What Does a Typical Psoriasis Journey Look Like?
April 14, 2022
![What Does a Typical Psoriasis Journey Look Like?
Symptoms Appear
Psoriasis, an inflammatory skin condition, leads to rapid cell growth and turnover. Some of the most common symptoms are:
• Dry, thick, raised skin
• Silvery-white scaly skin
• Small red bumps
• Itchy skin
Psoriasis symptoms may come and go. When they appear, it’s known as a flare-up.
The first flare—as well as subsequent flares—could occur because of a trigger. Common triggers may include:
• Stress
• Changes in diet or food sensitivities
• Heavy drinking
• Smoking
• Weather changes
• Skin injury, including tattoos and piercings
• Illness or an infection, such as strep
• Some medications (such as blood-pressure medications or mood-stabilizing medications)
Who Gets Psoriasis?
More than 125 million people worldwide have psoriasis.
• Psoriasis can affect men, women, and children.
• Psoriasis can affect people of any skin color and ethnicity.
• Symptoms can occur at any age.
While there are various types of psoriasis, plaque psoriasis is the most common, affecting up to 90 percent of people with psoriasis.
Psoriasis is a visible disease; when symptoms flare, it can affect your social life, leading to feelings of shame, embarrassment, even depression.
Getting Diagnosed
Psoriasis symptoms can be mistaken for other conditions, such as:
• Eczema and seborrheic dermatitis
• Ringworm or other fungal infection
• Lichen planus
• Pityriasis rubra pilaris
• Viral rashes
That's why it’s important to see a dermatologist who has experience diagnosing and treating psoriasis.
A board-certified dermatologist can typically diagnose psoriasis by examining your:
• Skin
• Nails
• Scalp
And asking you questions about your:
• Symptoms
• Family history
• Exposure to triggers
In some cases, the dermatologist may also do a skin biopsy to confirm a psoriasis diagnosis.
The dermatologist will also determine the severity of your condition based on how much of your body is covered in psoriasis.
• Mild = less than 3%
• Moderate = 3 to 10%
• Severe = more than 10%
*1% of your body surface is about the size of the palm of your hand.
It might be tough to accept a psoriasis diagnosis, at first, but it’s important to help you find the right treatment to control your symptoms and to prevent the disease from progressing.
Seeking Treatment
There’s no cure for psoriasis, but it can be treated several different ways. The right treatment plan can even help some people achieve remission.
You’ll work with your dermatologist to come up with the right treatment for you, based on:
• Your type of psoriasis
• The location of your psoriasis
• The severity
• The impact psoriasis has on your daily life
• Any other health conditions you may have
Treatments often are tried in this order:
1. Topicals
Typically, topicals are usually the first-line treatment for psoriasis. These are medications applied directly to the skin, such as cream, ointment, oil, gel, foam, and shampoo.
2. Phototherapy
Your dermatologist may also recommend regular phototherapy sessions to reduce or prevent flare-ups. Phototherapy uses narrowband UVB, which is a small wavelength of light to calm down skin inflammation.
3. Systemic medication
If those treatments don’t work, your dermatologist may prescribe a traditional systemic medication, which can be taken orally or by injection or infusion. These work by suppressing the immune system on a broad level.
4. Biologics
If you have moderate to severe psoriasis, or if traditional oral systemic therapies aren’t working, your dermatologist may recommend biologic treatment. Biologics can be injected or infused, and they work by targeting specific parts of the immune system that play a role in psoriasis.
Living with Psoriasis
No matter which treatment they’re taking, many people with psoriasis take lifestyle steps to help them control their condition. This can include:
Tracking Potential Triggers
Knowing your psoriasis triggers can help you take steps to prevent flares. Triggers can vary from person to person, so tracking your symptoms over time may help you pinpoint your specific psoriasis triggers. Keeping a journal is one way to track when your symptoms appear in relation to potential triggers.
Alternative Therapies
More than 40% of people with psoriasis also turn to complementary and alternative therapies, such as:
• Yoga
• Tai chi
• Acupuncture
• Massage
• Meditation
• Topical herbs or botanicals
Healthy Lifestyle Choices
It’s also important to make healthy choices, including:
• A nutritious diet
• Regular exercise
• Reducing stress
• Avoiding smoking
• Limiting alcohol
Skincare
Skincare steps you take at home can reduce itch and help keep symptoms at bay. Popular choices include:
• Taking short lukewarm—not hot—baths or showers
• Using a hydrating moisturizer to prevent dry skin
• Running a humidifier at home, if the air is dry
• Using a medicated shampoo, if you have scalp psoriasis
Trial and Error
Finding what works can take time and patience. A common goal is to find a treatment plan that results in psoriasis covering 1% or less of your skin.
Step therapy is a process in which you may have to try certain medications without any symptom relief before medical insurance will approve the next medication. Some health insurance requires step therapy, but the National Psoriasis Foundation is actively advocating against this practice, so people can get the psoriasis treatments that may help them the most more quickly.
If you’ve been on a psoriasis treatment for 3 months and haven’t reached your goal, follow up with your dermatologist. It may be time to try another treatment approach.
Stick with it—you may respond better to another treatment or even a combination of treatments.
Reaching Your Goal
If you do reach your goal, enjoy it!
But know that your treatment may lose effectiveness over time.
Remission typically only lasts 1 to 12 months, though for some people, it can be longer.
Be sure to see your dermatologist every 6 months to monitor the effectiveness of your treatment. If it stops working for you, it’s back to trial and error. The good news is, you’re likely to find another effective option.
SOURCES
Abdel-Azim, N.E., et al. (2017) Differentiation of pityriasis rubra pilaris from plaque psoriasis by dermoscopy. Archives of Dermatological Research.
American Academy of Dermatology
American Journal of Managed Care, “Psoriasis Patient Group Seeks to Curb Step Therapy Use With State Legislation.”
Donigan, J., et al. (2015) Psoriasis and herpes simplex virus are highly stigmatizing compared with other common dermatologic conditions: A survey-based study. Journal of the American Academy of Dermatology.
Gamret, A.C., et al. (2018) Complementary and Alternative Medicine Therapies for Psoriasis: A Systematic Review. JAMA Dermatology.
Hägg, D., et al. (2017) Severity of Psoriasis Differs Between Men and Women: A Study of the Clinical Outcome Measure Psoriasis Area and Severity Index (PASI) in 5438 Swedish Register Patients. American Journal of Clinical Dermatology.
Healio Psoriatic Disease. “Many patients with psoriasis try complementary, alternative therapies.” (2019)
Ladan, A., et al. (2017). Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey. Dermatology and Therapy.
Mayo Clinic, “Scalp psoriasis vs. seborrheic dermatitis: What's the difference?” (2017)
Menter, A., et al. (2019) “Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. Journal of the American Academy of Dermatology.
National Psoriasis Foundation](https://twill-happifiers-cms-uploads.happify.com/cms_uploads/en_US/img/crop_images/TwillCare-What-Does-a-Typical-Psoriasis-Journey-Look-Like_6382a27.png)
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