Introduction:

Psoriasis is a common skin condition characterized by a buildup of rough, dry, dead skin cells. They look like raised, reddish-pink areas covered with silvery scales and red borders. Psoriasis usually occurs on the scalp, elbows, knees, groin, and lower back. It is a chronic (long-term) disease that "comes and goes," and may show up as a few spots or involve large areas. It is not contagious -- you can' t spread it from one part of your body to another, or from person to person.

More than 6 million people in the United States have psoriasis. You can develop psoriasis at any age, though it usually comes on gradually, and it affects both men and women. Doctors think psoriasis may be an inherited disease that can be triggered by emotional stress. Most cases are not painful, although severe ones can be. About 5% of psoriasis sufferers develop psoriatic arthritis, which involves painful and swollen joints and can be a more serious condition.

Signs and Symptoms:

The following are symptoms of psoriasis:

• Raised skin lesions, deep pink with red borders, and silvery surface scales. The skin may be cracked and painful in severe cases.
• Blisters oozing with pus (usually occurs on the palms or soles)
• Pitted, discolored, and thickened fingernails or toenails
• Itchy skin in some people
• Joint pain (psoriatic arthritis) in some people

What Causes It?:

Researchers don' t know what causes psoriasis. They do know that people who have it produce more skin cells than normal. A faulty immune system seems to be involved: In people with psoriasis, T cells (a kind of white blood cell) mistakenly attack skin cells. The new skin cells move to the outer layer of the skin too quickly, where they build up and form thick patches. There seems to be a genetic component -- you are more likely to develop psoriasis if a close relative also has the condition. Several underlying factors may trigger the condition or flare-ups, including:

• Emotional stress
• Obesity
• Skin injuries or sunburn
• Streptococcal (strep) infection (symptoms sometimes first appear 2 weeks after strep throat)
• Cold or dry air
• Certain drugs (gold, lithium, beta-blockers)
• Heavy alcohol use or smoking

What to Expect at Your Provider's Office:

Your health care provider will examine your skin and ask questions about your physical and emotional health. You may need a blood test to check levels of calcium, zinc, and certain other elements, and a skin biopsy to confirm the diagnosis.

Treatment Options:

Your provider may suggest one or several different treatment options.

• Topical creams and lotions
• Medications
• Phototherapy (ultraviolet light therapy)
• Changes in your diet
• Vitamin or mineral supplements
• Exercise

Drug Therapies

Prescription

Topical creams include:

• Corticosteroids -- reduce inflammation and are often prescribed for mild to moderate psoriasis.
• Salicylic acid -- helps slough off dead skin cells. May be used along with topical creams or coal tar.
• Retinoids (drugs derived from vitamin A) -- Tazarotene (Tazorac) helps control symptoms by slowing down the rate at which skin cells grow and are shed. Tazorac is often used with a corticosteroid and with phototherapy. Should not be used by women who are pregnant or plan to become pregnant within three years.
• Calcipotriene (Dovonex) -- a form of synthetic vitamin D3 that slows down the rate of skin cell growth. May be used by itself or with other topical creams or phototherapy (light therapy).

Systemic drugs, used for more severe symptoms, are taken by mouth (orally). All can have serious side effects with long-term use. They include:

• Methotrexate -- helps block the growth of skin cells and reduce inflammation. May also be used to treat psoriatic arthritis. Long-term use can cause serious side effects, so your doctor will monitor you.
• Cyclosporine -- suppresses the immune system.
• Oral retinoids -- Acitretin (Soriatane) slows down the production of skin cells. Symptoms may return after you stop taking this medication. It can cause severe birth defects, so women must not get pregnant for at least three years after taking it.
• Biologics -- help suppress overactive parts of the immune system. These drugs may be given to people who fail traditional therapy or who have psoriatic arthritis. They are given by injection or infusion (IV).
  • Alefacept (Amevive)
  • Etanercept (Enbrel)
  • Infliximab (Remicade)
  • Ustekinumab (Stelara)
  • Adalimumab (Humira) -- for psoriatic arthritis

Over the Counter

• Nonsteroidal anti-inflammatory drugs (NSAIDs) -- reduce inflammation and pain, especially for psoriatic arthritis. NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve).
• Petroleum jelly -- Softens skin, helps it retain moisture.
• Coal tar ointments and shampoos -- relieve symptoms. Help UV light therapy to work more effectively.
• Capsaicin cream -- for pain and inflammation relief. May reduce redness, scaling. Main side effect is a brief burning sensation.

Phototherapy (Light Therapy)

One of the treatments for psoriasis involves ultraviolet light. Some people may be able to get relief from symptoms through brief exposure to sunlight each day. But too much sun can make symptoms worse, so your doctor will need to set up a treatment program for you. Be sure to wear sunscreen with an SPF of 15 or higher and avoid sunburn. Artificial ultraviolet light may also be used, often along with medications, under the supervision of your doctor.

Complementary and Alternative Therapies

Mind-body therapies and stress management, including meditation and hypnosis, may help treat psoriasis. Some studies have shown that people who practiced meditation before receiving phototherapy had better results than people who had phototherapy alone. Exercise can help, too, as can drinking plenty of water.

Taking daily baths with lukewarm water and mild soap can help slough off scales. After your bath, gently pat skin dry and immediately apply a moisturizer to seal in water.

Talk to your doctor before taking any supplements or herbs, because some can have serious side effects or interact with common prescription medications such as blood-thinners and birth control pills. If you are pregnant or breastfeeding, ask your doctor before taking any supplement, herb, or over-the-counter medication. Be sure to keep all your health care providers up to date on all therapies you use, including complementary and alternative therapies.

Nutrition and Supplements

• Avoid alcohol, simple sugars, and foods high in saturated fats. Some people find that a gluten-free diet improves their symptoms. Avoid foods likely to trigger allergies (citrus, milk, corn, eggs). If your doctor suspects food allergies, he may recommend an elimination diet or food allergy testing.
• Fish oil (10 g per day) -- Studies are mixed about whether fish oil can help relieve psoriasis symptoms. One study found fish oil reduced itching, redness, and scaling but did not reduce the size of skin lesions. But other studies found fish oil was no better than placebo. If you want to try fish oil, talk to your doctor before taking such a high dose. Fish oil can increase the risk of bleeding, particularly if you also take blood-thinning medication. There is some evidence that giving fish oil intravenously (IV) may help some people with psoriasis.
• Folic acid (400 mcg per day) -- If you take methotrexate, you may need to take a folic acid supplement. Ask your doctor.
• Shark cartilage (chondroitin sulfate, 80 - 100 g per day in two to four doses) -- Some early evidence suggests that shark cartilage may relieve symptoms in people with plaque psorasis. Do not take shark cartilage if you have diabetes. If you take calcium supplements, talk to your health care provider before taking shark cartilage. Shark cartilage can be expensive, and many people have equally good results with less expensive therapies.

Do not take vitamin A and D supplements. Both are used in prescription medications in high doses. You cannot get the same benefit from a supplement. Also, taking a supplement with your prescription medication could be dangerous if you get too much of these vitamins.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Oregon grape (Mahonia aquifolium), 10% in a cream -- Some evidence suggests that using a cream made with Oregon grape may slightly reduce symptoms of psoriasis. It' s not clear whether this cream would work as well as conventional medications, although one study found it worked as well as calcipotriene (Dovonex) for some people.
• Avocado and vitamin B12 cream -- Some preliminary research suggests that a proprietary cream containing avocado oil and vitamin B12 may reduce the symptoms of psoriasis. However, more research needs to be done.
• Aloe (Aloe vera), 0.5% in a cream -- Several studies show that using an aloe cream improves psoriatic plaques better than placebo.
• Coleus forskohlii (50 - 100 mg two or three times a day) has been historically used for psoriasis, although there is no scientific evidence to say whether it works.
• Oregano oil (2 - 6 drops, two times a day, diluted in water or juice ) -- Some people say that oregano oil improves their psoriasis symptoms, although no scientific studies have been done.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for psoriasis based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Apis mellifica -- for skin rashes that feel hot and dry and are sensitive to touch. Symptoms improve with cool baths and worsen with heat. This remedy is most appropriate for individuals who often feel sad, disappointed, or even depressed. They tend to cry easily but may also be irritable and envious by nature.
• Calendula -- used topically, particularly if the affected area becomes inflamed. This remedy will soothe but not cure the skin condition.
• Rhus toxicodendron -- used for psoriatic arthritis and for skin disorders accompanied by intense itching that worsens at night and improves with the application of heat. This remedy is most appropriate for individuals who are generally restless and unable to get comfortable at night.
• Sulphur -- for skin disorders that are accompanied by intense itching. This remedy is most appropriate for individuals who are thirsty, irritable when not feeling well, uninspired and messy under ordinary circumstances, and who describe a sensation of internal heat and burning. Symptoms tend to improve with open, cold air and worsen with warmth

Chiropractic

No well-designed studies have looked at using chiropractic to treat psoriasis. A few case studies have reported that spinal manipulation may reduce skin lesions in some people. Researchers are still not clear whether chiropractic care is helpful for all people with psoriasis.

Acupuncture

Acupuncture may help some people with psoriasis, although the evidence isn' t clear.

Following Up:

See your health care provider regularly until your psoriasis is under control.

Special Considerations:

A number of conventional medications used for psoriasis can cause birth defects. Pregnant women and those planning to become pregnant should not take these medications. Tell your doctor if you plan to become pregnant so you can discuss changing your medication.

Psoriasis may increase the risk of heart attack. Check with your doctor for follow up.