Plaque Psoriasis

With today’s treatment options, you have every reason to believe clear, healthy skin is in your future

You may have been shocked when you first found out you have psoriasis. But as one of up to 8 million Americans living with the condition—the most prevalent autoimmune disease in the United States—you are far from alone. And the first step toward taking charge is learning more about the disease and the many avenues you have to treat it.

So take a moment to read through this guide; even if you’ve been living with psoriasis for years, you may be surprised by what you learn. And if you’ve just been diagnosed, arming yourself with knowledge of the disease can help you and your healthcare team zero in on a treatment plan that can clear your skin—and get you back to living your life with confidence!   

What is plaque psoriasis?

Psoriasis is known as an immune-mediated disease—meaning it’s caused when something goes wrong with a person’s immune system. In the case of plaque psoriasis, T-cells, which usually attack germs and foreign invaders, begin to attack healthy skin cells. This triggers the body to start creating new cells at a rapid rate, resulting in itchy and/or painful raised round spots with silvery scales that can sometimes crack and bleed.  

Plaques can appear anywhere on the body, but most often show up on the elbows, knees, torso or scalp. Psoriasis can also affect more than just the skin, and is associated with multiple other conditions, including heart disease, obesity, diabetes, inflammatory bowel disease and depression. That’s why it’s key to find a treatment that works!

It’s also important to note that psoriasis is not contagious—you cannot catch it or spread it.

Who is at risk?

While scientists are still not sure what causes the immune malfunction behind psoriasis, it’s believed to be a combination of genetic and environmental factors. If one parent has it, you have a 10% chance of developing it yourself, and a 50% chance if both parents have it.

Some people find their psoriasis first appears after a stressful event, such as a move; after having an infection, such as strep; after a bad sunburn or skin injury; or after taking a certain medication, such as steroids, lithium or a beta blocker.

Plaque psoriasis strikes people of all genders equally, and while it most often shows up in people between the teen years and the mid-30s, it can occur at any age. Smoking also seems to increase a person’s chances of getting it.

How is it diagnosed?

Your healthcare provider may ask you questions about your medical and family history and will perform an examination of your skin. In some cases, they may take a small skin biopsy to confirm the diagnosis or rule out other conditions.

Once plaque psoriasis is confirmed, they will rank the severity, either by how much of your body is covered (less than 3% = mild; from 3% to 10% = moderate; more than 10% = severe) or via the Psoriasis Area and Severity Index (PASI) on a scale from 0 to 72, where a score higher than 10 suggests severe.

What this means for you

Regardless of whether you’ve just been diagnosed or have been living with psoriasis for a while, there’s every reason to believe you can find a treatment that works for you. Continue here to learn about the different options and remember—you’re a key member of your healthcare team. By staying up-to-date on the latest options, taking your medication as prescribed (and giving them time to work) and being open and honest with your doctor, you’ll be living with clearer, more comfortable skin in no time!

When reviewing your treatment options, your doctor will ask about your health history, changes in your current health status as well as how you feel about your psoriasis and what you’re willing to try to achieve clear skin. Your plan of attack may include any of the following methods:

Applying topical treatments. These medications, available as creams and ointments, both over-the-counter and by prescription, help reduce inflammation, itching and scaling. Examples include anthralin, calcipotriene, calcitriol, coal tar, corticosteroid, retinoid and salicylic acid. You may try topical treatments if you’ve just been diagnosed or if patches are small. 

Exposing your skin to light. Your dermatologist may suggest phototherapy—the use of ultraviolet light to treat your skin. This therapy helps to clear up plaques and reduce inflammation. Getting a phototherapy treatment involves exposing your skin to a lamp in your doctor’s office or to a prescription home phototherapy unit. Lamps range in size from a handheld wand to a full-body bed or booth. Light treatments typically happen a few times a week for a month or longer. Examples include ultraviolet B (UVB), psoralen + ultraviolet A (PUVA) and excimer laser. Phototherapy can also be used with medications. Note that tanning beds should not be used as a substitute for phototherapy.

Exploring body-wide (systemic) medication options. These medications slow skin cell growth and reduce inflammation. Examples include cyclosporine, methotrexate and drugs that block aspects of the immune system associated with psoriasis, such as biologics and PDE4-inhibitors. Immunotherapies are some of the newest treatments to target psoriasis.

What you can do

In addition to medication, you can also help lessen the symptoms of psoriasis by keeping skin moisturized; avoiding itchy or tight clothing; reducing stress; and maintaining a healthy weight (learn more about how to reduce the itch and discomfort of psoriasis at home, here).

And remember: How you feel about your psoriasis is unique to you. For some, large patches may not be a problem, while others may feel embarrassed about just a few small ones. No matter how you feel, it’s important to be open and honest with your healthcare provider. If your plaques are bothering you or embarrassment over your psoriasis is causing you to limit your activities, speak up!

“I’m living my best life again!”
____________________
REBEKAH GOUGER

These days, Rebekah Gouger is keeping her eyes focused on the future. The 29-year-old happily married Chattanooga, TN, resident is building a future in community-based grant development. “I’ve found a real passion in this career. I love being involved in my community—it gives me a sense of purpose!” 

When she’s not busy with that, Rebekah travels with her husband, Dakota, and goes on thrifting adventures, which she shares on her TikTok account @bekahthrifts.

But life wasn’t always this carefree for Rebekah—just a handful of years ago she felt overwhelmed by plaque psoriasis.

“Am I really going back to the dermatologist?”

Rebekah’s journey with psoriasis began in her early 20s, and at first was entirely manageable.

“I initially found a quarter-sized patch of irritation on my forearm, but it was winter so I assumed it was just because my skin was dry. When warm weather came it went away, confirming my beliefs, but I didn’t realize at the time that was probably due to the sun exposure.”

When the patch came back two winters in a row—each time growing in size and irritation—Rebekah mentioned it to her primary care doctor, who thought it might be a fungal infection and prescribed topical creams that didn’t work. 

Rebekah was no stranger to dermatologists, having undergone multiple rounds of acne treatments in her teens, so when the creams weren’t working, she figured it was time to see a skin specialist again.

“It was beyond frustrating—all I could think was I’m in my 20s—am I really going back to the dermatologist?” Still, even meeting with specialists didn’t help initially: They either misdiagnosed the condition or prescribed only topical creams or lifestyle changes that had no effect. “I completely changed my diet to try and avoid ‘trigger foods,’ but nothing worked.” 

“It was the sickest I’ve ever been in my life”

In 2020 Rebekah faced a double challenge when she contracted COVID-19. The virus hit her hard, leading to severe illness that pushed her immune system to its limits.

“It was the sickest I’ve ever been in my life—I couldn’t even get out of bed.” Following that, Rebekah’s psoriasis worsened.

So Rebekah saw a new dermatologist. Seeing how years of topicals really hadn't been cutting it, she suggested a systemic treatment for plaque psoriasis, an oral medication that blocks an enzyme central to the inflammatory process. It was a more comprehensive treatment plan than anyone had recommended to her before, and she immediately agreed.

“I feel like my body is mine again!”

“Within three days of taking my first pill, I stopped wanting to crawl out of my skin,” she says. “The plaques elsewhere were clearing up. I had a bit of nausea at first, which my doctor said was normal, and luckily that side effect did subside.”

Today, three years later, Rebekah is still taking the medication and credits it for changing her life. “For such a long time I didn’t feel good in my skin—finding a medication that made me feel whole was the ultimate blessing,” Rebekah says. “I’m so grateful to my doctor—I feel like my body is mine again!”

Rebekah’s go-to tactics for calming the skin

Here, Rebekah shares her strategies for calming her skin—ask your healthcare provider if they could work for you, too.

Eliminate stress. Research shows stress can trigger psoriasis flare-ups and worsen existing flares. “It’s definitely a big trigger for me personally. So now I work intentional stress-reducing activities into my day—I make time to have a quiet cup of tea in the morning, I go for regular afternoon walks, and I practice deep breathing exercises.” 

Find the right products. “I have a few skincare favorites that don’t irritate my skin further or cause flare-ups, including Cetaphil Very Dry to Dry Skin moisturizing cream and Good Fortune eczema-specific body oil, which you can find here. You have to find what works for you, but generally you’ll want to find products like these specifically made for sensitive skin conditions.”

Try this therapy. Red light, which is an emerging treatment for plaque psoriasis. Research posted in Lasers in Medical Science found that people with plaque psoriasis were able to clear 60 to 80 percent of their skin with two red light therapy sessions a week. “I tried it and it gave me excellent results, I’d suggest it to anyone who struggles with severe plaques,” notes Rebekah. “Paired with my medication it’s been a lifesaver.”

Check out the sauna. “Since my skin is definitely worse in the dry, cold winter weather, I make a point of visiting a sauna when I can. For some people I think sweat might be an issue, but for me the damp, warm steam is incredibly therapeutic."

Keep hydrated. Moisturization doesn’t just start with the skin, drinking enough water is also important. “I’m constantly drinking water these days, and I feel an immense difference in my skin when I’m not properly hydrated. If you have trouble drinking water, there are apps and special water bottles you can buy to help remind you, or you can try flavored water, seltzers—whatever it takes!” 

Stay connected. “Sometimes the best medicine is to just not feel alone,” admits Rebekah. “Whether that’s via an online group, friends and family, or even your heroes. Someone I’d love for everyone to check out is Whitney Simmons, she’s played a huge role in my accepting myself and realizing that just because I have plaques doesn’t mean I’m not beautiful.” You can find Whitney on Instagram @whitneyysimmons.

“Don’t self-diagnose!”
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RUDY MILES

Rudy Miles knows skincare. As a professionally licensed New York esthetician, makeup artist and the owner of Beauty by Rudy, he analyzes skin and matches his clients’ issues with the right products daily. “I was trained to ‘say what you see’ when working with clients. It’s important to address those issues with skincare, whether it be dryness, scaliness or acne, so the makeup works better,” explains Rudy.

So when he first noticed discoloration and dryness on his scalp, he immediately thought it was hyperpigmentation.

“I said, let me put some vitamin C and retinol on it, and I’ll use glycolic acid to help it fade. But none of those products worked. Since I’m bald, I’m always using the same products on my scalp that I use on my face. And my face was even, so I could not figure out why my scalp wasn’t. Still, I kept struggling to fix the issue on my own anyway.”

Rudy continued trying different products “for far too long,” before admitting nothing he was trying was working, and finally made an appointment with a dermatologist.

“He diagnosed me with scalp psoriasis. I was floored! But once I started on the treatments he prescribed, I actually started seeing improvement. By self-diagnosing the problem, I had just been making it worse!”

Here, Rudy shares the other tips he’s learned living with plaque psoriasis:

Be open to different treatments.
Rudy first started using prescription topical steroid creams and solutions. They did help, but the spots weren’t entirely gone. He saw an advertisement on social media for prescription light therapy. “I called my insurance, got approved and started going to treatments twice a week. It was a process. I got a small burn initially, so we had to change the intensity. Finding the perfect threshold took trial and error, but I finally noticed all the spots were gone one day! These days, I still apply a topical once a week to keep my scalp flare-free going forward.”

Make connections.
Once Rudy learned his diagnosis, he started researching his condition. That’s when he found the psoriasis group on Twill, a social support group app (download it at twill.health/twill-care) that features groups for multiple different medical conditions, including psoriasis. “I love the community! It’s great to have other people to talk to. Having something so visible can affect your self-confidence.”

Reach out.
Rudy uses his professional social media platforms to discuss tips and tricks on managing psoriasis. “Last week, a friend called me, and I could hear the distress in his voice. He was having some skin issues and wanted advice. I told him to see a dermatologist to get a correct diagnosis. I said, ‘Even if it’s psoriasis, you’ll be okay—there are treatments that work!’ ”