Getting Psoriasis Under Control

Psoriasis is an autoimmune skin disease that affects the speed at which your skin cells grow and turn over. More than 8 million Americans have this condition, with 2–3% of the worldwide population affected.

Psoriasis can appear at any age. For many, however, the initial onset occurs in your 20s to 30s or between your 50s and 60s. The different severity types of psoriasis include:

• Mild psoriasis affecting 3% of the body
• Moderate psoriasis affecting 3–10% of the body
• Severe psoriasis affecting more than 10% of the body

Severity also depends on how psoriasis affects a person’s quality of life. We’ll cover the symptoms of psoriasis, how to keep them under control, and how to improve your quality of life.

Symptoms of psoriasis

The most common signs and symptoms of psoriasis include itchiness and the presence of dry, thick, and raised patches on the skin. Depending on your skin’s complexion, these may be salmon-colored for those with fair complexion or deeper and hyperpigmented in people with a darker complexion. The patches are frequently covered with a silvery-white coating, often appearing like scales on a fish.

Usually, the symptoms of psoriasis undergo cycles with flares lasting weeks or months. These periods are followed by times where symptoms calm down, known as remission.

Types of psoriasis

There are many different types of psoriasis. The most common is plaque psoriasis. Others include pustular psoriasis, nail psoriasis, and psoriatic arthritis.

• Plaque Psoriasis
  • This is the most common type and is seen in 80–90% of patients.
  • You may see patches on your skin, raised skin plaques, scaling, and smaller plaques that join together to form larger plaques. These plaques will be found on the scalp, elbows, knees, back, or other parts of the body.
• Pustular Psoriasis
  • This type has pus-filled bumps that appear on the hands and feet. Although these areas can resemble an infection, the skin is not infected as the lesions do not have bacteria.
  • You will notice red, swollen skin with pus-filled bumps, extremely sore or painful skin, or brown dots that can scale.
• Nail Psoriasis
  • Your nails can also be affected by psoriasis, as the nails share similar proteins to the skin. If you have psoriasis, it is also likely that your nails may be affected. You may see changes to your fingernails or toenails.
  • You may notice tiny dents in your nails called pits, white or yellow discoloration of the nails, crumbling or rough nails, or lifting nails due to the buildup of skin cells beneath one or more nails.
• Psoriatic Arthritis
  • This type of psoriasis tends to accompany more severe forms and can affect the joints.
  • Joint involvement of psoriasis usually happens years after people develop skin symptoms. Symptoms of joint involvement may be subtle at first but can present with swollen or tender joints, heel pain, or stiffness in the morning that improves during the day.

Treating psoriasis

Psoriasis has no cure, but treatment may help reduce the severity of your symptoms. Your doctor may refer you to a dermatologist for specialized care if you are diagnosed with psoriasis.

Mild disease

For mild psoriasis, your doctor may prescribe topical corticosteroids like Cortisone. Other treatments include topical Vitamin D or topical retinoids like tazarotene (Tazorac). Other topical therapies used when there’s facial involvement include topical tacrolimus (Protopic). These are just a few of the topical options available. Your pharmacist will help your find the best price for these topical medications when you present your ScriptSave WellRx^® prescription savings card at your local pharmacy.

Moderate to severe disease

Treatments for more widespread psoriasis include phototherapy, where artificial ultraviolet B rays get used to slow the growth of the skin. The type of treatment will vary depending on the severity of your disease.

With more moderate to severe disease, your doctor may prescribe systemic medications like methotrexate (Rasuvo, Rheumatrex), cyclosporine (Gengraf, Sandimmune), or biologics.

Biologics represent a wide range of products composed of sugars, proteins, nucleic acids, or complex as a form of treatment. Some of these include:

• Adalimumab (Humira)
• Etanercept (Enbrel)
• Infliximab (Avsola)
• Ustekinumab (Stelara)
• Guselkumab (Tremfya)

The field of biologics is rapidly evolving. Most biologics are administered as infusions or injections, but some are given orally, like apremilast (Otezla) or tofacitinib (Xeljanz).

Common triggers

In addition to medications, you can take steps to help prevent flare-ups and keep your psoriasis in remission.

Reducing stress is a great way to keep flare-ups under control. Find calming ways to manage your stress and continue to practice it, like yoga, meditation, or breathing exercises. Avoid drinking excess alcohol, as this will dehydrate your skin and reduce your sleep. Do not smoke. It is bad for your lungs and will have long-term negative effects on your skin.

Avoid skin injuries and treat them quickly if you scrape, cut, or burn your skin, as these wounds will trigger your immune system. If traveling to the woods or places where insects are prevalent, use bug spray as the reaction from insect bites can activate your immune system.

Extreme weather such as dry and cold or dry and hot weather may trigger a psoriatic flare. Use gentle moisturizers to lock in your skin’s moisture if being exposed to extreme weather. Finally, your psoriasis may also flare if feeling under the weather. Some biologics will predispose you to viruses or fungal infections. Speak with your doctor regarding these side effects.

Gabriel Espinoza, MD has experience in caring for patients in both primary care and emergency settings. Some of the topics he has focused on during his medical career include various areas in public health, pediatrics, and wellness. He has co-authored a chapter on the utility of point of care ultrasound in the diagnoses of various eye conditions. The content written by Dr. Espinoza is for information and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician with any questions you may have regarding a medical condition.

References:

1. https://www.cdc.gov/psoriasis/index.htm
2. https://www.psoriasis.org/psoriasis-statistics/
3. https://www.health.harvard.edu/diseases-and-conditions/a-deeper-look-at-psoriasis
4. https://www.fda.gov/about-fda/center-biologics-evaluation-and-research-cber/what-are-biologics-questions-and-answers
5. https://www.aad.org/public/diseases/psoriasis/triggers/flares