Plaques of psoriasis present as a thick, white-silvery coating, scattered about the body, even affecting the face or scalp. However, its physical characteristics change depending on location, as psoriasis presents as raw, red, crevices or patches in areas of skin folds like the groin, buttocks, or armpits. No matter where it plants roots, psoriasis plaques can be a source of depreciating self-esteem and a physical cause itching, irritation or pain. It is a defect which causes overactive skin cells to build up, instead of shed off like normal skin. Because it is an inflammatory disease it may also be accompanied by joint aches called psoriatic arthritis. Psoriasis is an inflammatory autoimmune disorder which is not contagious. Although it is a chronic disease (no cure) there are functional OTC and prescription treatments for it.
Although research has not found a profound significance of diet in relation to psoriasis, maintaining a normal weight has shown to help psoriasis. Plus, eating a healthy diet is great for your skin foundation. An anti-inflammatory diet has been found to help some individuals such as discussed on https://www.psoriasis.org/about-psoriasis/treatments/alternative/diet-supplements. Recommendations include avoiding foods like: fatty red meats, dairy products, processed foods, refined sugars, nightshade vegetables, including potatoes, tomatoes and peppers. While, fresh fruits, vegetables, seeds, and nuts are encouraged. Gluten free diet is another topic discussed, as 25% of those with psoriasis also have gluten sensitivity, however for the remaining 75%, there are no studies that support need for a diet restriction.
OTC Skin Basics
Moisturizing products should be a daily part of your skin care routine. Olay Ultra Moisture Body wash is great for the non-sensitive crowd, while Dove soap offers a hydrating gentle alternative. Epsom salts soaks are also helpful to calm skin during bathing. As an overall moisturizer, Aveeno Skin Relief Gentle Scent Lotion is enriched with a triple oat complex, which can be quite soothing for irritated skin. To exfoliate thick plaques try using a lotion with an acidic component like Excipial Hydrating Healing Lotion or Am-Lactin moisturizing lotion. Nonetheless, although Urea and Lactic Acid components are great to smooth thick scales, they may burn in cracked, open skin, thus should be avoided in such.
Many of the OTC treatments for psoriasis are the same as those used for the flaking of seborrheic dermatitis, as showcased in our last blog. Thus, in a repeat of verbiage…Ingredients like Salicyclic acid, coal tar, and hydrocortisone all help to damper flake. Salicylic acid in products like Neutrogena T-Sal, is great at shedding off skin scales, but it may sting if there are scratched, open areas. Coal tar, in products like Neutrogena T-Gel, is an age old remedy which is underutilized due to the odor, despite some who swear by its power. Scalpicin Anti-itch liquid contains 1% hydrocortisone, plus aloe and melaleuca, rendering it helpful for not only flake but also itching and inflammation. Aquanil HC lotion is another similar option, but a more moisturizing form. Other natural products for itch include Aloe, Calamine, Camphor, or Calendula topicals.
For mild to moderate psoriasis, a mainstay of therapy is topical steroids. However, these medication are much stronger than what is available OTC. Topicals come in creams, ointments, gels, solutions, and even foams to meet the needs of all skin areas, hairy or not. Popular intensive strength brands include Halog, Ultravate, Clobex, Sernivo, Topicort Spray, and Olux Foam. Moderate to mild strength variations are also available, wherein mild steroids should be used for sensitive or rubbing areas such as the face, neck, armpits, groin, or buttock. Caution should be taken with any steroid as use greater than 2 weeks on sensitive/fold areas or 3-4 weeks straight on other areas may increase risk for side effects such as stretch marks, discoloration, skin thinning, etc. The correct long term use plan should be discussed with your provider. Alternatives to steroids would be non-steroidal anti-inflammatories like Elidel or Protopic, or vitamin D derivatives like Dovonex.
Otezla is a newer oral medication for those with mild to moderate psoriasis that need a little boost and the side effect profile is less risky than some of the other oral or injectable medications (please read on their website at www.otezla.com).
For those with moderate to severe psoriasis a topical medication may not be enough to provide relief from this skin condition. Another oral medication called Methotrexate has a long history of use in this condition, but it can carry the risk of causing liver damage, among a whole list of other serious side effects. Typically, routine bloodwork is required for the duration of treatment on this medication.
Biologics: Injectables or Infusions
Popular newer generation medications nicknamed the “biologics,” are self-injected or in office administered treatments. Commonly used brands include Enbrel, Humira, Stelara (in office), Cosentyx, and Taltz. Humira and Enbrel are the longest standing brands of this lineage. Remicade, which is an in clinic IV infusion, is also a long standing option. Nonetheless, the newer products have advantages in their ability to create therapeutic affects for inflammation through a more direct body target. Often these therapies induce significant skin improvement. However, all of these may have varying effects on psoriatic arthritis, with some like Humira being approved for such. The caveat with any of these treatments is that while decreasing the inflammatory immune reaction of the skin, it can also be an overall immunosuppressant causing increased risk for colds, flu, pneumonia, and skin or organ cancers among other side effects. Nonetheless, the long term safety data for several of the older generation biologics appear to show merely a slight increased risk for such versus the general population. It is best to research each product and ask your provider for educational brochures when considering such treatment types.
Remember, because psoriasis is not curable, prescription treatments are a life-long commitment. Moreover, this list is not exhaustive of what may be used for your psoriasis. Weighing the risk vs benefit and considering the severity of your psoriasis and its effect on your quality of life, is imperative in finding the best treatment for you.
*The information provided above or in any blogs on this site is for educational purposes only. I does not replace advice or necessary examination and diagnosis from your healthcare clinician. Please see your healthcare provider for any and all concerns with changes in your health or treatment of disease.*