Even the most skincare-savvy individuals would love to get insider intel from a dermatologist. But sometimes, it’s hard to ask a doctor your most burning questions — maybe you believe your concern is too trivial, or you’re embarrassed to get the answer in a face-to-face appointment. That’s why SpotlyteTM brings you Ask a DermTM, a regular column where we have professionals provide the answers to your questions, no matter how big or how small. In this installment of Ask a Derm, Dr. Neil Sadick breaks down everything you need to know about psoriasis, from diagnosis and treatment to support.
Some skin concerns are fairly straightforward: pimples are left alone or popped; dullness is addressed by speeding up cellular turnover (with the aid of a chemical peel or retinol); a questionable spot should be examined by a dermatologist to see if it could be skin cancer. But others are not as clearly defined. For example, what you think is a simple rash or a patch of dry, scaly skin could be a sign of something more significant. Psoriasis is one such skin concern — and it’s actually an autoimmune disease.
[Editor's note: Retinol shouldn't be used by those who are pregnant, considering getting pregnant, or nursing. Please consult with your doctor before use.]
What is psoriasis?
According to Dr. Neil Sadick, a quintuply board-certified NYC dermatologist, internist, surgeon, and professor of dermatology at Weill Medical College, this disorder is characterized by a proliferation of cell production within the outer layer of the skin. The result is a buildup of dry, scaly skin that often occurs in thick patches, or plaques. They can be itchy and sometimes painful. Though it looks like a rash, it is not contagious. It can also manifest in the finger- and toenails, creating a “pitted” effect that can resemble ice pick-like marks in the nails.
There are a few forms of psoriasis, but by far the most common is plaque psoriasis. If you have it, you may also notice thicker skin on palms and soles, observe erythroderma throughout the body (widespread “reddening” of the skin), and flakiness of the scalp that some might mistake for dandruff. That’s why the best way to know for sure if you’re dealing with psoriasis is to see a licensed dermatologist and, if necessary, ask them to do a biopsy to be certain.
Unfortunately, understanding psoriasis isn’t as simple as managing the occasional pimple. “We don’t know what the exact cause is,” explains Dr. Sadick. “However, it's usually a combination of immune, genetic, and environmental factors.” He notes that several genes have been identified that make people more susceptible to psoriasis, but there's no test that can really tell who will develop the disease.
That said, if you have psoriasis, you’re not alone: The National Psoriasis Foundation® shares that over eight million Americans live with this disease — including celebrities like Kim Kardashian and professional golfer Phil Mickelson — with many of them developing symptoms between the ages of 15 and 25. Dr. Sadick adds that other patients experience symptoms later in life. While men and women are equally susceptible to the disease, there is some indication that Caucasians are more prone to psoriasis. You’re also more likely to experience it if you have someone in your family history with the disorder.
There are also complications beyond dealing with rougher and thicker skin. Dr. Sadick shares that there is an association between psoriasis and an increased risk of cardiovascular disease. The most well-known association with psoriasis is psoriatic arthritis — chronic joint swelling and pain — which occurs in about 10 to 30 percent of people with the autoimmune disease. Yet, while the bad news is that psoriasis is a lifelong condition (in the words of Dr. Sadick, “Like most relationships, it has an unknown course”), the upside is that it’s not something that has to severely affect a patient’s life.
How do I manage my psoriasis?
The first aspect to consider is avoiding situations, ingredients, and even foods that could potentially trigger psoriasis flare-ups. Dr. Sadick shares that a key time of year when patients deal with more symptoms than usual is the winter months, due to ambient dryness in the air. (If you have psoriasis, you may notice that you experience relief in warm, sunny weather — more on this later.)
“Certain gluten and dairy products have been rarely associated with it, but the majority have been related to overgrowth of organisms in the skin or even in the GI tract, such as yeast,” he explains. Stress, smoking, and alcohol consumption could all cause flare-ups, too. (Yes, pretty frustrating that two of the most common coping mechanisms for stress can contribute to psoriasis…) Finally, Dr. Sadick adds that certain medications — including beta-blockers, lithium, and antimalarial drugs — and bacterial and/or viral infections could also worsen symptoms.
Your skincare regimen is also worthy of significant consideration when it comes to keeping flare-ups at bay. Ingredients that are notorious for drying out the skin should be avoided, including most retinols. “Trans-retinoids are used to treat psoriasis,” explains Dr. Sadick. “But the ones that are used for acne or cosmetic usage often exacerbate it.” Trans-retinoids are available by prescription only and much stronger than what you’d find at your local Sephora®. You can also ditch physical exfoliants like scrubs, which could irritate your skin.
[Editor’s note: As always, talk to your doctor before starting or stopping any medication.]
Are there skincare ingredients that I should be looking for?
Yes, and some of them may surprise you. For example, you don’t have to stop exfoliating altogether — in fact, it’s encouraged. “Salicylic acid, lactic acid, coal tar, [and other] major keratolytic ingredients are things I’d look for,” shares Dr. Sadick. “They help break down the thickened epidermis, and they slow down the growth of the outer layers [of skin].” Don’t overdo it, though — start using your chemical exfoliants once a week to see how your skin adjusts, and consult with your dermatologist if you are unsure. We like the mildest version of the cult favorite at-home peel, the Dr. Dennis Gross® Alpha Beta® Ultra Gentle Daily Peel ($88), which contains lactic acid to delicately slough off dead cells.
Other ingredients to look for are ones touted as anti-itch and anti-inflammatory, such as calamine and menthol. If you’re dealing with particularly frustrating scalp flakes, you can keep them at bay with zinc pyrithione, a popular component of anti-dandruff shampoos, which inhibits fungal and bacterial cell division. (Find it in the reliable Head and Shoulders® Classic CleanTM Anti-Dandruff Shampoo, $8.) Dr. Sadick notes that you should be wary of overusing dandruff shampoos with psoriasis as it could have a “paradoxical, irritant” effect. Use it only when you’re finding your scalp to be scaly.
Above all, hydration is essential to nourishing skin with psoriasis. “Using emollients in a very long-term and efficient fashion is one of the main keys to topical therapy,” Dr. Sadick adds. Popular emollients include mineral oil, plant-based extracts like shea butter and cocoa butter, and lanolin, an ingredient derived from shorn sheep’s wool. For a comforting all-over body treatment, try the Avene® XeraCalm® A.D Lipid Replenishing Balm ($34). It features mineral oil and evening primrose oil, the latter of which is loaded with fatty acids to help soothe parched skin.
However, there’s one aspect of a solid regimen that many with psoriasis skip in favor of soothing their skin, yet shouldn’t: sunscreen. If you have this disorder, you may have noticed that warm, sunny weather makes your skin feel particularly good. That’s because light therapy — which consists of careful, controlled exposure to UVB light — has long been used to help treat psoriasis via the form of excimer lasers or other special lamps. This methodology helps reduce skin inflammation and slow the proliferation of excess cells. However, because light therapy can get pricey (especially if you’re investing in your own at-home light!), many people with psoriasis opt for tanning beds or climatotherapy, which are ultimately unsafe.
“There are camps along the Dead Sea where people just lie out and have the sun improve their psoriasis, which it does,” explains Dr. Sadick. “However, the other paradoxical risk of increased skin cancer is the other side of the story.” Ultimately, these DIY treatments are no substitute for professional phototherapy.
The use of tanning beds is discouraged by the American Academy of Dermatology®, and for good reason: they can raise your risk of melanoma (the deadliest form of skin cancer) by 59 percent, with just one indoor tanning session increasing your risk of melanoma by 20 percent. We shouldn’t really have to say this, but do not ever, ever visit a tanning bed. Save light therapy for the professionals, and wear sunscreen whenever you’re outside to protect yourself from damaging rays. We’re especially fond of this completely clear formula from Supergoop!®.
What are my prescription options?
Of course, you should consult with your doctor on what’s best for your skin’s needs because there is a possibility that you’ll need a bit more help than over-the-counter products can provide. Dr. Sadick says that he typically starts his patients on topical treatments — usually topical corticosteroids or vitamin D derivatives — or steroid injections.
“In the more severe cases, the trend has been the development of new biologic [drugs] that target the inflammatory cytokines [proteins that help cells communicate with other cells] that are associated with psoriasis,” he adds. However, it’s important to note that biologics do offer some slight risk of impairment to the immune system, which can lead to a serious infection.
As nerve-wracking as that sounds, Dr. Sadick is part of a research group that investigates many of the new treatment options for psoriasis. “I understand how effective... and [relatively] safe these new treatment modalities can be,” he explains. “That's why I've taken a particular interest in studying these molecules, and being able to provide the best patient care with these new generation therapies.”
What other help is available to me?
Many with psoriasis can feel embarrassment or shame about their skin’s appearance, and patients with the disorder report higher rates of depression and anxiety. But you have nothing to be ashamed of: you have a chronic illness, and that is not your fault.
Knowledge is also power. If you don’t have a dermatologist that you trust, Dr. Sadick suggests looking for one on the website of the National Psoriasis Foundation or calling a licensed dermatology practice near you. “You can either ask to speak to the dermatologist, or ask the manager of the office, ‘Does your practice have an active psoriasis treatment program?’ And, ‘Do you use biologics in your practice?’”
Finally, don’t be afraid to ask for help, and not just from your doctor. You don’t have to suffer in silence. In addition to connecting with others that have psoriasis, lean on the loved ones in your life for emotional support. Open, heartfelt discussions about this autoimmune disease can go a long way in making you not only feel more confident in your relationships with other people, but also in your own skin.
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