Psoriasis Awareness: Triggers and Treatments

Aug 21, 2019

In recognition of Psoriasis Awareness Month, we look at triggers and treatment options for patients with psoriasis.

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Psoriasis is a prevalent autoimmune disease affecting more than 8 million Americans. This chronic autoimmune disorder is characterized by redness of the skin and silver scaly plaques due to inflammation. It commonly affects the scalp, elbows, and knees, but can also affect palms, soles, and nails. Itch from psoriasis can be present in 70-90% of psoriasis patients and can have a significant effect on quality of life.

How to Prevent and Manage Flares

Biologic therapy is recommended for moderate to severe psoriasis. Biologics are given by injection or intravenous infusion and have become a common treatment for psoriasis in the last 10+ years. Biologic options for treating psoriasis include Cimzia® (certolizumab pegol), Cosentyx® (secukinumab), Enbrel® (etanercept), Humira® (adalimumab), IlumyaTM (tildrakizumab-asmn), Remicade® (infliximab), SiliqTM (brodalumab), SkyriziTM (risankizumab), Stelara® (ustekinumab), Taltz® (ixekizumab), and Tremfya® (guselkumab). While systemic drugs which target the entire immune system, biologics only target specific parts of the immune system.

While remaining adherent to biologic therapy is the best way to ensure itching and flares are avoided, identifying and managing triggers can also minimize flares.

Triggers will vary from person to person and each individual needs to learn to identify their own triggers.  Some common triggers include stress, infection, and medications.

Stress can cause psoriasis flares and it is important to find relaxation methods and activities to help reduce stress. Meditation and exercise are good techniques to reduce stress levels, but when these are not sufficient, help from a therapist or a stress management course might be helpful.

Because infections affect the immune system, they can cause psoriasis flares. It is important to be extra wary of flare symptoms after having any type of infection and keep in touch with your health care provider.

Certain medications, including lithium, antimalarials, propranolol, quinidine and indomethacin, have also been associated with causing psoriasis flares. An earache, bronchitis, tonsillitis, strep throat, or a respiratory infection can all trigger psoriasis symptoms. It is important to let all of your doctors know of your condition to ensure these medications are avoided or only used when the benefit outweighs the risk of a flare.

Keeping the skin moisturized and removing scale and flaking are other ways to keep itching under control. Over-the-counter lotions that contain ingredients like salicylic acid, lactic acid, urea, or phenol can help remove scale. Limiting hot showers and baths to less than 10 minutes or taking cold showers can provide relief to itchiness. Storing lotion in the refrigerator and applying cool lotion provides itch relief.

Living with psoriasis can be very challenging. Our clinicians at the Accredo Rheumatoid Arthritis and Inflammatory Conditions (RA&I) Therapeutic Resource Center (TRC) are able to provide individualized education and counseling to address the needs of each patient living with psoriasis.

We partner with patients through our continuous interaction to keep them engaged and adherent to their therapy. In addition, we ask patients disease-specific questions to determine the severity of their psoriasis and its impact to their quality of life. This helps us understand individual disease control and act when there is evidence that intervention could improve disease outcomes.

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