Mental Stress and Its Effects on Vascular Health

Psoriasis: Symptoms, Causes And Treatments

Treatments for psoriasis fall into four categories: topicals, phototherapy, systemics and complementary or integrative medicine, according to the NPF. The choice of therapy depends on the severity of the disease, says Dr. Green.

Topical treatments are creams applied directly to the affected area, slowing the rapid production of skin cells and reducing inflammation. The most common topical medications are topical steroids, which contain an anti-inflammatory ingredient to heal swelling and redness and usually require a prescription from your doctor. However, topical steroids can't be used in some areas because they may cause side effects like bruising, pigmentation and redness.

In 2022, the U.S. Food and Drug Administration (FDA) approved a new, nonsteroidal topical cream for adults for the first time in 25 years called tapinarof. "Patients can use this treatment from head to toe without any limitations, which is great for those who have mild to moderate psoriasis," says Dr. Green.

The FDA has also approved several over-the-counter (OTC) topical treatments for psoriasis, such as lotions, shampoos, tars and bath foams that often contain coal tar and salicylic acid.

Phototherapy is a type of light therapy that a dermatologist may prescribe if topical treatments are ineffective. This therapy involves regularly exposing the skin to ultraviolet (UV) light—, particularly UVB light. UVB rays are found in natural sunlight and slow the growth of skin cells.

There are several types of phototherapy, and it's most effective when patients receive therapy at least two to five times a week for several weeks, according to the AAD. Phototherapy is not prescribed for patients with skin cancer or in the case of any condition or medication that makes them more sensitive to UV light.

Systemic treatments are prescription drugs taken orally or through an injection or infusion and are usually prescribed when topicals and phototherapy are unsuccessful. These drugs, known as biologics or biosimilars, work throughout the body to target specific molecules inside immune cells and correct the overactive immune response causing psoriasis flares.

Biologics and biosimilars include medicines that come from live organisms, including animal cells and microorganisms like yeast and bacteria. Both treatments are highly regulated by the FDA and deemed by the organization to be safe and effective.

Can You Prevent Psoriasis Flares?

"The best way to prevent psoriasis flares is to follow your dermatologist's treatment recommendations, moisturize well and avoid trauma to the skin. Lowering stress can also help," says Dr. Stevenson.

The AAD suggests practicing stress-relieving activities, such as yoga, meditation and attending support groups. Lifestyle changes like reducing alcohol consumption, quitting smoking, avoiding skin exposure to dry, cold weather, treating infections and avoiding cutting yourself while shaving can also help prevent flares. Dietary considerations, such as increasing fruits and vegetables and avoiding foods that are high in fat, sugars, sodium and meat as well as limiting processed foods, may play an important role in minimizing psoriasis symptoms, according to an article in Immunity .

What is the Best Medication for Psoriasis?

The best medication for psoriasis will depend on your unique experience, such as the type and severity of symptoms. As mentioned above, topicals, phototherapy and systemic treatments are used, with a combination of these treatments typically providing the most promising results.

For the best possible outcome, it's important to regularly visit with your general practitioner or a dermatologist to manage symptoms.

Do Home Remedies Work for Psoriasis?

In addition to prescription treatments, the AAD notes that OTC products, shampoos, creams, ointments and bath solutions for psoriasis containing the active ingredient coal tar may reduce symptoms of psoriasis and slow the growth of skin cells. Mild corticosteroids or hydrocortisone can also assist in decreasing itch and inflammation. However, either should first be tested on a small area of the skin before using regularly, as skin irritation is possible.

Other OTC solutions, like scale softeners with salicylic acid, can remove and soften scales, as well as reduce swelling. Anti-itch products containing ingredients like calamine or menthol may also assist with treatment.

Dermatologists also recommend using cold compresses and moisturizing the skin every day to help alleviate itching, in addition to taking medication and applying ointments and creams as directed.

Psoriasis : What Is It & Treatments

© Provided by Getty Images Psoriasis

Overview

A chronic skin disease which results in scaly, often itchy areas in patches.

Symptoms

Raised patches of skin, which are red, burn or itchy, and covered with white or silver scales.

What are people curious about? Severe psoriasis symptoms Psoriasis arthritis treatment medication Scalp psoriasis treatment Psoriasis types

Causes

Psoriasis is said to result from abnormal immune reaction which causes rapid buildup of skin cells. This forms scaly patches on the skin surface.

Diagnosis

The diagnosis of psoriasis is mainly based on obtaining information from the patients.

→ Common treatment options

→ How is this diagnosed?

Highlights

Treatments can help manage condition, no known cure

Diagnosed by medical professional

Often requires lab test or imaging

Common for ages 18-35

Family history may increase likelihood

Urgent medical attention recommended in severe cases

Medications

Psoralens: Are used in combination with light therapy.

Methoxsalen

Immunosuppressants: Reduce inflammation by reducing the strength of the body's immune system.

Methotrexate

Biologics: Reduce inflammation by suppressing the immune system

Etanercept . Ustekinumab . Secukinumab

Topical retinoids: Reduce inflammation.

Tazarotene

Vitamin D analogues: To slow skin cell growth.

Calcipotriene

Calcineurin inhibitors: Reduce inflammation and plaque buildup.

Tacrolimus . Pimecrolimus

→ Do you have a health question on your mind for psoriasis? Ask professionals from across the world

→ Interested to know more? Check out the full article here

For informational purposes only. Consult a medical professional for advice. Source: Focus Medica.

How To Manage Psoriasis As You Age

Cosmetic Products and Procedures for Aging

Retinol (a derivative of vitamin A) is one of the most common ingredients in skin aging treatments. Research shows it may indeed be effective at combating fine lines associated with natural aging, likely because it helps the skin retain water and boosts collagen production. Retinol is also used to treat psoriasis by slowing rapidly growing skin and decreasing scales.

A number of retinols, both topical and oral, are approved by the U.S. Food and Drug Administration (FDA) for the treatment of psoriasis. Just be sure to talk to your doctor before using an over-the-counter retinol cream. "It's a balance, because it might be a little irritating," says Unwala. Follow your doctor's instructions for applying any new product or medication to your skin. You may need to test the product out a couple of times per day first on a small patch of skin for four or five days.

Avoid harsh exfoliating products, such as loofahs, body beads, and motorized brushes, to scrub off dead skin. "That would be traumatizing for active areas of psoriasis," says Unwala. Traumatizing active psoriasis can not only worsen symptoms but also possibly lead to secondary bacterial infection. Instead of harsh or exfoliating products, opt for gentle, fragrance-free, nonsoap cleansers, which won't irritate sensitive skin. Cleansers and moisturizers with coal tar and salicylic acid, in particular, may help when you're having a psoriasis flare.

Other anti-aging treatments, such as Botox and face-lifts, are generally safe for people with psoriasis. Just be careful with laser treatments, microneedling, or microdermabrasion. These induce very targeted damage to promote wound healing and strengthening of the skin, and any damage to the skin can worsen psoriasis lesions. "You want to have your psoriasis under good control before getting any of these treatments," says Unwala.

Managing Psoriasis and Hair Changes With Age

You may want to color your hair — possibly for the first time — as you notice your first grays. Be sure your psoriasis is under control before you hit the salon. "In general, we recommend not doing any chemical procedures on your hair when you have active psoriasis," says Unwala.

If you're not currently experiencing a psoriasis flare, getting your hair colored is usually considered safe. Just be sure to tell your stylist if you feel burning or pain. Also try to avoid braids or extensions, which pull on the hair and irritate the scalp. "If hair is too tight, it can make psoriasis worse, because trauma worsens psoriasis," says Unwala.

The Link Between Psoriasis and Health Conditions With Age

Skin and hair changes aren't the only things you should be aware of as you get older. "There's a strong connection between psoriasis and internal health," says Unwala. Having psoriasis may put you at higher risk of certain health conditions that are more common with age.

Metabolic syndrome and heart disease

According to a review published in 2018, numerous studies have strongly linked psoriasis to metabolic syndrome, a collection of conditions that includes abdominal obesity, high blood pressure, high cholesterol, type 2 diabetes, insulin resistance, and nonalcoholic fatty liver disease. The risk of being diagnosed with metabolic syndrome increases with age, and having it ups the risk of heart disease, according to another study from 2018.

"We can consider [psoriasis] as a risk factor for heart disease, just as we think of family history, smoking, and gender as risk factors," says Unwala. Metabolic syndrome, she explains, involves inflammation in the bloodstream, and psoriasis is an inflammatory disease. Certain drugs used to treat metabolic syndrome, including blood pressure medications, may also trigger psoriasis flares.

The good news is that treating psoriasis can help reduce your risk of heart disease. "Treatment of skin results in overall improvement of health, which is especially important for an older population at higher risk of heart disease," says Unwala. Making lifestyle changes, such as eating a healthy diet and exercising regularly, can also help keep your heart healthy and lower your risk of metabolic syndrome.

Osteoporosis

A study published in 2019 linked psoriatic conditions to lower bone mineral density, which can lead to bone loss and osteoporosis later in life. Having metabolic syndrome further increases the risk of osteoporosis, according to a study from 2016. To help reduce this risk, the Bone Health & Osteoporosis Foundation recommends getting plenty of calcium and vitamin D and performing weight-bearing exercises.

Depression

Psoriasis also has a strong connection to depression, according to the National Psoriasis Foundation (NPF). Depression is a common — but not normal — part of getting older, whether or not you've been diagnosed with psoriasis.

There are many effective treatments for depression, so be sure to tell your doctor about any signs of depression you've experienced. These may include persistent feelings of sadness, hopelessness, or worthlessness; loss of interest in your favorite activities; difficulty sleeping or concentrating; irritability; and changes in appetite or weight.

Psoriatic arthritis

Psoriatic arthritis is an inflammatory condition involving joint pain and stiffness that affects about 30 percent of people who have psoriasis, according to the NPF. Although it typically begins between the ages of 30 and 50, it can be diagnosed at any age.

Keep in mind that there are many causes of joint pain with age beyond psoriatic arthritis, and treatments vary depending on the kind of arthritis you have. "You often need a specialist to determine what type of arthritis you have," says Unwala.

How Menopause May Affect Psoriasis

Menopause is defined as going a full year without having a period. It usually happens in your late 40s to early 50s, with symptoms of perimenopause beginning up to 14 years earlier.

During perimenopause, estrogen, progesterone, and testosterone levels gradually decline, leading to potentially exhausting symptoms, such as hot flashes and night sweats. This period of time can also be stressful in general, as you may struggle to care for children and aging parents while taking on new responsibilities at work. And stress is a known trigger of psoriasis flares. All of these factors have an effect on overall health and may increase the risk of conditions that are separately linked to psoriasis, including osteoporosis, mood changes, and heart disease.

You may also find that you have more psoriasis flares around the time you go through menopause. "It is possible that hormonal changes of menopause can contribute to psoriasis," says Unwala.

Staying Healthy As You Age

A few steps can help reduce your risk of osteoporosis, depression, and heart disease as you age. First and foremost, maintain a healthy diet. That means focusing on fresh vegetables, fruits, whole grains, fish, and lean meat and dairy, while limiting processed foods, sodium, and added sugar. The National Institute on Aging recommends consuming 1,000 to 1,200 milligrams of calcium every day, depending on your age and sex, to build bone strength. Talk to your doctor or a registered dietitian to see what's right for you.

Exercise also helps keep your bones and heart strong, reducing the risk of both osteoporosis and heart disease. Staying active additionally reduces the risk of depression, especially if you choose an activity that involves a lot of socializing, such as tennis or a swim class. As a bonus, exercise reduces the risk of dementia and supports cognitive function with age, including memory, comprehension, and problem-solving skills.

Lastly, be sure to discuss not just your skin but also your whole physical and mental health with your dermatologist. Let your doctor know if you're struggling to maintain a healthy diet, stay active, or quit smoking. "A lot of people don't realize they're at risk and may have gone many years without seeing a general practitioner," says Unwala. "We feel that one of our roles is to make those connections for people."

Adjusting Your Psoriasis Treatment Plan With Age

Many medications to treat psoriasis are considered safe as you get older, including corticosteroids, vitamin D analogues, tazarotene (Tazorac), acitretin (Soriatane), apremilast (Otezla), methotrexate (Trexall), and some biologics. Your doctor may be more cautious with topical steroids though, because both aging and topical steroids cause the skin to thin. Let your doctor know if your skin appears more transparent (which can signal thinning) or if it bruises easier, has purple spots, or has visible blood vessels.

Most importantly, make sure your dermatologist knows about every medication you're taking and any other diagnoses you've received. Some psoriasis medications aren't safe for people with liver disease, kidney disease, or heart failure, all of which are more common in people over 65. Other medications, including biologics, may not be appropriate if you have certain infections, including hepatitis B, which is more common in older adults who were born before a hepatitis B vaccination existed.

Cancer is also more common with age. It's important to let your doctor know if you've been diagnosed with any kind of cancer. "Your dermatologist needs to know, because it will affect treatments for psoriasis," says Unwala.

While your treatment may change as you age, it's important to keep in mind that psoriasis treatments have very likely improved drastically since you were first diagnosed. "The vast majority of people we treat have skin that's close to clear on some of these medications," says Unwala. "We have really effective tools now. It's a new world for psoriasis treatments, and it's very exciting."

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