If you're dealing with psoriasis, take heart in knowing that you're not alone. According to the National Psoriasis Foundation, more than 125 million people worldwide—that's anywhere from 2% to 3% OF THE ENTIRE POPULATION—suffer from the condition. Heck, even Kim Kardashian has been open about her psoriasis struggles. Point being, a lot of people have it. The less than great news is that it's a chronic condition, with no known cure. If you have psoriasis, you have it for life. But there are lots of ways you can treat and manage the symptoms and keep flare-ups at bay. Ahead, Dr. Dhaval G. Bhanusali, MD, a board-certified dermatologist at Hudson Dermatology & Laser in New York City, and Dr. Orit Markowitz, MD, a board-certified dermatologist in New York City, explain what psoriasis is, what causes it, and most importantly, what you can do about it.
What Is Psoriasis and What Causes It?
"Psoriasis is an inflammatory, autoimmune disease in which your own immune system attacks your body," explains Markowitz. It's most often thought of as a skin condition; increased inflammatory markers in the body cause the body to attack the skin, which leads to a breakdown in the skin barrier. The skin reacts by forming red, flaky scales, she explains. Because it's an autoimmune disease, the body continues to fight back, which only exacerbates the issues, she adds. Bhanusali notes that there's also thought to be a disorder in immune regulation at play, which leads to new skin cells being produced faster than dead skin cells are removed, hence the flakiness and scale. It's also worth pointing out that psoriasis is a systemic condition that can trigger inflammation not only on the surface of the skin but also systemically, where it can cause increased joint pain and even GI issues, he says. "Often patients with very mild skin symptoms can have more severe systemic symptoms and vice versa," he explains.
Internal issues aside, there are a few different types of psoriasis and ways that it manifests on the skin. The red, scaly, inflamed patches (which can also be itchy) we're talking about are known as plaque psoriasis, the most common kind. They typically show up on the elbows, knees, and scalp, though it can also crop up on other parts of the body, says Bhanusali. There's also inverse psoriasis, which shows up as bright areas of red, shiny, inflamed skin, usually under the armpits, breasts, or in the groin, explains Markowitz. "Lastly, there's also pustular psoriasis, which looks like white, little pimples surrounded by broad areas of red skin," she adds.
Who Is Most Likely to Have Psoriasis?
"While anyone can get psoriasis, the research has shown that it's most common in Caucasian skin and, while it can happen at any age, most commonly presents between the ages of 15–25, though it's still unclear why," says Markowitz. It's also believed to be more common in females, though some literature shows it may be less severe, adds Bhanusali.
What we do know is that it's most definitely genetic. "Like most chronic diseases, psoriasis does have a genetic component. If both parents have it, their child has at least a 50% chance of developing the disease," says Markowitz. Bhanusali agrees, noting that it definitely runs in families: "Almost all of my psoriasis patients have someone else in their family who also has it," he says.
What Causes Psoriasis Flares?
Here's the thing—while psoriasis is a chronic, lifelong condition with no known treatment, it's really only an issue (at least as it pertains to skin) when it flares up. "Some people have flares constantly, while others may only see a flare once every few years," Bhanusali explains. When flares do happen, they can last for days, weeks, or even longer, so the best plan of attack is to try to keep those flares at bay as much as possible. As the saying goes, the best offense is a good defense. "With good management, your flare-ups can go away and stay away," notes Markowitz.
As is the case with other chronic conditions such as eczema and rosacea, there are many different things that may trigger a psoriasis flare, and this is largely dependent on the individual. Determining what your particular triggers are is paramount. "Anything that can cause stress on the skin, a drastic change in temperature or tight clothing, or anything that can irritate the skin—certain skincare ingredients, rough fabrics—can cause a psoriasis flare-up," explains Markowitz. (To that point, psoriasis tends to be worse in the colder, drier months.) Other lifestyle factors and habits play a role, too. "Anything that can lower someone's immunity, like stress or a poor diet, is going to worsen a chronic disease, psoriasis included," she adds. Bhanusali agrees, noting that he attributes the uptick in psoriasis cases he's seen since the COVID-19 pandemic to increased stress.
What Are the Best Psoriasis Treatments?
It's more than likely there will have to be a prescription involved. The good news is there are many medications that can help, ranging from topical steroids to oral immunosuppressants. As far as general things you can do at home, both doctors we spoke with agree that moisturization is the name of the game. "It's a great way to improve symptoms, particularly itchiness and scale," says Bhanusali. Markowitz adds that you want to opt for a super-thick, rich moisturizer or ointment, something very occlusive that will help seal and protect the skin barrier that's been broken down due to the psoriasis. What you don't want to do is try to scrub off excess scale and flaking. "Many psoriatic patients are tempted to use scrubs, but this will only further damage their already compromised skin and possibly cause further flare-ups," warns Markowitz.
When it comes to warding off flares, there are other lifestyle changes that can help. To the point of psoriasis being worse in the winter, Markowitz notes that tropical environments can be very beneficial. The humidity helps keep moisture on the skin, and some people see an improvement when their psoriasis is exposed to sunlight (though she cautions that wearing sunscreen is still a must, of course). Swimming in salt water can also help slough off dead skin cells, improving the look of psoriasis patches, she adds. In other words, consider this another excuse to book a trip to the islands. Making sure you're exposing your skin to only soft, non-scratchy fabrics, in both bedding and clothing, can also be helpful for many patients, Markowitz points out.
The bottom line: There's no getting rid of psoriasis, but if you're one of the millions of people who has it, there are plenty of different ways that you can manage it and keep it under control.
National Psoriasis Foundation. Psoriasis Statistics. Updated October 8, 2020.
Cleveland Clinic. Psoriasis. Updated October 17, 2020.