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

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.

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 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.