Psoriasis isn't curable, but it is controllable. The best treatment plan for you depends on several factors including the severity of your disease, the type of psoriasis you have, and what body parts are affected.
â€œThe biggest factor for determining prognosis is the amount of disease someone has,â€ says Michael P. Heffernan, MD, a dermatologist at the San Luis Dermatology and Laser Clinic in San Luis Obispo, California. Psoriasis can show up anywhere on your body, but itâ€™s most commonly seen on the knees, elbows, face, scalp, back, palms, and feet.
The amount of disease is estimated by determining what percentage of the skin on a person's body is affected, with an amount the size of the palm of the hand equal to about 1 percent of the skin.
â€œMost people who have small amounts of skin disease tend to stay with small amounts of skin disease, and most people who have large amounts â€” 10, 20, or more â€˜handfulsâ€™ of psoriasis â€” tend to be people who get more and more psoriasis,â€ Dr. Heffernan says.
A concern, he says, is that one in three people with psoriasis will eventually develop some form of psoriatic arthritis.
â€œPsoriatic arthritis can be as severe as or worse than rheumatoid arthritis. It can be debilitating and really have a significant impact on peopleâ€™s lives,â€ Heffernan says.
Dermatologists tend to be much more aggressive about psoriasis treatment for people if they see signs of active arthritis and extensive skin disease.
Women and people who have psoriasis before they are 20 are also at greater risk for developing psoriatic arthritis. Talk to your doctor if you are experiencing new or worsening joint pains, particularly in the morning, as this may be a sign of psoriatic arthritis.
Your prognosis of psoriasis is also a matter of how much your psoriasis bothers you. â€œWe are more aggressive in treating people whose psoriasis bothers them greatly,â€ Heffernan says.
â€œYou might not have 10 or 20 handfuls, but if it involves your hands, your feet, your genitals, or your face, we might become much more aggressive earlier because these areas tend to be most bothersome.â€
There Are Different Ways of Treating Psoriasis
Whatâ€™s the best way to live with a diagnosis of psoriasis? Mild cases may be treated with moisturizers and over-the-counter products. Using body creams will help keep your skin from getting too dry and cracking.
Some patients find that taking a warm â€” not hot â€” bath every day in bath oil, Epsom salts, Dead Sea salts, or oatmeal helps calm some of the redness caused by psoriasis and removes some of the scales. Just be sure not to soak too long; get out before the skin on your fingers starts to get wrinkly.
If over-the-counter products donâ€™t help, the next step may be prescription medication.
Doctors usually start with topical medications, including creams, ointments, lotions, and gels. Most are corticosteroids. Others contain synthetic vitamin D, vitamin A derivatives, or tar-like ingredients. Your doctor also may suggest a special shampoo if your scalp is affected by psoriasis.
For the most severe forms of psoriasis, dermatologists may prescribe oral medications to decrease skin cell growth or to dampen the immune system.
Some people with moderate to severe cases of plaque psoriasis and psoriatic arthritis may benefit from biologic drugs. Relatively new, biologics are injected or given intravenously and work by targeting the specific inflammatory triggers of psoriasis.
In many cases, light therapy can be an effective treatment for psoriasis, Heffernan says. These treatments often require two to three short visits per week.
Does Psoriasis Cause Depression?
People who have severe psoriasis are more prone to depression. Part of this may be the result of battling a chronic disease that affects the way you look â€” especially if psoriasis is on the face or hands.
If you have psoriasis, acknowledge your feelings about your condition and take charge of your treatment â€” emotionally and physically. Talk to your dermatologist about your treatment choices and, once you agree on a plan, keep up your efforts.
You may find that itâ€™s also much easier to control your condition once you acknowledge your feelings and get them out in the open. If youâ€™re facing psoriasis and depression, you may benefit from the help of a mental health professional as well.
Does Psoriasis Raise Cardiovascular Risk?
Patients with psoriasis may be at increased risk for heart disease and stroke, particularly if the condition is left untreated.
Researchers believe that the inflammation responsible for those red, scaly plaques may also damage the heart and circulation. Your doctor can discuss with you specific screening tools available to measure your risk and what can be done to reduce it.
How Long Does Psoriasis Treatment Take?
Treatment should improve your psoriasis. â€œIt can take three months or more to see the full benefits of a psoriasis treatment,â€ Heffernan says.
Patients who use the same medications for a while may find that their treatment becomes ineffective as their body gets used to them. If that happens, talk to your doctor about changing the drugs. You may need a different class or strength of medication.
Be realistic about the time commitment you need to make. â€œOne of the great difficulties is the amount of time and effort required to get skin clear," Heffernan says.
"The average patient says he spends up to 30 minutes a day putting on his topical medicines. Thatâ€™s a lot to ask of people.â€ However, Heffernan adds, remember that adhering to your treatment plan means youâ€™re likely to see results and eventually clearer skin.
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