Psoriasis is a skin disorder that appears as raised, reddish-pink areas covered with silvery scales and red borders. Psoriasis most commonly appears on the scalp, elbows, knees, groin, and lower back. It "comes and goes," and may appear as a few spots or involve large areas. It is not contagious, either to other body parts or other people. More than 6 million people in the United States have psoriasis, which is seen in both sexes and all age groups. It can be triggered by emotional stress and can run in families. Severe cases can be physically painful and emotionally traumatic due to its unsightly appearance. Approximately 10 percent of psoriasis sufferers develop psoriatic arthritis, a painful arthritic condition.
Signs and SymptomsThe following are symptoms of psoriasis.
- Raised skin lesions, deep pink with red borders and silvery surface scales; may be cracked and painful
- Blisters oozing with pus (usually occurs on the palms or soles)
- Pitted, discolored, and possibly thickened fingernails or toenails
- Itchy skin in some people
- Joint pain (psoriatic arthritis) in some people
What Causes It?The cause of psoriasis is uncertain, but researchers do know that it involves a higher-than-normal rate of skin-cell production. Dead skin cells accumulate and form thick patches. Several underlying factors may trigger the disorder or flare-ups, including the following.
- Faulty immune system
- Genetics (hereditary)
- Emotional stress
- Skin injuries or sunburn
- Streptococcal (strep) infection (symptoms sometimes first appear two weeks after strep throat)
- Certain drugs (gold, lithium, beta-blockers)
- Acidic foods
What to Expect at Your Provider's OfficeYour health care provider will examine your skin and ask questions about your physical and emotional health. You may need a blood test to check levels of calcium, zinc, and certain other elements.
Treatment OptionsYour provider may suggest one or several different treatment options.
- Topical creams and lotions
- Light therapy
- Changes in your diet
- Vitamin or mineral supplements
- Elimination therapy (in which you discontinue taking certain medications or eating certain foods)
Topical creams include the following.
- Corticosteroids — reduce inflammation and irritation; can only be used for a short period of time at the beginning of treatment
- Salicylic acid ointments — help the scales to shed
- Capsaicin ointment — blocks chemicals in the skin that cause inflammation; painful if used on open wounds
- Calcitriol ointment — may be as effective as corticosteroids with fewer side effects
- Etretinate — for severe cases that do not respond to other treatments
- Methotrexate — an anti-cancer drug that reduces symptoms; serious side effects
- Psoralen — used with UV therapy; least toxic oral medication
- Tegison — inhibits rapid cell growth; more effective with UV therapy; numerous side effects
- Nonsteroidal anti-inflammatory drugs (such as ibuprofen)—reduces inflammation and pain especially for psoriatic arthritis; various side effects
- Petroleum jelly—softens skin, helps it to retain moisture
- Coal tar ointments and shampoos—relieves symptoms; helps UV light therapy to work more effectively; possibly serious side effects
Complementary and Alternative TherapiesYou may benefit from mind-body therapies and stress management. Exercise can help too, as can drinking plenty of water.
- Eliminate alcohol, simple sugars, inflammatory fats (meat, dairy). Avoid acidic foods (pineapple, oranges, coffee, tomato) and any allergic foods (wheat, citrus, milk, corn, eggs).
- Essential fatty acids: omega-3 (oily fish, flaxseed oil, 1,000 mg two times per day)
- Vitamins: B12 (100 to 1,000 mcg) may need to be intramuscular injections, folate (400 mcg per day), vitamin E (400 to 800 IU per day)
- Minerals: zinc (30 mg per day), selenium (200 mcg per day)
- Quercetin: 500 mg three times per day before meals
- Digestive enzymes taken with each meal help with proper protein digestion.
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.
- Milk thistle (Silybum marianum) stops breakdown of substances that contribute to psoriasis, protects the liver.
- Yellowdock (Rumex crispus), red clover (Trifolium pratense), and burdock (Arctium lappa) are alternatives.
- Sarsaparilla (Smilax sarsaparilla) can be effective in psoriasis.
- Coleus forskohlii (tincture, 1 ml three times a day) has been historically used for psoriasis.
Topical creams may relieve discomfort. Chickweed (Stellaria media) relieves itching, and marigold (Calendula officinalis) speeds healing of open lesions.
There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for Psoriasis based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
- Apis mellifica —for skin rashes that feel hot and dry and are sensitive to touch; symptoms are relieved by cool baths and worsened by heat; this remedy is most appropriate for individuals who often feel sad, disappointed, or even depressed; they tend to cry easily but may also be irritable and envious by nature
- Calendula —used topically, particularly if the affected area becomes inflamed; this remedy will soothe but not cure the skin condition
- Rhus toxicodendron — used for skin disorders accompanied by intense itching that worsens at night and improves with the application of heat; this remedy is most appropriate for individuals who are generally restless and unable to get comfortable at night
- Sulphur —for skin disorders that are accompanied by intense itching; this remedy is most appropriate for individuals who are thirsty, irritable when not feeling well, lazy and messy under ordinary circumstances, and who describe a sensation of internal heat and burning; symptoms tend to improve with open, cold air and worsen with warmth
No well-designed studies have evaluated the effect of chiropractic on individuals with psoriasis, but there have been a few case reports about spinal manipulation reducing skin lesions in some individuals. One expert, for example, wrote about a 52-year old man with severe psoriasis who experienced significant improvement after receiving chiropractic care (even more than the improvement seen with conventional medication). Although this report is encouraging, researchers are still not clear whether chiropractic care is helpful for all people with psoriasis.
Following UpSee your provider regularly until your psoriasis is under control.
Special ConsiderationsIn pregnancy, oral medications can be damaging to a fetus and topical creams can be absorbed into the bloodstream.
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