“At points in my life, psoriasis covered me from head to toe. It really embarrassed me,” Bridget, a producer in New York, says. “I would try to wear long sleeves and pants in summer, or style my hair in ways so the flakes weren't as visible on my scalp, but nothing really worked. I would feel so self-conscious, especially before dates when it was hot out and I was dressed for winter.”
Two to three percent of the global population experiences psoriasis, according to the World Psoriasis Day consortium, and while that percentage may seem low, it equates to more than 200 million people. But unless you live with the condition, it is rarely talked about.
“Psoriasis is a systemic, immune-mediated disorder,” Dr. Hadley King, board-certified dermatologist says. This autoimmune disease is an inflammatory skin condition in which skin cells fail to mature properly, which causes them to keep proliferating. Psoriasis often manifests as a rash that’s covered in a white or silvery substance that looks a bit like yeast (though it’s not), that can appear anywhere on the body. This is how plaque psoriasis, the most common manifestation of the condition, presents, but there are other types that show up slightly differently on the body, including guttate (a rash and peeling), pustular (pus-filled bumps), inverse (a smooth, shiny rash), and erythrodermic (a peeling rash across the whole body).
Psoriasis can be a serious and frustrating condition. But understanding what it is and the treatments and lifestyle changes that may help calm your flare-ups is the first step to taking back control of your skin.
What Triggers Psoriasis?
The exact cause of psoriasis and the triggers for individual episodes are unknown, as Bridget experienced. “I never knew when or why I was going to get a flare-up,” she tells me.
Because it’s an autoimmune condition, the most obvious explanation is that something triggers the immune system and causes it to malfunction, which provokes the T cells in your body to begin attacking healthy skin cells. But why the immune system begins to misbehave is still a mystery.
What is known is that the condition can be genetic, and that the emergence of psoriasis or individual flare-ups can be triggered by stress, illness or infection, and certain medications, including beta-blockers, Xanax, valium, NSAIDs, and antibiotics. Smoking and alcohol can also cause an attack.
“My psoriasis started showing in high school, and it got worse through college, especially during my freshman year when I [partied] every night,” Mike Miller, Editor-in-Chief of Wilderness Times tells me. “At that time, I wasn’t aware that alcohol can cause outbreaks, and I’ve learned it the hard way.” Beyond anecdotal, Mike’s experience is backed up by science, where studies have shown that people who drink heavily may not respond to psoriasis treatments as well. King says that “some studies suggest that people who have psoriasis and drink heavily may find that their skin gets better when they stop.”
The Hormonal Connection
Hormones also play a role in psoriasis. “Sex hormones and prolactin have a major role in psoriasis pathogenicity [or cause], and there are a lot of other hormones which can influence the psoriasis clinical manifestations as well: glucocorticoids, epinephrine, thyroid hormones, and insulin,” Dr. King says.
Because psoriasis is an inflammatory disorder with a hormonal link, it is not uncommon for psoriasis patients to develop other autoimmune conditions as well, including thyroid disease, rheumatoid arthritis, and celiac disease.
Studies have also shown a link between psoriasis and the female sex hormones, estrogen and progesterone; specifically higher levels of estrogen seem to keep the condition at bay, whereas higher levels of progesterone seem to worsen symptoms. For this reason, it’s not unusual for psoriasis to flare around puberty (as in Bridget’s case) and menopause, and for the condition to seemingly disappear or dramatically improve during pregnancy, only to appear again postpartum.
What Can You Do About Psoriasis?
Psoriasis is a difficult condition to treat as the triggers, solutions, and lifestyle changes vary from person to person and can even gain or lose effectiveness for one patient over time. Both Mike and Bridget found treatments that were promising for a time, only to have them abruptly stop working.
Dermatologists have come to rely on a few go-to treatments for psoriasis ranging from over-the-counter creams to prescription medications. “Psoriasis can be treated with topical medications such as topical corticosteroids and vitamin D derivatives,” Dr. King says. She also recommends phototherapy treatment, which involves exposure to artificial UVB light either in a doctor’s office or through a portable device at home, though it should be noted that direct sunlight is not typically recommended for psoriasis patients.
You and your doctor can also explore if taking a high-estrogen birth control may improve psoriasis symptoms, though research on the efficacy of birth control and psoriasis is mixed, plus high-estrogen supplements have been linked to other side effects including a low sex drive, bloating, and even the potential to increase the risk of certain cancers.
Lifestyle Tweaks for Psoriasis
One of the best lifestyle habits that can help keep your psoriasis calm is to make sure that your skin is always moisturized, which makes sense given its manifestation as dry, scaly patches. Creams or moisturizers that include humectants, emollients, and occlusive ingredients like petroleum jelly, lanolin, and silicone are the best for treating flare-ups. Dr. King specifically recommends Cetaphil Moisturizing Cream, Simple's Kind to Skin Replenishing Rich Moisturizer, and Cerave Moisturizing Cream. Dr. King says you can also look for products that contain squalane or Centella asiatica, nicknamed "cica," which are shown to have anti-inflammatory properties. And to combat the itching, a good old oatmeal bath or a moisturizer that contains the ingredient can be helpful.
There are also over-the-counter homeopathic pills like Loma Lux, which could potentially keep psoriasis symptoms at bay, as does limiting alcohol, avoiding smoking, and avoiding too much time in the sun. Being overweight or obese can also worsen psoriasis symptoms, though the link between the two still isn’t totally clear.
Bridget estimates that she’s seen nearly 30 doctors for her condition and has used a host of medications to try to treat her psoriasis. She has found some relief by taking Otezla, which she describes as “the best.” But the thing that helped Bridget the most, she says, was finding a doctor who took her condition seriously and who understood both the mental and physical toll psoriasis can take.