Managing Psoriasis: From Triggers to Treatments

Psoriasis is among the most common skin conditions. Psoriasis appears as reddish patches of skin covered with silvery scales that tend to itch, burn, and hurt. It can appear almost anywhere on the body, depending on the type.

Plaque psoriasis

This is the most common type marked by patches on the trunk and limbs, especially the elbows and knees, and on the scalp. 

Inverse psoriasis

This is a plaque type of psoriasis that tends to affect skin creases such as those under the arm, around the groin, and buttocks, or under the breast. The red patches may be moist rather than scaling.

Pustular psoriasis

This is white bumps filled with pus near or inside red skin blotches. They can hurt and be scaly, flaky, or itchy. It’s most likely to affect the palms of your hands, soles of your feet, and fingers and toes.

Guttate psoriasis

This is a type of psoriasis that shows up on your skin as red, scaly, small, teardrop-shaped spots. It doesn’t normally leave a scar.

Erythrodermic psoriasis

This is a severe type of psoriasis that affects a large area (more than 90%) of your skin. It causes widespread skin discoloration and skin shedding.

 Sebopsoriasis

This type typically appears on your face and scalp as bumps and plaques with a greasy, yellow scale. This is a cross between psoriasis and seborrheic dermatitis.
Nail psoriasis

This causes skin discoloration, pitting and changes to your fingernails and toenails.

Causes and Triggers

Psoriasis happens when the immune system makes certain areas of your skin produce new cells too quickly, causing thick, scaly patches. The exact cause is unknown, but it’s believed that most people with psoriasis inherit specific genes that affect the immune system, making them more likely to get the condition. But it is not enough to have a genetic connection. Flare-ups usually happen when triggers, like stress, start the psoriasis. Stress causes the body to release chemicals that increase inflammation, which is thought to lead to psoriasis flare-ups.

Treatment Options

Several treatment options can relieve psoriasis symptoms. Common psoriasis treatments include:

  • Steroid creams.
  • Moisturizers for dry skin.
  • Medicated lotions or shampoos.
  • Vitamin D3 ointment.
  • Vitamin A or retinoid creams.

If your symptoms of psoriasis don’t improve after treatment, or if you have large areas of involvement (10% of your skin or more), your healthcare provider may recommend the following treatments:

Light therapy: LED lights at specific wavelengths can decrease skin inflammation and help slow your skin cell production.

PUVA: This treatment combines a medication called psoralen with exposure to a special form of ultraviolet light.

Retinoids: These vitamin A-related drugs can help your psoriasis symptoms but may cause side effects, including birth defects.

Immune therapies: Newer immunotherapy medications (biologics and small molecule inhibitors) work by blocking your body’s immune system so it can’t cause an autoimmune reaction.

Methotrexate: Providers recommend this medication for severe cases of psoriasis. It may cause liver disease. If you take it, your provider will monitor your progress with blood tests. You may need periodic liver biopsies to check your liver health.

Cyclosporine: This medicine can help severe psoriasis but it may cause high blood pressure and kidney damage.

Consultation with a Dermatologist

Dr. Riza Milante, a board-certified dermatologist and dermatopathologist, explains that although psoriasis can be challenging for both patients and their family members, it is manageable with lifestyle choices and medication. Please consult your board-certified dermatologist to determine the best treatment option for you.

References:

Cleveland Clinic (n.d.). Psoriasis.  Retrieved from: https://my.clevelandclinic.org/health/diseases/6866-psoriasis

Holland, K (2022). Everything You Need to Know About Psoriasis. Retrieved from: https://www.healthline.com/health/psoriasis

Morgan, K. (2024). Pustular Psoriasis: What to Know. Retrieved from: https://www.webmd.com/skin-problems-and-treatments/psoriasis/pustular-psoriasis

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