Psoriasis

Georgia Mossman has five things in common with millions of others who have psoriasis.

1. Her psoriasis is like theirs because it's different, uniquely her own.
2. What works for some might not work for her.
3. What works for her might not work for some.
4. A treatment will work well once, not as well the second time, and then not at all.
5. She doesn't know why she has it.

Add unknown cause and stir in unknown cure, and you have a recipe for frustration. It's easy to see why doctors like Laurence Miller, M.D., an adviser to the National Psoriasis Foundation and the National Institutes of Health, say, "When it come to psoriasis, modern medicine is absolutely inadequate."

Psoriasis is a disease in which the skin cells run amok. Normally, skin renews itself in about 30 days—that's the time it takes for a new skin cell to work its way from the innermost layer of skin to the surface. In psoriasis, that cell reaches the top in just 3 days, as if the body had lost its brakes. The result is raised areas of skin called plaques, which are red and often itchy. After the cells reach the surface, they die like normal cells, but there are so many of them the raised patches turn white with dead cells flaking off.

Psoriasis usually goes through cycles of flare-ups and remission, with flare-ups most often occurring in winter. Sometimes it disappears for months or years. It can improve or worsen with age.

Without a cause, there is no cure. But there are many things you can do for yourself. Keep in mind, however, that what works for someone else might not work for you. You have to experiment and devise your own battle plan. Here are some strategies you can try.

Get a new attitude. Philip Anderson, M.D., a professor and chairman of the Department of Dermatology at the University of Missouri-Columbia School of Medicine, says the most important thing is to accept the fact that you have psoriasis and focus your attention on learning how to manage it and prevent it from getting serious. "Don't waste energy fussing over every bump," he says. "That's not a good idea."

Dr. Miller agrees. "I see some of my psoriasis patients maybe twice a year," he says. "There is no law that says every person with psoriasis has to get rid of every flake on the body. I put my hands about a foot apart and tell them, 'It takes this much effort to get you 80 percent clear.' Then I stretch my arms out as far as I can and say, 'For the final 20 percent, this is what you have to do.' I never say, 'Learn to live with it.' When you think you've run out of treatments, you've gone from A to Z, you start over again at A. Mild psoriasis can be controlled totally by following some of these remedies."

Lubricate your chassis. Emollients top every dermatologist's list of over-the-counter treatments. Psoriatic skin is dry, and that can mean a worsening of the psoriasis and increased flaking and itching. Emollients help your skin retain water. The emollient can be your favorite nonirritating body oil or something as mundane as vegetable shortening or petroleum jelly. They're most effective applied right after bathing, when you're still dripping wet. (For safety's sake, avoid bathing in bath oil, which can make the tub as slick as ice.) Dr. Miller recommends Sarna lotion, which contains menthol and camphor, to soothe itching.

Seek the sun. With regular doses of intense sun, 95 percent of psoriasis sufferers improve. (The Dead Sea area of Israel is famous for its climatotherapy, and many people regularly travel to sunny climes.)

"The disease seems to be so much worse in wintertime or in a variable or humid climate that you should consider moving to a warm, dry area," Dr. Anderson says. It's the ultraviolet waves that fight psoriasis, and the UVB rays work the fastest. But there's a catch-22. UVB's are also the ones that give you a sunburn and run up the risks for skin cancer. They can also cause psoriasis sufferers to break out in previously unaffected areas.

There is, however, an out. Sunscreen. "The benefits of sunbathing can outweigh the risks of skin cancer and spreading psoriasis if you use sunscreens on the places where you don't have psoriasis and only expose the affected areas to the full force of the sun," says Dr. Miller.

Turn on the lamp. Get yourself a small UVB sunlamp to treat patches of psoriasis, suggests Dr. Miller. Each person's needs vary, so consult your doctor first. You may prefer the UVA light found in tanning parlors, but it's weaker and needs much more time to work.

Use tar without feathers. Over-the-counter coal tar preparations are weaker than the prescription versions but can be effective in mild psoriasis, says Dr. Miller. You can apply the tar directly to the plaques or immerse yourself in tar bath oil and treat your scalp with tar shampoo. Since even the OTC tars can stain and smell, they're usually washed off after a certain amount of time, but some kinds can be left on the skin to enhance the effect of sunlight or UVB treatments. "Tar makes you more sensitive to the sun, so be careful," Dr. Miller warns.

He notes that some new tar products "have been made a little more elegant and cosmetically acceptable in gel form. They don't smell like tar pits, and they can be used daily and wash off easily." He gives these precautions: "If any tar product causes burning or irritation, stop using it. And tar should never be used on raw, open skin."

Get wet and warm. "Baths and heated swimming pools are excellent for psoriasis," Dr. Miller says, by flattening plaques or cutting down scaling. "But how water can actually make itching worse."

Or get wet and cold. A cold-water bath, maybe with a cup or so of apple cider vinegar added, is great for itching. "Another thing that really works is ice," Dr. Miller says. "Just dump some ice cubes into a small plastic bag and hold it against the afflicted skin."

Try cortisone for small areas. "OTC topical cortisone creams are weaker than their prescription cousins, but they're worth trying, and they're safer on the face and genital areas," Dr. Miller says. "But if you use it all the time in these areas, it will become less effective, and when you give up on it, the psoriasis can rebound. Just use it until you show some improvement, and then gradually wean yourself off."

Seal off psoriasis. Researchers have discovered that covering lesions with tape or plastic wrap for days or weeks can help clear up psoriasis, especially if cortisone cream is applied first. "I've slept in Saran Warp and a shower cap," says Mossman ruefully, not saying how it affected her marriage.

"The cells on the surface get real soggy and damaged," Dr. Anderson explains. "It seems to slow down the proliferation." This treatment, however, is good only for small areas, "no bigger than a half dollar. You have to be careful because the skin can get gooey and infected, and then the psoriasis can get worse."

Don't risk injury. New lesions often appear on injured skin, Dr. Anderson says. Researchers believe the trauma to the skin may send the body into ungovernable overdrive. "People with psoriasis shouldn't go out picking blackberries, just like a man with a bad back shouldn't be a piano mover," Dr. Anderson says. You can injure your skin with such things as tight shoes, watchbands, dull razors, and harsh chemicals.

Lose weight if you're overweight. While scientists can't swear obesity worsens psoriasis, Dr. Anderson says, "it's one of the most reliable connectors. Weight loss helps many people with psoriasis. If you lose weight and maintain normal weight, the psoriasis is almost always better."

De-stress yourself. "I say a 13-year-old girl break out in psoriasis from head to toe after her father died," Dr. Miller reports. There's overwhelming evidence that stress can trigger psoriasis, agrees Eugene Farber, M.D., president of the Psoriasis Research Institute. "If you lie on the beach in Hawaii for a week, you get better. Even going into the hospital for surgery can make your psoriasis better. Although it's stressful, you're relaxing and being cared for. Any absence from your daily stresses, for any period of time, is helpful."

Go fishing. No, this isn't stress relief. It's a cute way to say try adding fish oil capsules containing the fatty acid EPA (eicosapentaenoic acid) to your diet. Dermatology and biochemistry professor Vincent Ziboh, Ph.D., of the University of California, Davis, School of Medicine, is encouraged by what he's found. "About 60 percent of the people we studied responded well," he reports. The area and thickness of the plaques decreased, as did redness and itching.

But there are important cautions to consider. "A small number of people will not improve, and a small number will get worse," Dr. Ziboh says. "There's no guarantee." His original study was small and short-term, "so the results are not conclusive. We saw no adverse effects, but over a longer period of time, there could be some." For example, fish oil can cut down on blood clotting, so it can amplify the blood-thinning effects of other medications you may be taking. "If you take it, have your doctor monitor you," he warns.

And, Dr. Ziboh notes, not all fish oil is the same. "We analyzed the fish oils we used and found the actual percentage of EPA in capsules varied from 1 percent to 10 percent" he says. "You should expect close to 17 percent."

Although the people in his study were taking 11 to 14 grams a day, he says, "I think you could do as well or better with half that dose." But make sure you check with your doctor first. While it's a good idea to eat fatty fish, such as salmon or mackerel, he adds, you'd have to eat at least 1 or 2 pounds a day to get 5 grams of EPA.

Treat infections. There's a well-documented but unexplained link between infections and the initial onset of psoriasis. Existing psoriasis is also known to worsen when an infection strikes. Mossman suffered a case of insect bites all over her lower legs. Soon afterward, she had her first outbreak of psoriasis—on her scalp, elbows, and knees.

"We see children walk in with psoriasis covering their bodies two weeks after a strep throat," Dr. Miller says. The key here, Dr. Anderson advises, is early and proper treatment of all infections, and extra attention to psoriasis when you have any type of infection.

PANEL OF ADVISERS

Philip Anderson, M.D., is professor and chairman of the Department of Dermatology, University of Missouri-Columbia School of Medicine.

Joel Bernstein, M.D., is a clinical associate professor of clinical pharmacology, University of Chicago Pritzker School of Medicine in Illinois.

Eugene Farber, M.D., is president of the Psoriasis Research Institute and former professor and chairman of the Department of Dermatology, Stanford University School of Medicine in California.

Laurence Miller, M.D., is a member of the Medical Advisory Board of National Psoriasis Foundation and a special adviser to the director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.

Maurice Stein is a cosmetologist and Hollywood makeup artist. He is the owner of Cinema Secrets, a theatrical makeup house in Burbank, California.

Vincent Ziboh, Ph.D., is a professor of dermatology and biochemistry at the University of California, Davis, School of Medicine.