Psoriasis is a chronic, recurring, non-contagious skin disorder that is characterized by raised, thickened reddish patches on the skin covered with silvery-white scales that may vary in severity and affect any part of the body, including the nails, scalp and the genital region. There are about 125 million psoriasis sufferers world wide. This makes up 3% of the world’s total population! It is estimated that six to seven million Americans have psoriasis, and each year 150,000 to 260,000 new cases are diagnosed.
The incidence of psoriasis is much lower in dark-skinned West Africans and African-Americans than in light-skinned persons of European origin. Incidence is also low in the Eskimos and the Japanese, and is extremely rare in Native Americans. Genetic, geographic and environmental factors may play a major role in this striking disparity between the races.
Most psoriasis patients undergo intense emotional turmoil while they fight to control their disease which tends to have periods of flare ups and remissions the year around. Though no cure has yet been discovered, observing certain principles in life style and skin care management will provide patients a scope for optimum control of the disease. Following are a few tips that would be useful for the psoriasis sufferers:
1. Maintain desirable health habits. Psoriasis flare ups are common when you are weak or tired. Taking a balanced diet while reducing red meats and alcohol will go a long way in helping the skin to maintain a calm milieu interior. Patients should also drink plenty of water and get at least 7-8 hours of uninterrupted sleep every day. Do moderate exercises at least 3-4 times every week.
Remember that good nutrition, rest and exercise tune up your body and mind and keep up the equilibrium which is essential to reduce the psoriasis flare ups. These healthy habits will also reduce the chances of contracting infection, another important factor in psoriasis aggravations.
I always remind my patients that medications have only about 30% role in the management of psoriasis. Rest of the 70% involves lifestyle adjustments.
2. Quit Smoking. Many studies have pointed out that pustular psoriasis of the palms and soles, a variant of psoriasis, is aggravated by smoking. Patients who quit smoking found their lesions clearing up faster. Research also suggests that severity of psoriasis may be linked to smoking. Hence it is highly imperative that you totally give up smoking if you want to get rid of those itchy, scaly, red patches.
3. Avoid alcohol. Alcohol is a trigger for psoriasis. There is no doubt about it. Though some dermatologists allow moderate consumption of alcohol in psoriasis, it is my personal observation that even a small quantity of alcohol (like a glass of wine or beer) does cause flare ups in patients. Hence the verdict is – No Alcohol in any forms!
4. Learn to manage your stress. Stress has long been linked to the induction and exacerbation of all types of psoriasis. As mentioned above, psoriasis can be considered a life style disease (much like hypertension or increased blood pressure), a combination of genetic predisposition and psycho- neuro-immuno-hormonal triggers playing a significant role in the causation, initial triggering and maintenance of the disease.
Psoriatics should try to learn and master any one of the stress management techniques like progressive relaxation, biofeedback, yoga etc. Counselling sessions and psoriasis support group participations will be beneficial for those who find it difficult to relax by themselves. According to the National Psoriasis Foundation, stress reduction works best when combined with appropriate medical treatment.
5. Avoid aggravating medications. Certain medications taken for other diseases can aggravate or even precipitate psoriasis. Medications that can trigger psoriasis are:
Anti-malarial drugs like chloroquine
Beta-blockers (medication used to treat high blood pressure) and heart medication.
Corticosteroids. Steroids are double edged swords. They can control severe psoriasis quickly, but sudden withdrawal can cause severe flare ups. Personally I avoid prescribing steroids to my patients unless it is absolutely necessary, that is, psoriasis is severely compromising their quality of life. Only after exhausting other treatment modalities do I take up this group of medications and most patients would do well to steer clear of steroids as a first line of treatment for psoriasis. Even topical steroids should be used very carefully and under medical supervision in psoriasis.
Non-steroidal anti-inflammatory drugs like indomethacin worsen psoriasis in most patients.
Lithium , the antipsychotic drug is a known aggravator of psoriasis.
If you have a family history of psoriasis or you are suffering from the disease, inform your physician if you are taking any of the above drugs. Your doctor may be able to substitute alternate medication.
6. Avoid Scratching, rubbing and picking at the lesions. Any injury to the skin in both involved and uninvolved areas can produce new psoriasis lesions by irritating the basal layer of the skin and switching on the spurting action of the epidermal cells. Research shows that about 50% of people with psoriasis experience the ‘Koebner phenomenon’ – developing a psoriatic lesion at the site of a skin injury. Hence patients should carefully avoid any direct injury to the skin. Scrubbing to remove the scales is a mistake, as this can worsen the disease.
7. Treat any infectious foci at the earliest. Studies show that some infections can trigger psoriasis. Streptococcal throat infections often precedes an outbreak of guttate psoriasis(small drop like lesions), especially in children. Inverse or flexural psoriasis is frequently aggravated by a candidal infection in the folds. Severe generalized psoriasis recalcitrant to treatment is seen in immunodeficient conditions like HIV infection. Treating the infection lessens or clears the psoriasis in most cases. Also look for signs of any infectious foci in your mouth(dental caries), throat(tonsillitis), sinusitis, gall bladder(cholecystitis), urinary bladder(cystitis) etc. Finding and treating these infections could give much better control over your psoriasis status.
8. Treat the disease before it worsens. Most effective way to stop the itching and appearance of new lesions in psoriasis is to treat the psoriasis properly as soon as the lesions appear. Consult your dermatologist at the earliest sign of a break out.
9. Take good care of your skin. Keeping the skin moist and supple is of paramount importance in psoriasis. Any dryness will increase the scaling, flaking and itching which will further aggravate the condition.
Soak in a luke-warm oatmeal bath. This relieves itching and hydrates the skin layers.
Pat your skin dry; do not rub or scrub. See tip number 6 above. Developing a habit of gently patting your skin dry is advisable.
Apply emollients and moisturizers. Emollients soften the skin. Moisturizers lock in the skin’s own moisture to prevent dryness and cracking. One of the best ways to lock in moisture is to apply moisturizer after bathing. Regular use of moisturizers can help prevent the itch and pain of dry skin and reduce scaling and inflammation. A urea containing lotion is preferred during the day and a cream or ointment(if you don’t mind a little messiness) at night to maintain the hydration of the epidermal layers.
Use sunscreen. Patients using retinoids should apply sunscreen 15 to 20 minutes before going outdoors and wear protective clothing. Sun exposure can cause sunburn, which can in turn trigger psoriasis. But complete avoidance of sun can cause more harm than good. A moderate supply of UV rays is indeed good for clearing up of the psoriatic lesions!
Wear cotton clothing .Synthetics will irritate and heat up the skin and worsen psoriasis and are best avoided. If you have to wear them, wear thick cotton undergarments beneath.
Look out for winter worsening: Cold, dry weather worsens psoriasis. Emollient creams and ointments should be used copiously during winter months. Before application of the moisturizer, remember to moist the skin with luke warm water. The use of humidifiers, both at home and work, can add moisture to the air in winter months and help in avoiding exacerbations. Remember that air-conditioning can dry out the skin and aggravate psoriasis just like winter! Keeping the AC to minimum required coolness and regular application of moisturizing creams can overcome this problem.
10. Learn to live with Psoriasis. While there is no permanent cure, psoriasis can be successfully managed so that one experiences more good days than bad. Numerous treatment options are available, and recent advances are revolutionizing the management and care of psoriasis. No single treatment will be effective for all patients. Hence a dermatologist will consider a patient’s overall health, age, lifestyle, and the severity of the psoriasis and then decide on a treatment option that will achieve maximum effectiveness.
Psoriasis patients will do well to keep a positive mental attitude towards life and its happenings. Remember, any negative signal from the mind is an instant trigger for psoriasis!
Psoriasis, though quite a common disease, has not received the attention it deserves from the health authorities in most countries. As a result, the much needed awareness campaigns and funding of research projects have been lagging behind for decades. It was in this context that in 2004 the first World Psoriasis day was launched. Conceived by patients for patients, World Psoriasis Day is a truly global event that sets out to give an international voice to the 125 million psoriasis sufferers.