August is Psoriasis Action Month

What do Kim Kardashian, Kris Jenner, singers Cyndi Lauper and LeAnn Rimes, golfer Phil Mickelson, and comedian Jon Lovitz have in common? Psoriasis is the answer. They join 8 million Americans and 125 million people worldwide living with psoriasis.

Despite celebrities sharing their stories, psoriasis is frequently misunderstood by the public. Let’s look at psoriasis, dispel some myths, review treatment options, and talk about ways to save on life-changing medications for psoriasis at a pharmacy near you.

The what, why, and how of psoriasis

Psoriasis is a skin disease that occurs when patches of skin cells mature at warp speed and then fail to slough off like normal skin cells. Normal skin cells have a three-to-four-week process of maturing, working their way to the outer surface of your skin, dying, and shedding.

In psoriasis, the skin cells rise to the outermost layer of your skin in three or four days. Once at the surface of your skin, they remain and build up rather than dying and sloughing off.

Scientists believe a malfunction in your immune system — your bacteria and virus-fighting system — causes psoriasis.

You may inherit psoriasis from your parents. If you have one parent with psoriasis, you have a 10% chance of developing the disease. If both of your parents have psoriasis, your chance climbs to 50%.

Whether or not you carry a gene for psoriasis, scientists believe something triggers a malfunction in your immune system to overreact. Triggers include:

• Skin injury — burn, cut, scrape, or insect bite
• Stress
• Excessive alcohol
• Throat infections
• Immune disorders — lupus, irritable bowel disease, multiple sclerosis
• Hormonal changes — puberty and menopause
• Medications — including beta blockers for high blood pressure, lithium for bipolar disorder, antimalarial drugs, and tumor necrosis factor inhibitors which are used to treat psoriasis but, in some people, make psoriasis worse.

Who gets psoriasis?

Men and women are affected equally by psoriasis. Although psoriasis is diagnosed in people of any age, including children, it often makes its first appearance in 20- to 30-year-olds and 50- to 60-year-olds.

More White than Black people are diagnosed with psoriasis. The key word here is diagnosed. Actual rates of psoriasis may be similar, but the typical clinical signs may not be as apparent in darker skin.

Nearly a third of people develop psoriatic disease, or a combination of psoriasis and arthritis. Psoriatic arthritis’s first appearance is typically in those 30 to 50 years of age, but people of any age may develop it.

Common misconceptions about psoriasis

Even though psoriasis is common, it is often misunderstood. Psoriasis is not:

• Contagious
• Transmitted by touching
• Due to poor hygiene
• Dry skin that can be treated with moisturizers

Types and locations of psoriasis

Psoriasis can be sorted by type and location. You can have more than one type of psoriasis at a time and more than one area affected at a time. Throughout your life, you may experience different types of psoriasis. Here are the types of psoriasis:

Plaque psoriasis is the most common type. Eighty percent of people with psoriasis have this variety which appears as raised, red, scaly patches of skin.

Guttate psoriasis often appears in younger people after strep throat. Guttate psoriasis appears in small round lesions called papules. It can cover larger areas of the body, particularly your arms, legs, and torso.

With inverse psoriasis, the exterior of the skin is shiny and red. The damage from this psoriasis lurks beneath the outermost skin layer. This type of psoriasis often occurs in the armpits, groin, and under skin folds.

Pustular psoriasis lesions are non-infectious pus-filled blisters surrounded by redness and inflammation. Pustules can appear anywhere on your body, particularly on your hands and feet.

Generalized pustular psoriasis also has pus-filled lesions, but they appear quickly and cover a large part of your body. Fever, chills, weight loss, and fatigue accompany generalized pustular psoriasis. Seek emergency medical care if this type develops.

Erythrodermic psoriasis is the least common type. It appears like a burn with red, hot, peeling skin over a large area of your body. Because your skin can slough off, you may lose fluids, become dehydrated, and get infections through open wounds. Seek medical care immediately if you have signs and symptoms of erythrodermic psoriasis.

Here are three types of psoriasis identified by location:

Scalp psoriasis can cause thick or thin patches of flaking patches throughout your scalp, hairline, forehead and neck, and ears.

Nail psoriasis causes pitting, discoloration, and pain in the fingernails and toenails. The nail may separate from the nail bed. This type often accompanies psoriatic arthritis.

Genital psoriasis affects both the genitals and upper and inner thighs. Two-thirds of people with psoriasis will have genital psoriasis at some point.

Signs and symptoms of psoriasis

Signs and symptoms vary by type of psoriasis. With plaque psoriasis, the most common type of psoriasis, you’ll notice red patches of skin with silvery scales. Other types of psoriasis cause small rash-like lesions or pustules. Psoriasis commonly affects your:

• Elbows
• Knees
• Scalp
• Face
• Lower back
• Palms of your hands
• Soles of your feet

But any part of your body can be affected.

With mild psoriasis, less than 3% of your body is affected. With moderate psoriasis, 3 to 10% of your body has lesions. And with severe psoriasis, psoriasis covers more than 10% of your skin. To get a better idea, the area covered by your hand (palm and fingers) is about 1% in most people.

How your quality of life is impacted also gets factored into the severity. Young women, anyone with psoriasis on their face, and those with psoriatic arthritis may be considered to have more severe psoriasis based on the negative impact of having more noticeable skin changes or pain.

Diagnosing psoriasis

Eczema, rashes, and other skin diseases mimic psoriasis. A visit with a dermatologist, a doctor specializing in skin disorders, can diagnose which type of psoriasis you have. If you have darker skin, rather than red skin lesions, you may see violet or dark brown patches with gray scales.

In addition to examining your skin, scalp, and nails, the dermatologist will ask you about any family history of psoriasis, associated symptoms like joint pain, recent stress, and other medical conditions.

The dermatologist may take a small sample of affected skin to examine under a microscope.

With all the information at hand, the dermatologist can make a treatment plan.

Psoriasis Treatment

Psoriasis treatment comes in several forms. Deciding the best treatment(s) depends upon:

• The type of psoriasis
• How severe it is
• Where it’s located
• How much psoriasis is impacting your life
• Your other medical conditions

Steroid creams and ointments

Most people use ointments or creams to treat their psoriasis. Of those, corticosteroids are the most common, are effective, and are safe when used as directed. Corticosteroids come in different strengths. You can buy mild formulations of hydrocortisone cream (Cortizone-10) over the counter. Stronger formulations need a prescription. Here are some examples from moderate to high strength:

• Hydrocortisone valerate (Westcort ointment)
• Triamcinolone acetonide (Kenalog)
• Dexomimetasone (Topicort)
• Augmented betamethasone diproprionate (Diprolene ointment)

Non-steroid creams and ointments

• Calcipotriene (Dovonex) — a synthetic Vitamin D applied directly to the psoriatic lesions
• Calcipotriene-Betamethasone (Taclonex) — a combination of Vitamin D and steroid
• Calcitriol (Vectical) — another form of Vitamin D
• Tazarotene (Tazorac) — a Vitamin A derivative
• Tapinarof (VTAMA)
• Anthralin (Drithocreme HP) — used for scalp psoriasis in people over 12 years of age
• Coal tar — inexpensive over-the-counter shampoo, foam, soap, or ointment that is marketed under many different brand names.

Systemic medications

Systemic medications work throughout your body. These medications are taken by mouth, as injections, or as intravenous infusions. Dermatologists prescribe them for moderate to severe psoriasis.

• Acitreten (Soriatane)
• Methotrexate
• Cyclosporine (Gengraf)
• Apremilast (Otezla)
• Tofacitinib (Xeljanz and Xeljanz XR)
• Biologics — a group of drugs aimed at correcting your over-active immune system. Many get airtime for treatment of rheumatoid arthritis and Crohn’s disease, as well as psoriasis and psoriatic arthritis. Dermatologists prescribe more than a dozen biologics for psoriasis, including:
  • etanercept (Enbrel)
  • adalimumab (Humira)
  • ustekinumab (Stelara)
  • abatacept (Orencia)
  • secukinumab (Cosentyx)
  • ixekizumab (Taltz)

Your doctor may prescribe a combination of medications. Biologics are made from living cells, highly targeted, and effective. As a result, they are expensive. Read on for ways to save on over-the-counter and prescription medications, including biologics.

Light therapy for psoriasis

Light therapy or phototherapy involves shining ultraviolet light on the affected skin. Light therapy can be performed at the doctor’s office or with a home phototherapy unit.

Alternative treatments for psoriasis

Alternative or complementary treatments include acupuncture, relaxation techniques to reduce stress, eating nutritious foods, and maintaining an active lifestyle.

Saving on psoriasis medications

A two-second search on ScriptSave^® WellRx revealed a cost savings of $70 ($10 vs $80)* for Westcort at pharmacies one mile apart. Another two seconds uncovered cost savings of thousands of dollars on biologics. Biologics are made from living cells, highly targeted, and effective. As a result, they cost a lot more.

To learn more about how prescription discount cards work and to receive your free Rx savings card or coupons for medications, visit WellRx. Enter your medication and zip code and prepare to save a boatload (or enough to buy a boat?) throughout treatment.

Prognosis

Psoriasis can’t be cured. Psoriasis is also unpredictable. It tends to flare and go into remission spontaneously. Medications help minimize the serious flares and prevent psoriasis from becoming severe. Treatment also helps you achieve remission that can last months or years.

When visiting your dermatologist, the National Psoriasis Foundation recommends you and your doctor set treatment goals. According to goals in the Treat to Target program, your lesions cover no more than 1% of your body after three months of treatment. A healthy lifestyle, avoiding known triggers, and using medications, should be a goal you can reach.

Teresa Otto, MD, is a freelance medical writer on a mission to inform readers about the positive impact of good nutrition and a healthy lifestyle. She is a retired anesthesiologist who practiced in Billings, Montana, for most of her career. She graduated from the University of Washington School of Medicine in Seattle and did her anesthesia residency and fellowship at New York University and Columbia-Presbyterian in New York.

Resources:

https://www.psoriasis.org/psoriasis-statistics/

https://www.nhs.uk/conditions/psoriasis/causes/#:~:text=These%20skin%20cells%20gradually%20move,about%203%20to%207%20days.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678535/#:~:text=In%20addition%2C%20psoriasis%20is%20found,%2C%20vitiligo%2C%20and%20alopecia%20areata 

https://www.dermatologytimes.com/view/find-the-difference-drug-related-psoriasis

https://www.cdc.gov/psoriasis/index.htm

https://www.medicalnewstoday.com/articles/medical-myths-all-about-psoriasis

https://www.aad.org/public/diseases/psoriasis/what/look-like

https://www.psoriasis.org/locations-and-types/

https://www.nhs.uk/conditions/psoriasis/symptoms/

https://www.aad.org/public/diseases/psoriasis/what/symptoms

https://www.aad.org/public/diseases/psoriasis/treatment/could-have/skin-color

https://www.psoriasis.org/treatments-for-psoriatic-disease/

https://www.aad.org/public/diseases/psoriasis/psoriasis-medications-light

https://jamanetwork.com/journals/jamadermatology/article-abstract/2698668

https://www.psoriasis.org/treat-to-target/