While there’s no cure for psoriasis, there are ways to live well when you have it. From treatment options to lifestyle changes, you can boost your quality of life and help avoid flares.
In the WebMD webinar, “What to Know About Psoriasis,” George Han, MD, PhD, explained its causes and triggers, health issues that make it worse, and how it's linked to your mental health. He also dispelled common myths about it.
Han is an associate professor in the Department of Dermatology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He specializes in psoriasis, atopic dermatitis, and other skin conditions.
“We think of psoriasis as the combination of a genetic predisposition – something in your body that's revved up and ready to produce psoriasis – and also some kind of trigger,” he says.
“That trigger could be as simple as some kind of injury to your skin or a medication. The immune cells in your body are activated, which leads to a cascade of events that results in more inflammation.”
What Causes Psoriasis?
If you have a family history of psoriasis, you’re at a higher risk of having it. But its exact cause is unknown. Experts believe it’s a mix of genetic and environmental factors.
Among things that can trigger your psoriasis are:
- An injury to your skin (called Koebner phenomenon)
- Drugs such as beta-blockers, lithium, and antimalarial medications
- Infections
- Smoking
- Drinking alcohol
- Obesity
How Can You Treat Psoriasis?
There are different treatments for psoriasis including:
- Topical therapies (corticosteroids, vitamin D analogues, retinoids)
- Phototherapies (NBUVB, excimer laser)
- Immunomodulators (oral medications, biologic therapies)
Certain lifestyle choices can lower your risk of psoriasis, and you risk worsening symptoms. These include:
Physical activity. Vigorous exercise, like jogging for 15 minutes a day at 6 miles per hour, can lead to a 25%-30% lower risk of getting psoriasis. The same trend is seen with doing daily aerobic exercises.
Weight loss. Fat cells can be hosts to inflammatory cells, which can cause psoriasis. So weight loss helps lower your psoriasis risks.
Healthy eating. The Mediterranean diet might lower the severity of your psoriasis and slow its progression. It has a high amount of fruits, vegetables, whole grains, extra virgin olive oil, and fish. If you have a gluten sensitivity, it may be helpful to your psoriasis to go gluten free.
Poll Question
Han explained how various things can be psoriasis triggers. In a poll of webinar viewers, 54% said stress caused them to have a psoriasis outbreak.
Question: This has made my psoriasis flare:
- Stress: 54%
- Something else: 20%
- Cold weather: 14%
- Drinking alcohol: 6%
- A bug bite: 2%
Not only does stress trigger psoriasis, but psoriasis itself can also lead to tension. It’s linked to higher rates of mental health issues like depression and anxiety.
“You're not alone in terms of psoriasis affecting other parts of your life,” says Han. “It’s been studied that psoriasis has a major impact on quality of life, similar to major depression and cardiovascular disease.”
Viewer Questions
Who should be on your psoriasis care team?
Can a general dermatologist treat psoriasis, or do you need one with additional training?
Ideally, you have an internist, dermatologist, dietitian, and mental health professional on your care team.
It’s been shown time and time again that psoriasis is closely linked to depression and anxiety. It’s important to have someone to talk to. A rheumatologist might also be helpful if you’re at risk for psoriatic arthritis. A general dermatologist can treat your psoriasis. But if they’re not a good fit for you, find someone who specializes in psoriasis.
At the end of the day, all that matters is that you don’t give up. There’s a doctor out there who’s able to give you the treatment you need.
Are there ties between COVID, the COVID vaccine, and psoriasis?
Does psoriasis always get worse, or can it stabilize and go into remission?
We saw full-body psoriasis, called erythrodermic psoriasis, during the pandemic. In some cases that happened a few weeks after someone got COVID. But in other cases, it happened a couple of weeks after somebody got a COVID vaccine.
Part of the vaccination process is to get your immune system to "wake up." The idea is to do this specifically toward something, in this case, COVID. But there are also some off-target effects, where it's revving up your immune system in general. This could trigger your psoriasis to worsen.
But that didn’t seem to happen in people who were on effective treatments for their psoriasis.
In terms of outlook, once you get psoriasis, you’re usually stuck with it. There are always exceptions though.
But in classical plaque psoriasis, where you have the lesions on your elbows, knees, lower back, or other areas, those forms tend to stick with you.
The severity depends on the person. Some people get scalp psoriasis, and that’s all they have in their lifetime. But other people get scalp psoriasis and then develop it in other areas.
In general, psoriasis tends to get worse and then decide where it wants to stabilize.
While most psoriasis cases tend to be lifelong, you and your doctor can work together to find ways to control it.
Are some complexions, ethnicities, or races more likely to have psoriasis?
What is the most commonly misunderstood thing about psoriasis?
Right now, the highest risk for psoriasis is in the Caucasian population. But the risk isn’t that far off when you look at Black or Asian populations.
But we know that in darker skin tones, we often underestimate the severity of psoriasis. This is because in a lighter skin tone, you can easily see redness. But in darker skin tones, it's harder. We’re starting to break down those differences.
I think it's important to take a deeper dive into this and start to understand relative risks of developing arthritis in these populations.
The biggest misconception with psoriasis is that it's just skin deep. It’s not just as simple as something on the surface of your skin.
Psoriasis is a condition happening inside your body. It can affect your joints, your cardiovascular system, and your mental health. This condition isn’t just cosmetic.
Watch a replay of the WebMD webinar “What to Know About Psoriasis.”
Watch other free WebMD webinars by leading experts on a variety of health topics.
