What It’s Really Like To Live With And Treat Psoriasis

In honor of World Psoriasis Day, The AEDITION speaks with a board certified dermatologist and patients about their experiences living with and treating the chronic skin condition.
Patient Perspective
Written by India Bottomley
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What It’s Really Like To Live With And Treat PsoriasisRomina Farías/Unsplash

Psoriasis is a chronic skin condition that is believed to impact two to three percent of the population. It causes patches of inflamed, red, and flaky skin on the face and body that tend to have a silvery appearance. These symptoms are caused by the overproduction of skin cells, and, for those who suffer from psoriatic arthritis, it can also lead to joint pain and stiffness. What causes someone to develop psoriasis remains somewhat of a mystery, and there is currently no cure. Treatments are highly personalized in nature and often require quite a bit of trial and error to determine what works best.

In honor of World Psoriasis Day, we spoke to New York City-based board certified dermatologist Morgan Rabach, MD, and two psoriasis patients to better understand the skin condition and how to manage it.

What Is Psoriasis?

Not to be confused with eczema or rosacea, psoriasis is a chronic skin condition that causes patches of red, dry, flaky skin. It most commonly appears on the elbows, knees, lower back, and scalp, but the patches can show up anywhere on the body. No two psoriasis cases are the same, and the condition usually manifests in unpredictable cycles that alternate between periods of no (or minor) symptoms and more intense flare-ups. During these relapses, the patches of irritated skin can be large, itchy, burning, and even painful.

The severity of the condition varies by patient. For many, psoriasis patches are more of a cosmetic concern than anything else. But, for others, the discomfort and appearance of large areas of irritation can affect their quality of life — causing physical pain and discomfort.

Who Does Psoriasis Affect?

According to the World Health Organization’s 2016 Global Report on Psoriasis, the condition affects men and women equally. It is thought that some 100 million people worldwide have been diagnosed with the condition, and it would appear that it is gradually becoming more common.

There are slightly higher numbers of cases of recorded cases in Caucasian patients compared to other ethnicities, but this disparity may be due to differences in the number of people seeking treatment in different demographics. There are no clear factors that make one group more susceptible to the condition than others, though there is often a misconception that psoriasis is a contagious skin condition. Psoriasis is not contagious, and it is thought to be triggered by certain infections, genetics, and injuries to the skin.

What Causes Psoriasis Flare-Ups?

Psoriasis flare-ups can be caused by a variety of triggers, Dr. Rabach says. She lists medications, stress, illness, changes in weather, alcohol consumption, and smoking as some potential culprits. There are no specific irritants (such as ingredients in foods, cosmetics, or detergents) that are known to trigger psoriasis relapses. As a result, treatment plans for patients with psoriasis may include lifestyle changes that help manage and prevent future relapses. Dr. Rabach advises that people eat a well-balanced diet, maintain a healthy body weight, and destress whenever possible to stay on top of symptoms.

The Relationship Between Psoriasis & Arthritis

Around a third of people who have psoriasis will develop psoriatic arthritis. The condition can develop up to 10 years after a person first experiences skin complaints linked to psoriasis, and experts believe it happens because the immune system begins to attack healthy tissue by mistake. Not everyone who has dermatological symptoms will go on to develop arthritis, but it’s not clear why some people do while others don’t.

To treat psoriatic arthritis, patients are advised to first consult with their primary care physician before being referred to an internist or rheumatologist to manage the condition moving forward. Treatment usually includes the use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and disease-modifying anti-rheumatic drugs (DMARDs), which can be particularly effective when taken early on in the degenerative process.

How Is Psoriasis Treated?

Courses of treatment for psoriasis often involve a combination of topical creams, light therapy, and lifestyle modifications. “The standard of care for patients with psoriasis are topicals consisting of different strengths of steroids and vitamin D cream,” Dr. Rabach explains. “Depending on how much of the body’s surface area is affected, we use light therapy — usually narrowband UVB.” For smaller areas, she uses an excimer laser.

There is more recent research into whether biological medications, which alter the immune system, can help treat psoriasis, but Dr. Rabach cautions that there is a lack of long-term data to support such options.

Patient Perspective

We spoke to two people who have different experiences of living with psoriasis. Joey is managing an increasing number of relapses, while Sue is experiencing the onset of psoriatic arthritis.

Joey, 32, New York City

Joey was diagnosed with psoriasis three years ago. Her first flare-up occurred during a stressful period when she was completing her PhD. Relapses have become increasingly frequent, but she is able to keep symptoms under control working closely with a dermatologist.

The AEDITION: What does psoriasis look like for you?

Joey: My psoriasis symptoms are mostly patchy red rashes that tend to be pretty flakey and sore. I usually get them on my hands, forearms, and back. The ones on my knuckles, in particular, get very painful. It’s something I have lived with for a little while now, so I can spot the very first signs that a relapse is on its way. Because we still haven’t found a treatment that works well for me, I have to see my dermatologist regularly. It also has an impact on me emotionally. It’s a condition that’s not really severe enough for me to consider myself ‘ill,’ but I don’t feel like a completely healthy 30-something anymore, which can be tough at times.

The AEDITION: What treatments have you tried?

Joey: So far, we’ve managed to find some creams that make me more comfortable, but they do not seem to shorten the length of time my flare-ups last. Each time I have a flare-up, we decide whether to stick with what kept me comfortable last time or if we should try something new. It’s quite experimental, but I’m pleased I’m able to manage the discomfort now. On the other hand, the fact that my particular case affects my hands and forearms means that I am self-conscious a lot of the time. It’s something I am working on with a therapist as well as with my dermatologist to approach things from both perspectives.

The AEDITION: How does psoriasis impact your daily life?

Joey: Initially, the impact showed through in my confidence levels. I went from wearing sleeveless tops and dresses to wanting to wear long sleeves all the time. I would dread hot summer days when I’d have to show my skin. These days, it means I spend a lot of time taking care of myself. I have overhauled my diet to eat clean and unprocessed foods. I practice yoga and meditation to manage stress. It isn’t always easy, but I’m finding it easier the longer I live with it. It’s like anything: It’s a shock and quite strenuous to begin with, but, over time, you adapt.

Sue, 45, Denver, CO

Sue was dealing with dermatological symptoms of psoriasis for close to a decade before she began experiencing joint pain. She received a diagnosis of psoriatic arthritis after a series of tests and has been adapting her lifestyle and adjusting medication ever since.

The AEDITION: What does psoriasis look like for you?

Sue: Psoriasis has been a part of my life for quite some time, and it’s something I knew I may be at risk of developing because I have a family history of the condition. In the beginning, it was mostly just a few flakey patches of skin from time to time. Gradually, it developed into a more significant problem for me, with the patches getting larger during flare-ups. More recently, joint pain is something I have to live with.

The AEDITION: What treatments have you tried?

Sue: The treatment is two-fold. I see a dermatologist who has found great solutions for the dermatological side of the issue. I have light therapy and also apply a couple of steroid creams that appear to work very well. The joint pain is managed with some relatively mild anti-inflammatory drugs for now, but I have a treatment plan set out in case things get worse.

The AEDITION: How does psoriasis impact your daily life?

Sue: It’s quite a variable thing. I can be fine on some days and in a lot of pain on others. That’s probably the most difficult aspect — not knowing when I’m going to feel alright or not. I have already adapted my lifestyle significantly to prepare for the bad days to become more frequent. I now work for myself so I can set my own pace. When I recently moved, I opted for a single-story house as opposed to one with stairs. On good days, there is no difference between my abilities and anyone else’s, but it’s something that is there in the background that I have to be aware of.

The Takeaway

Like so many skin conditions, living with and treating psoriasis is a very personal experience. Some patients only experience mild dermatological symptoms, while others have more severe flare ups and develop psoriatic arthritis. If you think you might be experiencing skin concerns related to psoriasis, it is important to consult with a board certified dermatologist to create the best treatment plan for your needs.

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INDIA BOTTOMLEYis a contributing writer for AEDIT.

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