December 13, 2024
Photography by Portra/Getty Images 1393811822
Discover the latest from skin care professionals, including insights on new treatments, tips for managing flare-ups, and views on holistic approaches.
Living with psoriasis comes with unique challenges, but access to accurate information and expert guidance can make a world of difference.
In this Q&A, three board certified dermatologists, Dr. Christopher Rex, Dr. Olivia Choi, and Dr. Ahmad Chaudhry share their insights on psoriasis care, the latest treatments, and common misconceptions. Here’s what they think every patient should know to navigate this journey with confidence.
Christopher Rex, MD, FAAD is a board certified dermatologist who has treated patients with psoriasis for over a decade. He’s also the founder, CEO, and CMO of Peak Dermatology, where he currently works as a physician.
Olivia Choi, MD, PhD, FAAD is a board certified dermatologist who has treated patients with psoriasis for 7 years. Currently, she works as a medical director in dermatology at Johnson & Johnson and is a member of several professional organizations including the American Academy of Dermatology, Women’s Dermatologic Society, and Skin of Color Society.
Dr. Ahmad Chaudhry, MBBS is a board certified dermatologist who has treated patients with psoriasis for several years. Currently, he works as a hospital physician and a consultant dermatologist at Scandinavian Biolabs.
The first is that psoriasis is contagious; it absolutely isn’t. It cannot be transmitted through skin-to-skin contact or by sharing personal items.
Psoriasis isn’t contagious because it isn’t “just” a skin condition; it’s an autoimmune condition … It can also impact overall health and is linked to cardiovascular disease, diabetes, and psoriatic arthritis.
It’s important to get the truth out about the root cause of psoriasis so we can replace fear and ignorance with understanding and support for people living with this condition.
— Dr. Choi
With the introduction of medications termed “biologics” today, we’re dealing with specific receptors closely related to the systemic pathways that directly cause the psoriasis rather than shutting down the whole immune system. These medications are not only more targeted, they’re leading to complete clearances of the condition and limited to no side effects.
— Dr. Rex
The most promising advancements in psoriasis treatment, to date, are biologics. These therapeutics are extremely effective with research showing that many people can achieve 90% skin clearance, or completely clear skin, after a few months.
Many patients are also able to maintain clear skin and experience long-lasting disease control with a few injections per year.
Next on the horizon are highly effective oral treatments that target similar inflammatory pathways for those who want to avoid injections.
— Dr. Choi
I advise my patients to watch for early warning signs like mild itching, small red spots, or scalp scaling. Stress, certain medications, and infections are common triggers.
I recommend keeping a symptom diary to identify personal triggers. When patients notice these early signs, they should increase moisturization and contact their healthcare provider promptly.
— Dr. Chaudhry
The best way to approach flare-ups is to treat the active areas immediately with topical remedies such as sunlight, topical steroids, Vtama (a new FDA approved non-steroidal cream). Also recalibrate and find what behavior or environmental trigger set off the flare and seek to change it.
— Dr. Rex
It’s important to listen to your body, understand your personal triggers, and be open to working with your healthcare provider. Psoriasis is … like a fire — it can leave burning debris behind that rekindles the flame and is easier managed if you put it out before it gets too big, so it helps to have a strategy. I say this both as a dermatologist … and as a psoriasis patient myself.
My psoriasis developed during my second pregnancy. I can often feel the spot get itchy before I see changes in my skin. I know my flare-ups can be triggered by changes in weather, crawling on the floor with the kids, or not managing my stress. When I’ve triggered a flare-up, I ramp up gentle skin care practices to keep my skin hydrated and may even consider preventive treatment.
— Dr. Choi
Finding the right treatment often requires patience and partnership with your healthcare provider. What works for one patient may not work for another. I encourage patients to be open about their treatment goals, lifestyle constraints, and concerns about different therapies. Sometimes we need to try several approaches before finding the optimal combination.
— Dr. Chaudhry
First and foremost, find a healthcare provider who makes you feel comfortable because open communication is critical to managing this disease. You need to be honest about what you’re going through, how psoriasis is impacting your quality of life, what’s possibly triggering symptoms.
As patients, we must be patient. Many treatments take time to show results, so be disciplined and use a treatment consistently for the recommended duration before deciding if it works. If a therapy doesn’t fit your lifestyle, isn’t effective or has stopped working, advocate for yourself.
And finally, lean on others for support. Mental health is health, and it’s common to feel isolated living with psoriatic disease. Connecting with others who understand and share your lived experience can help you cope with the ups and downs of this condition.
— Dr. Choi
The answer here has to be based on the results a patient is trying to achieve. If 100% clear skin is the goal and you have 30% to 60% body surface area affected by psoriasis, most holistic treatments alone won’t get you 100% clear quickly. I recommend a combination of both natural holistic treatments alongside prescription treatments.
You can start off using prescription and holistic treatments and once you attain your desired clearance level, gradually taper off the prescriptions and continue to maintain your health with the holistic treatments.
— Dr. Rex
Regarding holistic approaches, I support integrating evidence-based complementary practices with conventional treatments. Regular moisturization, stress management, and dietary modifications can complement prescribed medications. However, I caution against abandoning prescribed treatments in favor of unproven alternatives.
— Dr. Chaudhry
Psoriasis involves several factors, so embracing a comprehensive management approach is essential. A comprehensive plan can include learning to avoid your personal triggers as much as possible, managing other related or existing health conditions, and implementing diet and exercise changes.
Because stress can also trigger flare-ups, prioritizing mental health is key — whether that’s through a personal hobby, therapy, support groups, or counseling. The emotional burden is real … talking and connecting helps.
— Dr. Choi
The myth and misinformation that hurts my heart the most is the belief that psoriasis is infectious. This leads people to not touch their loved ones. I mentor a lot of younger physicians and I always emphasize “touch therapy” in psoriasis care — “whenever appropriate touch your psoriasis patients directly on their psoriasis plaques.” I believe this is a nonverbal queue of reassurance that mentally goes a long way.
— Dr. Rex
First, the notion that psoriasis is somehow caused by poor hygiene. This is completely false and unfortunately leads to stigma and social isolation for many patients. Psoriasis is an autoimmune condition, not a reflection of someone’s cleanliness.
Second, the belief that psoriasis is contagious. I’ve heard patients face discrimination at swimming pools, hair salons, and even in intimate relationships due to this misconception. You cannot “catch” psoriasis through contact.
Third, the myth that psoriasis is “just cosmetic.” This undermines the serious physical and emotional impact of the condition. Psoriasis can cause significant pain, itching, and joint problems, and is linked to several other health conditions.
— Dr. Chaudhry
One common myth I’d like to dispel is that psoriasis is rare in skin of color. That’s not the case. While it may be less common in some racial and ethnic groups, it’s not rare. People of color with psoriasis face challenges like misdiagnosis, delayed diagnosis and treatment access barriers at much higher rates — all of which contribute to this misconception.
Another myth is patients with darker skin tones don’t need specialized treatments. Different skin tones may require different approaches, and caution is needed because those with higher melanin levels may be more prone to pigmentation changes following psoriasis.
The choice of treatment could impact severity of pigmentation change. We have data showing that pigmentation changes actually impact quality of life and depression even more than just psoriasis skin clearance.
— Dr. Choi
Many patients underestimate the importance of consistent treatment during remission periods. Another often-neglected area is the psychological impact — depression and anxiety are common comorbidities that deserve attention and support.
— Dr. Chaudhry
People living with psoriasis, no matter how little, overlook the internal systemic consequences of poorly managed psoriasis. Psoriasis is not just a skin (condition), it is a pro-inflammatory systemic disease that affects all organ systems. So leaving your psoriasis unattended is slowly increasing your chances of all the other really bad consequences.
— Dr. Rex
Psoriasis does affect several areas of the body systemically. Some of the major areas affected by psoriasis include:
Joints: Psoriatic arthritis affects about 10% of patients with skin findings leading to joint pain, stiffness and swelling. It can be so severe as to cause visible malformation of the fingers and toes.
Metabolic syndrome: is a term used in medicine to describe a chain reaction of systemic events that increases risk of obesity, hypertension and diabetes.
Heart: The cardiovascular system is also affected leading to an increased risk for heart attacks and stroke in people with poorly or untreated psoriasis.
Liver disease: There is a connection between psoriasis and non-alcoholic fatty liver disease (NAFLD).
Mental health: Individuals with psoriasis can express psychological obstacles such as depression, anxiety and societal stigmatization.
Gut health: Psoriasis is closely related with incidents of Crohn’s disease and ulcerative colitis.
Immune system: As an autoimmune condition, psoriasis causes the individual’s immune system not to function optimally which affects the way they deal with other diseases or infections.
— Dr. Rex
Psoriasis is a systemic autoimmune condition, not merely a skin issue, and treating it proactively is key to avoiding other health ramifications.
The dermatologists recommend early recognition of flare-ups, collaborating closely with healthcare providers for personalized care, and combining medical treatments with holistic practices for optimal results.
They also emphasize the importance of addressing emotional and mental health for a well-rounded approach to managing psoriasis.
Medically reviewed on December 13, 2024
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