In the world of skin conditions, there are few that are as common as psoriasis. Psoriasis affects as much as 2% of the population with red, damaged skin, and it comes in a few different varieties. A question many people ask, especially if they're young or just beginning to experience the symptoms of psoriasis, is this: will it ever go away? Can it be cured?
What Is Psoriasis?
Psoriasis is a skin condition that is largely characterized by red, cracked patches of skin, often accompanied by silvery scales and rough, thick plaques. It can appear pretty much anywhere on the body.
There are four primary types of psoriasis (and a couple of other less common types), which doctors use to identify particular treatment options.
- Plaque psoriasis. This is the most common kind of psoriasis. It's characterized by patches of affected skin on the torso and limbs, especially around the elbows and knees, and in the scalp. Some cases also see issues with finger and toenails, which become thick and pitted and occasionally even separate from the nail bed.
- Inverse psoriasis. This version of psoriasis most commonly affects folds and creases in the skin, such as armpits, groin, buttocks, and under the breasts. Sometimes, due to their location, the plaques are moist rather than dry and scaled.
- Pustular psoriasis. This is similar to plaque psoriasis, but rather than scaly patches, the skin forms pustules spread over the body.
- Guttate psoriasis. This form of psoriasis causes small, teardrop sized patches of scaly psoriasis rather than larger patches, and is less prominent on the face.
The specific causes of psoriasis are unknown. It's essentially an autoimmune disease that affects the skin, causing the skin to regenerate too quickly. It is, in a sense, healing kicked into overtime.
Your skin normally has several layers. The outer layers die and shed, while the inner layers grow to replace them. This is the natural skin cycle, and it typically takes around a month for a layer of skin to grow and surface to be shed, though the older you are, the longer it takes.
With psoriasis, something triggers your skin to speed up this cycle. This causes new skin to grow beneath your existing skin, pushing healthy skin up before it's ready. Existing skin grows thick and cracks because of the pressure from beneath it. It's not dead and ready to be shed, so it just grows thicker and painful as it is damaged.
As an autoimmune disease, psoriasis is a genetic condition, and it can indicate a higher risk of other genetic conditions. A study from 2017 found that people with psoriasis were much more likely to develop other autoimmune diseases, including type 2 diabetes and psoriatic arthritis. It's also possible that psoriasis is a signal for high risk of fatty liver disease and even heart attacks.
Triggers and Cycles
Psoriasis varies from person to person. Some people struggle with it constantly and consider it a good day when it's only affecting their scalp. Other people see cycles where psoriasis comes and goes, slipping into and out of remission.
Unfortunately, psoriasis cannot be cured. At least, current medical science does not know how to cure the disease, though it's possible that some medication or genetic therapy may be developed in the future that could cure it.
Modern study has found that people with psoriasis have about 25 genes that are different from people without the disease. Which ones are important, and which ones trigger the disease, are currently unknown. In fact, roughly 10 out of every 100 people have those genes, but only 2-3 of those 100 develop psoriasis.
Psoriasis that can be controlled tends to have triggers, similar to skin allergies or reactions. These triggers also vary from person to person; one person might be unaffected by, say, drinking, while another will get a flare-up every time they have more than a glass of wine.
So what can trigger a psoriasis flare-up? Many things.
- Changes in hormones. Puberty is the big one, and pregnancy is also a very common trigger for psoriasis, but other hormone changes stemming from hormone therapy, bodily imbalances, and other diseases can cause it as well.
- Alcohol. Drinking heavily can trigger psoriasis, even if you haven't had it before, and can make existing flare-ups worse. It can also inhibit treatments.
- Smoking. Smoking is bad for you in pretty much every conceivable way, so it should be no surprise that it can double your risk of getting psoriasis.
- Sunlight. For some people, sunlight or, more specifically, sun damage, can cause psoriasis.
- Obesity. One complication of obesity is an increase in the number of folds and creases in the skin, which are hotspots for psoriasis.
- Weather. Dry air, low sunlight, and cold temperatures can exacerbate or trigger psoriasis.
- Stress. Stress makes a lot of your bodily systems go haywire, and stress hormones can trigger psoriasis outbreaks.
Psoriasis tends to be more common in men, the obese, and the highly stressed.
Treatment Options
Psoriasis can't be cured, but it can be managed. Avoiding triggers is one major way to help minimize psoriasis outbreaks, but there are some other options you can consider, individually or as part of an overall treatment plan, to help minimize outbreaks and control them when they happen.
Diet. There is some evidence to suggest that diet can help keep psoriasis under control. An observational study in 2018 indicated that the Mediterranean diet was correlated with a lower incidence of flare-ups. However, that's correlation and not a tested causation, but if changing your diet can help, why not give it a try?
The Mediterranean diet is rich in fruits and vegetables, with whole grains, nuts, and fish making up most of the rest of it. Heavily processed foods and red meats are generally left out.
Medications. There are a lot of different medicated skin creams that are used to treat psoriasis. Some of them include topical steroids and other medications that are aimed at reducing the skin cycle and calming the immune system, specifically to address the presumed causes of psoriasis. Others are more like petroleum jelly and various moisturizers, which are meant to help minimize plaques and reduce the cracking and inflammation caused by a psoriasis flare-up.
Some potentially relevant medications include calcineurin inhibitors such as tacrolimus and pimecrolimus, though these are generally used as short-term treatments to help with flare-ups rather than long-term treatments.
Phototherapy. Treatment with ultraviolet light, called phototherapy, can penetrate the skin and slow the growth of the skin cells that are already working overtime and causing your flare-up. Some people have found great success with this treatment, but others find that the UV light damages their skin and either has no effect or makes their flare-ups worse.
Sunlight. Similar to phototherapy, some people find that exposure to natural light helps reduce the incidence and level of their flare-ups. Try not to over-do it; a sunburn will do the opposite, and you don't want to have to fight two skin issues at once. However, some light exposure every day, like through a morning walk or jog, can be plenty to help reduce flare-ups.
Immunosuppressants. Because psoriasis is a disease of the immune system going overtime, some medications that serve as immunosuppressants can be useful for suppressing the immune system and keeping it from causing psoriasis flare-ups. Of course, even a low-grade immunosuppressant can have a widespread effect over the rest of your body, so you need to be aware of what you're getting into before you go on a long-term course.
Stress reduction. There are a lot of alternative medicine treatments, like acupuncture, meditation, and topical turmeric applications that serve to reduce stress. Since stress can trigger hormones in the body which, in turn, can trigger a psoriasis flare-up, anything that reduces stress can help reduce the incidence and severity of psoriasis episodes. Yes, alternative medicine can be effective at some things after all.
Vitamin A supplements. One example of a supplement that has been found to help with large-scale psoriasis flare-ups is vitamin A. This vitamin – also known as retinoic acid – and some derivatives have been shown to have therapeutic results. You will want to talk to your doctor to make sure that the vitamin isn't going to do more harm than good, and that it won't interfere with any other treatment you're on, but it can be pretty effective.
Vitamin D supplements. Vitamin D is what your body synthesizes when you get exposure to sunlight, and it's very important for your body. Many people these days have chronically low levels of vitamin D. There are some psoriasis-focused vitamin D creams, like calcipotriene, which can be obtained via prescription and can help slow the growth of new skin and control psoriasis flare-ups.
Managing Outbreaks
The treatments above are intended to help suppress ongoing outbreaks to less than 1% of your body's surface – about the size of the palm of your hand – or to prevent those outbreaks from occurring in the first place. However, if you are having outbreaks that you can't manage, or that you want to manage in other ways, there are some other treatments you can consider that won't interfere with existing medications and other more intense treatments.
Moisturizing. Keeping your skin moist may help to suppress some psoriasis outbreaks, but it's largely there to keep your skin from itching or hurting. Topical moisturizers help reduce inflammation and irritation, as well as pain and itching. This is good because scratching or picking at psoriasis plaques can make the problem worse, and it can break the skin in a way that runs the risk of infection.
You can keep your skin moist by using lotions and creams, as well as using a humidifier in the home when the air is otherwise very dry. Using a lotion after a shower or bath can help retain moisture as well.
Baths. Speaking of baths, soaking in a warm bath with a mild soap can help reduce dry skin and soothe itchy spots. You can also include essential oils, oatmeal, Epsom salts, or dead sea salt in the bathwater to give further soothing and moisturizing effects.
Stress reduction. It's worth mentioning again because stress has been shown to be the number one cause of psoriasis flare-ups, so anything you do that can reduce your stress in daily life can help reduce the incidence of psoriasis flareups that you experience.
This includes living a healthy lifestyle. Reduce smoking and drinking, and cut smoking entirely if you can. Eat a healthier diet, even if you don't want to switch entirely to a Mediterranean diet. Get regular exercise, which can help improve a wide variety of systems, reduce stress, and help you lose weight. Practice good sleep hygiene and try to get as much high-quality sleep as you can.
Avoid harsh products. If you're the kind of person who has a skincare routine, it can be tempting to go aggressive with exfoliating products, chemical peels, alcohol lotions, and other harsh soaps. These can be useful for some people, but they can also damage the skin and trigger a psoriasis outbreak.
Psoriasis is likely to be with you for life, but you can successfully manage it by avoiding triggers and treating flare-ups when they happen. Some people experience total remission for months or years at a time, as well, so it's definitely a possibility. There's always the chance it can come back, but properly managed, a flare-up doesn't have to last long or be very bad.
