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WHAT IS IT?
Your skin is your body’s largest organ-and one of its hardest working. It protects you from the sun, stores water and fat, helps control your body’s temperature, and fends off assaults from invaders such as dirt, insects, smoky air, and germs.Despite the heroic job your skin does, you most likely don’t give it much thought until something goes wrong-something like psoriasis, a problem marked by patches where the outer layer of skin grows too quickly. The patches, most often on the knees, elbows, and scalp, turn red and form thick, dry scales. Psoriasis tends to stay in patches, but in some people it can cover large parts of the body.
Almost 6.5 million people in the United States have psoriasis. The disease most often appears between the ages of 15 and 35 and affects men and women equally. Psoriasis is a chronic problem. That means that if you have it, you’ll have it all your life with outbreaks that come and go. A number of triggers can lead to an outbreak-stress, a cold, a fever, a sore throat, even a cut or scrape.
Most of the time psoriasis isn’t serious. It can be annoying, though, and can disrupt your daily routine. Psoriasis can’t be cured, but you can do a lot to avoid outbreaks, ease the discomfort, and speed recovery when outbreaks do occur. Your doctor can help.
WHAT IS HAPPENING?
Your skin has two main layers. The epidermis, the top layer you can see, is a thin but tough cover that protects the softer tissues below. The dermis, just beneath the epidermis, contains blood vessels, hair follicles, nerve endings, and oil and sweat glands.
Psoriasis is a problem with your epidermis. The cells in your epidermis replace themselves about every 28 days. As these cells are shed, new cells rise up from the lower section of this layer to take their place, continuing the cycle.

When you have a psoriasis attack, sections of your epidermis grow too fast. The whole process takes about 4 days instead of 28. New cells reach the top of the skin before the old ones can wear off. As the cells pile up, patches of thick skin grow.
WHAT CAUSES IT?
Psoriasis is something of a mystery. It’s thought to be an autoimmune disorder. That is, outbreaks seem to be brought on when a person’s immune system-the body’s defense against disease-reacts too strongly to something that doesn’t bother most people. But no one can say why some people have a problem with their immune system and others don’t. Fortunately, doctors do know a lot about what makes outbreaks more likely, and many effective treatments are now available. Some of the things that can spur an attack are beyond your control. You can do plenty about others, though.

THINGS YOU CAN’T CHANGE

Family history
If your mother, father, or a brother or sister has psoriasis, you have a greater chance of getting it than someone from a family in which no one has the problem. Doctors aren’t sure why. But some researchers have found several genes that seem to be linked to a person’s risk of getting psoriasis.

Injury
Damage to the skin-a scrape or cut, a rash caused by an allergy, or even a bad sunburn-can bring on a psoriasis attack in some people. The damage signals the immune system to produce new cells to heal your skin. But if you tend to get psoriasis, your body won’t stop making skin cells when it’s supposed to. Then you get a flare-up.

Illness
Strep infections, common colds, sore throats, and chicken pox can lead to a psoriasis flare-up. Experts believe that this has to do with the immune system. If an infection triggers your immune system, it may also trigger psoriasis.

Weather
Winter weather-cold temperatures, dry air, and even lack of sunlight-can trigger some outbreaks of psoriasis.

THINGS YOU CAN CHANGE

Certain medicines
Several drugs can cause a psoriasis attack. If you take an antimalaria medicine, your psoriasis may flare up two to three weeks later. Other drugs that can affect you include lithium, a drug used for depression and other emotional disorders; Inderal and other drugs called “beta-blockers” used for high blood pressure; quinidine, used for heart problems; and indomethacin, a drug to reduce inflammation that is often given for arthritis. Even stopping some drugs such as corticosteroids (drugs used to treat arthritis and skin problems) too quickly can trigger an outbreak.

Stress
Psoriasis and stress seem to be linked. Some people get outbreaks when they’re under a lot of pressure at home or on the job. Doctors aren’t sure how or why stress causes flare-ups.

Alcohol
Liquor, wine, or beer may trigger an outbreak in some people, or make an outbreak harder to treat. Experts don’t know why.
WHAT YOU CAN DO FOR YOURSELF
Psoriasis can’t be cured, but you can take steps to prevent attacks and to treat them when they do flare up.

Get relief during an attack
Resist the temptation to pick at dry scales. New patches may form if you scratch.
Soak patches in warm-not hot-water until they are soft and plump. Gently rub excess skin away with a washcloth, loofah sponge, or pumice stone. Stop when more tissue won’t rub off with gentle pressure. When you remove the scales this way, it helps the patch clear up. Medicated creams can also seep into the skin more easily if there’s no crust on the patch.
Moisten patches right after a bath or shower to keep them from drying out. Use moisture creams or lotions, hydrogenated vegetable cooking oil, or petroleum jelly. Make sure these substances don’t trigger your outbreaks, though. Test them on a small area of skin first.
Use lotions to keep skin moist all over your body. Many lotions that contain aloe vera and jojoba seem to help clear up patches, or at least soothe itching.
Try some over-the-counter shampoos and lotions made for psoriasis that contain coal tar, such as Balnetar lotion. These help some people but may make psoriasis worse in others. Try these products first on a small patch of skin to make sure they work for you. If you use these products, be careful in the sun; your skin may be more likely to burn where you’ve used them.
Add bath oil, medicated oatmeal soaps or soaks (like Aveeno), Epsom salts, or Dead Sea salts to your bath water. There are also some over-the-counter coal tar products that you can use in the tub.
Use skin care products that contain salicylic acid. This medicine can slough scales and dead skin. Your doctor may suggest that you use it with other drugs such as steroids, anthralin, or coal tar to boost their effects.
Get some sun, which can help clear up patches. The trick is to stay in the sun until just before you burn. How long this takes varies for each person. Talk with your doctor about the right amount of sun for you. Use a sunscreen everywhere you don’t have psoriasis. And remember, if you’re using products with coal tar in them, your skin will be more sensitive to the sun and more likely to burn.
If you have psoriatic arthritis, try to stay active. It may be painful, but a light walk can help lift your spirits and prevent further stiffness or muscle loss.
Take your medications. There are many new drugs that can help you. Your doctor or dermatologist can discuss which ones are best for you. Some drugs-if they’re stopped suddenly-can even lead to outbreaks. So talk to your doctor before you discontinue taking any.
Avoid the triggers
You can prevent outbreaks by avoiding things you know to be triggers. Do a little private-eye work. For a few days or weeks, keep a record of your activities, your moods, and any special events. Note if your psoriasis seems to get worse at certain times or after certain activities. This may help you spot triggers to avoid.

Limit or avoid alcohol
Alcohol can worsen outbreaks in some people. No one knows how much alcohol is too much, but studies suggest the less you drink, the lower your chances of an outbreak. If you do drink, talk with your doctor about whether it’s okay.

Don’t stress out
Your natural response to stress-any problem or demanding situation-causes changes in your body. Your blood pressure goes up, your heart beats faster, and your body releases a number of “fight or flight” chemicals for quick energy.

Brief bouts of stress aren’t harmful, but they can bring on an attack of psoriasis in some people. Also, a lot of stress day after day can take a toll on your general health. Built-up stress raises cholesterol levels and worsens high blood pressure, which can raise your risk of artery and heart disease. Stress can cause other health problems as well, including depression, headaches, and sleep disorders.

Here are some tips for reducing stress:

Exercise. People who exercise often tend to feel less tense and more relaxed.
Laugh more. Studies show that laughter releases stress-busting hormones.
Don’t try to be perfect. Set goals you can meet. Ask yourself if every single thing you do has to be the best.
Control your anger. When you’re angry, ask yourself three questions: Is this problem important? Is my anger justified? Can I do anything to fix the problem? If the answer to any of them is “no,” take a few deep breaths and tell yourself to calm down. If any answer is “yes,” don’t seethe silently; do something to change the situation.
Take breaks during a hectic day to calm down. It doesn’t matter what you do as long as it’s a time-out. Aim for at least 20 minutes a couple of times a day.
Keep a pet, if you aren’t allergic to animals. They may shed and slobber, but studies show their owners have fewer health problems than people without pets.
Relax using yoga, deep breathing, meditation, or stretching exercises.
WHAT YOUR DOCTOR CAN DO FOR YOU
Your doctor’s goal is to reduce swelling and slow rapid skin cell growth. Doctors often start with the most basic treatments that have the fewest side effects. If the first treatments don’t work, your doctor may try others or mix two or three. You and your doctor will need to be careful, though, because simply changing treatments can cause a new flare-up in some people.

It can take three or four weeks for patches to go away, even when treatments work, and they don’t work the same way for everyone. So your doctor will create a treatment plan just for you. Psoriasis is treated based on how severe it gets, how much of your body is covered by it, and how it impacts your life. You may need to try new treatments now and then. That’s because a treatment may work for a time, then stop working. No one knows why.

Your doctor may suggest some of the following treatments:

Hydrocortisone creams
These creams can be found under the brand names Anusol-HC, Gynecort 10, and Lanacort 10, to name a few. You either rub creams that contain hydrocortisone into the patches or your doctor may tell you to coat the patches with the cream, cover each with an airtight bandage, and leave the bandage on overnight. Your doctor may also inject hydrocortisone into the skin near a psoriasis outbreak. Hydrocortisone is a strong medicine, so follow your doctor’s advice closely.

Pro
Works well for some people.
Easy to use.
Available in many different strengths, from mild to strong.
Not messy.
Con
Stopping the hydrocortisone suddenly can cause a new flare-up. You have to taper off when quitting.
Can make your skin more likely to burn in the sun.
Can irritate healthy skin, causing rashes, burning, or blisters.
Can cause stretch marks.
Can make the skin thinner and cause problems such as increased risk of infections. People who have other problems that also thin the skin, such as diabetes, shouldn’t use hydrocortisone.
Injections can only clear up a small number of patches at one time.
Coal tar
Creams, ointments, shampoos, and bath oils that contain coal tar can also help. Brand names include Aquatar, Balnetar, and Denorex. You can get some of these over the counter; for others, you’ll need a prescription. Your doctor may advise you to use one of these products and then expose your skin to natural or artificial sunlight, which makes them more effective. Or your doctor may suggest you combine coal tar products with other drugs. Ask your doctor how to use coal tar products, above all if you’ll be using them on a child under two.

Pro
Can make patches go away for 6 to 12 months.
Con
May make your skin more sensitive to sunlight.
May increase your risk of skin cancer.
May irritate healthy skin and cause a rash.
May sting or burn when applied.
Are smelly and can stain clothes.
Anthralin creams and ointments
Your doctor may suggest anthralin creams or ointments such as Anthra-Derm, Drithocreme, and Micanol. You leave the product on psoriasis patches for 20 to 30 minutes, and then wash it off. Or your doctor may advise you to leave it on overnight. Micanol is a newer version of Anthralin. People who use Micanol report fewer skin irritations. It also seems to stain far less. You’ll still need to be careful though.

Pro
Can make patches go away for several weeks.
The new formula, Micolin, won’t stain or irritate healthy skin as much as the older versions.
Con
Must be put on with care because they irritate the healthy skin near patches, causing redness, rashes, or burning.
Can stain skin, hair, bedding, bathtubs, and anything else they come into contact with.
Dovonex
Dovonex is an ointment that contains vitamin D, which your skin needs to stay healthy. In studies, the ointment produced very good results in 60 percent of patients and at least some improvement in more. A small group of people did not respond to the drug.

Dovonex works best when it ‘s used alone; don’t mix it with other creams or lotions unless your doctor says it’s okay. Never use more than your doctor prescribes. The drug works slowly, and it may be some time before you notice results.

Pro
Highly effective for many people with psoriasis.
Odorless.
Won’t stain.
Con
May cause rashes on the face and reddening of the area around the patches.
Cannot come into contact with face, eyes, or genitals.
May cause higher levels of calcium in the blood, which can lead to kidney stones.
Can raise calcium and vitamin D in your blood to unhealthy levels.
Shouldn’t be used if you are pregnant, plan to get pregnant, or are nursing.
Can increase skin problems in adults over 65 years old.
Not approved for children.
Should not be combined with other treatments unless your doctor tells you to.
Topical retinoids
Retinoids are drugs related to vitamin A that work well for plaque psoriasis. The first topical retinoid approved by the FDA is tazarotene, sold under the brand name Tazorac. Tazorac improved psoriasis symptoms in 70 percent of patients who applied it in the correct daily dose. And in clinical trials, its effects lasted up to 12 weeks after treatment.

Pro
Easy-to-use gel.
Can be used on the face.
Con
Can cause skin reactions if not used properly. Be sure to follow your doctor’s advice.
Can cause birth defects. A pregnant woman or woman planning to get pregnant shouldn’t use this drug.
Oral retinoids
Oral retinoids, like topical retinoids, are related to vitamin A. Two oral retinoids, Soriatane and Accutane, are used to treat pustular and erythrodermic psorasis that don’t benefit from other remedies.

Soriatane works well and has fewer severe side effects than older retinoids. Before Soriatane, women who chose retinoid therapy were warned not to conceive not only during treatment, but never to become pregnant. Women who take Soriatane must not become pregnant while taking the drug, but they can later, after stopping treatment.

Accutane is normally given to people with severe cystic acne. It has not been approved by the FDA as a psoriasis treatment, but doctors have found that it can help some psoriasis patients.

Retinoids are even more effective when used with other treatments such as ultraviolet light.

Pro
Work well for some people, chiefly those with pustular and erythrodermic psoriasis.
Easy to use.
Con
They cause birth defects, so if you’re a woman, you must not take them if you’re pregnant, and you should always use two forms of birth control. Experts recommend you don’t become pregnant for three years after you stop taking Soriatane, or for at least one month after you stop taking Acutane.
In combination with alcohol, Soriatane can convert into a more dangerous substance called retinoid etretinate. A women who takes Soriatane can’t drink, and she needs to wait at least two months after stopping treatment before using alcohol again.
Can raise triglyceride levels in your blood-which raises your risk of heart disease.
Can also cause dry mouth, chapped lips, fatigue, headache, and muscle aches.
Methotrexate
Methotrexate (MTX) is an anticancer drug, but it also works well to relieve severe outbreaks of psoriasis and psoriatic arthritis that won’t respond to other treatments. Brand names include Folex and Mexate. Taken as a pill or an injection, the drug slows the growth of skin cells. The drug can have side effects, though, so work closely with your doctor to be sure the drug isn’t causing other problems. Your doctor may recommend that you take the vitamin folic acid with MTX. If you take MTX for a long time, your doctor may ask you to get a liver biopsy to make sure you don’t have cancer or another problem.

Pro
May work when nothing else does.
Very effective for severe cases of psoriasis and psoriatic arthritis.
Con
May cause hair loss.
May cause liver damage.
Lowers the number of infection-fighting white blood cells.
Can cause birth defects if either the mother or father is taking it during the time of conception.
Can cause nausea, fatigue, loss of appetite, and sores in the mouth.
Cyclosporine
This oral medication was first given to people who had an organ transplant because it prevents the immune system from attacking new tissues. But doctors discovered that cyclosporine works very well on stubborn psoriasis patches, too. Since cyclosporine slows the immune response, it can also stop psoriasis in its tracks. It manages to select the right skin cells to slow down, and it also reduces inflammation.

There’s a new form of cyclosporine called Neoral that’s easier for your body to absorb than the older formula called Sandimmune.

Pro
Works well in treating severe flare-ups.
May help when all else fails.
Con
May cause kidney damage and high blood pressure.
May cause increased hair growth.
May cause shaking hands.
The effects of long-term use are still being studied, and so far are unknown.
Ultraviolet light therapy
Your doctor shines a light with ultraviolet (UV) rays-the rays in sunlight that make us burn or tan-on psoriasis patches. This treatment helps with stubborn outbreaks that don’t respond well to drugs.

There are two types of UV light, ultraviolet B and ultraviolet A. Ultraviolet B light alone can clear up patches; ultraviolet A light works best with a drug called psoralens. You take psoralens as a pill or spread it on your skin in a cream before being exposed to the light. The drug makes your skin more sensitive to the light’s healing effects. This combination of light and psoralens is called PUVA therapy.

Some people may need treatment a few times a week; others may need treatments only once a month. Your doctor may start with a short treatment to see if or how well it works. If it does work, your doctor may lengthen the amount of time for each treatment, then increase the number of treatments. After the patches go away, you may need to sit under the lamp for a few minutes once a week to keep them from coming back.

Pro
Works well for psoriasis that covers large areas.
May be safer than natural sunlight.
Con
May raise your risk of skin cancer, including malignant melanoma, the most serious type. But studies have not confirmed this.
Short-term side effects include nausea, itching, and reddened skin.
Long-term use of UV light may cause premature aging of the skin and cataracts. Protective eyewear should be worn during treatments. Your doctor may shield your face, which gets the most exposure to sunlight over your lifetime.
Home phototherapy
Home ultraviolet light B (UVB) equipment can be used by some people with psoriasis. But if you want to try it, you’ll need a prescription. Your doctor will also need to give you very detailed advice on how to use it and will need to keep a close eye on you.

Pro
Can be used at home, but treatment should be under direction of a physician.
Con
Has the same risks as other UVB therapy.
Rotational therapy
When a patient does not respond to any of the standard remedies, a doctor will try a rotational therapy-a combination of treatments that might include coal tar with UVB, PUVA, methotrexate, and cyclosporine. Treatment with each therapy lasts from 12 to 24 months; then the patient is switched to another. Changing treatments helps prevent any single treatment from becoming less effective.

Pro
May work for extremely severe or chronic cases of psoriasis that don’t respond to conventional therapy.
Con
Each treatment has its own set of side effects.