It Took Me Years to Find the Right Psoriatic Arthritis Medication

From verywellhealth.com

By Leslie Beth Herbert

My pain began in 2009. It started in my back but eventually reached my shoulders, hips, and back. The karate and bootcamp classes I often attended became difficult to join as I often woke up stiff with limited mobility.

I tried physical therapy and applying ice and heat, but that provided little to no relief. My doctor sent me for a mammogram, ultrasound, and cancer screenings, which all showed no reason for my pain. Finally, I had an X-ray and magnetic resonance imaging (MRI) that confirmed I have arthritis. Unfortunately, this diagnosis was only part of the puzzle. It would be years of treatment trial and error before I received my psoriatic arthritis diagnosis.

Read on to learn about my journey in receiving a psoriatic arthritis diagnosis and medication that works for me.

WHEN TREATMENTS JUST AREN’T WORKING, PERHAPS THE DIAGNOSIS IS WRONG (OR INCOMPLETE)

The next few years were a whirlwind as I went to different providers trying to find treatments and medications that worked for me. I saw:

• Two back doctors
• A knee doctor
• Two rheumatologists
• A neurologist

I started carrying a thick binder to appointments with notes and tests from previous doctors. I had to advocate for myself. 

I’m an educated patient. I have a doctorate and two children who have navigated serious health conditions, including cancer. I had my suspicions about what was causing my pain, but I knew that doctors wouldn’t take me seriously if I just came out and told them my self-diagnosis. Instead, I learned to ask them guided questions. My questions would spark them to consider other conditions—including those I thought might be at play.

I faced some very difficult appointments. One doctor suggested that my pain was all in my head and put me on an antidepressant. I was frustrated and desperate, so I tried taking the antidepressant. It didn’t do anything for my pain.

A SIGN OF HOPE: A MEDICATION ACTUALLY HELPED

Before I got any clear answers, I developed uveitis (a rare type of inflammatory eye disease) in my eye. I felt a stabbing pain in my eyeball, and the entire area around it felt like I had been punched. I went to an ophthalmologist, who suggested I try a biologic. Soon after that I started Humira, and the medication changed my life.

I noticed the results almost immediately. I wasn’t as stiff in the morning. I regained my range of motion and did karate with little pain. I was still tired, but as a working mom with two young kids, that was to be expected. 

I was on Humira for four years, and I became a spokesperson for the patient experience on the medication. Unfortunately, I eventually had to go off the Humira because I was having recurrent thrush infections. Medications like Humira weaken the immune system to stop it from attacking the points; unfortunately, that can leave patients vulnerable to fungal infections and viruses. I felt better most of the time while on Humira, but I got sick more often. 

PAYING ATTENTION TO IGNORED SYMPTOMS

During a 2016 appointment, my primary care doctor noticed skin issues. I didn’t have the plaques that are typical of psoriasis, but I had patches of dry, itchy skin and dandruff, and some pimple-like bubbles on my skin. I was so focused on the pain in my joints that I never paid much attention to my skin symptoms. And yet, they’d be the key to finding a treatment that worked. 

This updated diagnosis from my doctor, partnered with the need to switch off of Humira, prompted me to start on Stelara, a medication for psoriatic arthritis and other conditions. So far, it’s been great. I teach karate, keep up with work and home life, and enjoy traveling with my family. 

Even though I now have a diagnosis and targeted treatment, I still rely on lifestyle changes and home remedies to feel my best. The most important is movement. I try to run two miles every day. They’re slow and steady, with my dog stopping to sniff every few feet, but they keep me feeling less stiff. I also swear by turmeric supplements (I keep a jar on my desk), as well as muscle relaxers to help when I have enthesitis (inflammation of the tendons or ligaments) or muscle pain. I get enough sleep and try to manage stress. 

PAVING THE PATH FOR A LIFE WITH A CHRONIC ILLNESS

I know this disease is progressive. I take medication to slow it down, but I can’t stop it entirely. Most recently, I’ve noticed pain in my hands. My husband has started silently stepping in to open jars for me, so I don’t have to feel embarrassed asking him for help. I see a pain psychologist who has rheumatic arthritis. She’s helped me accept and process living with this chronic disease. 

Meet The Author

LB Herbert lives in Texas and shares her experience with psoriatic arthritis nationally. She’s a volunteer with the National Psoriasis Foundation, where she helps other people with the condition connect with resources and support.

Courtesy of Laura Beth Herbert

https://www.verywellhealth.com/psoriatic-arthritis-medication-8416214  

The GP who cured his psoriasis by cutting out carbs

From inews.co.uk

Psoriasis is a long-term, chronic skin disease that affects about 1.1 million people in the UK. If you are genetically predisposed to it, it can be triggered by anything from a throat infection to a period of stress, leading to itchy, scaly, and often painful patches of skin around the body. It is commonly found on the knees, elbows, trunk and scalp, and can affect your ability to sleep and concentrate.

There are several forms of therapy, including topical ointments, light therapy and injections to help manage psoriasis and slow the growth. However, there is no cure. This means that many with psoriasis, including Dr David Fox, a GP based in Hastings and father of two, find ways to live with the disruptive condition.

But while trying a new way of eating, the 42-year-old GP found that there was another way to manage, and even get rid of, his psoriasis. Here he tells i about how eating low carb has been an enlightening, and skin-clearing, process.

I’ve had psoriasis since I qualified as a GP in 2010 when I was 28. It was a really stressful time for me, which I imagine was a trigger. Once it’s triggered, it can hang around as a long-term condition.

I lived with it on my scalp, arms and legs for a long time. You can keep it covered if it’s on your arms and legs, but psoriasis on the scalp is difficult. Because it was so visible, people would comment and it was a nightmare to manage. You’re constantly flaking as if you’ve got heavy dandruff, it’s sore, and you constantly scratch. I’m not a particularly vain man, but it was very visible when my hair was cut short and would make me uncomfortable.

Obviously, as a GP, I see far worse things than psoriasis, so I wasn’t feeling too sorry for myself. But it can be hard to find manageable treatments. I used steroid-based creams and they were always effective in the short term, but if I stopped using them, the psoriasis would come back – plus, it was hard to use them on my scalp. I didn’t feel my condition was serious enough to take the immunosuppressant drugs – they can be very effective but also risk side effects, including severe infections, as they affect the whole immune system.

I hadn’t really thought about food being a trigger for psoriasis. I knew that alcohol, which is a common psoriasis trigger, was a trigger for me but I didn’t really connect the dots between the problem with alcohol being its carbohydrate content. However last year, out of curiosity and listening to a colleague’s advice, I started following the keto diet. I wasn’t thinking about my psoriasis at all, but I wanted to see if it would make me feel a bit better and healthier.

Avoiding carbs has dramatically improved Dr David Fox’s psoriasis (left) – he has also lost weight and has more energy (Photo: lacaosa/Getty)

There are some doctors who make living a healthy lifestyle their ‘thing’, but I, like a lot of other GPs, didn’t really look after myself. I kept focusing on reducing calories and doing more exercise, eating lots of carbs such as bread and potatoes, always having a pudding and drinking regularly. Eating keto and then low carb was my way of claiming back my health, and it became a major eye-opener to how diet could run the body’s inflammatory system.

Following the keto diet, you keep your carbohydrates down to about 20 grams a day, which shifts your body from a state dependent on burning glucose to one dependent on burning fat. This means your energy source is fat itself, and when they are used as energy, they release ketones. Before going on the diet, I’d have had toast or porridge, a wrap at lunch and pasta or potatoes at dinner; after, I was instead filling up on cheese, meats, eggs, some fish, such as anchovies, and dark green vegetables like kale or broccoli.

It will always lead to weight loss, and people will find that inflammatory conditions will settle because the inflammation can be caused by sugar consumption. But you will also have other potential benefits – I found I had more energy and slept better after a few weeks.

Within a month, my skin became less actively inflamed and then the patches steadily decreased. After 10 months this psoriasis I’d had since 2010 was gone.

Experiencing those benefits definitely makes the diet easier to stick to. But there is some risk to doing keto, especially if you don’t do it properly, so I would not always recommend it without doing proper and thorough research.

While eating keto, I found the need to supplement with zinc and biotin to prevent hair thinning. You won’t notice the effects straight away (as it takes time for your hair to change) but you need to really keep up the right supplementation.

After doing keto for about four months, I’d lost enough weight and felt that I could relax my diet a bit and move onto a low carb version – instead of limiting yourself to 20 grammes of carbs a day, on low carb you’re aiming generally below 90, which is equivalent of one portion in a balanced meal kit such as Gousto. This meant I could reintegrate eating with my family and all the other things you have to sacrifice by eating a diet that’s not suitable for everyone else. During the time I was keto, the only place I could find the right kind of food when out and about was in M&S, shopping from the supermarket’s ‘three for £8’ deli section – that was where I did most of my shopping for work. You have to be very, very organised and plan carefully and that’s not always possible.

Many NHS professionals, and colleagues of mine, are very interested in intermittent fasting and low carb diets. It’s very helpful for people who do shift work and helps them to keep their weight down. There are examples around the UK where they are bringing low carb as an option to their patients who are prediabetic (at the highest risk of developing diabetes) and those with diabetes who aren’t on insulin. I do recommend it to some of my patients – we have started support groups at our practice for diabetics to offer them low carb support, and we’ve had some great progress there.

It is, however, only an option. It overlaps with the movement against ultra-processed foods (UPF) because avoiding UPFs leads to a low carb, low sugar kind of diet. The Mediterranean diet, too, is effectively a low carb diet. And it’s not as extreme or hard to sustain as eating keto. It’s just the framing (‘reduce carbs and reduce sugar’) that seems to be linking all of these things together. That makes it easy for patients to understand and therefore becomes more about common sense. And there are lots of resources out there to make sure what you do is safe. I tend to recommend the Freshwell online resources which are very patient friendly.

I see that period spent doing keto as a period of enlightenment that made me realise what was possible with my diet, and staying low carb is how I sustain it. I feel amazing – my hunger reflex has gone down, I don’t crave sugar, I can eat with my growing family, and my sleep, energy and psoriasis have all improved dramatically. This is how I want to feel all the time.

https://inews.co.uk/inews-lifestyle/gp-cured-psoriasis-cutting-carbs-3053195

Living Day to Day With Psoriasis

From webmd.com

Steven Siracuse was about 19 years old when his psoriasis got bad. Rash-like patches showed up on his elbows, forearms, knees, calves, and scalp. A college freshman at the time, he covered up in long-sleeve shirts to avoid questions and stares. He also used steroid creams that didn’t help.

Now, more than 10 years later, his skin is mostly clear. It didn’t happen overnight. It took several years of dermatology appointments and plenty of self-discipline.

Steven Siracuse

“Even at my worst, my case would be considered moderate,” says Siracuse, a financial analyst for a credit union in Buffalo, NY. “Some people have it all over their bodies. They have it all over the face. ... I always tried to keep that in perspective and tell myself that I was fortunate compared to other people.”

Over the years, Siracuse did what he could to manage the physical and mental effects of psoriasis. He worked closely with his dermatologist to find the right treatment and get his insurance company to cover it. He made the move from a high-stress job to a lower-stress one. He quit smoking cigarettes and cut back on alcohol. He patiently explained what the patches on his skin were when people asked questions or made comments that hurt.

Basically, he did many of the things that psoriasis experts recommend.

Making certain lifestyle changes can have a powerful impact on your health, and it may help your treatment work well.

There are some changes you can start making today, if you need to.

Lose Extra Weight

When you have psoriasis, your immune system releases chronic inflammation inside your body. It can affect your skin and other organs and tissues.

The more weight you carry, the more inflammation your body creates, which makes psoriasis worse, says Francisco Tausk, MD. He’s a professor of dermatology, allergy, immunology, and rheumatology at the University of Rochester Medical Centre in New York.

Tausk says studies show that biologic drugs used to treat psoriasis work better when people drop extra pounds.

Your goal should be to gradually get to a weight that’s healthy for you, says Dawn Marie R. Davis, MD, a professor of dermatology and paediatrics at Mayo Clinic in Rochester, MN.

Ask your doctor or dermatologist to help you get there.

Eat Healthier and Exercise

A balanced, nutritious diet with sensible portion sizes can help you lose weight. Tausk says ideally, the best eating plan would be a plant-based diet of whole foods. If you’re not ready for that, try to eat more vegetables and legumes, and cut back on red meat and saturated fat.

“You may want to give up on yourself, but you’re not going to want to give up and no-show on your friend. So find an accountability buddy.”

Dawn Marie R. Davis, MD, professor of dermatology and paediatrics, Mayo Clinic, Rochester, MN 

Make a grocery list of healthy foods before you go to the store so you don’t buy tempting snacks that aren’t on the list, Davis says. And swap out your favourite treats for healthier substitutes. For example, buy baked veggie chips instead of potato chips, or sparkling flavoured water instead of soda.

Exercise can also help you drop pounds. If you’re not active already, ask your doctor to help you get started -- especially if you also have psoriatic arthritis, which makes joints painful and stiff. In that case, you can try low-impact exercises like swimming, yoga, or walking in supportive shoes, Davis says.

When you find a type of workout that you like, make it a habit, she says. If you like to swim, for example, set out your goggles, swimsuit, and towel the night before. Then call a friend who’s into swimming and ask them to meet you at the pool the next morning. That helps make you accountable.

“You may want to give up on yourself, but you’re not going to want to give up and no-show on your friend. So find an accountability buddy,” Davis says.

Cut Back on Booze

Research shows that limiting how much alcohol you drink can make your treatment more effective and help keep symptoms at bay longer.

Even drinking in moderation may affect your psoriasis, though, Davis says.

Francisco Tausk, MD

If you drink while you’re taking the medication methotrexate for psoriasis, your odds of liver damage will go up. What’s more, Tausk says, people with psoriasis already have “a much higher incidence” of fat in their liver along with inflammation and damage, a condition called non-alcoholic steatohepatitis.

“So if you add another insult, which would be the alcohol, you’re stressing the liver much more,” Tausk says.

Talk to your doctor or dermatologist about what’s safe for you. Ask if you need to think about giving up alcohol.

If You Smoke, Quit

Kicking the habit is linked to fewer psoriasis flare-ups. Let your doctor know if you need help quitting. And if you live with someone who smokes, ask them if they’d be willing to quit or at least light up outside.

“Direct smoking and perhaps even second-hand or third-hand smoke” can impact someone’s psoriasis, Davis says.

Take Care of Your Mental Health

Some people with psoriasis see their condition get worse due to ongoing stress, Tausk says. “Chronic stress is very associated with depression, and it’s very pro-inflammatory,” he says.

Talk to your dermatologist if you notice that your psoriasis flares up when you’re stressed. Depending on things like your personal situation and how bad your flare is, they might add a medication to your usual regimen or change your treatment until your stress gets under control, Davis says.

Things that can help you take charge of stress include:

• Meditation apps
• Mindfulness-based stress reduction
• Exercise or yoga
• Making time for hobbies you enjoy

It’s important to speak to your doctor or dermatologist if you’re feeling anxious or depressed. They can refer you to a mental health specialist like a psychologist or psychiatrist, so you can get the help and relief you need -- and deserve.

“We have surveys on our psoriasis patients that prove that they have a higher rate of depression and anxiety,” Davis says. “It is not uncommon for people to share that they feel different, they feel left out, they feel picked on.”

“[People] with psoriasis have more loneliness,” Tausk says. “They feel stigmatized. They tend to not participate in a lot of activities because they’re embarrassed.”

If that’s you, consider meeting other people with psoriasis, who may be able to relate to what you’re going through. Your dermatologist can point you to local support groups and other online resources.

“The National Psoriasis Foundation has groups in different cities,” Tausk says. “If [people] think that what they have is the worst thing in the world, they realize that there’s always people [who] are worse, and they’re able to share their experiences.”

Stay on Top of Your Physical Health

Having psoriasis makes you more likely to get other health conditions.

“We used to see it as just [affecting] the skin. Well, not anymore,” Tausk says. “Nowadays we see psoriasis as a systemic disease that affects different parts of the body.”

He says more and more research links psoriasis with problems like inflammatory bowel disease and a type of eye inflammation called uveitis.

Other serious conditions tied to psoriasis include:

• Psoriatic arthritis
• Heart disease
• High blood pressure
• Metabolic syndrome
• Type 2 diabetes
• Dyslipidemia

Make sure your doctor tests you for related health conditions and get treatment if you have any of them, Davis says. Often, getting another condition under control can make your psoriasis easier to treat, she says.

The key is to go to all of your medical appointments.

“It’s so important for patients with psoriasis to maintain a relationship with their dermatologist or their primary care provider because psoriasis is a complicated disease,” Davis says. “If patients don’t come back to visit us, we don’t know what’s going on, and we can’t help them with all the variables that they have to address.”

Make Lifestyle Changes That Last

“We understand that we’re asking our patients to do a lot,” Davis says. “And while it appears to be uncomplicated, it’s difficult to put into practice.”

You don’t have to change everything about your lifestyle at once, she says. You can work on changing one thing at a time, and that can help you turn it a habit.

Your psoriasis may still act up at times, but “you should be so proud of yourself for being proactive, resilient, dedicated, and empowering your own health,” Davis says.

https://www.webmd.com/skin-problems-and-treatments/psoriasis/features/cm/living-day-to-day-with-psoriasis 

How do I know if I have psoriasis?

From nebraskamed.com

Psoriasis is a chronic skin condition that affects up to 3% of the population. It is characterized by a thick, scaly rash that typically itches and can sometimes be painful.

“Psoriasis is an immune-mediated disorder that results in inflammation and hyperproliferation (thickening) of the skin” says Sarah Lonowski, MD, MBA, Nebraska Medicine dermatologist. “Psoriasis is typically a chronic condition, but can be characterized by periods of flares and periods of inactivity.”

Psoriasis is not the same as eczema. Eczema is associated with dry, sensitive skin that causes intense itching. It tends to affect different parts of the body than psoriasis, though there can be overlap. Eczema often begins in babies or young children and may improve with age.

Psoriasis most commonly develops in individuals 30 to 60 years old. Both a genetic predisposition and environmental triggers are thought to be important in triggering the condition.

Environmental triggers for psoriasis include:

• Certain medications
• Infections such as strep throat
• Stress
• Cold, dry weather conditions
• Smoking
• Sudden withdrawal of oral or injected steroids

While psoriasis and eczema have similar symptoms, there are ways to tell them apart. Both are associated with patches of red, inflamed, scaly skin. However, the distribution of psoriasis on the body is typically different than that of eczema, and the plaques of psoriasis are typically thicker and more well defined than those of eczema.

Psoriasis can commonly involve the elbows, knees, scalp, lower back, palms of the hands and soles of the feet. Eczema usually appears on parts of your body that bend, such as the inner elbow, behind the knees and neck.

“Unfortunately, there is no cure for psoriasis, but we do have many new and highly effective medications to treat and control the condition,” says Dr. Lonowski.

When to seek medical advice

“The severity and frequency of psoriasis flare-ups can vary greatly for each individual,” says Dr. Lonowski. “If your condition is not severe or bothersome, you may choose not to seek medical treatment. However, symptoms such as itching, pain and flaking often lead people to seek treatment.”

Medical conditions associated with psoriasis

Psoriasis is increasingly being viewed as an inflammatory condition of the entire body, rather than just of the skin, notes Dr. Lonowski. Psoriasis has been associated with “metabolic syndrome,” which includes conditions such as heart disease and diabetes.

Even if the skin condition is not bothersome, your primary care doctor should evaluate and monitor you for these other potential health issues, notes Dr. Lonowski. Some people with psoriasis also develop psoriatic arthritis, which causes joint pain. Dr. Lonowski is part of a multidisciplinary clinic that focuses specifically on psoriasis and psoriatic arthritis to help patients better manage these conditions.

Treatments for psoriasis

A variety of treatments are now available for psoriasis that have fewer side effects than traditional treatments and are very effective, says Dr. Lonowski. These newer immune-mediating therapies target and suppress the components of the immune system that are producing the overactive immune response. This, in turn, decreases inflammation and subsequent itching and rash.

Treatments for psoriasis include:

• Creams and ointments
• Oral medications
• Injectable medications called biologics
• Infused (IV) medications

“Your treatment regimen depends on the severity of your symptoms, areas and percentage of the body affected, your level of discomfort, as well as other factors,” says Dr. Lonowski.

Maintaining a healthy lifestyle can also help you better manage the disease. This includes healthy lifestyle habits such as:

• Abstain from smoking
• Eat a healthy diet, specifically following a Mediterranean diet
• Exercise regularly
• Maintain a healthy body weight
• Reduce stress

“If you have significant itching and rash that won’t go away, remember you don’t have to live with it,” says Dr. Lonowski. “We have many effective treatments that can alleviate the symptoms of psoriasis and other chronic skin conditions.”

https://www.nebraskamed.com/health/conditions-and-services/how-do-i-know-if-i-have-psoriasis 

Expert debunks psoriasis myths

From msn.com

Psoriasis is a condition that causes dry, flaky red patches of skin that are covered in silver scales.

Although psoriasis is a relatively common condition, affecting around 1 in 50 people in the U.K., there is a lot of misinformation surrounding it, particularly on social media.

Ali Hedley, Medical and Professional Affairs Manager from Epaderm, has debunked some of the most common psoriasis myths.

Psoriasis is just dry skin

People often think that psoriasis is just dry skin, but it is actually a long-term skin condition.

"Contrary to popular belief, psoriasis is a chronic skin condition, not just dryness," Ali explains. "Our skin naturally sheds and produces new skin cells. For those with 'normal' skin, this takes place every 3-4 weeks and for those with psoriasis this takes place every 3-7 days, causing psoriasis patches to appear."

Psoriasis looks like eczema

The two skin conditions are often confused, but they are very different.

"Distinguishing itself from eczema, psoriasis exhibits thicker, more raised, and redder patches," Ali says. "Eczema generally targets the folds and creases of your body (behind the knees, between the elbows, on the neck), psoriasis often targets the surface of the skin (scalp, elbows, outer knees)."

Psoriasis is contagious

Although much is still unknown about the skin condition, it is known that it is not contagious.

"Psoriasis is not contagious. There is still research to be done to understand the cause of psoriasis but it does tend to run in families," the expert insists. "People with the psoriasis gene will find many triggers that cause a flare-up, most commonly infection, skin injuries, stress, and hormonal changes."

Psoriasis can be cured

Although it can be treated, psoriasis cannot be cured.

"While there's no cure for psoriasis, there are lots of simple and effective treatments to make skin more comfortable including emollients and moisturisers," Ali explains. "Epaderm Ointment provides practical relief during flare-ups. The over-the-counter emollient, with no fragrance and just three ingredients, is an effective option for moisturising and softening the skin."

Only topical treatments can help with psoriasis

There are a number of things you can do to treat your psoriasis, including taking baths.

"Many people believe that creams, moisturisers and ointments are the only options to treat psoriasis but there are other options," Ali states. "As long as the water isn't too hot, baths are a great way to ease the symptoms of psoriasis. Staying active, maintaining a balanced diet, and substituting your traditional hand soaps for the Epaderm Cream are various ways to support skin health beyond topical treatments."

https://www.msn.com/en-ae/health/other/expert-debunks-psoriasis-myths/ar-BB1klyYa?apiversion=v2&noservercache=1&domshim=1&renderwebcomponents=1&wcseo=1&batchservertelemetry=1&noservertelemetry=1

Can You Get Psoriasis On Your Lips?

From healthcentral.com 

Lip psoriasis is extremely rare, but it’s not out of the realm of possibility. Here’s what experts say to look for and what to do if you are diagnosed with the chronic skin condition

While the chronic skin condition psoriasis (PsO) is most commonly seen on the knees, elbows, and scalp, if you’re living with psoriasis, you know first-hand that it can occur just about anywhere on the body, including the lips. While extremely rare (only around 120 cases have been reported in the scientific literature, noted one Cureus case report on oral psoriasis), the condition can affect your mouth area, resulting in painful mouth sores and cracked lips.

If you have psoriasis and you’ve been experiencing mouth pain, it’s logical to wonder if the skin disease is to blame. We went to two board-certified dermatologists to find out more about psoriasis on the lips—including what the symptoms look and feel like, what causes it, and how to treat it.

Lip Psoriasis: What Is It?

While psoriasis can occur on the lips—as well as on the tongue and inside the mouth—it’s very rare, according to Marisa Garshic, M.D., a board-certified dermatologist in private practice and assistant professor of dermatology at Weill Cornell Medicine in New York City.

“Psoriasis involvement of the lips in isolation has been very rarely reported in the medical literature but may also precede development of psoriasis lesions elsewhere on the body,” adds Pooja Rambhia, M.D. a board-certified dermatologist at UnionDerm in New York City. She notes that if you don’t already have psoriasis elsewhere on the body, it can be incredibly difficult for physicians to diagnosis since there are so many different conditions that affect the lips—and because psoriasis doesn’t always appear the same ways on the lips as it does on other areas of the skin.

“More commonly, you can have what’s called ‘geographic tongue’ where you have generally asymptomatic white migrating lesions on the tongue,” says Dr. Rambhia. “Approximately 10% of patients with psoriasis present with findings of a geographic tongue.” These white lesions can also spread to the lips or inner cheeks, she adds.

                                                                                  GettyImages/Tero Vesalainen

What are the Symptoms of Psoriasis on the Lips?

The reality is that symptoms of psoriasis on the lips can look and feel like a variety of other afflictions, including eczema and cheilitis (a broad term for inflammation of the lips). According to Dr. Garshick, lip psoriasis may also be asymptomatic. But when symptoms of psoriasis on the lips do happen, the most common symptoms, our experts say, include:

• Burning sensation of the lips

• Fissuring or cracking of the lips

• Red patches associated with small pustules

• Soreness and general pain

• White scaling

How Can You Tell the Difference between Psoriasis and Cheilitis?

Cheilitis is an umbrella term that refers to inflammation of the lips and the surrounding skin, and according to Dr. Rambhia, lip psoriasis can be considered a type of cheilitis, though a very rare one. “There are many different causes and subsequent diagnosis of cheilitis,” she says. “Some examples include actinic cheilitis, angular cheilitis, eczematous cheilitis, and contact dermatitis.”

Dr. Garshick adds that while it can be quite cumbersome to differentiate between lip psoriasis and other inflammatory lip conditions, there are some ways to tell them apart. These are some of the most common ailments that affect the lips, and how they differ from psoriasis:

Chapped Lips

Chapping may appear as flaking on the lips and the surrounding skin, and typically can be cleared up with hydrating lip balms and occlusive ointments, whereas lip psoriasis may not respond to these over-the-counter treatments and typically will involve redness as well.

Contact Dermatitis

“While contact dermatitis can also appear as red, flaky patches [like psoriasis], it is often in an area that has been exposed to an allergen or an irritant,” says Dr. Garshick. “For this reason, it may worsen with certain triggers or be present in other areas.”

Perioral Dermatitis

Perioral dermatitis is a common inflammatory skin condition that primarily affects the area around the mouth (peri-oral) but can also extend to the nose and eyes. Rather than the white-coloured rash of lip psoriasis, perioral dermatitis typically appears as a red or pink rash with small, raised bumps or pustules. The rash may be itchy or uncomfortable and can sometimes cause a burning sensation.

Cold Sores

Also known as fever blisters, cold sores are small, fluid-filled lesions or blisters that typically appear on or around the lips, mouth, or nose. They are caused by the herpes simplex virus (HSV), primarily HSV-1.

What Triggers Lip Psoriasis?

As Dr. Rambhia explains, there are no specific triggers isolated to lip psoriasis. However, some triggers for psoriasis in general include:

• Hormonal fluctuations: Psoriasis has been shown to be influenced by various hormonal fluctuations, including those seen during puberty, postpartum, and menopause.

• Infections: Streptococcal infections have been shown to trigger a specific subtype of psoriasis, called guttate psoriasis.

• Injury or trauma: Psoriasis can frequently “Koebnerize”. The Koebner phenomenon refers to the development of fresh psoriatic lesions in areas of previously unaffected skin following injury or trauma in individuals with psoriasis.

• Medications: Various medications, including but not limited to lithium and beta-blockers, have been associated with psoriasis flares.

• Smoking: A twin study published in the International Journal of Dermatology revealed that individuals who smoke heavily are over twice as likely to develop psoriasis.

• Stress: Stress can trigger changes in the immune system, leading to inflammation and immune system dysregulation. In psoriasis, the immune system mistakenly attacks healthy skin cells, causing the rapid turnover of skin cells and the formation of psoriatic plaques.

How Is Psoriasis on the Lips Diagnosed?

To get psoriasis on the lips diagnosed, you’ll need to be examined by a board-certified dermatologist. “It’s important to share your history of persistent rashes on the skin, as well as any family history of psoriasis or evidence of psoriasis elsewhere on the body,” says Dr. Rambhia. “In some cases, a biopsy of the lip [tissue] is done to confirm a diagnosis.” Dr. Garshick adds that a biopsy is often recommended as it’s one of the only ways to accurately confirm whether it’s psoriasis, or another inflammatory condition.

How Do You Treat Lip Psoriasis?

Like anywhere else on the body, psoriasis on the lips can be treated with at-home remedies or medication—it all depends on the severity of your case and what your doctor recommends. “Treatment of psoriasis on the lips includes prevention of flare ups, for which regular use of Vaseline or Aquaphor can help to keep the lips soft and smooth,” says Dr. Garshick. She also notes that avoiding triggers, such as smoking, stress, and infections, can be beneficial. “Additionally, some options to treat psoriasis include topical steroid creams, topical non-steroidal creams, as well as systemic treatments such as biologics.”

At-Home Treatments

To help prevent and treat psoriasis flare ups on the lips, there are a few different measures you can take, including:

• Keep lips moisturized and protected with an ointment like Vaseline or Aquaphor.

• Avoid triggers such as smoking, stress, and spicy foods.

• Use soothing lip balms with anti-inflammatory ingredients like aloe vera and turmeric.

• Apply over-the-counter hydrocortisone cream to the area.

Prescription Treatments

If you’re unable to tackle psoriasis on your lips with at-home remedies, your doctor may prescribe you medication to help get it under control—this can include both topical and systemic treatments, such as:

• Topical steroid creams: These creams, which contain corticosteroids, work by reducing inflammation, itching, and redness associated with psoriasis flare-ups. However, when using these creams on the lips, caution must be exercised due to the thin and sensitive skin in this area. Strong steroid creams may cause side effects such as thinning of the skin, discoloration, or even exacerbate symptoms if used for prolonged periods or inappropriately.

• Biologics: These drugs are typically reserved for moderate to severe psoriasis that hasn't responded well to other treatments. Biologics work by targeting specific parts of the immune system involved in psoriasis inflammation, thereby reducing symptoms such as redness, scaling, and discomfort.

Takeaways

Psoriasis on the lips and perioral area is extremely rare, but there have been reports of it occurring in medical literature. Moreover, psoriasis of the lip typically only presents when you’ve already experienced psoriasis on other areas of the body. Though diagnosis of lip psoriasis can be very challenging as it often looks identical to other types of inflammatory rashes of the lips, it’s critical to see a board-certified dermatologist to get accurately diagnosed and treated.

https://www.healthcentral.com/condition/psoriasis/psoriasis-on-lips