There are several forms of psoriasis, a chronic skin disorder that affects more than 6 million Americans. Typically, people have only one type at a time, but multiple types can occasionally flare up simultaneously, and some types can change form in response to certain triggers. Plaque psoriasis—characterized by raised red lesions topped by a silvery scale and found on the scalp, elbows, knees and lower back—is the most prevalent. Other forms of psoriasis include guttate (small red bumps), inverse (appearing in the armpits and groin area), pustular (with blisters), and erythrodermic (which covers large areas of the skin and requires immediate medical treatment). Approximately 10 percent to 30 percent of people with psoriasis can develop psoriatic arthritis, which causes stiffening and swelling in and around joints.
The cause: Psoriasis is an autoimmune disorder characterized by rapid overproduction of skin cells, explains Day. Stress is a likely contributor to flare-ups, but certain drugs—including Eskalith (lithium), which is used to treat manic depression; Inderal (propranolol), a blood pressure medication; and Indocin (indomethacin), a non-steroidal anti-inflammatory prescribed for arthritis—can aggravate the condition. Pregnancy worsens psoriasis in about 18 percent of cases; some studies show that it can also flare up with a vengeance within four months of delivery.
The relief: While there's no cure, there are more available treatment options than ever.
1. Keep the affected areas clean. Psoriasis scales can harbor bacteria, says Bergfeld; choose a mild body wash. For shampoos, Bergfeld suggests using a tar-based product, such as Neutrogena T/Gel. Nizoral, an antidandruff shampoo now available without a prescription, may also provide scalp relief.
2. Consider a prescription-strength hydrocortisone cream. According to Bergfeld, over-the-counter hydrocortisone creams may provide relief for mild cases, but others may need extra protection.
3. Inquire about pharmaceuticals. "A class of drugs called biologics suppress the immune response—in a controlled way—that triggers the psoriasis," says Day. Two medications—Enbrel (etanercept) and Humira (adalimumab)—that were first used for rheumatoid arthritis are now prescribed to treat psoriasis.
4. Lower your stress levels by incorporating a daily relaxation regimen. According to the National Psoriasis Foundation (NPF), stress can trigger or aggravate psoriasis. Massage therapy, yoga, and meditation are all good anti-stress measures to try. Stress-relieving options are most effective when used in conjunction with more traditional therapies, according to the NPF.
5. Investigate hypnotherapy. A small (11 patients) randomized, controlled, pilot study from The Johns Hopkins School of Medicine found that hypnosis could be useful in moderating plaque psoriasis.
6. Try a mahonia-based topical treatment. Mahonia aquifolium, a berry that grows wild in Europe, was initially used as a folk remedy for inflammatory skin diseases, including psoriasis. A double-blind, placebo-controlled study published in the American Journal of Therapeuticals tested the efficacy of Relieva, a topical cream laced with a proprietary mahonia extract; the cream provided significant relief to patients with mild to moderate plaque psoriasis, with few side effects.
7. Seek out herbal solutions. Si Wu Tang or Tao Hong Si Wu Tang (6-10 grams daily) are two TCM formulas often prescribed for psoriasis, says Ding. Consult an NCCAOM-certified specialist for the correct dose.