Burden and Treatments
Psoriasis is a painful, severe, chronic non-communicable disease (NCD) of the immune system. It affects millions of people around the world. Symptoms are most visible on the skin, which can become inflamed, bleed, crack, itch or shed scales. However, psoriasis is not a skin disease. Over a third of people living with psoriasis of the skin also develop psoriatic arthritis. This is a type of inflammatory arthritis affecting your joints and tendons.
Having psoriatic disease can be a heavy physical, social, emotional and economic burden. It may also increase the risk of developing other conditions like heart disease or diabetes. While there is currently no cure for psoriatic disease, there is a range of treatment options to alleviate symptoms. We recommend anyone with psoriatic disease to contact a doctor (ideally a dermatologist or rheumatologist) to receive a correct diagnosis and set up an individual treatment plan.
Scroll down to read more about the burden of psoriatic disese, treating psoriasis of the skin or treating psoriatic arthritis.
- Cracking, bleeding skin
- Silvery, scaly patches
- Small red spots
- Thick, red, inflamed lesions
- Itching or burning sensation
- General soreness
- Pitted or cracked nails
- Nails separating from the nail bed
- Symptoms occur most often on your knees, elbows, scalp or upper body. Other common areas are your feet, hands, nails and in skin folds (including your genital area).
With psoriatic arthritis, you will probably experience one or more of these symptoms:
- General tiredness
- Tender, painful or swollen tendons
- Swollen fingers or toes
- Stiff, painful, throbbing, swollen or tender joints
- Feeling stiff and tired in the morning
- Difficulty with certain movements
- Nail changes (pitted nails, nails separating from the nail bed)
- Red, painful eyes
- Usually affects the joints closest to your fingernails or toenails. Other common areas are your lower back, wrists, knees or ankles.
It is very important to recognize, diagnose and treat psoriatic arthritis early on. This can relieve your pain and inflammation. It may also help to prevent or limit joint damage in the disease’s later stages. If left untreated, psoriatic arthritis can become disabling and crippling.
You can watch out for some warning signs of psoriatic arthritis:
- Tell your dermatologist if you feel any aches or pain
- Be extra alert after joint injuries
- Keep in mind that psoriasis of the skin precedes psoriatic arthritis in 85% of cases
- Know that psoriatic arthritis can develop both slowly (with mild symptoms) or rapidly (with severe symptoms)
- You can get psoriatic arthritis at any age, but it most often develops between 30 and 50
Yes. There are six main types of psoriasis of the skin, each with their own characteristics. It is important to remember that no type of psoriasis is ever contagious.
- Plaque psoriasis
About 80% of people with psoriasis have plaque psoriasis. It often occurs on your elbows, knees, back or head as thick, red, inflamed patches. Silvery, flaking scales are also a symptom of plaque psoriasis.
- Inverse psoriasis
Most commonly occurs in skin folds, such as your armpits, groin area, buttocks or under your breasts. In contrast to plaque psoriasis, the red lesions caused by inverse psoriasis are smooth and shiny.
- Guttate psoriasis
Occurs most frequently in children or adolescents. It causes tiny pink spots on your upper body, arms and legs. The spots are often thinner than the thick patches common in plaque psoriasis.
- Pustular psoriasis
Causes white pus blisters and red skin. Pustular psoriasis can cover your entire body or it can be limited to specific areas like your hand palms or foot soles. It mostly affects adults.
- Erythrodermic psoriasis
A severe, highly inflammatory type of psoriasis. Erythrodermic psoriasis can cause fiery red skin across your entire body, with skin scales falling off in sheets.
- Palmoplantar psoriasis
Affects your handpalms or footsoles. Palmoplantar psoriasis can cause scaly plaques, general thickening of the skin and deep, painful cracks and dryness. This can make it difficult to walk or use your hands.
Researchers are not yet sure what the exact cause of psoriasis is. However, various factors could play a role:
Psoriasis can run in families genetically: up to a third of people with psoriasis report having a relative with psoriasis. Research also shows that 10% of the population may carry a gene that makes them more likely to develop psoriasis. However, only 2-3% of them will eventually get psoriasis.
- External factors
Several external factors could “trigger” psoriasis to develop. These factors vary from person to person, so something that causes your psoriasis may leave someone else unaffected. Possible triggers include: stress, infection (like strep throat), skin injury (cuts, scratches, bug bites, sunburn) and medication (including lithium, indomethacin, quinidine).
- Immune system
Psoriasis appears to be closely related to how our immune system works. Normally, it takes 28 to 30 days for our bodies to develop new skin cells and shed the old. When you have psoriasis however, your immune system becomes overactive. It then produces new skin cells extremely fast, in less than 7 days. This means that your old skin cells pile up on top of each other. The result are the symptoms of psoriasis: inflamed skin, thick red patches and a constant flaking of old skin cells.
IFPA actively encourages scientific research into the disease. Discovering what causes psoriasis could vastly improve treatment or even help to find a cure one day.
Psoriasis can be anything from mild (covering less than 3% of your skin) to severe (covering 10% or more). This can change over time: sometimes your psoriasis may be worse, sometimes better. There might even be periods where your psoriasis is completely gone. Some external factors can then cause it to flare up again. These include smoking, drinking alcohol, certain foods, stress and being exposed to cold weather. However, a lot depends on how your own body reacts. This means that making individual lifestyle changes can have a positive effect on your psoriasis.
Nearly 3% of the world’s population has psoriasis.
Psoriasis can affect anyone – regardless of where you were born, what gender you have or what your body looks like. The disease often starts quite early in life (between the ages of 15 and 35), but even newborn babies or elderly people can develop psoriasis. Genetic factors may play a role, but there are also people without a family history who develop psoriasis. This means it is difficult to predict who will get psoriasis.
There is no specific medical test for psoriasis. Usually, a doctor can diagnose psoriasis by looking at your skin. Sometimes, this might include a skin biopsy under a microscope. Pitted nails can also be a tell-tale sign of psoriasis.
No, psoriasis is not contagious. Because you cannot catch psoriasis from someone else, there is no need at all to avoid people with psoriasis – you can hug them, hang out with them, go swimming, borrow each other’s clothes, hold their hand, have fun together, … just like with anyone else!
No, not yet. Psoriasis is a chronic disease and often requires lifelong treatment.
Yes, there appears to be a link with other conditions. When you have two or more diseases at the same time, these are called “comorbidities.” People with psoriasis have a higher risk of developing these comorbid conditions:
- Cardiovascular disease (heart disease)
- Type 2 diabetes
- Metabolic syndrome
- Liver disease
- High blood pressure (hypertension)
- Crohn’s disease
- Ulcerative colitis
- High cholesterol
- Psoriatic arthritis
Because these conditions can shorten your lifespan, it is very important to tell your doctor about any symptoms you have. This can help you prevent, monitor and treat comorbidities. Together with your doctor you can find the proper treatment or medication for your conditions.
Burden of Psoriatic Disease
Psoriatic disease can impact you on many levels – physically, emotionally, socially and economically.
- Physically, many people struggle with the symptoms of psoriatic disease. You might feel in pain a lot of the time, experience constant itching or burning and psoriatic arthritis can make you feel very tired. If you have any comorbid conditions, these can also significantly impact your health. While there are treatment options it can take a long time to find the treatment that works best for you.
- Emotionally, psoriasis can be hard to deal with because of the stigma and prejudice attached to the disease. This means others may discriminate, reject or ridicule you. You might react by feeling sad, lonely, hurt or angry. Some psoriasis symptoms (like skin lesions or scales that litter your clothes and surroundings) may also cause you embarrassment. And if you’re going through a psoriasis flare-up, you might feel dejected or frustrated.
- Socially, living with psoriatic disease can have a big impact on your relationships with friends, family, partners, co-workers or fellow students. Many people with psoriatic disease report feeling alone in the world with their disease. They feel others often don’t realize how severe psoriatic disease is and feel unsupported. There are also some persistent myths about psoriasis: that people with the disease are “unclean,” that they “caused their own psoriasis” or that the disease is contagious. While these myths are untrue, they can still make people more prejudiced. All of this can make it feel difficult to go out, meet new people and open up in relationships.
- Economically, there are significant costs associated with psoriatic disease. The medication you need may be very expensive or not covered by your insurance provider. When your disease is at its worst, the symptoms may force you to stay home from school or work. Getting (and keeping) a job where your appearance is seen as important, may also be more difficult with psoriasis. All of this may make you miss out on opportunities, fall behind in your studies or career and experience economic challenges.
Together, these factors can make psoriasis a very difficult disease to bear. That is why we at IFPA strive to improve the lives of the millions of people living with psoriatic disease across the world. Find out more about our vision and how we put this into practice.
There is a range of treatment options to help you manage your psoriasis symptoms. Over the past years, there have even been major improvements in psoriasis management. This means that today, having clear or almost clear skin is a more achievable goal than ever.
Because everyone is different, there is not one single treatment that works for everyone. That’s why it is important to talk to your doctor: together you can find the treatment that works best for you. Sometimes this can take time. You might have difficulties with certain side effects, or perhaps not all medications are easily available in your country. Different areas of your skin can also react in different ways, so maybe you will need a combination of treatments. Together with your doctor or pharmacist, you can adapt your treatment plan to match your needs.
Treating psoriasis of the skin
There are five main types of treatments available for psoriasis of the skin: topical treatments, systemic treatments, phototherapy, biologics and practical treatments.
Please note that the treatments listed below are not ranked in any order of importance.
Topical treatments are medicines that you can rub into your skin. Often, they are the treatment your doctor will prescribe. Common topical treatments include:
A medicine derived from hydroxyanthrone anthracene. It has been used for over a century to treat mild to moderate psoriasis. No long-term effects have been reported. However, it can stain your skin or clothing and you cannot use it on your face or genitalia.
A manufactured form of vitamin D3, sold by prescription. It is used for mild to moderate psoriasis, to flatted lesions and remove scales. A combination is available with the synthetic glucocorticoid betamethasone.
This prescription treatment is derived from vitamin A. It exists as a gel or cream and is used for mild to moderate plaque psoriasis. Tazarotene works by slowing down the growth of skin cells.
- Topical steroid creams, lotions or gels
These cortisone treatments slow down the growth of skin cells and decrease inflammation. Topical steroids are available in many different strengths and forms, most often by prescription. They are not to be confused with “steroids” as used by body-builders.
- Tar treatments
Helps treat scaling, inflammation and itching, and works well on scalp psoriasis. Stronger tar treatments require a prescription, but you can buy weaker formulas over the counter.
Systemic treatments are prescription treatments that you take internally, as a pill or injection. They can affect other parts of your body too besides the skin. Because of their risks, systemic treatments are mostly used for severe cases of psoriasis. Examples include:
Typically used for severe, disabling psoriasis. Methotrexate can improve your skin in four to six weeks. Side effects can include nausea, anemia, tiredness and insomnia. Regular lab tests might be needed to check for potential side effects to your liver and blood cells.
Used for severe, difficult-to-treat psoriasis. Cyclosporine can improve your psoriasis quickly, but the risk of kidney damage is so high that most patients take it for maximum one year in a row. Short-term side effects can include decreased kidney function, headache, high blood pressure, high cholesterol and flu-like symptoms.
- Oral retinoids
Manufactured drugs related to vitamin A. They slow down the growth of skin cells. Oral retinoids can cause birth effects, so if you are planning on having children, you should consult your doctor.
In phototherapy, psoriasis is treated with ultraviolet (UV) light. It is commonly used for moderate to severe psoriasis and often combined with topical treatments. You can receive phototherapy at a doctor’s practice or hospital, or with special home equipment. Frequent treatments (up to 3 times per week) may give you the best results.
- UVB phototherapy
Uses UV light B. This safe and effective treatment is often used in combination with other treatments.
PUVA, or “psoralen plus UV light A”, combines the light-sensitizing medication psoralen with UVA. PUVA can very effectively improve your psoriasis, but may increase your risk of developing skin cancer.
- Laser treatment
With a narrow beam of UV light, smaller areas of skin or skin lesions are targeted and treated.
Biologics are newer treatment class. They are made from the proteins of living cells, which are cultivated in a laboratory. (Unlike most medications, which tend to be combinations of chemicals.) The way biologics work is by blocking those parts of your immune system that rapidly create new skin cells (which is a typical feature of psoriasis). Biologics are used for moderate to severe psoriasis. You can take them as a pill, by injection or by intravenous (IV) infusion.
Because they are a relatively new treatment, little is still known about biologics’ long-term safety. And since they suppress parts of your immune system, you may become more vulnerable to infections when taking biologics. That is why it is important to talk to your doctor about possible side effects of biologics. Other obstacles can be their high cost and the fact that not all biologics are approved in all countries.
Finally, there is a range of practical, relatively easy solutions you can use to help remove psoriasis scales, improve your skin’s suppleness and make you feel better.
Keeping your skin moisturized is an important part of treating your psoriasis. Applying creams, lotions or even regular oil can give you relief from dry, itchy skin.
- Natural sunlight
Sunlight on your skin can help clear your psoriasis temporarily. Please remember that excessive sunbathing increases your risk of developing skin cancer, particularly in individuals with fair skin.
- Bath solutions
When taking a bath, you can add apple cider vinegar, Dead Sea salts, Epsom salts or special oatmeal products to the water to soothe your skin. Swimming in salt water can help too.
- Salicylic Acid
This can loosen scales so other treatments can penetrate your skin more easily. You can usually find salicylic acid in your local pharmacy.
- Cold water
Showering in cold water or using a cold pack can provide relief. Do avoid hot water, as this can dry your skin out even more.
Treating psoriatic arthritis
There are four types of treatment available for psoriatic arthritis: NSAIDs, DMARDs, biologics and alternative treatments. It is crucial to always consult your doctor before changing your treatment plan or starting a new treatment.
Please note that the treatments listed below are not ranked in any order of importance.
NSAIDs are Non-Steroidal Anti-Inflammatory Drugs. They include both over-the-counter treatments (like aspirin or ibuprofen) and prescription treatments. NSAIDs decrease inflammation, joint pain, stiffness and swelling, and improve your joints’ range of motion. This can make it easier for you to go about your daily activities even with psoriatic arthritis.
Using NSAIDs as a treatment may be sufficient for you for a long time. If NSAIDs stop working for you or your psoriatic arthritis gets worse, your doctor may advise a stronger treatment.
Some NSAIDs can put you at risk of stomach problems like ulcers or bleeding. This risk depends on how strong your NSAID is, how long you take it and in which dosage. However, many people with psoriatic arthritis don’t experience any problematic NSAID side effects.
DMARDs are Disease-Modifying Anti-Rheumatic Drugs. They can relieve your more severe symptoms, possibly slow down joint damage or keep your psoriatic arthritis from getting worse. DMARDs include the following treatments:
Malaria preventives are sometimes used to treat psoriatic arthritis (as they tend to be successful in treating rheumatoid arthritis). It can take months before you experience the benefits of antimalarials. Possible side effects include eyesight changes, headache, dizziness, nausea and vomiting. Some antimalarials can worsen your psoriasis of the skin.
Injecting corticosteroids into your joints or tendons can relieve acute, severe joint inflammation and swelling, and improve your motion range. However, taking corticosteroids long-term or in large doses is generally not recommended. Corticosteroids can provoke severe types of psoriasis or worsen your psoriasis of the skin afterwards.
Methotrexate is used widely to treat both psoriasis of the skin and psoriatic arthritis. It can provide relief both for your symptoms and prevent further joint damage. Because of its potential side effects however, methotrexate needs to be taken and dosed carefully. In low doses, you might be able to use it safely for years.
Biologics are considered a type of DMARDs. They are made from the proteins of living cells, which are cultivated in a laboratory. Biologics work by targeting those reactions of your body that cause psoriatic arthritis. They can slow down or stop damage to your joints, and may even keep the disease from getting worse. Biologics may be prescribed when your psoriatic arthritis doesn’t respond to other treatments. You can take them by injection or intravenous (IV) infusion.
Alternative treatments are practices or products outside of conventional medicine. Some people with psoriatic arthritis complement conventional treatments with these alternatives. They include exercise (yoga, tai qi), diets, herbal remedies, mind/body therapy (aromatherapy, meditation, mindfulness) and ancient practices (acupuncture, acupressure, massage).
A lot of the evidence supporting alternative treatments is anecdotal. However, more and more researchers are analyzing these treatments, their safety and their interaction with different medications. To ensure alternative treatments don’t interfere with your treatment plan and to avoid side effects, always consult your doctor before trying these treatments.
Photos: Anne S./Psoriasisförbundet