Psoriasis: It’s More Than Just A Skin Thing

On the surface, psoriasis may seem like an easy skin condition to treat. Head to the dermatologist and get a cream, right? It’s actually more complicated.

It is not a dangerous skin condition, but it can be embarrassing and takes some effort to manage. Psoriasis, like eczema, is a chronic health condition that currently has no cure and goes more than skin deep.

Both psoriasis and eczema have an autoimmune component that causes recurring flares and can present with other illnesses. Psoriatic arthritis, depression, inflammatory bowel disease, and heart disease are among them.

In honor of World Psoriasis Day on October 29th, remember to focus on ways to take control of your psoriasis and find relief.

Types of psoriasis

Researchers believe family history, immunity, and environmental triggers play a role in developing psoriasis. About 7.5 million people in the U.S. are estimated to have the inflammatory skin condition, according to the American Academy of Dermatology (AAD).

This skin condition can be difficult to diagnose because there are several different types. Each patient may have a different experience with symptoms and outbreaks.

• Plaque psoriasis, the most common type, is characterized by elevated, scaly patches known as plaques. They may look red or pink with silvery-white scales on lighter skin and brown or violet with gray scales on darker skin.
• Guttate psoriasis appears as small, dotlike lesions.
• Inverse psoriasis shows up as smooth and shiny lesions in body folds, common under the arms and breasts
• Pustular psoriasis looks more like white, pus-filled blisters.
• Erythrodermic psoriasis, the most severe and rare form, causes flushed skin, severe itching and pain, and flaking.

One thing to note is that it can show up anywhere on your body: hands and feet, mouth and lips, eyelids and ears, mouth and lips, skin folds, and other sensitive areas. The skin in each area is different and requires different treatments, meaning there isn’t a one-size-fits-all approach to getting the condition under control.

Some of the most common areas affected include:

• Elbows and knees. This is often plaque psoriasis, which can be itchy and painful and even cause the skin to crack and bleed.
• Hands and feet. Known as palmar-plantar psoriasis, the skin can look scaly or fissured or turn blistered and red.
• An outbreak on the nails causes a yellowish discoloration and may look like a fungal infection. The nail plate can lift off of the nail bed. The AAD reports fingernail changes occur in nearly 50 percent of people with psoriasis.
• Typically plaque psoriasis, it can range from mild to thick, crusted plaques on the forehead, neck, around the ears, or all over your scalp.
• While not common, it can appear on eyebrows, the nose, and upper lip, upper forehead, and around the hairline.
• Skin folds and genitals. Psoriasis can show up in these delicate areas, too, and may look smooth and shiny or have a waxy appearance. Red lesions, irritated by rubbing and sweating, are common in skin folds on your butt, armpits, or under your breasts.

More than just a skin issue

Beyond the physical symptoms – most notably raised bumpy patches and scaly skin – psoriasis is associated with other health conditions. Psoriasis is rooted in inflammation and an autoimmune response that causes the skin to regenerate more quickly than normal. Doctors also have associated heart disease and insulin resistance with psoriasis, which can lead to other chronic health problems.

There are a variety of triggers and environmental factors that can cause a flare-up. One of the most frustrating aspects of psoriasis is that you may go years without any issues or symptoms and then something sets it off. Managing triggers is a key component of managing psoriasis.

Here are things to avoid or be mindful of if you’ve been diagnosed:

• Stress
• Sunburn
• Allergies
• Alcohol
• Diet
• Cold, dry weather
• Infections or illness
• Skin injuries
• Certain medications
• Smoking and secondhand smoke
• Other conditions such as high blood pressure, obesity, insulin resistance, and diabetes

Researchers continue to investigate whether psoriasis contributes to more serious health complications or vice versa. Some of the comorbidities linked to psoriasis include:

• Psoriatic arthritis
• Depression
• Inflammatory bowel disease
• Diabetes
• Metabolic syndrome
• Heart disease
• Pregnancy complications
• Polycystic Ovarian Syndrome
• Chronic Obstructive Pulmonary Disease
• Cancer

Be mindful of your mental health

You may think a quick fix will resolve your itchy and irritated skin, but those diagnosed with the condition soon learn it’s something they must manage and control for a lifetime.

Due to the painful and persistent nature of the condition, psoriasis can negatively impact your self-image and quality of life. Many patients report feelings of depression and self-esteem issues. Researchers continue to study a link between depression and developing psoriasis, as well as if psoriasis worsens various mental health conditions.

Psoriasis often appears between the ages of 15 and 25 but can develop at any age. The plaques and lesions can show up in prominent areas that are hard to hide, causing sufferers to self-isolate and feel self-conscious. The misconception that it is contagious makes matters worse. It can be especially embarrassing for teens who may have a shaky self-image and go to great lengths to fit in.

If you or your child is struggling with depression or anxiety, make sure to speak up and seek help. Talking to your doctor is key, and mental health concerns should be addressed with your dermatologist or psychologist. Many people change what they wear, try to hide their skin, or avoid social situations, which magnifies feelings of isolation or low self-esteem.

There are a variety of treatments available:

• Over-the-counter and prescription creams and medications
• Changing to chemical-free soaps and cosmetic products
• Dietary and lifestyle changes such as cutting out nicotine and alcohol
• Topical corticosteroids and retinoids
• Moisturizers and other at-home treatments
• Stress management and mental health support

Many doctors also emphasize reducing inflammation, avoiding triggers, and making diet and lifestyle changes. If you have psoriasis, it’s important to monitor your weight, heart health, and other cardiovascular risk factors. Find a dermatologist who will be a partner, willing to collaborate with your primary physician, or refer you to a good therapist.

Since it is a systemic condition, you need to focus on self-care and address underlying issues or lifestyle factors that might cause a flare-up. Your dermatologist can help and will work with you to develop the best treatment plan. Make sure to let them know if your psoriasis becomes more widespread, causes you pain or discomfort, or your joints start to ache or swell.

APDerm offers a variety of medical, cosmetic, and surgical dermatology services. Contact APDerm today if you are concerned about psoriasis or other chronic skin problems.