Although psoriasis is not curable, it is treatable. However, treating psoriasis can be tricky business. While there are a number of effective options out there—like topicals, UV light, and biologics—according to Mona Gohara, MD, a board-certified dermatologist based in Connecticut, successfully getting rid of psoriasis flare-ups is just as much about what you don't do to your complexion as what you do to it.
Psoriasis is characterized as an inflammatory skin condition that shows up in scaly patches that occur primarily on "high-pressure" areas, like your scalp, elbows, and buttocks (though it's worth noting that these patches can show up anywhere, even in the fingernails and hair). Courtney Rubin, MD, a board-certified dermatologist and co-founder and chief medical office of skincare brand Fig.1, adds that psoriasis can be caused by many underlying factors including genetics, environmental exposures, and abnormal immune cell function.
In the latest episode of the Well+Good YouTube series Dear Derm, Dr. Gohara suggests staying away from anything that might cause irritation to the skin to avoid psoriasis flare-ups. And one of the main culprits, according to her, is fragrance.
Fragrances: A Root Causes of Psoriasis Flare-Up
"Fragrances, as much as we love them, can act as skin irritants in many situations," says Dr. Gohara. "So particularly when we have inflammatory skin conditions, such as psoriasis we want to make sure that the skin barrier remains intact and isn’t irritated so it can do its job in fortifying our skin and keeping it protected from further inflammation."
A note to this end: Some beauty products contain "masking fragrances" that are added to formulas to disguise chemical scents. This means that even products that say "unscented" on the label can contain fragrance. To ensure that you're reaching for a bottle without fragrance, make sure your formula says that it's fragrance free.
Other Skin Care Triggers That Can Cause Psoriasis Flare-Ups
In addition to watching out for rogue scents, you'll also want to take a discerning eye to the sudsy formula you use to clean your face and body. "When we scrub our skin with harsh soaps or cleansers or rub really hard, it makes room for psoriasis to come out more," says Dr. Gohara. To avoid this, she recommends using oil-based cleansers because they effectively remove makeup, dirt, and grime without needing to rub skin too hard, which means they'll help you avoid friction and irritation.
How To Treat Psoriasis, According to a Dermatologist
Of course, this is only the beginning of your psoriasis treatment program. To find out how to craft a full regimen, check out the video above. It includes juicy tidbits like using a gentle cleanser, which is great for everyone, not just psoriasis. In particular, Dr. Gohara recommends Dove body wash for sensitive skin and Vanicream gentle body wash to help keep the skin healthy and calm.
Beyond a good cleansing routine, Dr. Rubin adds that the most important course of action when it comes to managing and getting rid of psoriasis is visiting a board-certified dermatologist, for two reasons. “Many prescription psoriasis medications are stronger and more effective than over-the-counter options,” she says. “In addition, there are many skin diseases that can mimic psoriasis, but need to be managed and treated in a completely different way.”
With that in mind, Dr. Rubin says it’s always worth consulting with an expert to confirm a psoriasis diagnosis before trying any type of psoriasis treatments, especially with severe flare-ups. A dermatologist will have many different types of psoriasis treatments in their arsenal.
For mild psoriasis cases, Dr. Rubin says a topical regime is often prescribed. That can include “a combination of topical steroids, topical vitamin D analogs, topical retinoids and topical keratolytic agents such as salicylic acid,” she says. “These work at the surface of the skin to calm down inflammation and remove excess layers of skin that give psoriasis plaques a scaly look.”
2. Light Therapy
When topical treatments aren’t doing the trick, Dr. Gohara recommends trying ultraviolet light therapy. And no, this doesn’t mean you should lay out in the sun or a tanning booth. Dr. Gohara says light therapy treatments involve going into a dermatologist’s version of a light box for treatment. Light therapy treatments, Dr. Rubin explains, “expose the affected areas of skin to narrow-band UV-B light several times per week.” She adds, “this leads to reduced inflammation in the skin and locally suppresses aberrant T-cell activity in the skin.”
3. Systemic Immunosuppressive Sgents
Moving up the treatment ladder you’ll find different medications. Systemic immunosuppressive agents are “medications taken by mouth, or sometimes by injection, that suppress the immune system, reducing inflammation and aberrant T-cell function in the skin,” Dr. Rubin explains. These can include methotrexate, mycophenolate, and cyclosporine.
Dr. Rubin warns that these medications require close supervision and monitoring from the prescribing physician. And, Dr. Gohara adds that people respond differently to oral medications. Some may experience great results from taking them, while others may see no improvement.
4. Biologic Agents
Dr. Gohara refers to injectable medications known as biologics as the “ace in the hole treatments” for getting rid of psoriasis. “These medications actually act against the very inflammatory markers that are creating psoriasis in the first place,” she says. “They act at the cellular level.”
Dr. Rubin says these injectable medications “block specific types of immune signaling in the body, such as TNF, IL-12, IL-23 and IL-17 signaling, and lead to reduced aberrant T-cell function in the skin.” And, like with oral medications, Dr. Rubin notes that biologic agents also require close monitoring from your physician.
Whether to employ biologic agents is an individual decision. Dr. Gohara says some people use them when they only have a few spots of psoriasis, while others have it all over their body. Either way, it’s an option she fully backs. “[Biologics] are one of the few ways that you can actually put psoriasis to rest for many years, if not life,” Dr. Gohara says.
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