I just got diagnosed with psoriasis. What should I know?
The first thing to know is that the science behind psoriasis has come a long way and is improving every day! While a diagnosis used to feel a bit doomsday-ish, most psoriasis cases are now very well managed and impressive clarity is no longer a rarity. Read on for a more detailed understanding of the condition and its care.
What Is Psoriasis?
Psoriasis is an immunologic condition of:
- Recurring, often scaly, thick and red patches in the skin;
- Nail changes, and
- Thick patches in the scalp.
The condition can affect 10% of the body, in mild cases, to 20% or more of the body in severe cases (which can also come with mild to debilitating arthritis). As unnerving as the skin lesions can be, they are NOT infectious or contagious. In fact, psoriasis is just a form of allergy, much like a contact dermatitis or eczema.
Stress is a big trigger and people with psoriasis can feel stressed or depressed about their appearance, how they are treated, the daily medications and products they have to spend time on, and the expense of therapy. Relatives, friends, and caregivers need to be educated about the condition to provide a strong support system.
Doctors must find the time to listen to their patients and watch for clues that are possible triggers for flare-ups, and for comorbidities that may be signs of common causes of inflammation that can then trigger obesity, hypertension, diabetes, or arthritis.
Watch out for infections — they are a common trigger for psoriaiss. Check for tuberculosis, strep throat, urinary infection, hepatitis. Medical problems such as obesity, hypertension, heart disease, arthritis should also be monitored.
Psoriasis groups exist all over the world and are great sources of assistance for treatment recommendations and subsidies as well as emotional support and even psoriasis-friendly career searches. A great place to start: the International Federation of Psoriasis Associations.
How Is Psoriasis Diagnosed?
You cannot diagnose psoriasis on your own. Psoriasis can be confused — even by experts — with other skin conditions like contact dermatitis, atopic dermatitis, dandruff, or even just dry skin. To properly diagnose and manage psoriasis, dermatologists sometimes order tests such as patch tests, biopsies, and other lab work.
Dermatologists use the PASI (Psoriasis Area and Severity Index) to measure the extent and severity of the psoriasis.
How to Treat Psoriasis?
Do not self medicate. Because psoriasis is multifactorial with many potentially serious comorbidities, you should follow your doctor’s instructions. Management often involves several things at once, including:
- Biologicals — these very targeted medications can be dramatically effective at clearing psoriasis but must be taken with your dermatologist’s close monitoring as regular bloodwork is often required to reduce some possible risks such as immunosuppression;
- Patch testing to more accurately identify ingredients you should avoid and the use of hypoallergenic products;
- Lifestyle changes such as working with a nutritionist for a healthier diet, appropriate exercise, and adequate sleep;
- Stress management and psychological wellbeing, including possibly working with a therapist or support group.
Each patient and each person’s psoriasis is unique. Successful treatment — even as high as PASI 90-100 — can be achieved but is more likely when caring for the entirety of the patient, from preventive care to allergen avoidance, nutrition and mental health, monitoring inflammatory markers, managing comorbidities like diabetes and arthritis, etc.
Important Information On Topical Steroids
A topical steroid is sometimes prescribed to help quickly bring down the inflammation of a flare. Some that are typically prescribed include clobetasol propionate ointment, betamethasone dipropionate ointment, and mometasone furoate lotion. If you are prescribed a topical steroid, your doctor will give you clear instructions on how to apply it and for how long to use it (normally just a few days to up to two weeks). It is very important that you follow your doctor’s instructions. Specifically, it is very important not to use topical steroids more frequently or for longer than what your doctor prescribes.
Because relief can be so dramatic with a topical steroid, some people continue to use it after the prescribed amount of time and reach for it again and again with every new flare. Some even develop a dependence on it and use the topical steroid daily for years, almost like a moisturizer. This has several risks, among them:
- Steroid acne;
- An additional contact allergy — several topical steroids are common contact allergens (and contact dermatitis tends to coexist with psoriasis);
- Tachyphylaxis: the more you use a topical steroid the less effective it becomes so that you need more and more of the medication to try to achieve the original results. This encourages even more over-use;
- Thinning of the skin, leading to heightened sensitivity to ever more ingredients;
- Barrier defect, which can be welcoming to opportunistic microbes and a secondary infection that can complicate therapy;
- Rebound effect: when finally taken off of steroids after consistent use, patients may experience a flare-up that can be even more severe than their worst episode prior to steroids (some severe cases require hospitalization); and
- Debilitating and possibly fatal conditions like adrenal insufficiency and Cushing’s Syndrome. The risk is higher with higher-potency corticosteroids, occluding the application area (applying the steroid and covering it with a bandage, which increases absorbency), applying the steroid in covered or striae-prone areas like the groin or underarms, using topical steroids while also using oral or high-dose inhaled steroids, and for children due to their higher surface area-to-volume ratio.
- Do not self diagnose.
- Have your psoriasis managed by a specialist — they may need to monitor some lab work regularly and tend to have access to the best, newest treatment options.
- Limit your steroid use to severe emergencies, as prescribed by your doctor. Follow your doctor’s instructions carefully. Topical steroids are not for long-term use.
- Ask about a patch test and be mindful about avoiding your particular allergens in everything from hair and body cleanser, conditioner, facial cleanser, to daily moisturizers, virgin coconut oil, makeup … even clothing and digital accessories! Curious about top contact allergens? Click our Allergen-Not-An-Allergen tab and explore.
- Prioritize a healthy lifestyle: lessen inflammatory and junk foods, eat anti-inflammatory foods (the Mediterranean Diet is generally a good guide but check with your doctor), exercise appropriately, get 7-8 hours of sleep a night, and prioritize your mental health.
Want more helpful information? Check out this livestream on psoriasis with our resource expert, a dermatologist and dermatopathologist who is a leading expert on the condition: https://s.myvmv.com/PsoriasisLiveVideo.
Laura is our “dew”-good CEO at VMV Hypoallergenics and eldest daughter of VMV’s founding dermatologist-dermatopathologist. She has two children, Madison and Gavin, and works at VMV with her sister CC and husband Juan Pablo (Madison and Gavin frequently volunteer their “usage testing” services). In addition to saving the world’s skin, Laura is passionate about health, inclusion, cultural theory, human rights, happiness, and spreading goodness (like a VMV cream!)