What is psoriasis?

Psoriasis is a noncontiguous common skin condition that causes rapid skin cell reproduction resulting in red,
dry patches of thickened skin. The dry flakes and skin scales are thought to result from the rapid buildup of skin
cells. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

Some people have such mild psoriasis (small, faint dry skin patches) that they may not even suspect that they
have a medical skin condition. Others have very severe psoriasis where virtually their entire body is fully
covered with thick, red, scaly skin.

Psoriasis is considered a non-curable, long-term (chronic) skin condition. It has a variable course,
periodically improving and worsening. Sometimes psoriasis may clear for years and stay in remission. Some
people have worsening of their symptoms in the colder winter months. Many people report improvement in
warmer months, climates, or with increased sunlight exposure.

Psoriasis is seen worldwide, in all races, and both sexes. Although psoriasis can be seen in people of any age,
from babies to seniors, most commonly patients are first diagnosed in their early adult years.

Patients with more severe psoriasis may have social embarrassment, job stress, emotional distress, and other
personal issues because of the appearance of their skin.

What causes psoriasis?

The exact cause remains unknown. There may be a combination of factors, including genetic predisposition and
environmental factors. It is common for psoriasis to be found in members of the same family. The immune
system is thought to play a major role. Despite research over the past 30 years looking at many triggers, the
"master switch" that turns on psoriasis is still a mystery.

What does psoriasis look like? What are the symptoms?

Psoriasis typically looks like red or pink areas of thickened, raised, and dry skin. It classically affects areas over
the elbows, knees, and scalp. Essentially any body area may be involved. It tends to be more common in areas
of trauma, repeat rubbing, use, or abrasions.

Psoriasis has many different appearances. It may be small flattened bumps, large thick plaques of raised skin,
red patches, and pink mildly dry skin to big flakes of dry skin that flake off.

There are several different types of psoriasis including psoriasis vulgaris (common type), guttate psoriasis
(small, drop like spots), inverse psoriasis (in the folds like of the underarms, navel, and buttocks), and pustular
psoriasis (liquid-filled yellowish small blisters). Additionally, a separate entity affecting primarily the palms
and the soles is known as palmoplantar psoriasis.

Sometimes pulling of one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is
medically referred to as a special diagnostic sign in psoriasis called the Auspitz sign.

Genital lesions, especially on the head of the penis, are common. Psoriasis in moist areas like the navel or area
between the buttocks (intergluteal folds) may look like flat red patches. These atypical appearances may be
confused with other skin conditions like fungal infections, yeast infections, skin irritation, or bacterial Staph
infections.
On the nails, it can look like very small pits (pinpoint depressions or white spots on the nail) or as larger
yellowish-brown separations of the nail bed called "oil spots." Nail psoriasis may be confused with and
incorrectly diagnosed as a fungal nail infection.

On the scalp, it may look like severe dandruff with dry flakes and red areas of skin. It may be difficult to tell the
difference between scalp psoriasis and seborrhea (dandruff). However, the treatment is often very similar for
both conditions.

Can psoriasis affect my joints?

Yes, psoriasis is associated with joint problems in about 10%-35% of patients. In fact, sometimes joint pains
maybe the only sign of the disorder with completely clear skin. The joint disease associated with psoriasis is
referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of
the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory,
destructive form of arthritis and is treated with medications to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. In most cases, the skin symptoms occur
before the onset of the arthritis.

The diagnosis of psoriatic arthritis is typically made by a physician examination, medical history, and relevant
family history. Sometimes, lab tests and X-rays may be used to determine the severity of the disease and to
exclude other diagnoses like rheumatoid arthritis and osteoarthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail symptoms
accompany the skin and arthritis symptoms. Nails may have small pinpoint pits or large yellowish separations
of the nail plate called "oil spots." Nail psoriasis is typically very difficult to treat. Treatment option are
somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the
nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

How many people have psoriasis?

Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S.
population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in
about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.

Is psoriasis curable?

No, psoriasis is not currently curable. However, it can go into remission and show no signs of disease. Ongoing
research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis contagious?

No. Research studies have not shown it to be contagious from person to person. You cannot catch it from
anyone, and you cannot pass it to anyone else by skin-to-skin contact. You can directly touch someone with
psoriasis every day and never catch the skin condition.

Can I pass psoriasis on to my children?

Yes, it is possible. Although psoriasis is not contagious from person to person, there is a known genetic
tendency, and it may be inherited from parents to their children. It does tend to run in some families, and a
family history is helpful in making the diagnosis.

What kind of doctor treats psoriasis?

Dermatologists specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the
treatment of joint disorders and psoriatic arthritis. Many kinds of physicians may treat psoriasis, including
dermatologists, family physicians, internal medicine physicians, rheumatologists, and other medical doctors.
Some patients have also seen other allied health professionals such as acupuncturists, holistic practitioners,
chiropractors, and nutritionists.

The American Academy of Dermatology and the National Psoriasis Foundation are excellent references to help
find physicians who specialize in this disease. Not all dermatologists and rheumatologists treat psoriasis. The
National Psoriasis Foundation has one of the most up-to-date databases of current psoriasis specialists.

How is psoriasis treated?

There are many effective treatment choices for psoriasis. The best treatment is individually determined by the
treating physician and depends, in part, on the type of disease, the severity, and the total body area involved.

For mild disease that involves only small areas of the body (like less than 10% of the total skin surface), topical
(skin applied) creams, lotions, and sprays may be very effective and safe to use. Occasionally, a small local
injection of steroids directly into a tough or resistant isolated psoriasis plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (like 20% or more of the total skin
surface), topical products may not be effective or practical to apply. These cases may require systemic or total
body treatments such as pills, light treatments, or injections. Stronger medications usually have greater
associated possible risks.

For psoriatic arthritis, systemic medications that can stop the progression of the disease may be required.
Topical therapies are not effective.

It is important to keep in mind that as with any medical condition, all medications carry possible side effects.
No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any
medication requires thorough consideration and discussion with your physician. The risks and potential benefit
of medications have to be considered for each type of psoriasis and the individual patient. Some patients are not
bothered at all by their skin symptoms and may not want any treatment. Other patients are bothered by even
small patches of psoriasis and want to keep their skin clear. Everyone is different and, therefore, treatment
choices also vary depending on the patient's goals and expressed wishes.

A particularly effective approach to psoriasis has been commonly called "rotational" therapy. This is a common
practice among some dermatologists who recommend changing cycles of psoriasis treatments every six to 24
months in order to minimize the possible side effects from any one type of therapy or medication.

For example, if a patient has been using oral methotrexate for two years, then it may be reasonable to take them
off of methotrexate and try light therapy or a biologic injectable medication for a while. By rotating to a
medication that doesn't affect the liver, the potential of cumulative liver damage may be reduced.
In another example, a patient who has been using strong topical steroids over large areas of their body for
prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy like
calcipotriene (Dovonex), light therapy, or an injectable biologic.

What creams or lotions are available?

Topical (skin applied) medications include topical corticosteroids, vitamin D analogue creams (Dovonex),
topical retinoids (Tazorac), moisturizers, topical immunomodulators (tacrolimus and pimecrolimus), coal tar,
anthralin, and others.

• Topical corticosteroids (steroids, such as hydrocortisone) are very useful and often the first-line
treatment for limited or small areas of psoriasis. These come in many preparations, including sprays,
liquid, creams, gels, ointments, and mousses. Steroids come in many different strengths, including
stronger ones are used for elbows, knees, and tougher skin areas and milder ones for areas like the face,
underarms, and groin. These are usually applied once or twice a day to affected skin areas.

Strong steroid preparations should be limited in use. Overuse or prolonged use may cause problems
including potential permanent skin thinning and damage called atrophy.

• A vitamin D analogue cream called calcipotriene (Dovonex) has also been useful in psoriasis. The
advantage of calcipotriene is that it is not known to overly thin the skin like topical steroids. It is
important to note that this drug is not regular vitamin D and is not the same as taking regular vitamin D
or rubbing it on the skin.

Calcipotriene may be used in combination with topical steroids for better results. There is a newer two-
in-one combination preparation of calcipotriene and a topical steroid called Taclonex. Results with
calcipotriene alone may be slower and less than results achieved with typical topical steroids. Not all
patients may respond to calcipotriene as well as to topical steroids.

A special precaution with calcipotriene is that it should not be used on more than 20% of the skin in one
person. Overuse may cause absorption of the drug and an abnormal rise in body calcium levels.

• Moisturizers, especially with therapeutic concentrations of salicylic acid, lactic acid, urea, and glycolic
acid may be helpful in psoriasis. These moisturizers are available as prescription and nonprescription
forms. These help moisten and lessen the appearance of thickened psoriasis scales. Some available
preparations include Salex (salicylic acid), AmLactin (lactic acid), or Lac-Hydrin (lactic acid) lotions.
These may be used one to three times a day on the body and do not generally have a risk of problematic
skin thinning (atrophy). Overuse or use on broken, inflamed skin may cause stinging, burning, and more
irritation. These stronger preparations should not be used over delicate skin like eyelids, face, or
genitals. Other bland moisturizers including Vaseline and Crisco vegetable shortening may also be
helpful in at least reducing the dry appearance of psoriasis.

• Immunomodulators (tacrolimus and pimecrolimus) have also been used with some success in limited
types of psoriasis. These have the advantage of not causing skin thinning. They may have other potential
 side effects, including skin infections and possible malignancies (cancers). The exact association of
these immunomodulator creams and cancer is controversial.

• Bath salts or bathing in high-salt-concentration waters like the Dead Sea in the Middle East may help
some psoriasis patients. Epsom salt soaks (available over the counter) may also be helpful for a number
of patients. Overall, these are quite safe with very few possible side effects.

• Coal tar is available in multiple preparations, including shampoos, bath solutions, and creams. Coal tar
may help reduce the appearance and decrease the flakes in psoriasis. The odor, staining, and overall
messiness with coal tar may make it harder to use and less desirable than other therapies. A major
advantage with tar is lack of skin thinning.

• Anthralin is available for topical use as a cream, ointment, or paste. The stinging, possible irritation, and
skin discoloration may make this less acceptable to use. Anthralin may be applied for 10-30 minutes to
psoriatic skin.

What oral medications are available?

Oral medications include acitretin, cyclosporine, methotrexate, mycophenolate mofetil, and others. Oral
prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare if administered to
many patients.

• Acitretin (Soriatane) is an oral drug used for certain types of psoriasis. It is not effective in all types of
the disease. It may be used in males and females who are not pregnant and not planning to become
pregnant for at least three years. The major side effects include dryness of skin and eyes and temporarily
elevated levels of triglycerides and cholesterol (fatty substance) in the blood. Blood tests are generally
required before starting this therapy and periodically to monitor triglyceride levels. Patients should not
become pregnant while on this drug and usually for at least three years after stopping this medication.

• Cyclosporine is a potent immunosuppressive drug used for other medical uses, including organ-
transplant patients. It may be used for severe, difficult-to-treat cases of widespread psoriasis.
Improvement and results may be very rapid in onset. It may be hard to get someone off of cyclosporine
without flaring their psoriasis. Because of the potential cumulative toxicity, cyclosporine should not be
used for more than one to two years for most psoriasis patients. Major possible side effects include
kidney and blood-pressure problems.

• Methotrexate is a common drug used for rheumatoid arthritis and, in high doses, for cancer treatment.
For psoriasis, it has been used effectively for many years. It is usually given in small weekly doses (5
mg-15 mg). Blood tests are required before and during therapy. The drug may cause liver damage in
some patients, particularly if there is preexisting liver disease or if given for prolonged periods of time.
Close physician monitoring and monthly to quarterly visits and labs are generally required.
What injections or infusions are available?

The newest category of psoriasis drugs are called biologics. All biologics modulate (adjust) and sometime
suppress (quiet) the immune system that is overactive in psoriasis. Currently available biologic drugs include
alefacept (Amevive), adalimubab (Humira), infliximab (Remicade), etanercept (Enbrel), and ustekinumab.
Newer drugs are in development and may be on the market in the near future. As this class of drugs is fairly
new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be
monitored. Although previously available, efalizumab (Raptiva) was removed from the U.S. market in early
2009 due to reported safety concerns for the development of a serious brain infection, progressive multifocal
leukoencephalopathy (PML). Individuals still taking Raptiva should contact their health-care professional to
discuss risks and benefits of treatment with this drug.

A recently approved biologic product for adults who have a moderate to severe form of psoriasis is ustekinumab
(Stelara). Stelara is a laboratory-produced antibody that treats psoriasis by blocking the action of two proteins
which contribute to the overproduction of skin cells and inflammation.

Some biologics are self-injections for home use, while others are intramuscular injections or intravenous
infusions in the physician's office.

Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and
other labs prior to starting therapy.

As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild
local injection-site reactions (redness and tenderness). There is concern of serious infections and potential
malignancy with nearly all biologic drugs.

Precautions include patients with known or suspected hepatitis B or C infection, active tuberculosis, and
possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a
history of cancer and patients actively undergoing cancer therapy.

In particular, there may be an increased association of lymphoma in patients taking biologics. It is not at all
certain if this association is directly caused by these drugs. In part, this is because it is known that certain
diseases like rheumatoid arthritis or psoriasis may be associated with an inherent increase in the overall risk of
some infections and malignancies.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per
person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans may
fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior
authorization request for coverage approval. Some of the biologics manufacturers have patient-assistance
programs to help with financial issues.

The choice of the right medication for your condition depends on many medical factors. Additionally,
convenience of receiving the medication and lifestyle may be factors in choosing the right biologic medication.

Currently, the four main classes of biologic drugs for psoriasis are:

1. TNF-alpha blockers (tumor necrosis factor),

2. drugs that block T-cell activation and the movement of T-cells,

3. drugs that decrease the number of activated T-cells, and

 4. drugs that interfere with interleukin chemical messengers of inflammation.

TNF blockers

TNF blockers include Enbrel (etanercept), Remicade (infliximab) and Humira (adalimumab). TNF-alpha
blocking drugs may have an advantage of treating psoriatic arthritis and psoriasis skin disease. Their
disadvantage is that some patients may notice a decrease in the effectiveness of TNF-alpha blocking drugs over
months to years.

TNF blockers are generally not used in patients with demyelinating (neurological) diseases like multiple
sclerosis, congestive heart failure, or patients with severe overall low blood counts called pancytopenia.

The major side effect of these class of drugs is suppression of the immune system. Because of the increased risk
of infections while on these drugs, patients should promptly report fevers or signs of infection to their
physicians. Minor side effects have included autoimmune conditions like lupus or flares in lupus. Additionally,
it is best to avoid any live vaccines while using TNF blockers.

• Enbrel (etanercept) is a self-injectable medication for home use. It is injected via a small needle just
under the skin, called subcutaneous injection. It is usually dosed once or twice week by patients at home
after training with their physician or the nursing staff. Sometimes a higher loading dose is used for the
first 12 weeks and then it is "stepped down" to half the dose after the first 12 weeks. Enbrel has the
advantage of at least 16 years of clinical use and long-term experience.

• Remicade (infliximab) is an intravenous (IV) medication strictly for physician office or special infusion
medical center use. It is dosed specifically based on your weight. It is currently not for home use or self-
injection. It is injected slowly over time via a small needle into a vein. It may usually be dosed once a
week. There have been reports of antibodies to this drug in patients taking it for some time. These
antibodies may cause a greater drug-dose requirement for achieving disease improvement or failure to
improve. The IV route may be more time-consuming, requiring physician during the infusions.
Remicade has the advantage of fast disease response and good potency.

• Humira (adalimumab) is a self-injectable medication for home use. It is injected via a small needle just
under the skin as a subcutaneous dose. It is usually dosed once every other week, totaling 26 injections
in one year. Dosing is individualized and should be discussed with your physician. Sometimes a higher
loading dose is used for the first dose (80 mg) and then it is continued at 40 mg every other week. It may
give results as soon as one to two weeks of therapy. Humira has the advantage of at least 11 years of
clinical use and long-term experience.

Drugs that block T-cell activation and the movement of T-cells

• Raptiva (efalizumab) blocks both T-cell activation and the movement of T-cells into the skin. As noted
above, Raptiva was withdrawn by the manufacturer from the U.S. market in April 2009 following a
black-box warning issued in late 2008 by the U.S. Food and Drug Administration. (FDA). Raptiva may
continue to be available in other countries.

It is dosed specifically based on your weight. Labs are required before starting injections and weekly for the 12
weeks of therapy. Injections are placed just under the skin (subcutaneous) and may be given in the physician's
office or at home.

Raptiva seems to work well over several years without losing its effectiveness, therefore having the advantage
of "staying power." Raptiva may cause flares of arthritis in some patients. Raptiva may also cause a decrease or
drop in the platelet (blood-clotting element) count. Platelet counts are usually checked before starting and
periodically (often quarterly) while patients continue Raptiva.

As with other biologics, live vaccines are not advised while patients are taking Raptiva. It is usually best to have
any required vaccines weeks before starting therapy.

As with all biologics, Raptiva has been associated with possible infections and malignancy (cancer). The
relative risk of these two side effects is fairly low. The most serious reported side effect in patient taking
Raptiva was the onset of progressive multifocal leukoencephalopathy (PML) in several patients. PML is a rare,
potentially fatal, severe neurologic disorder which is thought to be caused by a particular viral infection of
brain. PML usually occurs in individuals whose immune system is weakened or suppressed and leads to
permanent loss of brain function. Symptoms of PML include unusual weakness, visual changes, loss of
coordination, difficulty speaking, and personality changes.

Drugs that decrease the number of activated T-cells

• Amevive (alefacept) decreases the number of available activated T-cells that play a role in causing
psoriasis. It is given intramuscularly (injected in the muscle) usually in the physician's office and given
once a week for 12 weeks. Many patients may see improvement in their symptoms that lasts
approximately 12 months (more or less). Amevive may not be uniformly effective for all patients, and
some patients improve more than others. The average time to maximum improvement for many patients
is about 14 weeks.

Amevive should generally not be used in patients with HIV infections as the drug causes a decrease in
the CD4 cells (part of the immune system that HIV also attacks).

Also, because of the immune-system suppression, Amevive may not be a good choice in patients with
active cancer or infection. As Amevive is one of the two currently available drugs that inhibits T cells
directly, there may be a potential concern for immunosuppression and increased susceptibility to
infections including PML. The risks and benefits of treatment with biologics need to be assessed for
each individual.

Drugs that interfere with interleukin mechanisms

• Ustekinumab is the newest biologic injectable medication used to modulate the immune system. It is an
interleukin-12/23 human monoclonal antibody. Ustekinumab targets chemical messengers in the
immune system involved in skin inflammation and skin-cell production. This drug is planned to be
dosed subcutaneously (just under the skin) once a quarter (every three months). It has been very
promising with very good clearance rates in the clinical trials thus far. A major advantage may be the
convenience of a quarterly medication. The concerns for infection and malignancy may be similar to the
other biologics.

What about light therapy?

Light therapy is also called phototherapy. There are several types of traditional medical light therapies called
PUVA, UVB, and narrow band UVB. These artificial light sources have been used for decades and generally
available in a physician's office. There are a few companies who may sell light boxes or light bulbs for
prescribed home light therapy.

Natural sunlight is also used to treat psoriasis. Daily, short, controlled exposures to natural sunlight may help or
clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may
need to be protected during sun exposure.

There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating
medication and a special light source) that have been used to treat psoriasis.

PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure. The
photosensitizing drug in PUVA is called psoralen. These treatments are usually administered in a physician's
office two to three times per week. Several weeks of PUVA is usually required before seeing significant results.
The light exposure time is slowly and gradually increased during each subsequent treatment.

Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin
is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun
sensitive and must avoid sun exposure for a period of time after PUVA.

Common side effects with PUVA include burning, tanning of the skin, potential skin damage, increased brown
spots called lentigines, and possible increased risk of skin cancer, including melanoma. The relative increase in
skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a
physician and discontinued when a maximum number of treatments have been reached.

UVB phototherapy is an artificial light treatment using a special wavelength of light. It is frequently given daily
or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and
exposure is gradually increased by 15-60 seconds per treatment or per week. Potential side effects with UVB
include skin burning, skin damage, and possible increased risk of skin cancer, including melanoma. The relative
increase in skin cancer risk with UVB treatment needs further study.

Sometimes UVB is combined with other treatments such as tar application. Goeckerman is the name of a
special psoriasis therapy using this combination. Some centers have used this therapy in a "day care" type of
setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.

What is my long-term prognosis with psoriasis?

Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable. There
have been a few studies showing a possible association of psoriasis and other medical conditions, including
obesity and heart disease.

What does the future hold?

Psoriasis research is heavily funded and holds great promise for the future. Just the last five to 10 years have
brought great strides forward in treatment of the disease with medications aimed at treating the overactive
immune system that causes the skin inflammation of psoriasis. Ongoing research is needed to decipher the
ultimate underlying cause of this disease.

Psoriasis At A Glance
 • Psoriasis is a chronic inflammatory skin disease.
• Psoriasis has no known cause.
• The tendency toward developing psoriasis is inherited in genes.
• Psoriasis is not contagious.
• Psoriasis gets better and worse spontaneously and can have periodic remissions (clear skin).
• Psoriasis is controllable with medication.
• Psoriasis is currently not curable.
• There are many promising therapies including newer biologic drugs.
• Future research for psoriasis is promising.

I was diagnosed with psoriasis after being put on lithium for manic depression. I use Dovonex ointment,
Advantim creams and antifungal creams. Have used coal tar creams, soaps and solutions in the past to no avail.
I find a swim in salt water daily in summer and a bit of sun and regular exercise plus water all help the skin.
Must keep skin moisturized and have found sorbelene with glycerine & Vit E to be a good basic cream.
Published: January 20 ::

Comment from: swtgretchen, 25-34 Female (Patient)

I just got guttate psoriasis for the first time three months ago from getting strep throat. It took four doctors to
figure out what I had. Everyone else thought it was an allergic reaction to the amoxicillin they gave me. I still
have it. I read about the light therapy, but the doctor said for me not to go to the tanning salon because it's not
good for me. I realize the risk, but I would rather take the risk than be itching from head to toe with this horrible
thing! Published: December 17 ::

Comment from: Sas, 25-34 Female

I never had any symptoms of psoriasis until a month or so into my first pregnancy. My scalp got flaky and I
would wake each morning with white all over my pillow and then all my nails started lifting off the skin and
patches appeared on my elbows, knees and arms. Once I finished breast feeding it all started clearing except for
my scalp. My nails grew back and my skin cleared but then I got pregnant again and all the same areas came
back. My second child is now 3 years old and apart from my nails being back to normal nothing else has
cleared. I saw many doctors and have tried many creams, but now pretty much just live with it. What I hate
most is when my lower legs flare up and I can't wear anything short in summer. My father has it in his scalp and
both my mother and sister have different skin disorders so I'm guessing it's genetic. I just hope my boys don't
end up with it! Published: November 19 ::

Comment from: Allison, 19-24 Female (Patient)

I am 19 years old and when I was 14 I got tons of red and scaly bumps on my whole body; my arms, stomach,
chest, legs and then it started creeping to my face. Doctors, dermatologist etc. didn't know what was going on,
and then I finally had tests done and I was diagnosed with Guttate Psoriasis. None of the creams or treatment
worked for me, and I got sick of applying them on my whole body 3 times a day. Then I resorted to tanning. It
is not covered by my insurance or anywhere in doctor offices in my town so I went to the local tanning salon.
Ever since then I have been able to control my Psoriasis. It's sad that I have to resort to it, because of skin
cancer, melanoma etc., but it is the only thing that helps (for me) and it gets bad again when I don't tan.
Published: November 19 ::

Comment from: fayetta, 75 or over Female (Patient)

My doctor prescribed Enbrel, but then my psoriasis flared to encompass my entire body. Now, I have been
given a prescription for methotrexate, which I have not started yet. I pray that I will get some relief from this
ugly and miserable disease that keeps me awake at night with the itching. Published: December 17 ::

Comment from: reddog, 55-64 Male (Patient)

I have tried everything from coal tar baths to injectables. Enbrel was really helping to clear my psoriasis, but my
insurance doesn't want to pay. So today, I returned to the doctor. We are going to start on Soriatane and see. I
have 40% body coverage and it seems to be progressing. I have had this for 25 years and have gotten little
relief. Published: December 17 ::

Comment from: Mimi, 45-54 Female (Patient)

I'm 54 and have had the common form of psoriasis for 8-9 yrs. It started under my fingernails, then my shins,
then the sides of my palms, and just lately - under both big toenails! Probably hereditary from my grandmother.
Nothing worked until I tried Relieva. My docotr tossed me a trial tube of this cream one day and it started
working. Almost immediately the itching stopped, then the plaques started disappearing. My shins are
completely clear now for over 1 year. Unfortunately, it doesn't work for nails. You don't need a prescription, it's
100% drug-free (highly concentrated banana peel oil!), and it works for 50% of cases. Thank God it works for
me! I woulld crawl over broken glass to get some! Hopefully it will work for some of you as well. Good Luck!
Published: October 30 ::

Comment from: jenniferg, 13-18 Female (Patient)

I am 15 years old and I've had slight psoriasis on my scalp, forehead, back, and chest since kindergarten. I went
to a homeopath doctor and a chiropractor in first grade, and it went away. It came back this year, and in the
early months I put loads of moisturizing cream-such as Jason's- on it every night, and it went away. it came
back about a week ago and I'm starting to put cream on it again, and hopefully it will work! Published: October
28 ::

Comment from: Moragmc, 55-64 Female (Patient)

I have had psoriasis on the soles of my feet for several years. This summer it seemed to be clearing up, maybe
because I wore open sandals. A few weeks ago, when the weather got a little colder, I wore socks, and within
days, I had excruciating itching and the psoriasis had come back with a vengeance. Creams only seem to make
the itching worse. Published: October 15 ::

Comment from: MT, 25-34 Female (Patient)

I’ve suffered with psoriasis for 22 years. When my doctor told me that I had psoriasis, I was just 12 years old. I
had no idea what it was, but his clear and short explanation made me understand it straight away. “You have
psoriasis. You will see this plagues your skin very often. It won’t kill you, it will not reduce your life time, not
even a second, but you have to get used to living with your creams maybe until you die (Hopefully not).” For
the first few years, I was just trying to understand what made it better or worse. My best treatments have been
steroid creams or ointments (they are seriously strong stuff, but at least they work quickly and you don’t have to
use them too much). Published: August 29 ::

Comment from: 55-64 Female (Patient)

The best treatment I've had is cyclosporine. Unfortunately, when I wean off of the cyclosporine, I have a return
of the symptoms. Published: August 06 ::
I have had psoriasis since I was 10 and it was not until I was in college that it started to get really bad. In
addition to my scalp, I started to get patches on my arms, legs, back and stomach. With about a year to my
wedding, I started to talk to my dermatologist about other treatments. I started light treatments (three times a
week) in addition to creams and ointments. I did see some slight results, but I did not want to walk down the
aisle with any patches. With about six months until the wedding, I went on Enbrel (two times a week). In a
month, I started noticing dramatic results, and by the time I got married, I was practically psoriasis-free! That
was three years ago, and I have been using Enbrel on and off since then. When I am off of it, the patches start
up where it first began 18 years ago: on my scalp and elbows. Once I start back on the Enbrel, it does its job
quickly and clears up the spots. When I first started on Enbrel, I did notice I had a harder time fighting colds
and seemed to get sicker quicker. Now I do not feel I have any side effects, and I am so thankful to be lucky
enough to have wonderful insurance that covers most of the medication. Published: July 29 ::

I have psoriasis on my scalp. I also have really dry skin on my arms. I know it's not dandruff because it is when
I am stressed out. I begin to "pick" at the sores in my scalp. I have bought "T-GEL" and found quick relief for
the itching and burning of the plaques. The shampoo stinks, but if you put it in your hair and get out of the
shower and let it sit 10+ minutes, you get a soothing/tingling feeling. Great relief! Whatever you do, don't
overuse the shampoo. It will dry out your hair! Also I've learned to skip other styling products or rinse out daily.
Published: June 13 ::

I have tried all drugs in the books to no avail, until I tried Enbrel, but for about two years. Then we tried Humira
and like magic all the patches disappeared, except for a few areas on my legs. Once again I can wear short
sleeves and free of psoriatic arthritis as well. Published: June 12 ::

Well, I do know what DOESN'T work for my psoriasis. I have used steroid creams, with little improvement.
Just when I think it's getting better, it flares up again. Also, I talked to my doctor and he said that you need to
modify your treatments frequently because Psoriasis gets "Used to" the medicine, and the medicine becomes
less effective. Also, I have never been "Clear" so I’m going to talk to my doctor soon about my condition.
Published: June 10 ::

Comment from: Nanny, Female

I had psoriasis in my elbows and scalp many years ago. I tried creams and ointments that doctors gave me. I
used the coal tar ointment. I was using that when we drove from MD to Florida. I used it on my elbows. My
right elbow was on the door where the window is and that elbow was exposed to more sun (and probably
magnified by the window) and it disappeared from that arm. While in Florida I used the ointment on the left
arm and made sure it was in the sun and it cleared up. I had a flare up later and was applying the creams and
ointment the doctors gave me. We had a cabin in the mountains and we lived in the water. Swimming, boating
and fishing. The river had a high sulfur content. One day after swimming for hours with my children my elbows
were itching. I rubbed them and the patches of scales just peeled off. I have never had a break out of such
magnitude again. Published: January 20 ::

Comment from: nicole, 19-24 Female (Patient)

I've had psoriasis since I was born. Both my parents have it, so they knew what it was when they saw it. I get it
on my scalp really badly sometimes, and haven't found a shampoo that works yet, but I’m always trying. My
mom and I have noticed that it tends to get worse with us when we are stressed out. It always gets worse at the
end of the semester. Has anyone else noticed this? Also, I get psoriasis on my torso, especially on my stomach
and up my spine, but I’ve never seen a website mention this. Published: January 20 ::

Comment from: donnakay56, 55-64 Male (Caregiver)

My husband has been using Polytar soap for 35 years. Now I can't find it anywhere. Products with coal tar in
them have always worked for him in the past, but I don't know what to do now. Anyone else having the same
problem, getting products with coal tar? Published: January 20 ::

Comment from: RameeD, 25-34 Female (Patient)

My psoriasis started when i was maybe in my late teenage years. I didn't notice it at first, but when I became
pregnant it went away. Shortly after I stopped breast feeding it came back. I only get it behind my ears, my front
scalp along the hairline and my eyebrows. I really hate it, but I have found an Rx that works good for me. I am a
Woman of color and I use Derma Smoothe FS Scalp Oil. It smells like baby oil and it is the best. When I use it I
never itch my head. I would highly recommend this to another person experiencing the same discomfort as me.
Published: January 20 ::

Comment from: char, 45-54 Female (Patient)

I have been using Soriatane, I have recently noticed my gums have been bleeding and now they have small
brow areas around the gums, will this correct itself or do I have permanent damage, I am stopping the drug. I
would appreciate any information you might have. Published: October 15 ::

Comment from: Brandon H, 13-18 Male (Patient)

I am 17 years old today actually! I’ve been using Clobex and it works well, but I just hate using creams. The
only negative thing I’ve seen from it is that it turns you spots white but that’s it. I’m sure if your out in the sun a
lot they will look better, but I’m not. Published: October 15 ::

Comment from: kdakin, 45-54 Female (Patient)

Last year I went to the foot doctor because my toe nails looked bad I thought it was nail fungus infection. He
took off both toe nails then this year I had another one removed after that I noticed a breakout on my hand rash
with little white spots in the center. I finally got to a dermatologist and found out that I had psoriasis. What a
shock to find out that my so called 'toe nail fungus' was really psoriasis. Published: August 14 :