Psoriasis and Skin Infections
Howard Chang, 40, has had guttate psoriasis since he was 7 years old. Guttate psoriasis is the second most common type (after plaque) and is characterized by widespread, small red spots on the skin. But Chang says itâ€™s not just the psoriasis that makes him uncomfortable in his own skin. In 33 years of living with the chronic autoimmune condition, the California resident has found that he's also more prone to infections such as cellulitis.
Cellulitis is a skin infection that starts when bacteria, often a variety of staph or strep, get into the deeper layers of the skin. In someone with psoriasis, irritated, flaky, inflamed areas â€” especially if those areas are frequently touched or scratched â€” are the perfect entry points for these bacteria. Thereâ€™s also some evidence that psoriasis medications that suppress the immune system may increase a personâ€™s risk for cellulitis.
â€œThere does appear to be an increased risk for infections such as cellulitis in patients taking TNF (tumor necrosis factor) blockers such as Enbrel, Humira, and Remicade,â€ says Bruce Bebo Jr., PhD, director of research and medical programs for the National Psoriasis Foundation. â€œThere are warnings in the prescribing information for this.â€
Bebo notes, however, that most, if not all, of the data on TNF and cellulitis come from those taking the drugs for rheumatoid arthritis, not psoriasis.
Symptoms of cellulitis include:
- Warmth over the reddened area
Cellulitis needs to be addressed early. If left untreated, it can progress to a collection of pus (called an abscess), or the infection can spread through the bloodstream â€” a very serious condition.
Chang also has eczema, or atopic dermatitis, which may further increase his incidence of skin infections. â€œMy dermatologist says Iâ€™m more vulnerable because I have psoriasis on top of everything else,â€ he says.
Treatments for Skin Infections
If you have psoriasis and a tendency toward skin infections, here are some steps you can take to reduce their recurrence:
- Wash with antibacterial soaps. â€œOne of the easiest things you can do is to use antibacterial soaps such as Dial or Lever 2000,â€ says Linda Wong, MD, of Kaiser Permanente-Dermatology in Baldwin Park, Calif.
- Use benzoyl peroxide. If antibacterial soaps donâ€™t seem to help, you can wash with a benzoyl peroxide cleanser, which is used to treat mild or moderate acne. Benzoyl peroxide, well known for its antibacterial action, is available in liquid, bar, lotion, cream, and gel form in various strengths. Start with the lowest strength first. â€œUse it once a day and see how your skin reacts,â€ Dr. Wong advises.
- Take a bath with chlorine bleach (sodium hypochlorite). Twice a week â€” three times, at most â€” fill a bathtub with at least a foot of water (40 gallons) and add a quarter to a half cup of chlorine bleach. Soak in the tub for 10 to 15 minutes â€” no more. â€œThis will reduce the bacterial load on the skin,â€ Wong says. Be sure to shower to rinse off the chlorine when youâ€™re done, and apply moisturizers â€” the thicker and greasier, the better. â€œI was worried that the bleach would burn, but it didn't,â€ Chang notes. â€œIt does dry out my skin, but I use moisturizers afterward, and they help.â€
- Change your clothes regularly. â€œI used to want to save my wife [from doing] laundry, so Iâ€™d wear clothes over and over again,â€ Chang says. â€œBut apparently bacteria can stay on your clothes and get on your skin. So now I change my clothes â€” and my towels â€” frequently to help stave off skin infections.â€
- See your doctor for medication. Antibiotics are the usual treatment for cellulitis. â€œIf I get an infection, Iâ€™ll call my doctor and sheâ€™ll prescribe a course of antibiotics for me,â€ Chang says. Donâ€™t wait for it to go away on its own: If the infection progresses to an abscess, you will likely need an incision and drainage to open the skin and remove the infected material.
If you have psoriasis and are prone to skin infections, take precautions and talk with your doctor about how best to prevent them. And if you do get an infection, be sure to have it treated immediately.
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