Doctors say psoriasis, a common skin condition related to the problem of immune system, is incurable. It usually goes through cycles — there is flare-up (active) and remission (inactive) period. The good news it can go into remission for years. And if you’re lucky, it can also go into complete remission, when it’s never coming back again (inactive permanently).
This complete remission is not easy to get. But with a few appropriate strategies, you can make it more likely.
Here are some of the best ones:
Topical treatments that work
In case of mild to moderate psoriasis, topical treatments can help a lot to soothe the problem. There are many topical treatments to choose from. Which is the best one? This varies from patient to patient. But the following ones are worth a try.
Keeping your skin moist ‘alone’ is not a cure for psoriasis, but it is one of the best ways to prevent the flare-up. Psoriasis makes irritated, dry skin more likely — increasing your risk of having itching, soreness, redness, scaling, and soreness.
What kind of moisturizers to choose depends on how dry your skin is! But in most cases, ones in ointment are more recommended since they are thicker, and heavier, and more effective to lock in moistures than light lotions or creams. Also, choose products with free-fragrance label! If necessary, use moisturizing soaps.
The best time to gently pat on the ointment is a few minutes after your shower /bath so your skin’s locked in moisture more optimally. You may need to reapply after changing clothes, and use more on extreme temperatures (too hot or cold days).
Avoiding long hot showers is important, too. It’s much better to go with lukewarm water for shower, and limit it to 10 minutes or less!
Topical salicylic acid
Available both by prescription and non-prescription (over-the-counter), salicylic acid acts as a peeling agent (also called keratolytic) to help reduce scaling and promote sloughing of dead skin cells. It is a common topical treatment for numerous different skin problems, including psoriasis.
To make it work more effectively, it’s often used with other topical treatments such as coal tar. While it can help remove the scales of psoriasis, it may cause skin irritation, temporary hair loss, and other discomforts if not properly used. Here are a few precautions to remember:
- Don’t use it over large areas of the skin to reduce the risk of absorbing too much salicylic acid into the body through the skin!
- Be extra careful when applying high amounts (strong) of salicylic acid, make sure to not left in contact with your skin for too long.
Topical coal tar
As the name suggests, it’s derived from coal. It has been used for treating psoriasis decades ago. For topical treatment, it’s available in numerous different formulations (e.g. ointment, lotion, shampoo, gel, cream, and even soap).
The way of how it works for psoriasis is not fully understood. But in general, it may have an effect on the mechanism of DNA synthesis, making keratinocyte proliferation decrease.
It’s not recommended for sensitive areas — such as flexural and genital areas — due to its irritant potential. Another drawback, it has poor patient acceptance because of cosmetic factors, such as; potent (strong) tar odor and staining of clothes.
- Don’t use it with UVA (ultraviolet A), because will make side effects more likely.
- Not recommended during pregnancy and breastfeeding.
- For higher concentration of coal tar formulation, use with prescription!
Creams containing vitamin D
People with psoriasis have abnormal life cycle of their skin cells in which cells grow and build up faster than normal, causing extra skin cells that appear in scales and red patches (they could be so itchy or even painful). Vitamin D may help slow this abnormal skin growth, driving the plaques of psoriasis to become less scaly and thinner. It might also stimulate immune cells to work more effectively, reducing the risk of psoriasis flare-up.
According to a study published in the journal JAMA dermatology 2010, vitamin D deficiency is quite common in people with psoriasis. Applying vitamin D creams topically may help soothe the disease. These include Calcitriol (Vectical) and Calcipotriene (Dovonex). To keep safe, use them with prescription! Calcitriol is more recommended (less irritating), though it’s more expensive.
Also, you can get more vitamin D through the following ways:
- Get enough exposure to the sunlight. Vitamin D can be produced naturally in the body in response to UV (ultraviolet) light. But be extra careful to the sun, psoriasis may increase the risk of skin cancer when you have aggressive exposure to the sun! So go with brief, daily exposure to keep safe!
- Fuel up on fortified cereal, another good source of vitamin D, to start the day. Hot cereal in the morning is recommended.
- Free-fat, or low-fat milk. Milk is one of popular choices when it comes to diet high in vitamin D and calcium. If you’re allergic to milk and dairy products, go with milk alternatives (e.g. almond milk, rice milk, or soy milk).
- Fatty fish, eggs, and fortified juices are also good for vitamin D booster. Just make sure to eat everything in moderation!
- If possible, ask your doctor whether you need vitamin D supplements.
Among topical treatments for psoriasis, corticosteroids may be the most frequently prescribed. In fact they’re one of common choices for first-line treatment. Typically, they’re powerful enough to relieve inflammation of mild to moderate psoriasis.
The strength and dose of the medication is dependent on several factors. If the location of the affected skin is more sensitive (e.g. face, pubic area, and skin folds), low dose (mild) corticosteroid ointments could be used (some experts don’t recommended corticosteroids for such sensitive areas due to their side effects). In cases of psoriasis on smaller, tougher-to-treat and less sensitive skin – stronger corticosteroid is worth a try (get it with prescription to keep safe).
Corticosteroid drawbacks are as follows:
- You need to use it carefully (prescription is usually required). Use the dose as lowest as possible!
- The affected skin could be thinner (especially for long-term use).
- Not recommended for long-term use. It’s more recommended as a short-term medication (only use it during flares). Long-term use, particularly if improperly used, will make side effects more likely.
To reduce risks, use gloves when applying corticosteroid ointments. Or wash your hands cleanly with soap if you don’t wear gloves! Since it is a short-term medication, rotating it with other topical treatments is your best bet.
Calcineurin inhibitors, typically containing tacrolimus (Prograf) and pimecrolimus (Elidel), have been proven to be well-tolerated and effective enough to treat atopic dermatitis. How about psoriasis?
Their efficacy for psoriasis is debatable, but many experts believe these topical agents are worth a try because of their safety profile. Side effects are usually mild. These may include mild stinging, itching, or skin’s warmth sensation.
The penetration of these agents into hyperkeratotic psoriatic plaques is not as well as corticosteroids, making them less effective to relieve inflammation and plaque build-up. But they’re an alternative option for sensitive areas of the body where corticosteroids and other topical treatments are too strong (too irritating).
Sensitive body sites (like face, pubic area, or flexural areas) are more likely to have high natural absorption. Since the absorption in these areas is naturally increased, calcineurin inhibitors will work better – plus these agents are relatively safer! To increase their penetration, they could be used with other active ingredients for psoriasis such as salicylic acid.
However, calcineurin inhibitors are also not recommended for long-term use. Although their side effects are usually mild, they could be potential to increase the risk of skin cancer if not properly used.
- To make treatment work more effectively, some topical medications are covered (occluded) with waterproof of dressing, plastic wrap, or cotton socks. While this option increases the amount of medication absorbed into the skin, you need to do this carefully and not left for too long – which is particularly true for medications that have irritate potential and other harmful side effects.
- Bath solutions. Adding Dead Sea salts /Epsom salts or oilated oatmeal in a bath may help improve your psoriasis symptoms. Take this DIY-therapy for about 10-15 minutes, and then apply moisturizer afterwards.
- Anti-itch solution. Itching is common during flare-up. Several ingredients are approved by FDA for psoriasis itching. These include hydrocortisone (a low-dose, weak steroid), HCI (diphenhydramine hydrochloride), menthol, camphor, calamine, and benzocaine. Since they’re potential to cause skin dryness and irritation, they’re not recommended for long-term use.
It seems there are many different topical treatments to choose from. Many times, you take some time before finding one or combination of them that going to be the most effective to treat your psoriasis. This is usually dependent on some of the following factors:
- The location of the affected skin.
- The type and severity of your psoriasis.
- How your body responds to treatment, whether or not you’re allergic to certain medication. If you have certain health condition (other than psoriasis), this may also affect your treatment.
- The dose (strength) of treatment.
- Your general health.
Does phototherapy work?
The answer may vary. But phototherapy is one of common suggestions to support topical treatments mentioned above, especially if the medication you put on the skin doesn’t work as well as expected.
There are several types of phototherapy to choose from. To keep safe and have benefits most, here are pieces of helpful information:
In appropriate exposure, natural ultraviolet (UV) is a good way to help slow growth of new skin cells, reducing psoriasis scaling and inflammation. But this doesn’t mean you need to get the exposure ‘out of control’. Too many rays can be counterproductive, increasing the risk of health problems such as skin cancer.
Therefore again — go with brief, daily exposures to sunlight (about 20 minutes per day). And use a sunscreen, SPF 30 or higher, to avoid counterproductive effects. Sunlight, even though in moderate exposure, could be dangerous for some people with psoriasis.
UVB (ultraviolet B) therapy with artificial lamps
Controlled, safe dose of UVB light from an artificial light source may be helpful enough to relieve mild-moderate psoriasis symptoms. It can be used either for single patches or widespread areas that don’t respond to topical treatments.
Although it’s given in controlled doses, there is still a chance for the lamps to give off UVA which might increase the risk of skin cancer. UVA will penetrate deeper into the skin. So make sure your therapist understands this risk clearly. Talk to her /him how to reduce the risk while being treated.
To improve the effectiveness of the therapy, it may be used with other treatments such as coal tar cream (this technique is called the ‘Goeckerman regimen’) or anthralin-salicylic acid paste (also called the ‘Ingram regimen’). Typically, the therapy is given several times, depending on how bad your psoriasis is!
It is a combination between psoralen (a light-sensitizing medication) and UVA. UVA exposure (in safe settings) is given after you take psoralen. Since UVA penetrates deeper into your skin, this will help make psoralen work more optimally.
PUVA is stronger than UVB therapy, it’s more aggressive treatment. It’s not recommended for mild and moderate psoriasis. But if the problem doesn’t improve with UVB therapy, PUVA might be suggested.
While this therapy is more powerful, it’s also more likely to cause side effects which some could be serious. Short-term side effects include increased sensitivity of the skin to the sun, skin dryness, or wrinkled skin. It might also increase the risk of melanoma (skin cancer).
Ex-cimer laser therapy
This therapy may be your best bet if you’re looking for a practical, quick solution. Compared to other phototherapies, it will make psoriasis patches get better more quickly.
It only targets the affected skin. In this therapy, a controlled UVB beam is highly focused and radiated to the patches. So the healthy skin is almost not affected, cutting down the possible side effects on the healthy area of your skin.
Also, the entire course of the therapy requires fewer sessions than other types of light therapy, because it uses more powerful UVB beam. Possible side effects include blistering, redness, sunburns, or scarring at the areas that have been treated. But mostly, side effects are mild.
Avoid triggers of your psoriasis flare-up!
If there are certain things that trigger the flare-up, avoiding them can help a lot to keep the disease off. These triggers vary between people with psoriasis. It may take some time before you can identify the real ones that trigger and provoke your flare-up.
In general, here are a few common culprits to avoid.
The effect of tobacco smoke on psoriasis is not fully known. Although it may vary from person to person, most experts agree quitting smoking is worth a try for anyone especially those with psoriasis. The more you puff, the more likely your flare-up to occur. So kick that bad habit if you’re seriously looking for a ‘cure’ (permanent remission).
Uncontrolled, high-tension of stress will take a serious toll on your overall health, including psoriasis. Stress is not only about ‘mental or physiological’ health issue since it can also affect you physically.
While stress worsens psoriasis symptoms, dealing with psoriasis can also make you frustrated. But whatever it is, controlling your stress is a must! Stress is inevitable, but you can manage it – there are plenty of ways to deal with.
If you have certain allergies (e.g. sensitivity to gluten, nuts, or animal dander), it’s important to avoid what triggers your allergy. Although it’s not clear yet whether psoriasis is an allergic reaction, keeping your allergy at bay is important.
Sometimes infections, including common infections (e.g. yeast infection, strep throat, and even thrush), may trigger psoriasis flares. Small, salmon-pink psoriasis droplets may occur 1-2 weeks after the infection. Fortunately, the flare-up often settles once the infection goes away.
So it’s important to protect yourself from any infection. Here are a few simple things to reduce your risk of infecting yourself:
- Maintaining hygiene practices. Wash both your hands cleanly before eating or after using toilet!
- Get vaccinated. Certain infections are preventable with vaccines.
- Don’t share using personal items (such as towels, toothbrush, or razor) with someone else!
- Prepare foods hygienically!
- Regularly disinfect and clean the ‘hot zones’, such as bathroom and kitchen (common areas with lots of bacteria or other infectious agents).
- Don’t practice risky behaviors (e.g. unsafe sexual intercourse).
- Stay at home and get enough rest if you have signs and symptoms of infection!
Tattoos (skin trauma)
Tattoos cause increased risk of infection and trauma. Repeatedly piercing your skin is a nightmare for your psoriasis. Trauma skin caused by tattoos or other skin conditions (bruises, bumps, burns, or cuts) may cause Koebner phenomenon, a psoriasis flare-up at the site of the skin injury. Treat the skin with extra care!
It’s not fully understood why and how alcohol affects psoriasis flares, but drinking in moderation is a must for anyone. For your best bet, avoid drinking to prevent flare-ups. Try iced tea or other nonalcoholic thirst-quencher!
There are certain medications that may provoke psoriasis flares after long-term use. These include ACE inhibitors, lithium, NSAIDs, beta-blockers, and steroids. If you in-doubt to any medicine you’re taking, see your doctor (especially if your medicine is irritating the skin).
How about extreme weather and hormone fluctuation?
Extreme, dry weather (winter’s cold) can provoke flare-ups. Such weather will cause skin dryness more likely. Many patients find their psoriasis tend to flare up in the winter and go into remission in humid days of summer. Keeping your skin moist is the key. If necessary, use a humidifier!
It seems hormones might also have an effect. Although the disease can affect people of all ages, it tends to peak between the ages of puberty and menopause. Interestingly, it usually improves during pregnancy.
Are oral /injected medications necessary?
If treatments outlined above are not helpful enough to cope with, oral or even injected medications are available.
This option is also called as ‘systemic’ treatment. It is more powerful, but also more likely to cause severe side effects. Therefore some oral /injected medications for psoriasis are not aimed for long-term use and might be alternated with other types of treatment.
It is powerful enough to reduce the excess production of skin cells caused by psoriasis and improve inflammation. In low doses, side effects are usually not serious (generally well-tolerated), these may include appetite loss, stomach discomforts, or fatigue.
This group of medicines may be prescribed for severe cases of psoriasis. But it’s not recommended during pregnancy since it increases the risk of birth defects. Hair loss and lip inflammation are quite common when people use Retinoids.
This miracle pill is quite promising. In clinical trials, many patients find a significant improvement of their psoriasis a few months after taking the pills. And the good news, it has NICE approval. Also at a low dose, it could be used for long periods (prescription is necessary), depending on your situation. Some possible side effects include stomach upset, headaches, or weight loss.
It works as well as methotrexate, but it’s usually prescribed only for very short-term use. It’s a kind of immunosuppressant medicine. Possible side effects include hypertension, kidney problems, and increased risk of cancer. That’s why it’s prescribed extra carefully!
If necessary, stronger medicines may be required. These include biologics with injection (e.g. Infliximab, Etanercept, and Golimumab), Hydroxyurea, and Thioguanine.
Herbs, supplements and alternative treatments
A number of alternative treatment options (including herbs and supplements) for psoriasis are available. But do they really work?
Unfortunately, none ‘in science’ have definitively been proved effective. However, some are thought generally safe and may be helpful enough to relieve mild signs and symptoms of psoriasis (e.g. scaling and itching).
Oil derived from fish (especially fatty fish high in omega-3 fatty acids) may help improve psoriasis inflammation. Moderate consumption (3 grams of fish oil or less a day) is well tolerated for most people, you may find it helpful.
Aloe extract cream (in regular use) will help prevent skin dryness, itching, or reduce psoriasis scaling & redness. To see improvements on the skin, you usually need to apply it regularly for a month or more!
Topical Oregon grape
Oregon grape extract is a good idea for one of your psoriasis home remedies. It may be effective enough to help improve mild-moderate symptoms of psoriasis. A few human studies show it works as well as conventional topical creams for psoriasis. Also, there is almost no side effect! So you should give it a try!