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Psoriasis is a skin disease that results from a problem with the immune system.
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One in three people who have psoriasis also develop psoriatic arthritis, which is an inflammatory joint disease.
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Treatments for psoriasis can range from pills and topical treatments to injectable medications.
More than just a skin condition, psoriasis is a daily challenge that can impact what you choose to wear, how you feel about yourself, how you manage stress and the way you care for your overall health. Whether you have psoriasis yourself or someone you love has it, it’s important to understand how this disease works.
What is psoriasis?
Psoriasis is an immune-mediated disease, which means it’s a condition that results from an immune system problem. It occurs because the immune system speeds up skin growth. While normal skin cells grow and shed within a month, skin cells in people with psoriasis do so in only three or four days. As a result, the skin cells pile up on the surface of the skin, causing inflammation, itchiness, burning and an appearance of scaly patches on the skin.
One in three people with psoriasis develops psoriatic arthritis, an inflammatory joint disease similar to rheumatoid arthritis. Failure to treat the arthritis can result in progression and permanent joint damage.
“That’s why I ask all of my patients with psoriasis symptoms how their joints are feeling,” said Matthew McClelland, M.D., dermatologist at Providence Medical Group-Bridgeport.
“If a joint feels stiff in the mornings but gets better as the day goes on, that’s usually an indicator of psoriatic arthritis in an individual with psoriasis; age-related osteoarthritis usually feels worse as the day goes on.”
Psoriatic arthritis commonly affects the hands and wrists and can cause joint pain in many parts of the body, including the joints of the spine.
Deciding whether or not to treat your skin symptoms is a personal choice — if you’re uncomfortable with the possibility of psoriasis treatment side effects, it’s perfectly valid to opt not to treat mild flare-ups. The fact that this is a systemic disease that can cause arthritis, heart disease and diabetes, however, is an important reason not to ignore it completely.
Psoriasis treatment options
While there is no cure for psoriasis, there are plenty of good, effective treatments available. Your primary care provider or dermatologist can go over all of the options and recommend a treatment plan based on the extent of your skin issues and whether or not you also have arthritis.
Treatments for skin issues
- Over-the-counter treatments: Dermatology products that contain salicylic acid can remove the dead skin that is so characteristic of psoriasis. However, the low concentrations available over the counter don’t usually work very well. Higher concentrations, available by prescription, are more effective.
- Topical steroids: These prescription creams and ointments can clear up skin patches somewhat and make your skin look better if you use them consistently. They’re usually the first line of treatment when people are newly diagnosed, as long as the psoriasis doesn’t cover a large portion of the body.
- Phototherapy: Doctors don’t recommend sun exposure or tanning beds because of the risk of skin cancer; medical phototherapy is a safer option that can work very well for the skin. Like the other treatments mentioned so far, however, it doesn’t affect the systemic disease.
Systemic treatments
- Pills: If you have a lot of psoriasis that’s not responding to treatment, or you have it on your face or other cosmetically sensitive areas, oral medications may help. Methotrexate, a first-line systemic agent, has been used for decades and works pretty well, but has potential side effects that require careful monitoring of the liver, bone marrow and other organs.
- Injectable targeted medications: Some of the newest options are targeted much more precisely to the specific immune system problem that causes psoriasis. These targeted therapies, theoretically, work better and cause fewer side effects than methotrexate and other traditional treatments. Injected medications such as Enbrel, Humira and Stelara are extremely effective. These clear the skin better than any other medication — in some patients, they clear it completely — and they also treat psoriatic arthritis. Some shots need to be administered twice a week, and Stelara is given every three months. These and other systemic medications may weaken the immune system and increase the risk of cancer and infection, but the increase is very slight. Cost is the main issue — most of these average about $20,000 per year.
New treatments are being developed all the time, and a lot of research is going on that may lead to a cure, or at least to the next best thing — a treatment that provides long-term clearance.
Self-care for psoriasis: How to manage symptoms at home
In addition to medical treatment, there are several things you can do to minimize psoriasis flare-ups, lower your systemic risks and improve your quality of life:
- Reduce stress: Stress can trigger flare-ups, so learning to manage stress better may improve your psoriasis — and it can help your mental health, too.
- Protect your skin: About 50% of patients experience what’s called the Koebner phenomenon, which is psoriasis that shows up in areas of trauma to the skin, such as sunburns, bug bites, scrapes and other injuries.
- Don’t smoke: Cigarette smoke may worsen both skin psoriasis and systemic diseases.
- Live a healthy lifestyle: Exercising, eating nutritious foods and losing weight if you’re overweight often improve psoriasis.
- See your primary care provider regularly: Make sure your primary care provider knows that your psoriasis puts you at higher risk for cardiovascular disease and diabetes, so he or she can monitor these risks at every checkup.
If you are motivated to keep psoriasis under control, there are plenty of tools that can help you. This is a condition that you’ll probably be living with for a long time, so keep exploring options until you find an approach that you feel good about and that will improve your well-being.
Find a doctor
If you are looking for a primary care provider or dermatologist to help manage your psoriasis, you can find one who’s right for you in our provider directory.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
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