriasis is the only type of psoriasis .”

Usually, if you have genital psoriasis, you also have the more typical psoriasis on your knees and elbows. But for some, genital psoriasis may be the only form of the condition they have.

How It’s Different From Other Forms of Psoriasis

Genital psoriasis usually doesn’t have the thick scales and silvery plaques associated with other psoriasis. Inverse (or skinfold) psoriasis, which includes psoriasis of the genital areas, accounts for up to 7 percent of psoriasis cases.

In 2 to 5 percent of psoriasis cases, the disease is isolated to the skin of the genital area. Still, inverse psoriasis can also show up in the pubic area, upper thighs, groin creases, anal area, or on the genitals.

“Genital psoriasis looks like a red rash with sharp borders,” says Dr. Ellis. “When it appears in the groin area, it is often mistaken for a fungus, like jock itch. When it appears on the genitals, it may be mistaken for a sexually transmitted disease.”

Because of this, “we often see patients who have been diagnosed and treated incorrectly,” he says. “A skin biopsy may be needed to make the diagnosis of genital psoriasis.”

Symptoms of genital psoriasis, like soreness, burning, and itching, are often made worse because the groin area is constantly exposed to friction, warmth, and moisture. “One of the characteristics of psoriasis is the tendency for it to get worse with any kind of skin trauma,” Ellis says. “In the groin area, tight clothing, skin rubbing on skin, athletic activity, and sexual activity can all make symptoms worse.”

A study published in June 2015 in the Journal of the American Academy of Dermatology found that patients who are younger at the onset of psoriasis, are male, or have more severe plaque psoriasis are more likely to develop genital psoriasis.

Treatments for Psoriasis on Your Genitals

Genital psoriasis occurs on skin that tends to be thinner and more sensitive than skin in other areas of the body. “Genital psoriasis is more sensitive, but also more responsive to treatment. You have to treat it gently, but you can often get symptoms to clear up completely,” Ellis says. Genital psoriasis treatments may include:

  • Medication applied to the skin, such as steroids, vitamin D, and mild tar preparations
  • Ultraviolet light treatments
  • Stronger oral drugs, such as Trexall (methotrexate), retinoids, and biologic drugs

A report published in December 2012 in the journal Dermatology and Therapy described a case of genital psoriasis that resisted other psoriasis treatments but responded well to the oral drug dapsone. Better known as an antibiotic for treating leprosy, dapsone cleared the genital psoriasis completely in four weeks and was continued for 10 months; the patient remained free of genital psoriasis for at least two years using only a topical therapy.

“All the same treatments that we use for other psoriasis may be used for genital psoriasis,” Ellis says. “Dapsone may be used as an alternative to other treatments.” He notes that it’s available as a pill or a gel.

Tips for Managing Genital Psoriasis

“The most important tip is to find a dermatologist that you feel comfortable with and can work closely with,” says Ellis. “Self-care includes avoiding skin trauma and excessive dryness. Skin hydration is an important part of management.”

Some ways to keep your skin hydrated include:

  • Avoiding long periods of bathing in hot water
  • Using a skin cleanser that is gentle on your skin
  • Asking your doctor to suggest a good skin moisturizer
  • Using your moisturizer after bathing, while your skin is still moist
  • Applying cool compresses to dry and itchy areas

Genital Psoriasis and Your Sex Life

Genital psoriasis can make your sex life more complicated, but it’s important to know that it does not interfere with sexual function. Start by sharing with your partner that genital psoriasis isn’t contagious.

Here are some other helpful psoriasis sex tips:

  • Use topical medication in the genital areas only as directed by your doctor. Don’t try to speed healing by using more.
  • Keep your genital area clean.
  • Do a gentle cleansing of the area after any sexual activity.
  • Use a lubricated condom to avoid irritating inflamed genital areas.

“Sometimes it helps for a patient and his or her partner to come to a doctor visit together,” Ellis says. “Knowledge is the key to living with psoriasis. Genital psoriasis is not contagious, and it’s nothing you need to be ashamed about. Let your doctor know if you have any symptoms. We have amazing treatments.”

Genital psoriasis is the worst: Patients sound off

GENEVA – The great majority of patients with genital psoriasis say their symptoms in the genital area are worse than elsewhere on the body, Kim A. Meeuwis, MD, reported at the annual congress of the European Academy of Dermatology and Venereology.

She presented a qualitative study in which 20 patients with longstanding genital psoriasis sounded off, sharing their perspectives on the disease in one-on-one, semistructured, face-to-face interviews.

Bruce Jancin/Frontline Medical News

Dr. Kim Meeuwis

“It’s not the case that every patient with genital psoriasis experiences worse symptoms, but by far, most patients report that several aspects of psoriasis – including intensified pain and discomfort – are worse in or unique to the genital area,” said Dr. Meeuwis, a dermatologist at Radboud University Medical Center in Nijmegen, the Netherlands.

Genital psoriasis is common. Epidemiologic studies show 30%-60% of psoriasis patients experience genital involvement at some point in the course of their disease. Yet patients seldom discuss their genital psoriasis with their physicians, and the patient perspective on how the experience of genital psoriasis differs from that of having psoriasis at other locations has been addressed only sparsely in the literature. This lack of attention was the impetus for the current study, she explained.

The 20 participants in the study had an average 18-year history of plaque psoriasis, with an average 7.5-year history of genital involvement. The genital psoriasis was rated moderate or severe in 70% of subjects at the time of the study.

The most commonly reported symptoms of genital psoriasis were itch and discomfort, each of which was cited by all study participants. This was followed by erythema, cited by 95%; stinging and burning, also cited by 95%; pain, cited by 85%; scaling, by 75%; and cracking, by 30%.

Of the patients in the study, 85% reported that their pain and/or discomfort were worse in the genital area than at other sites, and 10% said they were highly self-conscious about their genital psoriasis because others had misidentified them as having a sexually transmitted infection.

Since this was a qualitative study, Dr. Meeuwis provided representative quotes from several patients, including one who asserted, “I really only have discomfort on my psoriasis on the rest of my body … in my genitals is the only place that actually has pain, or the itching is … really, really bad.”

Dr. Meeuwis said the study results hold an important lesson for physicians who treat psoriasis: “Due to differences in patient experiences between genital and nongenital skin, it’s really important to make time for the specific evaluation of genital involvement in taking care of patients with psoriasis – and to be sure to ask about it.”

Dr. Meeuwis reported serving as a consultant to Eli Lilly, which sponsored the study, as well as being on an advisory board to Beiersdorf.

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Genital psoriasis

What is genital psoriasis?

Psoriasis is a common, long-term scaly skin condition that affects approximately 2% of the population. Genital psoriasis affects the genital skin, which includes the pubic area, vulva or penis, skin folds including natal cleft, and buttocks. It is known as anogenital psoriasis when psoriasis also affects perianal skin. Psoriasis does not affect mucosal surfaces.

Psoriasis is one of the most common diseases affecting anogenital skin. It can be part of more generalised plaque psoriasis, but it may also be the only affected area in 2–5% of cases. Rarely, generalised and localised pustular psoriasis can also affect the genital skin.

Genital skin can also be affected in inverse or flexural psoriasis, psoriasis that mainly affects the skin folds. Genital psoriasis may be associated with considerable discomfort and embarrassment, and may severely impair the quality of life and sexual well-being of those affected.

Who gets genital psoriasis?

Genital psoriasis affects males and females, children and adults. In children, genital psoriasis is most common under the age of 2, when it presents as psoriatic napkin eruption.

What are the clinical features of genital psoriasis?

Psoriasis of the external genitalia and perianal area often presents as well-demarcated, bright red, thin plaques. These usually lack scale, as friction between the skin surfaces rubs it off. Scales may be seen on the outer parts of the genital skin. Scales can be easily scraped off, leaving pinpoint bleeding.

In women, vulval psoriasis appears symmetrical. It can vary from silvery, scaly patches adjacent to the labia majora to moist, greyish plaques or glossy red plaques without scaling in the skin folds.

In men, the penis and scrotum may be involved. The glans penis, the bulbous part of the end of the penis, and the corona (the base or “crown” of the glans) are most commonly affected. In circumcised men, plaques can be more scaly than on the rest of the genital skin. In uncircumcised men, nonscaling plaques are more common.

Psoriatic napkin eruption presents as red and sometimes silvery plaques with well-defined borders in the nappy area of children under the age of 2 years. It usually clears up after a few months to a year, but may later generalise into plaque psoriasis.

Psoriasis in genital areas can be very itchy at times. The plaques may also be fissured and painful.

Psoriasis does not lead to scarring. The skin can return to a normal appearance with treatment or spontaneously.

See images of genital psoriasis.

What causes genital psoriasis?

Genital or anogenital psoriasis may be part of more generalised psoriasis. Psoriasis has multifactorial genetic and environmental causes. These are not fully understood. In the anogenital area, specific factors to consider include:

  • Colonisation by bacteria and yeasts (Candida albicans)
  • Injury to the skin, causing new plaques of psoriasis to develop (Koebner phenomenon)

Psoriasis in the genital area may also be worsened by contact with irritants such as:

  • Urine
  • Faeces
  • Tight-fitting clothes
  • Friction associated with sexual intercourse.

How is the diagnosis of psoriasis made?

The diagnosis of psoriasis is usually made by its clinical appearance, with symmetrical, circumscribed erythematous plaques. Laboratory tests such as swabs and skin biopsies are rarely necessary.

Histologically, there is no apparent difference between ano and non-genital psoriasis.

What is the treatment of genital psoriasis?

Treatment of genital psoriasis is individualised. There is limited published data for efficacy and safety of treatment options. The following suggestions for treatment of genital psoriasis are based on expert opinions and case reports.

Topical corticosteroid cream

  • A weak or moderate-potency topical steroid cream may be used as required.
  • Short-term intermittent use of moderate-to potent corticosteroids may be necessary but should be followed by a return to use of a weaker preparation.
  • Intensive, short-term, intermittent use of potent corticosteroids should be limited to a few weeks under the supervision of a medical practitioner.
  • There is increased absorption of topical steroids in genital skin, which can cause skin thinning.

Coal-tar derivatives

  • Mild topical coal tar preparations can be used alone or when treatment with a weak topical steroid is insufficient. Tar or ichthammol may be used, with zinc oxide, for napkin psoriasis.
  • Tar preparations can irritate. Mixing a tar with a steroid cream may reduce irritation.

Vitamin D analogues

Vitamin D analogues such as calcipotriol cream can be cautiously used alone or in combination with topical steroids. However, they may irritate genital skin.

Immunomodulators

  • There are limited data to support the use of the immunomodulators pimecrolimus cream and tacrolimus ointment in genital or anogenital psoriasis. They may cause local irritation and stinging, contact dermatitis, reactivation of herpes simplex, and increase the risk of thrush (Candida albicans infection).

Other

  • Bland emollients can be used as required to reduce skin irritation and act as a barrier cream.
  • Genital skin infections should be treated promptly.
  • Oral agents such as methotrexate, ciclosporin and acitretin are rarely necessary for genital psoriasis alone. They may be required in severe cases that fail to respond to topical treatments or for severe psoriasis on the rest of the body.

Therapy-resistant penile and vulval plaques should be re-evaluated clinically and histologically to rule out malignancy (penile intraepithelial neoplasia and vulval intraepithelial neoplasia).

Treatments to avoid in the genital area

Dithranol, tazarotene, UV rays (UVB phototherapy and photochemotherapy) and laser therapy should be avoided in the genital area.

What psoriasis treatments are available without a prescription?

Comparing shampoos: Psoriasis shampoos contain an active ingredient that can soften and loosen scale on the scalp. You’ll find many products to treat psoriasis that you can buy without a prescription. Your dermatologist may refer to these products as “over-the-counter” (OTC) treatments. No matter what you call them, these products work best for people who have very mild psoriasis, with one exception. Moisturizers can benefit anyone who has psoriasis.

Some OTC treatments contain an active ingredient (what treats the psoriasis) like coal tar or hydrocortisone. People have used these for years to treat psoriasis. Other active ingredients are so new that we know little about how well they work or whether they’re safe.

Here’s what we know about OTC psoriasis treatment:

Coal tar
This active ingredient is found in many psoriasis treatments—both prescription and OTC products. Coal tar has been used for years to treat psoriasis because it can:

  • Lessen the itching and flaking

  • Reduce redness, swelling, and scaling

  • Slow the rapidly growing skin cells

You’ll find coal tar in OTC shampoos, creams, ointments, and bath solutions for psoriasis.

Coal tar can irritate skin

Coal tar may irritate your skin, so it’s best to test the product on a small area before applying it to all of your psoriasis.

Hydrocortisone creams and ointments

You can buy a mild corticosteroid like hydrocortisone without a prescription. For a few small patches of psoriasis, a mild hydrocortisone works well. If you have more than a few small patches, you’ll likely need a prescription corticosteroid to see results.

Whether OTC or prescription, this medicine works quickly to:

  • Reduce the itch

  • Decrease inflammation

If you have cracked or bleeding skin, an ointment will likely feel better than a cream. Ointments tend to be more soothing and less irritating than creams.

Moisturizer
This may help anyone who has psoriasis because psoriasis makes the skin dry and scaly. Moisturizer helps to seal water in the skin, which can:

  • Relieve dryness

  • Help your skin heal

Dermatologists recommend applying moisturizer once a day, and more often when your skin is really dry. When shopping for a moisturizer, you want to select a:

  • Heavy cream, ointment, or oil rather than a lotion

  • Fragrance-free product

  • Product that you like and will use

Oil can be especially healing, but it’s also messy. To reap the benefits of oil, try applying it before bedtime.

Moisturize before washing

For best results, you want to apply your moisturizer within 3 minutes of bathing and after washing your hands.

Scale softeners
You’ll find OTC products and prescription medicines that contain salicylic acid. This active ingredient helps to:

  • Remove and soften scale

  • Reduce swelling

Because it can effectively remove scale, salicylic acid is often found in products for scalp psoriasis. Your dermatologist may also include salicylic acid in your treatment plan if you have thick plaque-type psoriasis anywhere on your body.

Removing the scale helps other medicine that you apply to your skin to work better.

It is important to use products containing salicylic acid as indicated in the instructions. Too much can worsen psoriasis, causing dry, red, itchy skin where you applied it. Other active ingredients that can soften and remove scale are:

  • Lactic acid

  • Urea

Scale softeners

To get the best results from a scale softener, it helps to take a warm (NOT hot) 15-minute bath before you apply this product.

Anti-itch products
Some people say that the itch is the worst thing about having psoriasis. The best way to get rid of the itch is to treat the psoriasis. Until you start seeing results from treatment, using an anti-itch product can help. Look for a product that contains calamine, camphor, hydrocortisone, or menthol. These ingredients tend to work best on itchy psoriasis.

If you decide to use an anti-itch product, beware that it can irritate and dry your skin. You can prevent this by finding one that feels moisturizing and soothing or by using moisturizer along with your anti-itch product.

Complementary and alternative treatments

You’ll find plenty of these for treating psoriasis. The US Food and Drug Administration (FDA) doesn’t regulate these products. As such, few of these treatments have been studied. Those that have been studied were tested on small numbers of people, so we don’t know how well these treatments work. We also don’t know whether they’re safe.

How a dermatologist can help

With so many products, it can be difficult to know what to use. If you don’t see the results you like with OTC treatment for psoriasis, you may want to see dermatologist. Dermatologists are the skin disease experts. They know how to tailor psoriasis treatment to the type of psoriasis you have. Sometimes, this requires combining treatments. You may also need one treatment plan to gain control over your psoriasis and another to maintain the results.

Images
Images from Getty Images

Menter A, Korman NJ, et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3: Guidelines of care for the management and treatment of psoriasis with topical therapies.” J Am Acad Dermatol. 2009 60(4):643–59.

Paghdal KV, Schwartz RA. “Coal tar: Back to the future.” J Am Acad Dermatol. 2009 Aug;61(2):294-302.

Supported in part by Novartis.

These two people finally found treatments that worked

Now 62, Engel has been dealing with psoriasis for the better part of five decades. She was a teenager living in suburban Philadelphia when a doctor first diagnosed her with psoriasis of the scalp and gave her shampoo to treat the itching. “When I was 16, I really didn’t understand the impact of it,” Engel says. “It wasn’t sinking in that this was going to be my little partner for life.”

Laurie Engel, graduation day, 1978

Before long, psoriasis began appearing elsewhere on Engel’s skin, ultimately covering nearly 90 percent of her body in small, round spots reminiscent of mosquito bites. From awkward explanations to early boyfriends and college roommates, to self-conscious beach vacations and social gatherings, the disease has been Engel’s lifelong companion ever since. But while psoriasis has been a constant for Engel over the last several decades, treatment for the disease has changed radically during that time.

People diagnosed with psoriasis in the mid-20th century often were fortunate to get a prompt, correct diagnosis — and once they did, treatments were strictly topical and only marginally effective. Today, the treatment toolkit has grown to include topical, oral, injectable and intravenous (IV) medications, which for many patients can yield near-total relief from psoriasis symptoms. “ provided patients a lot more options in terms of controlling their disease,” says Wynnis Tom, M.D., a dermatologist at Rady Children’s Hospital-San Diego. “It’s certainly helped to treat a lot more people, especially those with the severe types of psoriasis.”

For longtime psoriasis patients like Engel, each step forward in treatment has brought them one step closer to clearer skin and improved quality of life. While these medical advancements can’t erase years of physical discomfort and emotional strain, they have provided a sense of control over the disease that, in decades past, was largely unattainable. “I am so thankful for the research that has been done to provide such better options for treatment,” Engel says. “I feel strong and more in control of my psoriasis today than when I was in my 20s and 30s.”

Limited options, little relief

The noxious smell of fresh asphalt causes most drivers to roll up the windows. But for Engel, random encounters with road construction are more than merely unpleasant; they transport her back through the decades, to a time when soaking in a tar-infused bath for 20 minutes was the only way she could find relief from her psoriasis. “That was horrible,” she says. “It’s exactly what it sounds like. You get in a bathtub that is brown, and it smells like roadwork.”

Coal tar is still used in shampoos, lotions and soaks to reduce the itching, scaling and inflammation of psoriasis. For most people, it offers only mild relief, Tom says, and it’s typically only used in conjunction with other treatments. “It can be soothing for some, but it’s got a significant smell,” she says. “Usually by itself, it’s not that effective.”

In the early ’70s, when Engel was newly diagnosed, stinky tar baths and sticky tar shampoos made the short list of treatment options, along with topical steroids. “That’s what they had back then,” Engel says. “The bath to me was so humiliating.”

Around the same time, on the other side of the country, Pete Miller was also turning to tar to treat his psoriasis, and also with only minimal success. Miller, who was diagnosed in the early ’60s as a high school freshman, first heard from a general practitioner that his psoriasis was a case of ringworm. As a painfully shy 14-year-old, he withdrew from beloved sports like basketball because the shorts showed too much skin, and he dreaded mandatory shower time during his daily physical education classes. “You have this stuff all over you, and you’re self-conscious anyway,” says Miller, a retired elementary school principal and National Psoriasis Foundation board member in Portland, Oregon. “I can’t even tell you. I still wear the scars at 70 years old.”

As with Engel, tar-based shampoos, baths and ointments were Miller’s go-to treatments, but they offered little relief. “As I remember, the tar took the flaking away, but it didn’t do much for the redness,” Miller says. “Sometimes the redness was almost worse, but it didn’t itch as much.”

Both Miller and Engel spent much of their early adulthood slathering on creams and ointments, resenting the flakes that followed them everywhere and stressing over encounters with the opposite sex. Miller struggled with dating and intimacy, while one of Engel’s boyfriends stopped calling after she explained that the patches on her knees were psoriasis. But in the ’80s, both saw a light at the end of the tunnel: a new psoriasis treatment using ultraviolet (UV) rays.

Seeing the light

Miller was fresh out of college and working as a teacher when he first visited Palm Springs, California, and discovered the remarkable effect of intense sunlight on his psoriasis. “It’s just like a miracle what ultraviolet light does to your skin,” he says.

Miller began going to the desert oasis every chance he had during school breaks. “Everyone else would go golfing and I would stay and sunbathe. I wouldn’t want to use sunscreen because I wanted the full effect.”

In his 30s, Miller found a dermatologist who offered a way to bring Palm Springs — or at least its solar benefits — to him. The treatment, called PUVA, coupled light booth exposure to ultraviolet A (UVA) rays with psoralen, a pill that causes the skin to become more sensitive to light. When the treatment, still used today, debuted in the ’80s, it was groundbreaking. “It was the best treatment at that time for psoriasis,” Miller says. “It not only took the psoriasis away, it also gave me a nice suntan.”

Pete Miller speaking at NPF’s National Volunteer Conference, Chicago, 2017

Engel also received PUVA treatments through much of the ’80s and ’90s, with similar effect. “The PUVA treatments were probably the biggest breakthrough for me,” she says.

Instead of dabbing creams from head to toe, the light treated Engel’s entire body at once and could keep the psoriasis at bay for months at a time. However, relief came at a price: Because UVA rays damage the skin, Engel is permanently covered in freckles, and Miller has had a half-dozen basal cell carcinomas — a type of skin cancer — removed from his face and neck. Miller also had cataracts at an early age, which he suspects may be related to his heavy reliance on UV rays. Both Miller and Engel ultimately had to stop PUVA treatments when their cumulative exposure became too great.

For some people with psoriasis, phototherapy remains a viable option, especially the newer treatments that provide brief exposure to less-damaging ultraviolet B rays. “We pick very particular types of light now,” says Tom, the San Diego dermatologist. “We don’t give up on it as a treatment, but obviously we want to avoid skin cancers down the road.”

These improved phototherapies are part of a steady increase in the number of psoriasis treatment options that extended through the end of the 20th century, from systemic medications to topicals containing synthetic vitamin D. In the early aughts, the most revolutionary medications yet appeared on the market, forever altering the psoriasis landscape and the lives of people with psoriatic disease.

Biologics and beyond

It took Engel nearly a decade to give in to her dermatologist’s recommendations to try biologics, drugs that target the immune system cells and proteins responsible for the inflammation associated with psoriasis, administered with an injection or IV infusion. “I was just so fearful of suppressing my immune system,” she says. “I was afraid I was going to get sick.”

By 2008, when she could no longer do PUVA treatments, and the topical she was using stopped working, she finally decided to try a biologic. “I’ve never looked back,” she says.

Her skin cleared within eight months, and it’s stayed that way ever since, even after she had to switch to a second biologic in 2011. Engel’s success on biologics has made her more confident in her appearance, whether wearing short sleeves or baring her bikini-clad body on cruises with her husband.

“Having clear skin has been phenomenal,” she says. “I never take it for granted. I constantly am aware of it and feel very blessed.”

Laurie Engel and husband, nine years clear, 2017

While other medical concerns had her off her biologic for several months, she is awaiting clearance from her doctor to resume taking the drug.

Miller has had similar results since starting a clinical trial in July 2016 for a new biologic that was being investigated for the treatment of multiple inflammatory diseases, including psoriasis. Currently, his skin is 99 percent clear. “For the first time in my life, I feel kind of sexy,” he says. “I feel more confident. I just wish I’d had this back in my 20s and 30s and 40s.”

Despite the giant leaps made in psoriasis treatments over the past few decades, Tom says she believes there are still plenty of advances to come. Some newer biologics have fewer side effects than the early ones but aren’t as effective; others are highly effective but come with greater risks. “I think with efficacy, we’re getting there, but we still have safety to consider,” Tom says.

She also hopes to see expanded choices in topical medications, as well as less trial and error in determining which treatment a patient will best respond to. “We’re learning more and more about how to better tailor medications for the patients,” she says.

Ultimately, until a drug can completely shut down psoriasis — meaning people like Engel and Miller could live disease-free without regular treatments — there is work to be done. “There’s still quite a lot of room” for progress in treatment, Tom says. “I don’t think we’re at the point of a cure.”

Know your options

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10 Do-It-Yourself Home Remedies for Psoriasis

Whether it’s from a friend, a colleague, or a psoriasis support group member, you may frequently hear about a natural or complementary psoriasis treatment and be tempted to try it. These do-it-yourself remedies, when used alongside your traditional psoriasis treatment, may offer temporary relief from some psoriasis symptoms, which can range from itchy, flaky skin associated with mild to moderate forms of psoriasis to the irritation that occurs when you have a more severe form of the disease.

The fact is, however, that there’s little scientific evidence to suggest that psoriasis home remedies work, says Stefan C. Weiss, MD, a dermatologist at the Weiss Skin Institute in Boca Raton, Florida. Still, you may find at least temporary relief by following some of these suggestions — and, as Dr. Weiss points out, it won’t hurt to try. Just be sure to consult with your doctor first.

Potential home remedies may include modifications to your diet — such as drinking more water and consuming fresh fruits and vegetables — that are good for your general well-being, along with improving your psoriasis and relieving some of its symptoms.

Many people believe that activities such as yoga can relieve psoriasis flares and pain by reducing stress, which is known to trigger symptoms. “It’s impossible to avoid all stress in our lives,” says Colby Evans, MD, a dermatologist in Austin, Texas, and a member of the board of trustees of the National Psoriasis Foundation (NPF)

But stress-management techniques — whether it’s prioritizing daily tasks, getting enough sleep, or connecting with support groups — can relieve a lot of those psoriasis-triggering feelings. People also believe that Dead Sea salt baths can alleviate the itching and burning associated with psoriasis.

Then there are spices and supplements that may provide anti-psoriasis benefits. Despite the lack of scientific evidence, psoriasis patients have reported some success with healthy oils like those found in avocado, coconut, fish, and flaxseed. Tea tree oil can relieve symptoms of scalp psoriasis when used in specially formulated shampoos. Besides its dietary benefits, olive oil can be applied to the scalp and hair, and it can help loosen skin flakes associated with psoriasis. Apple cider vinegar may also help relieve the itch associated with scalp psoriasis.

Whatever the home remedy, it’s important that you discuss treatment options with your healthcare providers. Do-it-yourself therapies should not be used as a replacement for your prescribed medications and treatments, but they may be helpful additions to your overall psoriasis management regimen. Check out these ideas for treatments that you can talk to your doctor about.

Psoriasis

These medications can be very effective in treating psoriasis, but they all have potentially serious side effects. All the systemic treatments for psoriasis have benefits and risks. Before starting treatment, talk to your doctor about your treatment options and any risks associated with them.

There are 2 main types of systemic treatment, called non-biological (usually given as tablets or capsules) and biological (usually given as injections). These are described in more detail below.

Non-biological medications

Methotrexate

Methotrexate can help to control psoriasis by slowing down the production of skin cells and suppressing inflammation. It’s usually taken once a week.

Methotrexate can cause nausea and may affect the production of blood cells. Long-term use can cause liver damage. People who have liver disease shouldn’t take methotrexate, and you shouldn’t drink alcohol when taking it.

Methotrexate can be very harmful to a developing baby, so it’s important that women use contraception and don’t become pregnant while they take this drug and for 3 months after they stop. Methotrexate can also affect the development of sperm cells, so men shouldn’t father a child during treatment and for 3 weeks afterwards.

Ciclosporin

Ciclosporin is a medicine that suppresses your immune system (immunosuppressant). It was originally used to prevent transplant rejection, but has proved effective in treating all types of psoriasis. It’s usually taken daily.

Ciclosporin increases your chances of kidney disease and high blood pressure, which will need to be monitored.

Acitretin

Acitretin is an oral retinoid that reduces the production of skin cells. It’s used to treat severe psoriasis that hasn’t responded to other non-biological systemic treatments. It’s usually taken daily.

Acitretin has a wide range of side effects, including dryness and cracking of the lips, dryness of the nasal passages and, in rarer cases, hepatitis.

Acitretin can be very harmful to a developing baby, so it’s important that women use contraception and don’t become pregnant while they take this drug, and for 2 years after they stop taking it. However, it’s safe for a man taking acitretin to father a baby.

Biological treatments

Biological treatments reduce inflammation by targeting overactive cells in the immune system. These treatments are usually used if you have severe psoriasis that hasn’t responded to other treatments, or if you can’t use other treatments.

Etanercept

Etanercept is injected twice a week and you’ll be shown how to do this. If there’s no improvement in your psoriasis after 12 weeks, the treatment will be stopped.

The main side effect of etanercept is a rash where the injection is given. However, as etanercept affects the whole immune system, there’s a risk of serious side effects, including severe infection. If you had tuberculosis in the past, there’s a risk it may return. You’ll be monitored for side effects during your treatment.

Adalimumab

Adalimumab is injected once every 2 weeks and you’ll be shown how to do this. If there’s no improvement in your psoriasis after 16 weeks, the treatment will be stopped.

Adalimumab can be harmful to a developing baby, so it’s important that women use contraception and don’t become pregnant while they take this drug, and for 5 months after the treatment finishes.

The main side effects of adalimumab include headaches, a rash at the injection site and nausea. However, as adalimumab affects the whole immune system, there’s a risk of serious side effects, including severe infections. You’ll be monitored for side effects during your treatment.

Infliximab

Infliximab is given as a drip (infusion) into your vein at the hospital. You’ll have 3 infusions in the first 6 weeks, then 1 infusion every 8 weeks. If there’s no improvement in your psoriasis after 10 weeks, the treatment will be stopped.

The main side effect of infliximab is a headache. However, as infliximab affects the whole immune system, there’s a risk of serious side effects, including severe infections. You’ll be monitored for side effects during your treatment.

Ustekinumab

Ustekinumab is injected at the beginning of treatment, then again 4 weeks later. After this, injections are every 12 weeks. If there’s no improvement in your psoriasis after 16 weeks, the treatment will be stopped.

The main side effects of ustekinumab are a throat infection and a rash at the injection site. However, as ustekinumab affects the whole immune system, there’s a risk of serious side effects, including severe infections. You’ll be monitored for side effects during your treatment.

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