If you’ve ever noticed inflamed, scaly patches of skin on your body and wondered what they are (and what you should do about them), psoriasis, an autoimmune disorder that causes such scaly rashes to form on the skin, may be the cause.
While there are currently a number of treatments available for psoriasis, that’s not to say that developing scaly patches all over your body isn’t a bit scary. We get it, which is why we spoke with a slew of skin experts on all things psoriasis, including what you should (and definitely should not) do if you suspect you might have it.
What is psoriasis?
Joshua Zeichner, a New York City-based dermatologist, explains it in the simplest terms. “Psoriasis is a condition in which the immune system gets angry at the skin, leading to red, scaly plaques.” Usually, you’ll see these plaques on the elbows and knees, but psoriasis can appear anywhere, including the scalp, lower back, nails, and even the genitals.
Want to get even more specific? Psoriasis “is a genetic, autoimmune, inflammatory condition in which your skin cells divide too quickly and do not shed quickly enough,” says Tsippora Shainhouse, a board-certified dermatologist in Beverly Hills and a clinical instructor at the University of Southern California. These extra cells (that don’t get shed fast enough) are what creates the inflamed, scaly plaques on the surface of the skin. Psoriasis is considered to be both a common and a chronic condition, meaning that it’s usually a life-long disease and that flare-ups, as they’re called, can come and go at any time.
Even though psoriasis symptoms mainly manifest on the skin, the condition isn’t only skin deep — it is an autoimmune disorder, after all. As such, having psoriasis can also make you more susceptible to developing other diseases. According to Shainhouse, psoriasis is often associated with psoriatic arthritis, metabolic syndrome, elevated triglycerides, increased risk for heart disease, and obesity. So, if the superficial aspect of psoriasis isn’t enough to get you to a doctor, all of the aforementioned reasons should be.
What does psoriasis look like?
You can generally tell that it’s psoriasis, thanks to the main symptom: Dry, raised, scaly plaques that can be pink, white, or even silver in color. Sometimes these plaques will itch or crack, and possibly even bleed. Psoriasis patches themselves can range in size, from small spots or dandruff-like flakes to large plaques that cover entire areas of the body, and they can also erupt in waves (i.e. flare-up) for weeks or even months at a time.
But unfortunately, even when the plaques themselves are visibly in remission, they’re just lying dormant and could pop back up at any moment. This is why psoriasis is considered a chronic disorder, and for many people (including Kim Kardashian), keeping flare-ups at bay can be a life-long battle.
Under the overarching psoriasis umbrella, there are also many different types of the condition. All of the different forms of psoriasis are characterized by plaques, but the size, pattern, and location of each differ. The most common kinds are plaque psoriasis, guttate psoriasis, and inverse psoriasis, explains Nava Greenfield, a dermatologist at Schweiger Dermatology Group in Brooklyn, New York. Of these, plaque psoriasis is considered to be the most common form.
“Plaque will typically be on the elbows, knees, scalp, and trunk,” Greenfield explains. “Guttate lesions are smaller and usually [occur] mostly on the trunk, and inverse appears on sensitive areas such as axilla [armpits] and the groin.”
“Fun” fact about guttate psoriasis: It’s actually “named after ‘raindrops’, because you get a sudden eruption of small pink, scaly spots all over the trunk, usually after exposure to strep throat,” Shainhouse says.
So, what do you do about it?
Don’t just go to Google images and try to diagnose yourself — a dermatologist will have to examine your skin in order to make a concrete diagnosis, including determining which form of the disorder you have. Once you’ve been diagnosed, you can discuss treatment plans with your dermatologist. Luckily, there are now many different treatment options available for those with psoriasis, which includes topical creams, injections, and lifestyle alterations.
“With the right medication, most patients can achieve complete or near complete clearance” of symptoms, explains Gary Goldenberg of Goldenberg Dermatology in New York City.
According to Zeichner and Goldenberg, the proper treatment regimen will depend on how mild or severe your case is, as well as what kind of psoriasis you have. “For mild cases, skin care is important,” Goldenberg says. “I usually recommend [full-body] moisturizers, [and] topical steroids are also useful for itching and inflammation.”
Other topical options for mild cases include cortisones and vitamin D creams, Zeichner says. “More severe cases may require systemic medications like pills or shots to keep the inflammation calm.”
If you have scalp psoriasis, Zeichner also suggests using over-the-counter tar shampoos to help relieve dandruff and itching. Phototherapy could also be a viable option. “UV light is generally a no-no in dermatology since we know that too much can be associated with the development of skin cancer and melanoma,” Shainhouse explains. “However, it has an anti-inflammatory effect in psoriatic skin, and is a very useful option for reducing skin disease and symptoms.”
And what you definitely should not to do about it…
When it comes to psoriasis, certain lifestyle choices can greatly affect and even trigger flare-ups. “Lifestyle is very important,” Goldenberg explains. “I usually recommend an anti-inflammatory diet that’s rich in fruits, vegetables and fish, probiotics, and vitamin D supplements. Alcohol in excess and smoking can also make psoriasis worse.” In addition to alcohol and smoking, stress can also exacerbate symptoms, Greenfield says.
Finally, one last thing that can greatly worsen your psoriasis symptoms, although it may be even more tempting than an extra glass of wine with dinner: Picking at your scaly skin is the last thing you should do. “Rubbing and picking at the skin will actually worsen the spots,” Shainhouse says. “Psoriasis tends to develop in sites of skin trauma, including cuts and scratches.”
This is called the Koebner phenomenon. So, no matter how itchy or irritated your plaques may feel, try to keep your own hands off and enlist the help of a professional, ASAP.
Ultimately, if you do suspect that you might have psoriasis, the best thing to do is make an appointment with your dermatologist and remain diligent about following through with their prescribed protocol, even if that means no more wine with dinner.