The Ultimate Guide To Psoriasis: What Causes It And How To Treat It
Red flakey patches, inflammation, and scaling: these are all symptoms of the autoimmune disorder, psoriasis. Living with psoriasis can be debilitating, but if you know how to treat it and how to avoid flare-ups, you can learn how to manage the condition and keep flare-ups to a minimum. To give you guys the best advice, we consulted Adam Friedmann, consultant dermatologist at Stratum Clinics, who specializes in the skin condition, as well as Laura Southern, a Nutritional Therapist at London Gynaecology, for her tips on how to manage and treat psoriasis. Here’s everything you need to know.
What is Psoriasis?
Dr. Friedmann begins by clarifying “Psoriasis is not just an inflammatory skin condition; it’s a chronic autoimmune condition characterized by red, flaky patches on the skin. Psoriasis speeds up the lifecycle of the skin cell and causes them to reproduce much more quickly than they should. This results in thickening, redness, and scaling. It can affect the whole of the skin including the scalp and nails.”
As with most skin conditions, it varies from case to case. Dr. Friedmann says “The severity of psoriasis varies a great deal from person to person, with some people experiencing it as a minor irritation, whilst for other people, it can have a major impact on their quality of life. Even a small bit of psoriasis in a delicate area such as the face or genitals can cause immense distress. Occasionally it can be itchy or cause painful splitting or fissuring of the skin. As well as the skin affected, the nails can become abnormally brittle with flaking and pitting. Up to 15% of patients might develop arthritis associated with psoriasis.”
Dr. Friedmann outlines several clinical patterns of psoriasis:
- Chronic Plaque (also known as vulgar psoriasis): The commonest variant, it tends to occur on the extensor aspects of the elbows and knees and on the scalp. Skin changes include pink or red inflamed, thickened plaques with a copious white scale.
- Erythrodermic: Extensive disease covering more than 90% of the body surface area.
- Guttate: Multiple small spots of psoriasis that erupt on the trunk following a sore throat or illness.
- Pustular: The most severe form of psoriasis, skin lesions are red, tender and filled with pus spots.
- Inverse psoriasis: Similar to scalp psoriasis but can occur on the face, chest, armpits, and groin.
- Flexural: Raw, red areas in the groin, armpits or under the breasts.
What Causes Psoriasis?
Dr. Friedmann confirms, “The causes of psoriasis remain unknown, but it can run in families so genetics can play a role and also, it can be brought on by illnesses, stresses or even some medications. Although there is no cure, the condition can be well controlled with medication.”
Similar to eczema, if you have psoriasis, you’ll experience flare-ups at different times, triggered by a variety of different things; “Psoriasis tends to be intermittent in nature and is characterized by remission and ‘flare-ups’ although, in chronic plaque psoriasis, the scaly plaques may be stable over many years.”
“The commonest two causes of a flare-up in psoriasis are infections (such as a streptococcal sore throat or tonsillitis) and stress. Certain medications can cause a flare-up such as beta-blockers,” says Dr. Friedmann. However, he also adds “Often, there is no identifiable cause and the flare-up may gradually appear over time.”
Who is Most Likely to Develop Psoriasis?
According to Dr. Friedmann, everyone is a potential candidate for psoriasis, however, the likelihood increases when you’re an adult; “Psoriasis affects around 2% of people in the UK; it can start at any age but mainly occurs in adults under 35 years old, affecting men and women equally.”
How to Treat Psoriasis
“Unfortunately, there’s no cure for psoriasis,” says Dr. Friedmann. However, “There are a number of ways in which you can manage the symptoms and minimize the discomfort that the rash can cause.” He continues to explain that there are three main treatment strategies, depending on the severity, “namely creams, phototherapy (ultraviolet/sunlight) or systemic medication (oral or injectable drugs).” Dr. Friedmann explains the different methods of treatments:
1. “Creams include emollients, soap substitutes, vitamin D analogs, tar, and steroids.”
2. “Phototherapy involves precise doses of ultraviolet light being delivered by a medical UV-machine. Our expert dermatology nurses and physician’s assistant run the phototherapy clinic. Sessions maybe two or three times weekly depending on the type of ultraviolet therapy required.”
3. “Systemic medications include tablets such as acitretin, methotrexate and ciclosporin or injectables such as etanercept, adalimumab or ustekinumab. These powerful drugs are reserved for severe or life-limiting psoriasis. Biological drugs have been revolutionary in the treatment of psoriasis. These drugs, unlike standard immune suppression, which has a lot of side-effects, are very focused in their action and that tends to leave the immune system largely functioning normally. In targeting the processes that cause disease, they can bring about great improvement sometimes even maintaining 90-100% skin clearance. The biological drugs are the same as human antibodies in that they specifically target a single protein, molecule or enzyme involved in immune reactions, hence they are very specific.”
In-Office Treatments for Psoriasis
If you have psoriasis, visiting the derm’s office regularly for treatments will help lessen the severity of the condition. Dr. Friedmann adds that “Dermatology nurses will often be able to demonstrate how to use creams and moisturizers effectively.” Here are some in-office treatments Dr. Friedmann recommends:
Phototherapy: “Phototherapy (ultraviolet light treatment) can be administered in-clinic and might bring about some good control of the disease. Up to 80% of people treated with phototherapy can achieve ‘clear’ or ‘almost clear’ status, but the effect is not permanent and the condition might relapse over time.”
Dermalux ® LED Phototherapy: “This is a multi-award winning treatment that combines clinically proven wavelengths of light delivered at therapeutic doses to naturally stimulate skin rejuvenation and resolve problem skin conditions for the face and body. It can be used to help treat Psoriasis by preventing bacterial infection and relieving itchiness, the UV free light stimulates the body’s own natural response for healing. It is available in some clinics and whilst not as effective as UV phototherapy, it has fewer side effects.”
Clinical psychologist consultation: “Having a skin condition or such as psoriasis can have a big impact on your mood and confidence, and it can leave you feeling self-conscious or anxious when you meet other people. Seeing a psychologist can help with the social and emotional side of your care. They can help you adjust to your diagnosis or provide tools to help you cope with your symptoms.”
The Psychological Impact of Psoriasis
As with most skin conditions, it can also impact your mental health. Dr. Friedmann says, “The psychological and social impact of psoriasis can be profound. Social withdrawal can be common amongst sufferers with severe cases of skin conditions. With self-esteem and body image very low, fear of negative appraisal by others is a huge concern.”
He continues, “Psoriasis does not have to be severe to cause a lot of psychological disturbance and stress. Dermatologists are expertly qualified to assess the impact of psoriasis on the patient’s quality of life, so where necessary treatment might be offered that is both medical and psychological.”
As always, it’s important to talk to friends and family, and medical professionals if you’re feeling stressed out or anxious about any body concerns.
How Lifestyle Choices Can Help Improve Psoriasis Symptoms
It’s a widely known fact that eating well, getting plenty of sleep, and maintaining a healthy lifestyle has a huge impact on your body, skin, and hair health. This is especially true if you have psoriasis, as when your immune system is compromised, you’re more likely to experience a flare-up.
Dr. Friedmann makes some healthy lifestyle suggestions: “Adapting your lifestyle or diet can also be beneficial. Cutting out alcohol and cigarettes does tend to help those that suffer from psoriasis. Getting plenty of sleep and general de-stressing in life will also lead to an improved diet and better psoriasis. It is a known fact that stress and exhaustion lower the immune system and can make skin conditions such as psoriasis worse. The more one looks after oneself, the better the immune system and the more manageable psoriasis will be.”
However, Dr. Friedmann adds that lifestyle choices are not enough to manage the condition and that medical treatments and cream are also necessary. “As much as changes to one’s diet may help, as a medical dermatologist, treatment recommendations would usually involve either creams or phototherapy or systematic medication – dependent on the severity of the condition.”
How Your Diet Impacts Psoriasis
Many people with psoriasis will tell you how impactful a healthy diet can be. Nutritional Therapist, Laura Southern, explains why; “Psoriasis is an autoimmune disease where the body is basically attacking itself. About 70% of our immune system is in our gut, and if our digestion is not functioning properly then our immunity can be compromised leading to symptoms like allergies, intolerances, and in some cases auto-immune disease. There are certain foods that can increase digestive symptoms and cause food intolerances – the biggest triggers are gluten, dairy, and soy. So when diagnosed with an autoimmune disease, it makes sense to start with removing the triggers to lessen the load on the digestive system and see if that can ease symptoms.”
Laura continues, “Psoriasis is caused by inflammation, and there are certain foods that can increase inflammation in the body – namely sugar and processed foods. Removing or greatly reducing these foods, and including more anti-inflammatory foods such as essential fats and fresh vegetables and herbs can also ease symptoms.”
She also makes some healthy eating suggestions; “Reducing gluten, sugar, dairy, and increasing plant-based foods, fish, variety, etc will be supportive for the whole body – it provides a great deal more fiber, so this supports our gut bacteria. which then supports our digestion. This diet provides a larger variety of vitamins and minerals to help with any deficiencies that might be exacerbating the condition and stopping skin from healing, and it also supports the liver and detoxification pathways, which are essential in psoriasis.”
“There is also a link between coeliac disease (an autoimmune disease caused by gluten) and psoriasis. About 80% of psoriasis sufferers test positive for gluten antibodies (which means their bodies are reacting to gluten), though this does not mean they have coeliac disease. However, once your body is negatively reacting to any food it makes sense to cut it out,” clarifies Lauren.
If you think you may have psoriasis, it’s important to see a dermatologist who will help you to keep it under control. Finally, try to follow the guidelines for a healthy diet and lifestyle as outlined above, which can help to reduce and soothe flare-ups. If you have psoriasis and are struggling with it, be sure to speak to a doctor and your friends to seek support.
If you have any tips or stories you’d like to share with others about your journey with psoriasis, please leave a message in the comments below.