Dermatologists Share Strategies for Managing Psoriasis Effectively

Psoriasis affects millions worldwide, impacting not just skin health but also joints, immune function, and mental well-being. Dr. Prachi B Bodkhe, a dermatologist at Envi Aesthetics, emphasizes that while a cure is not currently available, effective management is achievable through medical supervision, lifestyle adjustments, and awareness of related conditions. She underscores the necessity of avoiding self-medication, stating, “Psoriasis management is complex, and treatments that work for one person may be harmful or ineffective for another.”

This World Psoriasis Month, dermatologists are focusing on early signs to watch for and strategies to manage this chronic condition effectively.

Recognizing Early Signs and Diagnosis

Dr. Akanksha Sanghvi, founder of Oprava Aesthetics, shares insights on the initial symptoms of psoriasis. “It commonly begins as a salmon pink patch, typically found on the knees, elbows, or scalp. Initially, it may feel slightly rough and have fine flakes, sometimes accompanied by a mild burning sensation. Over time, it becomes thicker with silvery scales,” she explains.

Differentiating between psoriasis and eczema can be challenging. Dr. Sanghvi points out, “The key symptom that distinguishes eczema from psoriasis is the intensity of itching. Eczema usually presents with intense itching, while psoriasis does not. The location of the rash also varies; psoriasis tends to appear on the scalp, knees, elbows, and lower back, while eczema is often found behind the knees, inside elbow folds, and at the nape of the neck, especially in children.”

To confirm a diagnosis of psoriasis, dermatologists utilize various diagnostic tools:

1. **Clinical examination**: Observing specific signs such as Koebner’s Phenomenon, symmetrical distribution, well-defined borders, and silvery scales.
2. **Nail changes**: Psoriasis may cause dents, thickening, discoloration, or nails lifting away from the skin.
3. **Psoriatic arthritis**: This condition can lead to joint pain, stiffness, and swelling, particularly in the fingers, toes, or lower back.
4. **Dermatoscopy**: A dermatoscope can reveal typical patterns indicative of psoriasis, such as tiny red dots and white scales.
5. **Skin biopsy**: A small skin sample can confirm psoriasis by showing thickened skin layers and microabscesses.

Symptom Management and Lifestyle Adjustments

Managing symptoms such as severe itching, scaling, and joint pain associated with psoriatic arthritis is essential. Dr. Bodkhe notes that effective management requires both short-term relief during flare-ups and long-term strategies to minimize recurrence. “Patients should use high-potency topical corticosteroids or calcineurin inhibitors to reduce inflammation. Additionally, fragrance-free ceramide-based moisturizers can help repair the skin barrier and alleviate itching,” she advises. For joint pain, she suggests physiotherapy alongside prescribed medications.

Other effective treatments include:

1. **Keratolytic agents** like urea and salicylic acid to loosen scales.
2. **Narrowband UVB phototherapy** to slow skin cell turnover.

Lifestyle changes, while not a replacement for medical treatment, can significantly improve quality of life. Dr. Bodkhe highlights several key adjustments:

1. **Diet**: Incorporate anti-inflammatory foods such as leafy greens, berries, fatty fish, nuts, and whole grains while reducing processed foods, sugar, and alcohol.
2. **Weight management**: Maintaining a healthy weight is crucial, as obesity is linked to more severe disease and poorer treatment responses.
3. **Stress management**: Techniques such as mindfulness, yoga, and breathing exercises can help lower stress hormones. Cognitive-behavioral therapy may also assist in coping with the stress of chronic illness.

Dr. Sanghvi details the various types of psoriasis and their treatment approaches:

1. **Plaque psoriasis**: The most common type, characterized by thick, salmon pink plaques with silvery scales.
2. **Guttate psoriasis**: Presents as small, red, scaly spots often following a strep throat infection.
3. **Inverse psoriasis**: Appears as smooth, red patches in skin folds with minimal scaling.
4. **Pustular psoriasis**: Features white or yellow pus-filled bumps on red skin, not caused by infection.
5. **Erythrodermic psoriasis**: A rare, severe type that affects most of the skin, causing intense redness, heat, and peeling, requiring immediate medical attention.

Understanding palmo-plantar psoriasis is crucial, as its diagnosis and presentation differ from other forms. This type manifests as thick, scaly plaques on the palms and soles, often resulting in painful cracks. Dr. Bodkhe notes, “These lesions can severely limit functionality and are often resistant to standard topical treatments.”

Treatment often requires a more intensive and multi-faceted approach, including:

1. High-potency corticosteroids applied under occlusion for better absorption.
2. Combination treatments with topical calcipotriol.
3. Targeted phototherapy, such as PUVA or excimer laser.
4. Systemic therapy using immunosuppressants, immunomodulators, and biologics like tofacitinib and adalimumab for severe cases or when psoriatic arthritis is present.

Psoriasis and Associated Conditions

Research indicates a connection between psoriasis and other autoimmune conditions. Dr. Bodkhe highlights the link between palmo-plantar psoriasis and thyroid dysfunction, stating, “Some studies show connections between palmo-plantar psoriasis and autoimmune thyroid conditions, specifically Hashimoto’s thyroiditis. However, not all patients with palmo-plantar psoriasis have thyroid-related illness.”

This association may stem from shared autoimmune mechanisms, where the immune system mistakenly attacks healthy tissues, and chronic inflammation that increases the risk of multiple autoimmune diseases. “Raising awareness is vital, as early detection and treatment of thyroid disease may stabilize skin symptoms,” Dr. Bodkhe adds. She urges clinicians to screen patients with palmo-plantar psoriasis for thyroid issues when symptoms suggestive of thyroid dysfunction arise.

Treatment approaches for psoriasis vary based on type and severity. Dr. Sanghvi explains, “The goal is always to calm the overactive immune system, reduce inflammation, and heal the skin.” Treatment options include:

1. **Topical treatments**: For plaque psoriasis, starting with corticosteroid creams, vitamin D-based creams, and emollients.
2. **Phototherapy**: Controlled UVB light for larger areas or when topical treatments are insufficient.
3. **Systemic medications**: Oral options like methotrexate, cyclosporine, or acitretin to control inflammation from within.
4. **Biologics**: Targeted injections that block specific immune signals, used for moderate to severe cases or when other treatments fail.
5. **Type-specific treatments**: Guttate psoriasis may respond well to moisturizers, light therapy, or antibiotics, while inverse psoriasis typically requires mild steroid creams. Pustular and erythrodermic psoriasis are more serious and often necessitate hospitalization with more powerful oral or injected medicines.

Across all types, Dr. Sanghvi emphasizes, “Avoiding triggers, keeping skin well moisturized, and following a dermatologist’s plan are key to long-term control.”