How to deal with psoriasis

If you have psoriasis, you know how hard it can be to deal with it. Often it can be an everyday battle with pain, irritation and aches, not to mention dealing with the stigma associated with such a visual skin condition - it can have a massive impact on your self-esteem.

But you’re not alone - according to the Australian Journal of Pharmacy, it’s estimated that psoriasis affects about 2.6 per cent of Australians. But, while it may be a fairly common skin condition, it can often be confusing to know how to treat it and what treatment options are available.

We’ve got your back. We asked two top dermatologists for their expert advice on everything we need to know about psoriasis, including the best way to control this inflammatory and often-irritating skin disease.

What is psoriasis?

Affecting both men and women of all ages, psoriasis is basically an autoimmune disorder that is inherited (if some of your family members have psoriasis, you are at higher risk of having it). “Psoriasis is a chronic inflammatory skin condition characterised by well-defined, red, scaly and often thickened patches of skin,” says dermatologist Dr Cara McDonald.

There are different types of psoriasis and it can present itself in several different ways. The most common type of psoriasis is plaque psoriasis, which often shows up in scaly patches on the scalp, knees, elbows and lower back. Another type is pustular psoriasis, which appears as raised bumps (pustules) filled with a white, thick fluid composed of white blood cells. "There are several distinct sub-types which may overlap," adds Dr McDonald. "These include classic plaque psoriasis, guttate psoriasis (widespread very small patches), palmarplantar psoriasis (affecting palms and soles), flexural psoriasis (affecting groin creases, underarms and under breasts), and sebopsoriasis (affecting mainly the scalp).”

There is also a type of psoriasis that can damage your joints - it's called psoriatic arthritis and is often mistaken for rheumatoid arthritis. “About six per cent of [psoriasis sufferers] have psoriatic arthritis, which can be quite destructive to joints - particularly the hands and feet if not treated,” adds New York dermatologist Dr Janet Prystowsky. 

If you think you may be suffering from symptoms of psoriasis, book yourself in to see a dermatologist – they will be able to examine your skin, scalp and nails, and your medical history for a correct diagnosis of psoriasis. 

What causes psoriasis?

So, what's the go? Are there certain things that trigger psoriasis? Well, the exact cause of psoriasis is mainly affected by the immune system and genetics (again, it all comes down to your family history). “The cause of psoriasis is multifactorial but there are often strong genetic factors,” says McDonald. “It is immune-mediated, meaning that the affected person’s own immune system is driving the disease. There are a number of known factors that can trigger the onset of psoriasis or make it worse. These include bacterial infections (most commonly strep throat infection), stress, sunburn, smoking and some medications.” 

Psoriasis symptoms

Different people experience different psoriasis symptoms, but you'll usually notice dry, red patches or silvery scales on your skin (side note: it’s not contagious!). “Psoriasis usually presents with well-defined scaly red areas of skin that tend to affect both sides of the body equally,” says Dr McDonald. “The scale is typically silvery white, except in skin creases where it will appear red and shiny but may peel. The most common sites [for] classic psoriasis are scalp, elbows and knees, but it can involve any area of the body.” While itching can sometimes be a problem, psoriasis is typically less itchy than eczema or dermatitis.

High blood pressure and cardiovascular disease are also common side effects that have been linked to skin infections like psoriasis. “People with psoriasis have an increased risk of heart attacks from atherosclerosis so it’s good to discuss this with your internist. The inflammation in atherosclerotic plaques is similar to what is seen in a psoriatic skin plaque. In this sense and also with arthritis, it is becoming apparent that it should be viewed as a systemic disease - not just a skin problem,” says Dr Prystowsky.

Treatment of psoriasis

“I frequently see people who have been told in the past ‘nothing can be done’ and they have therefore continued to suffer the physical and emotional burden of psoriasis unnecessarily. It’s been shown that psoriasis has a severe effect on quality of life and mental health, so treatment can be truly life-changing,” adds Dr McDonald.

Firstly, it’s important to consult a dermatologist as they will be able to assess what type of psoriasis you have, the severity and the best form of treatment. 

“When considering management, it helps to understand the underlying problems at the skin level. In psoriasis, there is inflammation within the skin (resulting in redness and itch) and excessive skin turnover (causing thickened, scaly skin). The two problems drive each other on in a vicious cycle, so if both are addressed it will improve faster. There is also a secondary problem of a disrupted protective skin barrier, so protection of the skin is also very important,” says McDonald.

While there is no cure for psoriasis, treatments have come a long way and there are now a range of solutions that can assist in managing this skin condition - no matter what form of psoriasis you may have. Here are six things that may help you manage your psoriasis and get your skin back on track: 

#1 / Prescription creams
Topical treatments are a common form of psoriasis treatment for mild-to-moderate symptoms. They aim to slow down the growth of skin cells, reduce inflammation and soothe any discomfort. “Inflammation and excessive cell turnover are typically addressed with prescription creams such as coal tar-based cream, salicylic acid, corticosteroids and calcipotriol (a vitamin D-based cream),” says Dr McDonald. "Emollients like petroleum (Vaseline) are very helpful, but usually topical steroids are prescribed. Other drugs include vitamin D analogs and retinoids," says Dr Prystowsky.

#2 / Prescription medication
Oral medication may also be prescribed for people who have moderate-to-severe psoriasis and psoriatic arthritis. This medication usually works to reduce the progression of psoriasis and the regularity of flare-ups. “The availability of medications known as biologics, which are very specific and targeted, has dramatically improved our ability to completely clear psoriasis, even in the more severe cases,” says Dr McDonald. Dr Prystowsky says immune suppressing medication may also be needed for persistent and severe psoriasis. “For severe cases, systemic immunotherapy is used."

#3 / UV light therapy
“Psoriasis responds well to sunlight as a therapy but the hazard in recommending it is that sunlight also increases photoaging and skin cancer risk,” says Dr Prystowsky. “So, it is best to consult with your dermatologist for the best strategies to manage your psoriasis.” 

“The use of low-dose ultraviolet light at specific wavelengths is very helpful for some people, but this should be managed by a specialist to avoid any risk of burning,” adds Dr McDonald.

#4 / Sunscreen
Don’t forget daily sun protection – just because psoriasis can respond well to sunlight, doesn’t mean you should go SPF-free on the daily. “Protection of the skin is also very important. A low-irritant, fragrance-free sunscreen and a good moisturiser should be used daily,” says Dr McDonald. La Roche-Posay Anthelios Ultra Cream SPF 50+ is a great option for sensitive skin types (our Review Crew® gave it 4.5 stars).

 #5 / Skin care containing ceramides
“Moisturiser containing ceramides can be particularly helpful in skin conditions where the skin barrier is disrupted, such as psoriasis. Skin care that contains ceramides will help restore the lipid balance in the skin and allow it to heal faster,” says McDonald. We recommend slathering on an over-the-counter cream like CeraVe Moisturizing Cream – it’s fortified with ceramides to help restore and protect your skin’s barrier while locking in moisture.

#6 / Maintain a healthy lifestyle
“Last but not least, general health measures should be considered. Stopping smoking, weight loss and avoiding sunburn or skin irritation are all helpful. Easier said than done, but stress minimisation is also important,” says Dr McDonald.

Wondering what those annoying bumps are on the back of your arms? It’s actually another common skin condition, called keratosis pilaris – and we know how to treat it!

Do you have psoriasis? What treatment works for you? Share with us in the comment section below.

Main image credit: @kimkardashian