- What triggers a psoriasis flare-up?
- Are there any other problems related to psoriasis?
- What is the outlook (prognosis) for psoriasis?
- How to prevent psoriasis from spreading
- Plaque Psoriasis: Symptoms, Treatments, and Complications
- Where Psoriasis Shows Up
- Psoriasis Getting Worse? Here’s What You Can Do About It
- What causes psoriasis to flare up and worsen?
- What are some tips to help get the condition under control?
- The takeaway
What triggers a psoriasis flare-up?
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 (a common treatment for bipolar disorder), drugs for malaria, and some beta-blockers (used to treat high blood pressure, heart disease, and some heart arrhythmias), can cause flare-ups of psoriasis symptoms.
- Infections. Certain infections, such as strep throat or tonsillitis, can result in guttate (small, salmon-pink droplets) 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 known as the Koebner phenomenon.
- Alcohol. Using alcohol may increase the chances of psoriasis flare-ups, at least in men.
- Smoking. Some experts think that smoking can worsen psoriasis symptoms.
Left untreated, psoriasis can lead to serious medical complications. What Is Psoriasis?
Psoriasis is a skin disease that causes scaling and inflammation (pain, swelling, heat, and redness). Skin cells grow deep in the skin and slowly rise to the surface. This process normally takes 23 to 30 days. For individuals with psoriasis, the process happens in just a few days. Fast-rising cells then pile up on the skin’s surface. This causes patches of thick red skin with silvery scales to form. Patches may be itchy or painful. Patches generally occur around the elbows, knees, legs, scalp, lower back, face, palms, and the soles of the feet.1,2
Psoriasis was originally viewed as strictly a skin condition, but we now know that it is an immune system disorder. Our immune system contains white blood cells called T cells. T cells help protect against infection and disease. With psoriasis, T cells are activated by accident. This results in rapid skin cell growth.1
Several types of psoriasis exist, but 80% of cases are plaque psoriasis. The symptoms are raised and thickened patches of red skin covered by silvery white scales.
Another form of psoriasis is guttate psoriasis, which accounts for 10% of cases. Symptoms include small red dots, generally on the trunk, arms, and legs. These dots do not become scaly.3
See Table 1 for more facts about psoriasis.4-9
The National Psoriasis Foundation defines psoriasis severity by the percentage of skin affected. Mild psoriasis affects less than 3% of the skin. Moderate psoriasis affects 3% to 10% of the skin. Severe psoriasis involves more than 10% of the skin. For easy reference, a person’s hand represents approximately 1% of the skin surface. Up to 90% of all psoriasis cases are considered mild.9
The physical and emotional effects of psoriasis are significant—similar to the effects of cancer, heart disease, diabetes, or depression.10 Psoriasis has a negative psychological impact, especially if it involves the hands, feet, genitals, or face. While psoriasis affects men and women equally, women experience a greater negative impact on quality of life.6,9
How Do I Know if I Have Psoriasis?
The symptoms of psoriasis are similar to those of other skin conditions. Symptoms of an allergy, for example, may include small red dots and itching. A dermatologist is the best doctor to diagnose and treat psoriasis.
There is no cure for psoriasis. Treatment focuses on managing symptoms. The goal of treatment is to minimize or eliminate symptoms. While symptoms may go away, they often reappear at a later time. The type of treatment depends on the severity of psoriasis, the type of psoriasis, other medical conditions that the patient has, and how the patient reacted to previous psoriasis medications.10 Table 210-12 lists common psoriasis treatments. For mild cases, 1 medication is often sufficient for treatment. A combination of medications is frequently needed for patients with moderate to severe psoriasis.
Coping with Psoriasis
Approximately 60% of people report psoriasis as a problem in everyday life. Many worry about symptoms getting worse or reappearing. Online Table 32,7,9,13-15 lists recommendations for living with psoriasis.
Table 3: Living with Psoriasis
Do not delay treatment because your symptoms are mild. Current symptoms do not predict future symptoms.
Learn as much as possible about psoriasis. This improves your understanding of the disease, triggers, and treatment options. The National Psoriasis Foundation (www.psoriasis.org) has easy-to-understand information. It also offers online support groups, which can help you learn how others have coped with psoriasis.
Psoriasis outbreaks are often triggered by external factors. Keeping a diary can help identify triggers.
Make an appointment with your dermatologist if you develop stiff or sore joints.
Inform your physician if you are pregnant or intend to get pregnant. Up to 25% of pregnant women experience worsening of symptoms. Your doctor may discontinue your medication during your pregnancy.
Take medication as directed to ensure maximum benefit. Never stop taking your medication without your dermatologist’s approval.
If you receive light therapy, your symptoms may worsen before improving. Do not experiment with light therapy (eg, do not go to tanning salons for self-treatment).
As psoriasis begins to heal, skin tends to flake and peel and may feel itchy. When itching is a problem, skin moisturizers may help.
Losing excess body weight may help. Overweight increases the severity of psoriasis and reduces the effectiveness of treatment.
Avoid tobacco products. Smoking plays a role in the onset of psoriasis and future flare-ups. Approximately 77% of nonsmokers experience 1 or more periods without symptoms compared with only 8.7% of smokers.
Limit alcohol. It increases flare-ups and may decrease the effectiveness of treatment.
Follow a healthy lifestyle. Hypertension, a high cholesterol level, and a lack of exercise increase the risk for psoriasis.
Adapted from references 2, 7, 9, 13-15.
Psoriasis is more than a cosmetic issue. Left untreated, it can lead to serious medical complications.
Dr. Zanni is a psychologist and health-system consultant based in Alexandria, Virginia.
People with psoriasis are more likely to have or develop some other problems. However, just because you have psoriasis does not mean that you will definitely develop these. The problems include the following:
- Joint problems. At least 1 or 2 out of every 10 people with psoriasis also develop inflammation and pains in some joints (arthritis). This is called psoriatic arthritis. Any joint can be affected, but it most commonly affects the joints of the fingers and toes. The cause of this is not clear. It can happen even in people who only have nail psoriasis. See the separate leaflet called Psoriatic Arthritis for more details. You should see a doctor if you have any form of psoriasis and you develop pain or swelling of any joint or pain in your heel (Achilles tendinopathy).
- Risk factors for cardiovascular disease. People with psoriasis are more likely to have some of the risk factors for developing cardiovascular disease (heart disease and stroke) such as high levels of cholesterol and other fats in the blood (hyperlipidaemia), high blood pressure (hypertension) and diabetes. You are more likely to have these risk factors if you have severe psoriasis rather than mild psoriasis. If you have psoriasis you may wish to see your GP or practice nurse to discuss risk factors for cardiovascular disease, and ways of tackling them. See the separate leaflet called Cardiovascular Disease (Atheroma) for more details.
- Obesity. Psoriasis is more common in obese people.
- Psychological problems. Some people with psoriasis may feel embarrassed about their skin problem and develop a negative body image. They may avoid certain activities such as swimming because of fear of uncovering their skin and of other people seeing it. Personal relationships may be affected. Some people with psoriasis develop anxiety and depression.
What is the outlook (prognosis) for psoriasis?
Psoriasis affects different people in different ways. In general, plaque psoriasis is a persistent (chronic) condition with flare-ups that come and go. However, some studies have shown that, over time, plaque psoriasis may go away completely at some point in around 1 in 3 people. Some people have a number of years where they are free from psoriasis and then it may flare up again.
The less common guttate psoriasis usually goes away completely after a few months. But, if you have an episode of guttate psoriasis, you have a higher than usual chance of developing chronic plaque psoriasis at a later time.
How to prevent psoriasis from spreading
Treating psoriasis is the best strategy for preventing it from spreading. Treatment often involves a process of trial and error. What works for one person might not work for another, and a person’s treatment needs may change over time.
Some treatment options include:
Share on PinterestMoisturizing the skin will aid the healing process, and may reduce symptoms such as itching.
It is essential to moisturize the skin because it can speed the healing process and prevent itching. A range of moisturizing lotions that are suitable for psoriasis are available without a prescription.
Tar shampoo and soap may also help. Ingredients that encourage old skin cells to fall off, such as salicylic acid, can reduce the appearance of flaky plaques. However, some of these products can be harsh on the skin, so getting advice from a professional can help determine the most suitable lotion.
Steroid creams, such as hydrocortisone, are also safe and effective for most people. They help with itching and can speed healing. Using steroid creams for a very long time may cause side effects, however, so talk to a doctor about the safe use of steroids.
A wide range of prescription medications can help with psoriasis. Topical steroid creams that are stronger than those available over-the-counter may help. Some other options include:
- antibiotics when psoriasis plaques become infected
- systemic drugs, such as methotrexate and cyclosporine
- biologic medications, which are immune system drugs given through an injection or intravenously (IV)
- new treatments, such as apremilast, that target specific parts of immune cells
Phototherapy is a light therapy that involves exposing skin to UVB light. In the first instance, a person will need to go to a clinic or doctor’s surgery for the treatment, but many people choose to continue the therapy at home. It is essential to use the correct equipment, which will require a prescription and to get regular medical checkups.
Some people find their psoriasis improves after spending time in the sun and many doctors recommend that people expose their skin to the sun. Do this for a short time at first and increase exposure time slowly. Never use sunbeds or tanning lamps, as these can increase the risk of developing melanoma by 59 percent.
Identifying and avoiding psoriasis triggers can prevent the immune system from overreacting and causing a psoriasis flare-up. When psoriasis appears, minimizing exposure to triggers can stop it from spreading.
Complementary and alternative remedies
Some people use complementary and alternative remedies, such as acupuncture, to prevent psoriasis from spreading. Other strategies, such as meditation and therapy, may help some people cope with the emotional effects and social stigma of having psoriasis.
You may think of psoriasis as being pretty straightforward—you’d know it when you saw it, right? But psoriasis doesn’t always present the same way or show up in the same places.
About 7.5 million people in the U.S. have psoriasis, according to the American Academy of Dermatology. People who suffer from psoriasis can have flare-ups that cause the characteristic red, itchy, scaly skin patches to show up on their skin. And it can show up wherever you have skin. “Psoriasis can appear anywhere—on the eyelids, ears, mouth and lips, skin folds, hands and feet, and nails,” Michael Siegel, Ph.D., vice president of research programs at the National Psoriasis Foundation, tells SELF. “The skin at each of these sites is different and requires different treatments.”
“The impact of psoriasis ranges from annoying to life-altering depending on the location and the extent of the disease,” Cynthia Bailey, M.D., a diplomate of the American Board of Dermatology and president and CEO of Advanced Skin Care and Dermatology, tells SELF. And, as you can imagine, it can have an impact on your self esteem. “I have young women who have just a few patches on their legs and won’t wear shorts or skirts because they’re embarrassed by it,” New York City dermatologist Doris Day, M.D., tells SELF. “They say people think they’re contagious.”
For the record, psoriasis isn’t contagious—it’s caused by a combination of genetics and environmental triggers like stress, sunburn, allergies, diet, certain medications (including lithium and the heart medication quinidine), and even the weather, per the National Psoriasis Foundation.
There are different types of psoriasis and, while Siegel says you can have any type of psoriasis in any part of your body, some are more likely to show up in certain places than others. Here are the most common places psoriasis appears on the body, and what you should look out for at each site:
1. Your elbows and knees
Psoriasis most commonly shows up on the elbows and knees, and it’s often plaque psoriasis, a form of the disease that appears as raised, red patches covered with a silvery white buildup of dead skin cells, Siegel says. “They are often itchy and painful, and they can crack and bleed,” he says.
2. Your scalp
Plaque psoriasis also commonly shows up here, Seigel says, and it can range from mild, slight scaling to thick, crusted plaques that cover a person’s entire scalp, per the NPF. It can also extend past a person’s hairline onto their forehead, back of the neck, and around their ears.
3. Your face
It’s not common for someone to suffer facial psoriasis, Dr. Bailey says, but it can happen. This form of psoriasis usually affects a person’s eyebrows, the skin between their nose and upper lip, upper forehead, and their hairline, according to the NPF, which notes that this type of psoriasis should be treated carefully because the skin in this area is sensitive.
4. Your hands and feet
The palms of your hands and soles of your feet can get a type of psoriasis known as palmar-plantar psoriasis. “Here, the skin is scaly, fissured, and sometimes blistered or red,” Dr. Bailey says. And it’s painful.
5. Your nails
Psoriasis can also impact your nails, where it causes a yellowish discoloration and can even lift the nail plate off of the nail bed, Dr. Day says. “It looks like a fungal infection to people who aren’t dermatologists, but it’s a little different,” she says. Nail changes occur in up to 50 percent of people with psoriasis, the NPF says.
6. Your genitals
Psoriasis can show up in the folds of your skin and unfortunately, even your genitals aren’t spared. “I have men who get it on their penis and women who get it on their vagina,” Dr. Day says. People may mistake it for an STD at first, she says, but it’s not. Genital psoriasis looks like psoriasis that shows up on other parts of your body, but psoriasis that can appear in skin folds (like the groin) often appears smooth and shiny, with a waxy appearance, and doesn’t usually have scales like plaque psoriasis, she says.
7. In skin folds, like your butt, your armpits, or under your breasts
This type of psoriasis is known as inverse psoriasis and it often shows up as very red lesions that can appear behind the knee, in the armpits, or even in someone’s butt, Dr. Siegel says. It can also appear under your breasts, per the NPF, and it’s often irritated by rubbing and sweating.
If you suspect that you have psoriasis, call your dermatologist.
While psoriasis is a life-long condition, there are various treatment options available, including creams and lotions for more mild cases and, for more severe cases, biologic immune-modifying medications that alter the immune system reactions that lead to psoriasis and can reduce the effects of substances in the body that can cause inflammation, Dr. Bailey says.
“Regardless of where psoriasis appears or to what degree it appears, it needs to be treated properly,” Siegel says. “Treating all degrees of psoriasis can improve a patient’s quality of life significantly.”
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Plaque Psoriasis: Symptoms, Treatments, and Complications
The treatment of plaque psoriasis is different for everyone. Most dermatologists will start with the simplest and least invasive treatment.
Initial treatments include:
- topical corticosteroids
- vitamin D preparations
- salicylic acid ointments
Topical skin treatments require diligent application and the careful avoidance of skin irritants.
If these are ineffective, several other treatments may be recommended, including:
- oral systemic medications
- intravenous medication
- skin injections
- natural therapy
- light therapy
Oral systemic medications
Your doctor may recommend treating your psoriasis systemically with a prescription drug or medication. A class of oral medications called disease-modifying antirheumatic drugs (DMARDs) can slow down or stop certain conditions that are caused by an overactive immune system.
- apremilast (Otezla)
- acitretin (Soriatane)
Injectable or intravenous medication for plaque psoriasis
Currently, there are several drugs on the market that are classified as biologics. Biologics target specific parts of the immune system. They block the action of a specific type of immune cell called a T cell, or block proteins in the immune system, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A, or interleukins 12 and 23.
Below are some examples:
- Humira (adalimumab): an injectable drug used to reduce inflammation caused by arthritis
- Stelara (ustekinumab): an injectable drug used for plaque psoriasis and psoriatic arthritis
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- Remicade (infliximab)
- Simponi (golimumab)
Natural skin treatments for plaque psoriasis
Because it’s a chronic condition, many people with plaque psoriasis will try alternative and natural treatment methods. One method that has gained significant attention in the psoriasis community is the mud and salt of the Dead Sea.
Thousands of people a year invest in expensive Dead Sea skin treatments or vacations to attempt to heal their psoriasis. Although the scientific evidence is limited regarding the effectiveness of these treatments, many believe it can help treat plaque psoriasis.
Light treatment for plaque psoriasis
Light therapy is a common treatment for plaque psoriasis. Because light therapy is nonpharmaceutical, it’s a popular choice prior to systemic medications.
Some people are able to achieve healing through regular limited sessions of sun exposure, while others fare better using a special light machine.
Check with your dermatologist before treating your psoriasis through exposure to sunlight. Too much sun exposure can burn your skin and make plaque psoriasis worse.
Where Psoriasis Shows Up
(PHOTOTAKEUSA.COM)Psoriasis is an autoimmune disease that affects the skin and can show up anywhere on the body. Some people live with mild cases of the condition, with less than 10% of their body affected, while others can have moderate or severe psoriasis covering from 20% to 80% of their bodies and cropping up in particularly difficult places.
The most common places to find the thick, red patches of plaque psoriasis (the most common type), are on the elbows, knees, and scalp. But it can crop up on the trunk, face, palms, or genitals, or in the folds of breasts or armpits.
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“Its really debilitating when it appears on the soles of the feet and the palms of the hands,” says Bruce Bebo, PhD, the director of research and medical programs for the National Psoriasis Foundation. “If it affects the groin and the genital area—thats very uncomfortable.”
Tailoring your treatment
Bebo says the approach to treatment differs based on “variables that include the type and severity of the psoriasis, the amount of body surface covered, and the location of the plaques on the body (psoriasis on the face is treated differently than on the arms and legs, for instance).”
Patients with only a few plaques and a small amount of skin to treat often will do well with topical medications such as a “a mild- to moderate-strength topical steroid,” says Bebo. But in sensitive locations such as the face and genitals, “alternatives to steroids are used. These include topical retinoids, vitamin D derivatives, and immunosuppressive agents.”
Chase Morris, a 7-year-old from Poca, W. Va., has several types of psoriasis dotting his trunk, scalp, eyebrows, and even infiltrating some of his skin folds. After finding a good physician and establishing a treatment plan, most of his psoriasis is currently in remission. “It sounds like a lot, but if you were to see him you may not notice unless you look closely at his scalp and eyebrows,” says his mother, Jennifer Morris.
“I dont know what Chases quality of life would be like today had we not found Dr. Cordoro,” says Morris, speaking of Chases doctor, who specializes in pediatric dermatology. “She taught me to do research and bring that new knowledge with me to appointments.” (For help finding the treatment you deserve, visit 4 Ways to Get the Best Care for Your Psoriasis.)
Improving your quality of life
“Psoriasis can be very psychologically, emotionally, and physically debilitating,” says Chases former physician, Kelly M. Cordoro, MD, now an assistant professor of dermatology at the University of California, San Francisco.
“I have a 43-year-old woman who has psoriasis covering most of her body. She is embarrassed to go to her childrens school events and to PTA meetings because shes flaking on her arms, hands, scalp, and ears.”
With proper treatment, however, your quality of life can be improved greatly. Often, someone living with psoriasis has to consult several doctors and research different treatment options before finding the right kind of therapy for their specific condition. But with the right treatment and good support you can live a more comfortable life with psoriasis.
Psoriasis Getting Worse? Here’s What You Can Do About It
If you live with psoriasis, you know that learning how to manage flare-ups is a key part of reducing this chronic condition’s impact on your day-to-day life. It’s also important to understand any factors that might be causing your psoriasis to worsen.
Since psoriasis is an autoimmune condition, identifying what’s going on underneath your skin is the first step. Unlike some other common skin conditions, using general over-the-counter products won’t target the underlying issue.
By learning more about the deeper causes behind your flares, you may be able to identify triggers and other issues. In turn, you may have better control over your symptoms.
What causes psoriasis to flare up and worsen?
Sometimes, psoriasis flare-ups can be completely random. But they can also occur in response to specific triggers.
The severity of a flare-up varies from person to person. That’s why it’s helpful to find out if you’re doing anything that may cause your psoriasis to worsen. Here are nine triggers that have been linked to flares:
Stress. An increase in stress levels or living with ongoing, chronic stress can cause your psoriasis to flare up. Psoriasis itself can also be a source of stress.
Cold and dry weather. When the temperature drops and the air gets dry, you may see your symptoms of psoriasis worsen.
Trauma to the skin. According to Melanie A. Warycha, MD, FAAD, a board-certified dermatologist at CareMount Medical in New York, trauma to the skin can cause your psoriasis to act up. This includes cuts, scrapes, bug bites, or a severe sunburn.
Certain medications. If you take any medications, consider asking your doctor if they might be worsening your psoriasis. Warycha says some medications, including beta-blockers, lithium, and anti-malarial drugs, can make your psoriasis flare up.
Weight. Gaining weight or living with obesity can cause worsening psoriasis symptoms, according to a 2013 study in JAMA Dermatology.
Smoking.In addition to triggering flare-ups, smoking is also known to increase the risk of developing psoriasis.
Infections.Warycha says certain infections and health conditions can also result in psoriasis flares, notably Streptococcal infection and HIV.
Alcohol. Alcohol consumption can also been linked to worsening of psoriasis symptoms.
Diet.There’s been increased research looking at the role diet plays in the symptoms of psoriasis. A 2018 study in JAMA Dermatology found that a reduction in calories in overweight people may help decrease the symptoms of psoriasis.
What are some tips to help get the condition under control?
You can take steps to feel more in control of your condition. Some of these steps you can take at home, while others need to be supervised by your doctor.
If you’re regularly experiencing flares, discuss your symptoms with your doctor. They can assess your condition and determine if your treatment plan is working effectively.
When it comes to making changes at home, these tips and lifestyle modifications are all options that you can try on your own:
Understanding your condition through self-education is solid step toward figuring out what works for you.
“Everyone living with psoriasis should educate themselves about the causes, triggers, disease course, and treatments,” Warycha told Healthline. To start, check out the resources offered by the National Psoriasis Foundation and The American Academy of Dermatology.
Keep skin well-hydrated
Keeping your skin well-hydrated makes a real difference. Warycha recommends daily application of a thick cream or emollient, such as petroleum jelly. This helps to keep the skin barrier intact, making trauma to the skin less likely.
“This is important as psoriasis exhibits the Koebner phenomenon — the formation of plaque psoriasis on parts of the body you typically don’t experience lesions — meaning skin injury, including cuts, scrapes, insect bites, and even tattoos, may trigger the development of a new plaque of psoriasis at that site,” she explained.
Use a humidifier
“Using a humidifier will help maintain moisture in the skin, especially in the cold and dry winter months,” Warycha told Healthline. Consider keeping a humidifier in your bedroom to use overnight. For an extra boost of moisture, keep a humidifier in any living space you use during the day.
Get a little sun
Exposing your skin to the UV rays from the sun can slow cell turnover. This helps to reduce scaling and inflammation, which in turn reduces the symptoms of psoriasis, reports the Mayo Clinic.
The key to this tip is to get “a little” sun. In other words, keep your exposure brief and monitor your time. Too much sun can cause sunburn and worsen psoriasis.
Maintain a healthy weight
When it comes to managing your psoriasis, Warycha says maintaining a healthy weight can help lower the levels of inflammation in the body. In addition to diet, engaging in physical activity can also help you manage your weight. If you’re finding it challenging to lose weight or maintain a healthy weight, talk to your doctor.
Avoid or limit alcohol
Drinking alcohol may impact the effectiveness of your medication, according to the Mayo Clinic. If your doctor is supervising your medical treatments, make sure to ask if or how much alcohol you can safely drink without interfering with your treatments.
Reduce your stress levels
Including daily activities that reduce stress levels may make it easier for you to manage existing flare-ups. Yoga, meditation, tai chi, breathing exercises, and physical activity can all reduce stress.
While there is no cure for psoriasis, being proactive, avoiding triggers, and working with your doctor can go a long way toward helping you manage the symptoms. If you have questions about your treatment plan or any of the lifestyle modifications that may improve your symptoms, talk to your doctor about the best approach for you.