“I hate how my scalp psoriasis causes flaking; it looks like I have dandruff all the time. It is so itchy!” said my friend Jasmine. Topical medicines had been challenging for her to consistently use, which made her scalp and body psoriasis difficult to treat.
But now medications known as biologics are revolutionizing the treatment of psoriasis by modulating the immune system. And they are giving people like Jasmine new options for living flake-free.
What is psoriasis?
Psoriasis is one of the most common skin conditions in the world, affecting an estimated 2% to 3% of the United States population. It is a chronic and inflammatory condition that primarily affects the skin but can be associated with manifestations in other parts of the body, including the joints. This condition has a preference for the skin on the front of the knees, back of the elbows, scalp and cleft at the top of the buttocks but can occur anywhere.
Psoriasis most commonly develops in adulthood, often between ages 30 and 39 or between ages 50 and 69. Psoriasis tends to affect men and women equally. Healthcare professionals often diagnose psoriasis by a physical exam, but a biopsy of the skin may be needed.
What causes psoriasis?
Psoriasis is an autoimmune disorder. Its cause is not completely understood. The mechanism is due, at least in part, to an issue with the immune system. The hallmark of psoriasis is inflammation that drives uncontrolled production and aging of skin cells that build up into thick plaques on the skin.
Factors that play a role in an individual’s risk for developing psoriasis or worsening severity of their psoriasis include:
- Genetic predisposition.
- Smoking.
- Alcohol use.
- Obesity.
- Infections — Infections can rev up the immune system, which can trigger a psoriasis flare.
It is estimated that 35% of individuals who develop psoriasis have a family history of the condition. One study of twins found that in 80% of cases, if one twin had psoriasis, both did.
What does psoriasis look like?
There are multiple forms of psoriasis: plaque, erythrodermic, guttate, pustular, inverse and nail psoriasis.
Lesions develop in response to trauma at the site where the trauma occurred. This is known as the Koebner phenomenon. For this reason, psoriatic lesions can be found at the belt line, where clothing rubs or at places that are commonly bumped during daily activities.
What is plaque psoriasis? What causes scalp psoriasis?
Plaque psoriasis is the most common type of psoriasis, representing over 90% of cases of psoriasis. This type of psoriasis is characterized by well-defined raised, red lesions that are rough to the touch and topped with a fine silvery-white scale. In darker skin tones, psoriatic plaques tend to appear more brown or violet in color and are topped with gray scale. It tends to present equally on both sides of the body on the scalp, knees, elbows and between the buttocks.
Scalp psoriasis can be confused with dandruff (seborrheic dermatitis). However, there is a form of plaque psoriasis that affects individuals’ scalps. The most common complaints of scalp psoriasis include itching and flaking. Psoriasis also can cause areas of hair loss.
How do you treat psoriasis?
There is no cure for psoriasis. Therapies are individualized based on the severity of the disease, patient preferences and other concurrent conditions such as psoriatic arthritis. Treatment can be applied to the affected area (topical) or throughout the whole body (systemic). For limited or mild disease, topical therapies are used. For moderate-to-severe disease, systemic agents are more common.
Topical therapies include:
- Steroids.
- Moisturizers.
- Vitamin D analogs.
- Tar.
- Immunosuppressants.
- Retinoids.
Systemic therapies can include:
- Phototherapy (a fancy term for exposure to light).
- Retinoids.
- Oral immunosuppressants.
- Oral, infused or injected immunomodulating agents often called biologics.
Lifestyle changes also could help with scalp psoriasis. You can try:
- Washing hair more frequently.
- Frequently brushing hair to remove scale.
- Using special topical oils and ointments that contain salicylic acid to help break down built-up scale.
How are psoriasis and mood related?
The association between psoriasis and mood is startling, and reflective of the toll skin disease can take on quality of life. People with psoriasis have higher rates of anxiety and depression than those without psoriasis. Social stigmatization is commonly reported. Further, psoriasis can be severe and disabling for some individuals, even impacting their financial security. If you or a loved one are affected, connect with peers affected by psoriasis through the National Psoriasis Foundation for support.
Relevant reading
Back on Track
Practical steps based on brain science and development to help kids thrive – post-pandemic and beyond
