woman with plaque psoriasis

Your Guide to Understanding and Treating Plaque Psoriasis

By Leah Campbell
January 26, 2022

If you’ve been diagnosed with psoriasis, you’re likely all too familiar with the most common presentation of the disease: plaque psoriasis. According to the National Psoriasis Foundation, approximately 80 to 90 percent of people with psoriasis have dealt with plaque psoriasis. So what sets plaque psoriasis apart from other types of psoriasis, and how should you treat it? We’ve got the answers to your biggest questions.

What Is Plaque Psoriasis?

As its name suggests, plaque psoriasis is typically identified by the formation of scaly patches, or plaques, usually on the elbows and knees—though it can develop on other areas of the body, as well. “The formed plaques are itchy and may even become painful and bleed due to cracking,” explains Lisa Stirling M.D., a board-certified dermatologist in Norfolk, Virginia, and medical adviser for eMediHealth.

The appearance of these plaques can vary by skin tone, but they’re usually raised and red, or darker in color, sometimes with a white or silvery layer of dead skin cells on top.

Who Is Most Impacted?

More than 8 million Americans are living with plaque psoriasis. “It’s more common in Caucasians than in other ethnicities,” Stirling explains, adding, “Plaque psoriasis is very prevalent in polar regions but is also common in densely populated countries and tropical regions.” This may simply be because of the extreme environmental conditions. For example, polar regions have dry air, reduced sunlight, and cold temperatures—all of which can contribute to psoriasis flares, according to the National Psoriasis Foundation.

Like all forms of psoriasis, genetics tend to play a role—if you have a family member with plaque psoriasis, you may be more likely to develop it yourself. And while psoriasis can develop at any age, JAMA Dermatology explains there are two common peaks of onset, between the ages of 20 and 30 and the ages of 50 and 60.

There’s no known cause of plaque psoriasis specifically. As for all forms of psoriasis, “Studies have shown patients with a family history of autoimmune conditions or a familial history of psoriasis have a higher probability of developing a form of psoriasis,” says New York City cosmetic dermatologist Michele Green, M.D. Just like with other forms of psoriasis, plaque psoriasis most likely results from a combination of genetics and environmental triggers.

How Is Plaque Psoriasis Diagnosed?

Plaque psoriasis is most often diagnosed based on a simple physical exam and the patient’s medical history, according to the Mayo Clinic. Doctors may take a skin biopsy to be sure, but this is rarely required, since the physical appearance of plaque psoriasis is usually telling enough for a diagnosis.

How Can I Deal with Flaking?

One of the most common complaints about plaque psoriasis is the skin flaking that goes along with it. “At the onset of psoriasis, the normal skin cells over the region start to die off and with the increase of cytokine production, it makes the skin scaly and flaky,” Stirling explains. “In order to have this under control, you’ll need to retain moisture in the affected area.”

She suggests switching to mild soap or body wash and wearing cotton or linen clothing materials as opposed to those that might further irritate affected areas.

What’s the Best Way to Keep My Skin Moisturized?

“The effects of psoriasis can be damaging on your body, including the acid mantle of the skin,” Green says. “If you suffer from psoriasis, you will need to moisturize frequently using a thick moisturizer. Your skin needs a moisturizer that acts as a barrier on the skin to prevent moisture loss and also a moisturizer that keeps your cells hydrated.”

Green further advises against hot showers and suggests using a humidifier whenever possible.

“In extreme cases, your dermatologist can prescribe a topical corticosteroid to reduce redness and inflammation,” Green says.

What Are My Treatment Options?

There are several different ways to treat plaque psoriasis, including:

  • Topical prescriptions: Prescription creams can be applied to the skin. These might include steroid creams such as Clobetasol or Fluocinolone.
  • Vitamin D analogues: Topical creams such as Calcipotriol or Maxacalcitol may be used to infuse areas of psoriasis with vitamin D to reduce symptoms and relapse rates.
  • Phototherapy: Controlled exposure to UV and/or UVB rays is typically provided in a doctor’s office.
  • Oral medications: Typically, systemic retinoids such as Acitretin or immunosuppressants like Methotrexate may be used to control the immune response.
  • Biologics: For moderate to severe cases, biologic medications like Cosentyx, Enbrel, and Humira work to suppress the immune system and reduce the appearance of plaque psoriasis.

Finding the option that is right for you and your condition may come down to how severe your plaque psoriasis is and how it responds to initial treatments.

“If topical treatments seem to work very slowly, or if there are signs of the condition worsening, your doctor might recommend you have light therapy done,” Stirling explains, for example. “Here, the affected skin is exposed to doses of UV light, which helps in slowing down cell growth.”

If psoriatic arthritis is also suspected, or if the plaque psoriasis is severe, oral and injected medications may need to be explored, says Stirling. “Depending on the severity of the condition, your doctor may prescribe topical treatments in the form of moisturizers, ointments, creams and shampoos containing salicylic acid.”

What Are Some Home Remedies for Plaque Psoriasis?

While you should always see a doctor if you suspect you have psoriasis, there are some ways you can help manage your condition at home alongside the recommended medical treatment.

For instance, Stirling suggests applying a cold compress to help relieve itching and reduce swelling when you have plaques. “Consider trying an oatmeal bath. It has a lot of benefits,” she says. “Soak yourself in a bath with a cup of colloidal oatmeal and rinse yourself with lukewarm water when you’re done. This will help your skin retain moisture.”

She further recommends using these options topically on the affected areas:

  • Glycerin, or aloe vera gel, to heal the skin, moisturize, and promote healthy cell growth
  • Turmeric gel or paste for the anti-inflammatory benefits
  • Olive oil for inflammation
  • Jojoba oil for reducing irritation
  • Coconut oil for skin hydration

Will Changing My Diet Help?

While an anti-inflammatory diet hasn’t been scientifically proven to help psoriasis symptoms, “It can’t hurt to follow an anti-inflammatory diet, as psoriasis is an autoimmune condition which can also be triggered by inflammation within the body,” Green says.

She suggests maintaining a diet that is well-balanced in fruits, vegetables, lean protein, fish, and whole grains, while avoiding dairy and processed foods. “Minimize alcohol consumption and quit smoking,” adds Green. “Studies have shown that smoking and alcohol can trigger inflammation, which can result in a flare-up of psoriasis.”

What About Dealing with Stress?

Stress is a known trigger for psoriasis flares, so while avoiding stress may be easier said than done, Green says, “Minimizing stress will prevent exacerbation of your psoriasis.”

Find ways to keep your stress under control, such as exercise, hobbies, and meditation. Green also suggests finding a support group for people living with psoriasis, to help you cope with your symptoms and help you deal with stressful situations. You can reach out to others here in the psoriasis community for support, as well.

How Can I Prevent Plaque Psoriasis Flare-Ups?

Stirling says there are a few things you can do to help manage and improve your plaque psoriasis symptoms:

  • Avoid scrubbing your skin when you shower to prevent irritation.
  • Use lukewarm water for showering, to prevent drying out the skin.
  • Do not scratch or touch affected areas. This can lead to worsening or new flares.
  • Avoid using perfumes (fragrances can be a trigger for flares for some people).
  • Talk with your doctor about diet changes, since excess sugar and processed foods may trigger inflammation and worsen the condition.

“It’s important to note that even though it affects the surface of the skin, psoriasis in all forms might increase your chances of developing other health complications,” Stirling explains. That’s why she says it’s important to manage your condition by following your doctor’s advice, working to prevent flares, and moisturizing often.

Green adds, “Frequent visits to your dermatologist to effectively manage your psoriasis are important in controlling your symptoms and improving your quality of life while coping with the disease.”

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