How To Treat Psoriasis

It often runs in families, which means your genes may be at least partly to blame. Unlike eczema, it’s not related to an allergy. There are multiple forms of the disease, but the most common is plaque psoriasis, in which skin cells divide too quickly, building up into thick, scaly patches that cause pain and itching. Some people with psoriasis may have just a few scaly patches; others may have the scales on most of their body. Symptoms can persist for long stretches but can also disappear for long stretches.

As frustrating as the condition can be-and there’s no cure-there is a wide variety of things you can do to reduce outbreaks and extend the length of remissions. Don’t get discouraged if one thing doesn’t work; go on and try another, or a combination of approaches. One important area to focus on is stress. It’s clear that stress often triggers an outbreak, so pay special attention to the recommendations below, and revisit the section on stress in Part 2 on page 52.

Do This Now

Prescription topical or oral drugs, and possibly light therapy, might be required to treat the underlying condition. But for additional at-home relief:

1. Use your fingernail or tweezers to gently scrape away the heaviest scales on the plaque. Only take off the scales that come off easily-don’t pull and damage the skin.
2. Once a day, soak in a warm bath to which you’ve added a handful of Dead Sea salt, available in health food stores and online. If you don’t have Dead Sea salt, try Epsom salt.
3. After your bath, massage in just enough sesame or jojoba oil to cover the scales.
4. Apply an over-the-counter 1% hydrocortisone cream. Do this two to four times a day, applying more oil beforehand.
5. Find 15 minutes every day to sit in the sun with the affected area exposed.

Why It Works

Scraping away the scales (in other words, the dead skin) lets oils and creams penetrate the skin better. Soaking in the salty bath relieves itching and soothes inflammation (and, as a valuable side benefit, it also relaxes you). Dead Sea salts are a popular treatment for psoriasis. In fact, clinics along the Dead Sea specialize in treating psoriasis, and according to several studies, 75 percent or more of the people who go to one find significant relief after several weeks. You don’t have to go to Israel for this therapy, though-your own bathtub will work.

The bathwater helps the sesame or jojoba oil penetrate the skin. In turn, the oils keep the skin moist and supple, making it easier for the hydrocortisone to penetrate. Hydrocortisone soothes the itching and flaking by dampening inflammation.

Dead Sea clinics combine soaks with plenty of sunlight exposure. We suggest sitting in the sun for 15 minutes because ultraviolet light destroys certain immune system cells in the plaques, slowing skin turnover. It’s why you have fewer flares in the summer.

Other Medicines

Herbs and Supplements

Aloe vera cream. One study in 60 patients with mild-to-moderate psoriasis found applying a 0.05% cream three times a day five days a week for four weeks resulted in a complete remission in 85 percent of the patients, compared to just 6 percent of those using the placebo cream, with no side effects. (The patients weren’t followed long-term, so there’s no information on how long the remission lasted.)

Honey, beeswax, olive oil. Mix equal parts of honey, food-grade beeswax, and olive oil in a jar and smooth onto the affected area at night. Cover with plastic wrap, then hold in place with elastic bandages. One study found this mixture along with a topical corticosteroid enabled most participants to use less steroid medicine than people who used the steroid alone.

Over-the-Counter Drugs

Coal tar. This old-fashioned therapy comes in many forms, including creams, gels, lotions, and salves. Although it can be kind of messy and smelly, it works very well with no side effects. Follow package directions.

Salicylic acid cream. The cream is often used with steroids, tar, or other topical treatments because it dissolves the scales so the medicine can penetrate more deeply. A milder version of this is used on warts. You can find it in drugstores. Just smooth it on before you use the medicine.

Prescription Drugs

Topical drugs. Most cases of mild to moderate psoriasis respond to topical prescription drugs. Doctors often prescribe more than one at the same time because they target different underlying causes of the disease, enhance each other’s effects, and reduce side effects. Prescription corticosteroids can lead to thinning of the skin and stretch marks, and the longer they’re used, the more likely you’ll become resistant to them.

• Tazorac (tazarotene) gel and cream is a form of vitamin A also known as a topical retinoid. It works by slowing the growth of skin cells.
• Dovonex (calcipotriene) is a synthetic form of vitamin D. It slows skin cell turnover, flattens lesions, and removes scales.
• Drithocreme (anthralin) is a synthetic form of chrysarobin, found in Goa powder from the bark of the araroba tree of South America, which has been used as a psoriasis treatment for more than 100 years. It slows the growth of skin cells, and is often prescribed with a steroid cream to reduce skin irritation.

Systemic drugs. If you have severe psoriasis, your doctor may prescribe methotrexate, Soriatane (acitretin), cyclosporine, or immune modulators (Amevive, Enbrel, or Raptiva) to suppress the immune system. These can have very serious side effects, however. Cyclosporine, for instance, may cause high blood pressure and kidney damage; while methotrexate (also used as a chemotherapy drug) can cause liver damage. Methotrexate is used only if no other drug works. Soriatane, similar to the acne drug Accutane, can raise cholesterol levels and may cause liver and bone problems. All of these drugs are reserved for only the most serious cases.

Other Approaches

Phototherapy. This treatment uses ultraviolet light to treat the disease, either in a doctor’s office or with a special light at home. The light is directed just to the affected area, and other parts of your body are protected during therapy. During medical phototherapy, you may need to take psoralen, a medication that enhances light’s effects. While actual phototherapy can take weeks to have an effect, even a few minutes a day in the sun helps with less serious outbreaks.

Mind-body therapies. Studies find that one-third of psoriasis outbreaks are stress related, making this condition ideal for relaxation techniques. Specifically, studies show some benefits from individual and group psychotherapy, meditation, and hypnosis. One study found patients who used meditation-based relaxation tapes during phototherapy healed faster than those who didn’t use the tapes. A study using hypnosis in 11 people found their skin improved more than those only taught to relax.

Prevention

Bathe in lukewarm water. Skip steaming showers and baths; they’re too drying. Instead, soak in a lukewarm bath to which you’ve added 1 tablespoon jojoba or sesame oil to moisturize skin. Alternate soaks with Dead Sea salts. Use soaps that don’t contain perfumes or dyes. Pat, don’t rub, your skin dry after bathing.

Slather on a heavy-duty moisturizer. Buy a large jar of heavy moisturizer for sensitive skin (no additives or perfumes) and use after bathing and several times a day. Good brands include Eucerin and Cetaphil.