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How Psoriasis Is Different for Everyone

Some people with psoriasis have just a few itchy patches, which they can control with creams they apply to their skin. Others get painful lesions over large areas of their bodies, which affect many aspects of their lives.

The things that can trigger an outbreak of psoriasis also differ from person to person. And some people have other health problems along with their psoriasis.

Because of all these things, as well as other factors like where you live and what your insurance covers, there's no one treatment plan for everyone with psoriasis. There's also no cure, so your treatment will focus on controlling your symptoms.

What Is the Psoriasis Severity Index?

Doctors use a scoring system called the Psoriasis Area and Severity Index (PASI) to label your psoriasis as mild, moderate, or severe. To figure out your PAS, your doctor will look at how serious your symptoms are. They'll also look at whether your lesions are widespread in four areas: your head, torso, arms, and legs.

PASI scores span from a zero up to 72. Generally, a score of 5-10 means you have moderate psoriasis, and any score over 10 means your condition is severe.

What Triggers Your Psoriasis?

Psoriasis triggers aren’t the same for everyone. Some of the things that might set off an outbreak are:

Treatments for Psoriasis

There are three major types of treatments:

  • Medications you apply to your skin
  • Medications you take by mouth or as a shot that affect your whole body
  • Light therapy, in which your skin is exposed to ultraviolet light

You and your doctor will choose a treatment plan based mainly on how serious your condition is, where on your body you have psoriasis, and how your skin has reacted to treatment in the past.

Some psoriasis medications can be expensive. So the type of health insurance you have may also affect what treatment you get. Your treatment is also influenced by which doctor you see, and what kind of health care is available in your area.

Treating Mild to Moderate Psoriasis

Doctors usually start with the mildest treatments, then use stronger ones if those don't work. Your treatment might include:

  • Topical treatments. You apply these prescription or over-the-counter medications right to your skin. Corticosteroids are the most common topical doctors prescribe for psoriasis. They’ll usually suggest mild ointments for sensitive areas like your face. You might use them daily when you're having a flare, and less often when you're in remission. Other topicals you might use include human-made types of Vitamin D, retinoids, and shampoos with coal tar or salicylic acid.
  • Complementary and integrative medicine. These are therapies outside of mainstream medicine like acupuncture, mind-body techniques, special diets, and supplements. Some of them may help ease itching and scaling for people with mild to moderate psoriasis. But there’s little scientific evidence about their effectiveness. They're also not regulated by the government like mainstream medications are. Tell your doctor if you're considering one.

Treatments for Moderate to Severe Psoriasis

If topical treatments don't work for you, your doctor will consider:

  • Phototherapy. In this treatment, a medical professional repeatedly exposes your psoriasis patches to ultraviolet (UV) light. You can also use a home phototherapy unit under the direction of your doctor. You can use it on its own or with other treatments.
  • Systemic treatments. Your doctor prescribes these oral, IV, or injectable drugs, which work in every part of your body. You get them when you have moderate to severe psoriasis or when other treatments haven’t worked.

It may take some trial and error to find out which drug works best for you. Even with treatment, your psoriasis will probably come back.

What Else Affects Your Psoriasis?

Here are some other things that can affect your psoriasis and your treatment:

  • Psoriatic arthritis. This condition that happens along with psoriasis causes painful, stiff, and swollen joints. People with psoriatic arthritis are more likely to have severe psoriasis and need stronger treatments. Doctors can treat it with nonsteroidal anti-inflammatory drugs (NSAIDS), disease-modifying anti-rheumatic drugs (DMARDS), immunosuppressants, and biologics.
  • Other complications or health conditions you have. People with psoriasis are at higher risk of several other health problems, including eye conditions, type 2 diabetes, high blood pressure, and other autoimmune disorders like Crohn's disease. Your doctor should choose psoriasis medications that don't interfere with those you take for other conditions.
  • Pustular or erythrodermic psoriasis. These rare and serious forms of psoriasis can affect your entire body and need treatment right away. Your doctor will usually prescribe a systemic drug.
  • Skin color. Psoriasis is often worse in people of color. If you have darker skin, your lesions may be thicker and cover more of your body. You could also need longer-lasting treatments and a higher dose.

Racial identity also plays a role in health care for skin conditions like psoriasis. One study found that Black, Asian, and Native American people with psoriasis are 40% less likely to visit a dermatologist than white people.

The researchers’ results were the same regardless of social and economic background and health insurance status, although Black and Hispanic people are less likely to have insurance.

Show Sources

SOURCES:

Mayo Clinic: “Psoriasis.”

National Psoriasis Foundation: “Topicals,” “Phototherapy,” “Systemics,” “Complementary and Integrative Medicine,” “Pustular Psoriasis,” “Erythrodermic Psoriasis,” “Treating Skin of Color,” "Paying for Treatment."

Psoriasis Forum: “Which Psoriasis Patients Develop Psoriatic Arthritis?”

Population Research and Policy Review: “Racial and Ethnic Disparities in Health Insurance Coverage: Dynamics of Gaining and Losing Coverage over the Life-Course.”

Health and Quality of Life Outcomes: “Quality of life in patients with psoriasis.”

World Health Organization: "Global Report on Psoriasis."

Canadian Agency for Drugs and Technologies in Health: "Clinical Review Report: Guselkumab (Tremfya)."

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