Diagnosing Plaque Psoriasis
Rodriguez got diagnosed quickly, but that isn't always the case. The redness, flakes, and itch of plaque psoriasis are easy to mistake for other skin conditions — even for well-trained doctors.
These are just some of the skin conditions that are confused with psoriasis:
People of color face unique challenges in getting a diagnosis. Psoriasis plaques look different on darker skin. They may be purple or gray, instead of red. Because most ads for psoriasis medicines feature White actors, people of color may not recognize the symptoms in themselves or realize when it's time to ask a doctor for help.
Life With Plaque Psoriasis
Your body usually makes new skin cells only when you need them. When you have psoriasis, a problem with your immune system causes those cells to multiply faster than needed. The extra cells pile up and form thick patches of dry skin covered with scales.
Possible Triggers for Psoriasis
Managing skin flare-ups involves a daily routine of thick creams and ointments that moisturize dry skin patches and prevent itching. Rodriguez adds vitamin E to her cream to increase the moisture content even more.
Everyone with psoriasis has different triggers that set off their symptoms.
Stress is a big trigger for Rodriguez. She does yoga three times a week to relax and unwind. "Scheduling that time to connect with my body, to stretch, to meditate, to connect with myself and breathe is really helpful," she says.
The Emotional Impact of Plaque Psoriasis
How Psoriasis Can Affect Your Emotions
"It was difficult for me to make friends. Psoriasis started to take over my identity, in a sense. I started to be very introverted, despite being someone who really did like having friends," Rodriguez says.
She reduced her circle to two or three close friends and avoided dating for fear of being rejected. "I was struggling so much with not loving myself that I didn't think anyone else out there would accept me," she says.
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For mild to moderate plaque psoriasis, a topical corticosteroid may be all you need to get clearer skin. Steroids come in creams, lotions, ointments, gels, foams, sprays, and shampoos. These medicines reduce redness, swelling, and itching, but they can thin your skin.
Nonsteroidal topical treatments are available when psoriasis doesn't improve with steroids. These medicines are made with ingredients that slow the growth of skin cells and help clear up scaly patches.
They include:
- Anthralin
- Calcineurin inhibitors like pimecrolimus (Elidel) and tacrolimus (Protopic)
- Calcipotriene (Dovonex)
- Calcitriol (Vectical)
- Coal tar
- Roflumilast (Zoryve)
- Salicylic acid
- Tapinarof (Vtama)
- Tazarotene (Tazorac)
This treatment exposes your skin to ultraviolet (UV) light to slow the growth of new skin cells. Phototherapy is an option if you have bigger areas of psoriasis on your skin than topicals can treat, but you don't want to risk the side effects of systemic medicines.
You get phototherapy at your doctor's office about three times a week. Or you can treat yourself with a light unit at home.
The most common side effects from light therapy are:
- Burning or stinging
- Dark spots on the skin
- Itching
- Skin redness
- Blisters or skin burns (rarely)
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Medicines that you take by mouth or as a shot are another way to manage moderate to severe plaque psoriasis. They're called "systemic medications" because they work throughout your whole system, or body. These medicines come in two types: biologic drugs and non-biologics.
Biologic drugs target the specific parts of your immune system that cause psoriasis. This group of medicines includes:
- Interleukin-12/23 (IL-12/23) inhibitors) like ustekinumab (Stelara)
- IL-17 inhibitors like brodalumab (Siliq), ixekizumab (Taltz), and secukinumab (Cosentyx)
- IL-23 inhibitors like guselkumab (Tremfya), risankizumab (Skyrizi), and tildrakizumab (Ilumetri, Ilumya)
- Tumor necrosis factor-alpha (TNF-alpha) inhibitors like adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), and infliximab (Remicade)
- Acitretin (Soriatane). This is a form of vitamin A that slows the growth of new skin cells.
- Apremilast (Otezla). It helps control inflammation in your body.
- Cyclosporine. It works on your immune system to slow skin cell production.
- Deucravacitinib (Sotyktu)
- Methotrexate (Rheumatrex, Trexall). It blocks a substance that makes your skin cells grow too fast.
Some of these medicines lower your immune system, which can slightly increase your risk for infections and cancers like lymphoma. Liver and kidney damage are other possible side effects. Your doctor will monitor you for these problems during treatment.
Alternative and Complementary Therapies
Some people try natural remedies like these along with medicine and phototherapy:
- Acupuncture
- Aloe vera
- Capsaicin
- Dead sea salts
- Herbal remedies like camptotheca, Mahonia aquifolium (Oregon grape), or indigo naturalis
- Massage
There isn't much research to show that alternative and complementary treatments work for psoriasis. Because some herbal remedies might cause side effects or interact with your psoriasis medications, it's always best to check with your doctor before you try them.
Diet isn't a treatment for psoriasis. But what you eat reflects on your skin. Pro-inflammatory foods like refined carbs (white bread, pasta), red meat, whole milk, cheese, soda, and baked goods can lead to more flares. Some people notice that their symptoms improve when they limit or cut out gluten, a protein found in wheat, barley, and rye.
The best diet for psoriasis is packed with anti-inflammatory foods like fish, fruits and vegetables, nuts and seeds, and olive oil.
Seek Support and Find Community
See a mental health provider or join a support group to help you cope with psoriasis and all the stresses it brings into your life. The National Psoriasis Foundation hosts in-person and online support groups, as well as one-on-one peer support sessions, where you can connect with people who really understand what you're going through.
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Today, Rodriguez shares what she's learned from more than 2 decades of living with psoriasis on her Instagram page, @beautifullyspotted. Her very first post 10 years ago was a picture of her face completely covered in psoriasis scales. Though she was nervous about sharing such a vulnerable image, "I knew someone might see it, and it might help them feel less alone in their journey," she says.
The Journey to Self-Acceptance
Rodriguez used to believe that strength meant hiding her skin and not revealing her emotions. Twenty-six years after her diagnosis, "I know that strength lies in being able to have these conversations and embrace whatever journey you're on," she says.
It can take time to learn to love the skin you're in. Everyone has their own way to find self-acceptance. Build resilience by practicing good self-care. Use mindfulness techniques like yoga, meditation, or spirituality. Surround yourself with people who truly understand and support you.
Celebrate every victory you achieve in managing your condition, no matter how small. And rather than focus on the negatives, try to embrace your new self-image.
Future Outlook and Research
As researchers have learned more about the causes of plaque psoriasis, their understanding has led to an explosion of new treatments. There are biologic drugs and Janus kinase (JAK) inhibitors to calm the immune system, and small-molecule drugs like apremilast (Otezla), roflumilast (Zoryve) cream, and oral deucravacitinib (Sotyktu) that can slip inside and change cells. These new medicines are helping people with psoriasis get clearer skin, with fewer side effects than older drugs.
A Silver Lining
It was hard for Rodriguez to see beyond the clouds in the early days of her psoriasis journey. The rollercoaster ride of flares and medicines that failed to clear them left her frustrated and sometimes overwhelmed.
"There were times when it felt like things weren't going to get better," Rodriguez says. "When you're given that diagnosis and you learn that this is something that's always going to be a part of you, it's very difficult to process that." Eventually she did find treatments that helped.
Be persistent, find the right support, and don't give up, she stresses. "Remain hopeful that you are going to get better, that there is a solution."
Learn More About Topical Psoriasis Treatments
OTC Topical Options for Plaque Psoriasis
Get the Most Out of Your Topical Treatment
