Treatment – what can i do?
I suffer from psoriasis. Are there any ways I can keep it under control? What are some of the challenges I will be faced with?
Better quality of life: how to improve the quality of life when dealing with psoriasis?
Early diagnosis and starting the treatment as soon as possible and avoiding triggers that could worsen psoriasis are key to successful disease management. Treatment must be effective. This helps disease management and reduces the negative impact on the quality of the patient’s life. Patients are further at risk for other diseases like diabetes, cardiovascular disease, high blood pressure, or depression if treated incorrectly.
Triggers for psoriasis – what to avoid?
We advise against triggers such as:
- Alcohol: frequent consumption of large amounts of alcohol may increase the risk of worsening or in relapse of psoriasis. In addition, there may be an interaction between alcohol and certain medication used to treat psoriasis. Increased risk of drug-related side effects is of concern.
- Smoking: smoking can be detrimental, especially for some types of psoriasis (e.g. palmoplantar form). Smoking is linked to increased risk of developing cardiovascular disease.
- Skin injuries and tears: any damages done to the skin are advised against as itching and rubbing the affected area may cause skin changes typical for psoriasis. Moisturize the skin instead.
- Stress: stressful situations are detrimental in the ongoing of the disease in psoriasis patients. Flare-ups can be triggered by stress, negative emotions, and everyday situations or can further worsen areas already inflamed. Various techniques, e.g. proper breathing technique, yoga, meditation, are advised. Consult your dermatologist if the flare-ups are triggered by your inability to limit or eliminate stress. Psychological or psychiatric consultation may prove beneficial.
- Being overweight: patients with psoriasis are more likely to suffer from obesity. Psoriasis treatment with systemic drugs, including biologics, may be less effective in overweight patients. Skin folds where rubbing occurs have been found to be less receptive to treatment. Bacterial and fungal infections are also more likely to occur in overweight patients. Overweight patients can consult a dietitian.
Psoriasis and skin care
The use of nourishing and moisturizing ointments is crucial to affective treatment of psoriasis when used simultaneously with prescribed treatments with active ingredients in both topical preparations (creams, ointments, etc.) and systemic medicines as it helps reduce the need for active ingredients.
- Daily application of a nourishing and moisturizing ointment is recommended. For best results apply to skin immediately after showering.
- Shower with lukewarm water and avoid hot baths.
- Avoid scratching the scalp while washing hair.
- After shower, dry your hands carefully and apply moisturizer. Wear protective gloves when in contact with irritants (cleaners, acidic substances).
- Use sun protection.
Nail psoriasis: nail care for psoriasis - practical advice
About half of patients with psoriasis also develop changes to the nails. When nails are affected follow these guidelines:
- Maintain short, straight-cut nails to reduce the risk of injury.
- Do not remove skin and dirt under the nails with sharp objects.
- After washing your hands, dry them and apply nourishing cream.
- Wear protective gloves when gardening or doing housework, as well as during sports or other activities.
- Wear socks and shoes made of natural materials. Shoes should be comfortable.
- Wear appropriate shoes at the beach or by the pool to avoid fungal infections.
- Ford AR, et al. JAMA Dermatol. 2018 Aug 1;154(8):934-950.
- National Psoriasis Foundation Webpage: https://www.psoriasis.org/blog/what-you-need-know-about-elimination-diets-part-1 Accessed March 2021.
- National Psoriasis Foundation Webpage: https://www.psoriasis.org/about-psoriasis/specific-locations/hands-feet-nails Accessed March 2021.
- Tips for Psoriasis Skin Care Webpage: https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-skin-care-tips Accessed March 2021.
- National Psoriasis Foundation Webpage: https://www.psoriasis.org/causes/ Accessed March 2021.
- Medical News Today_2018 Webpage: https://www.medicalnewstoday.com/articles/323231 Accessed March 2021.
- The Burden of Psoriasis Epidemiology, Quality of Life, Comorbidities and Treatment Goals: https://irishskin.ie/wp-content/uploads/2016/08/Burden_of_Psoriasis_Report_final.pdf Accessed March 2021.
Recensed by assist. Aleksandra Bergant Suhodolčan, MD; Departement of Dermatovenereology, University Medical Centre Ljubljana