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Thanks everyone for joining us! I am looking forward to your questions.
Let’s start with some questions from readers.
Great question. Unfortunately, people don’t grow out of psoriasis (it is common with eczema, but not psoriasis). Generally, psoriasis is considered an ongoing, life-long condition. There may be times over the years when it’s better or worse, sometimes due to certain triggers like the season, climate where you live, stress levels, and sometimes for no reason we understand, but I have never encountered a patient who slowly grew out of psoriasis over the years.
Hi, Kevin. Unfortunately there is no cure for psoriasis, but you can try using tar solution topically (two brands are Psorent and MG217) and sunlight (start with 15 minutes a day without sunblock and increase by 5 minutes every day.)
High humidity environments (like a steam room) and using a fragrance-free moisturizer may help soften scale and the skin, but saunas and other spa treatments are unlikely to make a big difference. Exfoliation can sometimes temporarily clear off some of the scales, but also can inflame the skin and make it redder. Regular exercise and maintaining a healthy weight help psoriasis. Not only do they help the skin, they also can protect the joints and defend against some of the conditions associated with more severe psoriasis, like diabetes and heart disease.
Hi, Sol. It is very important for a pregnant woman to check with her obstetrician to see which medications are permissible. Some obs allow medications to be used in the third trimester that they would not allow in the first trimester.
Yes, a lot of research is being done about the causes of psoriasis. Possible underlying causes include genetics, environmental exposures, and changes in skin bacteria. The leader in this regard in the National Psoriasis Foundation (www.psoriasis.org) which gives grants to scientists in many fields studying psoriasis. On the government side, the National Institutes of Health (NIH) also provide funding for studying psoriasis and psoriatic arthritis. Many years of this type of research has helped us understand that psoriasis starts with the immune system attacking the skin when it shouldn’t, which is the basis for many of the new treatments that have become available in the last few years.
Hi, Terence. The first thing to try is moisturizers to try to reduce the scale. You can also get an over-the-counter tar preparation, such as MG-217 or Psorent. Apply to the skin and keep on over night. Sun exposure can help as well. 15 minutes on the first day, and increase by 5 minutes a day. Even better, go to the beach! Avoid sunburn though-it can make the psoriasis worse. As far as diet goes, 16% of psoriasis patients will respond to a gluten-free diet, and some people believe that the “anti-inflammatory” diet helps. There are several versions of this that you can find on Google.
An excellent question and, yes, there is clear evidence that patients with psoriasis are at increased risk for obesity, heart disease, stroke, and diabetes. There is more research to be done to understand these connections, but it does seem likely that inflammation in the body is the cause of both. Another important question is whether treating the psoriasis may improve the risks of these other conditions. Although this research is only in the early stages, it does seem that treatment with certain medications (TNF alpha inhibitors) does decrease the risk of heart attack. If you have psoriasis, it is important to talk to your doctor about monitoring your weight, blood pressure, and cholesterol. You should also not smoke and avoid heavy drinking.
When used correctly, topical steroids are safe to use over many years. The most common side effects are on the skin, if overused they can cause thinning of the skin, stretch marks, and broken blood vessels. This is more likely with very strong steroids or when used on thin skin, like the face, underarms, or genitals. Taking regular breaks from use (like using for two weeks and then taking a one week break) can help reduce these risks.
When steroid creams are used in small children or over large areas of the body, they can be absorbed significantly into the bloodstream. Although rare, this situation can be more dangerous.
I’m a big believer in phototherapy. We use a type of light called “narrow band UVB” (not the same light that is used in tanning beds). It is safe and effective and research has shown that it does not lead to an increased risk of skin cancer. The only “con” is that it requires visits to a doctor’s office 2-3 times a week.
Eczema and psoriasis can sometimes be difficult to tell apart. Seeing a board-certified dermatologist is the best way to make sure you have the right diagnosis and treatment plan.
Although there are no certain rules, eczema tends to start in childhood on the folds of the elbows and behind the knees. It is very itchy and sometimes gets infected. Many children grow out of it but not everyone.
Psoriasis can start at any age but most commonly begins around age 20 or 50. It most commonly comes on the scalp, elbows, knees, and lower back with pink areas with thick scale. Although it can itch, it does not always.
Fingernail psoriasis is extremely difficult to treat. Doctors use topical cortisone and sometimes injections of cortisone into the nail matrix, which is near the cuticle. Systemic treatment, such as with biologics, will also treat nails.
A great question. About 30% of people with psoriasis get psoriatic arthritis. The arthritis can start years before or after the skin disease. Psoriatic arthritis is pain in the joints (especially the hands, feet, and lower back) in a patient with psoriasis on the skin. There is often stiffness in the morning or after sitting for a long time. There are many treatments available for psoriatic arthritis, which is important since it can cause permanent damage to the joints if not controlled.
Hi, Jackie. I like the idea of the coconut oil to remove the scales. Apply at night and then put a shower cap on her. In the morning, apply dandruff shampoo (selenium sulfide, zinc pyrithione, or tar) to dry hair, let it sit for 10-20 minutes, then wash the hair as normal.
Thanks for your question, Kermit. Oxipor is still available over-the-counter from online retailers like Amazon or Walgreens. Compounding pharmacies can mix up specific combinations of treatments, including tar. Sometimes that is helpful if you need it to be stronger or weaker than what is available commercially.
Psoriasis is an inflammatory disease in which there is an increase in blood flow to the skin. With large areas of involvement, you can get chills and feel feverish. You should get a thermometer and see if you actually are having fever. If your temperature is above 100 degrees, see your doctor to make sure that you don’t have an infection.
Certain drugs can definitely make psoriasis worse, including beta-blockers (like atenolol or metoprolol), lithium (for bipolar disorder), and indomethacin (for pain). Since all of these medications treat serious illnesses, it is critical to never stop taking a medication without consulting your doctor first. You should not have to choose between blood pressure control and worsening psoriasis, many classes of blood pressure treatment are available that do not worsen psoriasis. For some patients with serious heart disease who must take atenolol, consulting with a board-certified dermatologist to help keep the psoriasis under control is important.
We are not sure how diet influences psoriasis. Some people believe that avoiding certain foods, such as gluten and alcohol, can help psoriasis. You might want to look into the “anti-inflammatory” diet.
Thanks for the question, Tammy. Otezla is a new medication for psoriasis and psoriatic arthritis. It is a pill taken twice a day. Stomach upset is common in the first two months of taking it and often fades away after that. Eating ginger (crystallized or candied ginger) can help. If the problem is severe or does not improve after 2-3 months, consult with your dermatologist to see if you should consider another medication. In the original studies, about 40% of patients on Otezla got substantially better taking it and it seems they mostly improved bit by bit over time.
Hi, Pauline. There is no specific exercise that benefits psoriasis, but most skin diseases are aggravated by stress and exercise in general is a great stress reliever. Exercise is also therapeutic for arthritic joints.
Psoriasis is not contagious in any way.