FAQ

Treatment

Can you use acupuncture as a treatment for psoriasis?

Acupuncture and massage are two excellent methods of stress reduction, and stress reduction helps psoriasis. If acupuncture is effective for you, use it.

How can I control my mild psoriasis in between flares?

Your doctor will probably prescribe a high-potency steroid and a low-potency steroid like triamcinolone. When you are flaring, you should use the high-potency steroid two times per day for a couple of weeks until the plaque thins down. In between flares, you should use your low-potency steroid, to keep flares away. You want to use the least potent steroid that is effective on your psoriasis to avoid thinning and stretching of the skin.

At home I was receiving light therapy three days a week. I can’t fit much time into my schedule. Can light therapy be effective once a week or less?

Light therapy—either ultraviolet light B (UVB) or PUVA (the light-sensitizing drug psoralen combined with ultraviolet light A)—requires treatment two to three times a week to improve active psoriasis. Once the skin is clear, PUVA treatments every one to four weeks can maintain improvement.

However, with UVB, improvement is hard to achieve or maintain with fewer than two sessions a week. You may want to speak to your dermatologist about obtaining an at-home UVB phototherapy unit if scheduling is an issue.

I used topical steroids with great success for about a year but then they seemed to stop working. What happened?

The phenomenon of steroids losing efficacy is referred to as tachyphylaxis (a rapidly decreasing response to a drug). It is a common occurrence. To minimize this, your doctor may prescribe combination therapy with non-steroid agents such as vitamin D derivatives or immunomodulators.

Rotating therapy with other agents or light can also help minimize the effect.

I recently started taking a medication that prohibits me from drinking alcohol, and I’ve noticed that my psoriasis has improved a great deal. Is there a connection?

Alcohol appears to affect psoriasis in men more strongly than in women. Heavy drinking may actually lower treatment response, particularly in men. Abstinence from alcohol can improve the severity of the disease. In addition, it should be noted that alcohol may have dangerous side effects when combined with certain psoriasis medications, such as methotrexate, so it is very important that you inform your physician of your alcohol intake.

After years of trying different treatments for my psoriasis, I am looking at alternative approaches. What are reasonable expectations if I follow a regimen of meditation, light exercise such as yoga, and a diet that reduces my refined sugar intake?

A healthy lifestyle including a healthy, well-balanced diet, no tobacco, minimal alcohol and stress management will have a positive effect on your life and your psoriasis. Whether or not this will be adequate for disease control is highly variable, but the positive effects will translate into numerous benefits over your lifetime.

My doctor is recommending phototherapy for my psoriasis. What is the difference between narrow-band and broad-band UVB, and is one more effective than the other?

There are two types of ultraviolet light B (UVB) treatment: broad band and narrow band. Broad-band UVB is more commonly used in the United States; however, narrow-band has been shown in several studies to be very effective at treating psoriasis and is becoming increasingly available. The main difference is the range of UV wavelengths (usually 311-312nm for narrow-band and 290-320nm for broad-band). Both are administered in the doctor’s office, where the patient stands in a lightmbox lined with UVB lamps or an enclosure that contains the lamps. Smaller units are available to treat palms and soles, as well as for home use by prescription. Patients generally receive treatments two to three times per week.

It takes an average of 30 treatments to reach maximum improvements of psoriasis lesions. UVB may be used alone or in combination with topical treatments or systemic medications. Although narrow-band has been shown in several studies to be more effective than broad-band, it does not have the 80-year safety record of broad-band.

I am a 34-year-old woman who has been using clobetasol propionate cream for the past 10 years to treat my guttate psoriasis. I was recently diagnosed as a “glaucoma suspect” and am curious if perhaps there is an association between long-term clobetasol propionate cream use and glaucoma. If there is an association between the two, can you suggest any other medication(s) that I can discuss with my doctor to treat my psoriasis?

Prolonged use of topical steroids around the eyes can result in glaucoma as well as cataracts. Superpotent topical steroids should not be used around the eyes. Psoriasis patients with guttate psoriasis tend to have a very good response to increasing increments of ultraviolet B (UVB) light.
In general, it is impractical to treat patients with moderate to severe psoriasis with topical steroids.

Psoriatic arthritis

I have psoriasis and worry about developing psoriatic arthritis. What symptoms should I look for to detect early arthritis?

Psoriatic arthritis is a type of inflammatory arthritis that affects up to 30 percent of patients with psoriasis. In 70 percent of patients with psoriasis, the skin symptoms appear before the arthritis. Psoriatic arthritis can involve any joint in the body, including the spine, hips, knees, feet and hands. If you have persistent joint pain, swelling, stiffness or loss of motion which lasts more than six weeks, you should see your doctor for an evaluation.

I have psoriasis of the nails. I’ve heard that this is an indicator of psoriatic arthritis. Is that true?

Psoriasis can produce a variety of nail changes, which include pitting, ridging, a buildup of material under the nails (hyperkeratosis) or a lifting of the nail itself (onycholysis). Nail abnormalities are common (20 to 40 percent) in patients who only have psoriasis. However, 60 to 80 percent of psoriatic-arthritis patients–especially those with arthritis involving the joints at ends of the fingers (distal interphalangeal joints or DIP)–will have nail abnormalities too.

I have severe psoriasis and have just been diagnosed with psoriatic arthritis. Are any medications currently prescribed or on the horizon to treat both diseases?

Yes, several of the medications used to treat psoriatic arthritis will also treat psoriasis. Methotrexateis given orally or by injection once a week for both conditions. It is given with folic-acid supplements to minimize side effects. Laboratory tests need to be monitored by your doctor every four to eight weeks. Alcohol must be avoided while taking methotrexate.

The anti-TNF (anti-tumour necrosis factor) biologic medications include Enbrel, Remicade and Humira. These are used to treat both psoriasis and psoriatic arthritis in patients who are not adequately controlled on methotrexate. These biologic therapies decrease the inflammation in the skin and joints, thereby preventing further damage in most patients.

Remember that these medications may suppress your body’s ability to fight infections or heal normally, so it is very important to let your doctor know if you are scheduled for surgery or running a fever or feel sick before you take your next dose.

Psoriasis on specific skin sites

I have some specific questions about how to care for a 12-year-old girl with severe psoriasis. Her scalp is about 80 percent covered. What do you recommend for her treatment?

Topical corticosteroids seem to work very well for scalp psoriasis, if people can find the time to actually put them on. Topical steroids in a solution, shampoo or foam seem to be easiest to use in the scalp.

People with scalp psoriasis should try applying the medication twice a day for one week. It can be hard to find the time to do it and not miss any applications, but with such regular use, most patients will see the psoriasis improve quickly. If it doesn’t start to improve within a week, other things can be added, including salicylic acid or tar shampoos.

Occasionally I have psoriasis flare-ups in the genital area. Should I avoid being intimate with my spouse during these times?

Psoriasis involvement of the genital region can be uncomfortable and embarrassing for both men and women; it should not, however, preclude you from being intimate with your spouse. For men, psoriasis can affect both the penis and scrotum, resulting in chronic discomfort. To limit the irritation and discomfort during intercourse, it may be helpful for the man to wear a condom. This will help serve as a barrier to prevent further trauma and irritation.

Prior to intercourse, it is important to wash all medications from the genital area to avoid transfer of the medications to your partner. After intercourse, it is important to cleanse the area and reapply your medications as directed by your doctor. Psoriasis is not contagious, therefore, you cannot get psoriasis from someone through physical contact.

Co-morbidities

Is risk for skin infections higher in people with psoriasis than in people who don’t have psoriasis?

Psoriasis is characterized by skin cells which have a turnover rate higher than non-psoriatic skin. The bacterial flora associated with plaques of psoriasis is similar to those seen in non-involved skin. So theoretically, there should be no difference in terms of risk of infection.

However studies have shown that skin affected by psoriasis may be more susceptible to certain triggers, such as an increase in itching or scratching, which might lead to a higher incidence of infections in those with psoriasis–especially if there is abrasion of the skin.

Lifestyle

I love to swim but am concerned about chlorine making my psoriasis worse. Is there anything I can do to prevent that?

Swimming is great, and chlorine is actually a great disinfectant. You just have to make sure that you moisturize and/or apply medication as soon as you are done swimming.

How does my weight affect my psoriasis?

A study published in 2009 in the annals of Internal Medicine showed that “increasing adiposity [fat] and weight gain are strong risk factors for psoriasis in women.” In another study, cyclosporine was found to be three times more effective in the study group that lost 5 to 10 percent of their body weight compared with those who did not lose weight. All subjects had a body mass index (BMI) of 30 or greater (obese). The effect of weight loss alone has not yet been studied.

Is it okay to get tattoos when you have psoriasis, and can the dye irritate and cause infection or flare?

In general, reactions to tattoos are uncommon. There are cases of infections or allergic reactions to the dyes. These reactions are not more common in patients with psoriasis. If you would happen to have an abnormal reaction to the tattoo, the psoriasis could flare in this area. If you would not have a reaction to the tattoo, there would be no problem at all. It is just difficult to predict how often these unusual reactions occur. However, tattoos may “Koebnerize,” causing plaques at the site of the tattoo.

I am not overweight, am a regular exerciser and drink green smoothies and eat fruits and vegetables. I am wondering if I there are more drastic measures I could take, such as Gerson Therapy, Optimal health institute, or fasting?

Fasting clears psoriasis for many people, but prolonged fasting is not compatible with life! Take another look at your diet. Do you eat more than one or two servings of grain (bread, rice, oatmeal, cereal, pasta, baked goods) per day? Do you go without eating for more than three hours at a time? Are you eating fewer than three palm-sized servings of concentrated protein foods per day? You may be able to fine-tune your diet.

Journal your diet and your flares of psoriasis; it might help you identify a trigger food. How about lifestyle? Could you be over-exercising? Do you get 7-8 hours of uninterrupted sleep nightly? Do you have a peaceful interval built into your daily routine?

Triggers and causes

My psoriasis tends to get worse during the fall and winter. Why is this, and how can I take care of my skin during the cooler months?

You are not alone. Many patients get worse in cooler months, in part due to the lower humidity, which in turn dries out the skin. Psoriasis can occur in these dry areas.

Good skin care involves using mild soaps and emollients or moisturizers. Apply these agents to damp or wet skin. Additionally, psoriasis is a disease that responds very well to sunlight. Some patients remain clear in summer due in part to sunlight and tend to worsen in winter months. Dermatologists can use phototherapy or ultraviolet B (UVB) or ultraviolet A (UVA) to treat psoriasis.

Is there anything I can do to reduce my chances of having a psoriasis flare?

To reduce the risk of having a psoriasis flare, you need to reduce the triggers associated with psoriatic flares. These include skin injury; infections such as strep throat; and certain medicines such as lithium, beta-blockers, antimalarials, and some nonsteroidal anti-inflammatory drugs (NSAIDs).

Emotional stress may be a trigger for some individuals. While most patients find benefit with sunlight, a small percentage will actually flare when their psoriasis is exposed to the sun.

Do food allergies play a role in psoriasis?

This is an area of controversy. Even the definition of “allergy” versus “sensitivity” raises questions. In the case of gluten sensitivity, I think the answer is, “yes, for some people.” Other foods have not been studied. Most dermatologists advise that you avoid foods that seem to worsen your psoriasis, but this advice is not based on any scientific studies.