Why Wasn’t Your Psoriasis Diagnosed Sooner? (USA)

From healthcentral.com

If you’re dealing with an inflammatory skin condition, long-term relief depends on finding out what you have. For most people, a psoriasis diagnosis is straight-forward: A dermatologist spots the tell-tale patches of thick, red, scaly skin, with well-defined edges during a physical exam, per NYU Langone health. Sometimes a biopsy is used for confirmation. Yet it can still take years for some people get a diagnosis, according to the National Psoriasis Foundation. Why? The reasons range from not getting in front of the right provider to mistaking your symptoms for something else.

It Looks Like Another Disease

Dry, red, irritated skin? We’ve all had these symptoms, which is why psoriasis is often mistaken for other skin conditions, both by people who have it and by medical professionals. The most common PsO doppelganger is eczema, a group of inflammatory skin conditions that make skin dry, red, very itchy, and often scaly or bumpy. There’s also seborrhoeic dermatitis, which causes, flaky, itchy patches in oily areas of the skin; lichen planus, with its lesions on wrists and limbs; and pityriasis rosea, with torso rashes.

                                                                                Thinkstock

It Looks Like a Fungus

In the guessing game of “name that rash,” signs of psoriasis can also be confused with fungal infections. Ringworm is a temporary fungal infection that can resemble psoriasis with its raised, scaly, itchy patches on areas like the scalp and feet, per Cleveland Clinic, but it typically has flatter, smaller scales and rarely appears on the elbows and knees, where psoriasis is common. Likewise, PsO nail symptoms like discoloration, crumbling, or lifting up from the nail bed, can be mistaken for nail fungus.

You Have Dark Skin

Psoriasis can affect people of all skin tones, races, and ethnicities, but not all providers know how to spot it on darker skin. People of colour often face challenges in getting an accurate diagnosis and proper treatment, because the trademark red plaques with a whitish cap don’t show up the same way for them, according to the NPF. It’s important to note that plaques can appear salmon, dark brown, purple, or violet with greyish scale. Checking the NPF Skin of Colour Resource Center can help you know what to look for and help you find a provider who knows skin of colour.

You Have Joint Symptoms

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The NPF reports that one in three people living with psoriasis also live with its sister condition, psoriatic arthritis (PsA), which comes with both skin and joint symptoms. And while PsO is most-often a precursor to PsA, sometimes the joint symptoms start first and might be mistake for other types of arthritis. With PsA, you could have pain, swelling, or stiffness in one or more joints—often worse after inactivity—along with joints that feel tender, warm, or appear discoloured, yet may not have skin symptoms at first.

It’s Not in the Usual Places

PsO plaques form when an immune response in the body causes skin to grow more rapidly at the plaque sites, resulting in a scaly appearance, per UCDavis Health. These plaques can crop up anywhere on the body, but most often are found on the outer elbows and knees, as well as the lower back, face, and scalp. Less commonly, it affects the palms and the soles of the feet or causes nail changes. And it can crop up on genital skin as well, which can sometimes mistaken for a sexually transmitted infection.

Symptoms Come and Go

Psoriasis goes through cycles, flaring for a few weeks or months, then calming down for a spell before coming back again, according to the Mayo Clinic. And if you have a genetic predisposition for PsO, it can be triggered by infections, cuts or burns, and certain medications. You may get the issue treated and move on, not suspecting an inflammatory skin condition is lying under the surface. It’s important to note that having one parent with PsO means you’re at higher risk of getting it, and more-so if both parents have it.

It Looks Like Dandruff

GettyImages/Vitalina Nakonechna

The overproduction of skin cells on the scalp from psoriasis can cause skin to flake and drop into the hair and on shoulders. You’re right if you think that sounds a lot like dandruff, a scalp condition that impacts about half of all adults, per the NPF. Like seborrheic dermatitis, dandruff is the result of a fungus, which can be resolved by using medicated shampoos. Many people have tried to resolve scalp psoriasis with these products, only to become frustrated when it doesn’t work, per the NPF, a signal to consult a dermatologist.

Keys to Quicker Diagnosis

Like with any chronic disease, getting a diagnosis is the first step in helping you to find relief. That’s why you should consult your doctor if you’re experiencing any type of skin symptoms that are bothersome. That may mean asking for a referral to a dermatologist if your regular provider doesn’t give you the answers you’re looking for. If you’re not sure where to start, you can request a free information form from the NPF and they can connect you with a skilled provider in your area, including some who specialize in treating skin of colour.

Next Steps

Getting a PsO diagnosis can be a relief but it can also be overwhelming. Your dermatologist has a toolbox of treatment options to try to help you get your skin under control, ranging from topical medications and light therapy to systemic drugs and lifestyle changes. And know that you do not have to do this alone. Finding support in others living with PsO can be a huge help. You can connect with other PsO warriors at the NPF, the Skin of Colour Society, and the American Academy of Dermatology.

https://www.healthcentral.com/slideshow/5-reasons-why-psoriasis-sometimes-not-diagnosed?ap=nl2060&rhid=67ec2b8321f52bf01b0cca01&mui=&lid=141093361&mkt_tok=NTQxLUdLWi0yNDMAAAGi29xESWba6oRiv8q51csbSWuUelCZNXCcUcEIV6N1OWHOGCszHKVbG7EJHqFcSpBUTIh8uguMjEU9EUioCFXpdIqLjR9BmGVjNA4mRMW1dVQRlOQ

The #1 Nutrient to Focus On to Reduce Your Risk of Psoriasis

From eatingwell.com

Omega-3s may help support psoriasis

KEY POINTS

• No nutrient can cure or prevent psoriasis, but eating more omega-3s may help.
• Omega-3s help reduce inflammation and support your skin’s barrier.
• Eat more fatty fish, chia seeds and walnuts, and talk to your doctor about supplements.

Psoriasis is a chronic autoimmune condition that causes the skin to build up into scaly, inflamed patches—and if you live with it, you have likely wondered whether changing your meals could calm your skin. It is a fair question, and an honest answer matters here. “There is no diet proven to prevent psoriasis or cure it,” shares Yoon Hang Kim, M.D. But all hope isn’t lost. Kim adds, “Diet can plausibly influence inflammation and psoriasis symptom severity.” And focusing on certain nutrients may have an impressive impact.

If you want one nutrient worth extra attention, make it omega-3 fatty acids. Found in fatty fish, certain nuts and seeds, and supplements, these fats have a growing body of research behind them when it comes to inflammatory conditions. Because psoriasis is driven by an overactive immune response, an anti-inflammatory nutrient like omega-3s makes sense as a starting point. They are not a magic fix, and the evidence comes with caveats. But they may be a smart, food-first place to begin. Below, we break down what the research actually shows, how omega-3s may help, and practical ways to add them to your routine.

How Omega-3 Fatty Acids Help Reduce Your Risk of Psoriasis

Here are some of the reasons researchers are paying attention to omega-3s when it comes to psoriasis.

They Target Inflammation Directly

Psoriasis is fundamentally an inflammatory disease, and omega-3s influence the pathways that fuel it. “Omega-3 fatty acids fight inflammation,” says Geeta Yadav, M.D. Some research also suggests omega-3s help your body produce specialized pro-resolving compounds that signal inflammation to wind down rather than linger. These effects are promising but still being studied, so omega-3s are best viewed as a supportive piece of a broader plan rather than a cure.

They May Lower Psoriasis Risk in Genetic Studies

Some of the strongest signals come from Mendelian randomization research, which uses genetic data to reduce confounding. In one analysis, higher circulating omega-3 levels were associated with a reduced risk of developing psoriasis. Because this method looks at genetically predicted omega-3 levels, it strengthens the case for a possible protective link, though the authors note that further validation is still needed.

They May Help Balance Omega-3 and Omega-6 Intake

One reason omega-3s draw so much interest is the company they keep in modern diets, which tend to be heavy in omega-6 fats from vegetable oils, ultra-processed snacks and many packaged foods. Actively adding omega-3-rich foods, like fatty fish, walnuts and flaxseed, may help shift that ratio toward a more balanced, less inflammatory state. Higher circulating omega-6 fatty acids have been associated with an increased risk of psoriasis, while circulating omega-3 fatty acids showed no causal effect on the condition. Raising your omega-3 intake remains a practical, food-first way to help tip the balance in a more favourable direction.

They May Support the Skin Barrier

Beyond calming inflammation, omega-3s appear to play a role in skin barrier function and healthy skin cell activity. Researchers have linked these fats to better lipid balance in the skin and improved regulation of the cells involved in psoriasis. This supportive role is one more reason omega-3s show up so often in discussions about diet and skin health.

Strategies to Include Omega-3 Fatty Acids

Food is the best place to start when trying to increase omega-3 fatty acid intake. A common general goal is to eat fatty fish a couple of times a week, which helps you build a steady intake of EPA and DHA. Here are a few practical ways to get more omega-3s into your routine:

• Eat fatty fish twice a week. Salmon, mackerel, sardines and herring are rich in EPA and DHA. Two servings, each about the size of a deck of cards, is a realistic weekly target.
• Add plant sources of ALA. Sprinkle 1 tablespoon of ground flaxseed or chia seeds onto oatmeal or yogurt, or snack on a small handful of walnuts.
• Consider a supplement if you fall short. If you rarely eat fish, an omega-3 supplement can help close the gap. Talk with your doctor first, especially if you take blood thinners.

It is worth being realistic about what supplements can and cannot do. “It doesn’t work well as a stand-alone treatment, but in combination with prescription psoriasis medications, it appears to improve clearance faster than medications alone. The caveat is you need high doses—typically 3 to 4 grams per day of combined EPA and DHA,” says Joel Spitz, M.D. In other words, omega-3s may complement your treatment, but they are not a substitute for it, and the doses studied are higher than most people get from food alone.

Other Tips to Help Prevent Psoriasis

Omega-3s are one piece of a bigger picture. Your overall eating pattern and daily habits can also influence inflammation and flare frequency. These strategies may help support your skin and general health:

• Build meals around a Mediterranean-style pattern. “The strongest practical pattern is a Mediterranean-style, nutrient-dense diet with plenty of fruits, vegetables, whole grains, fish, nuts and olive oil, while limiting alcohol, refined sugar, processed foods and excess saturated fat,” says Kim. This approach naturally raises your intake of anti-inflammatory foods.
• Limit alcohol. Heavy drinking has been linked to more frequent and severe psoriasis. Cutting back may help, and it can also support your treatment working as intended.
• Aim for a healthy weight. Excess body weight is associated with higher inflammation and can make psoriasis harder to manage. Small, sustainable changes tend to stick better than crash diets.
• Quit smoking. Smoking is associated with higher psoriasis risk and severity. Stopping can support both your skin and your long-term health.

Our Expert Take

No single nutrient can prevent or cure psoriasis, but your diet may influence inflammation and how your symptoms behave over time. Omega-3 fatty acids stand out as the nutrient to focus on, with research linking higher circulating levels to reduced psoriasis risk (though more validation is still needed). Start with food first, lean on fatty fish and plant sources, and consider a supplement only with your doctor’s guidance, since meaningful supplement effects appear to require higher doses alongside prescription treatment. Round out your routine with a Mediterranean-style eating pattern, less alcohol, a healthy weight and no smoking. Together, these steps can support your skin and your overall health, even if they cannot promise a cure.

https://www.eatingwell.com/omega-3-for-psoriasis-12010664 

Eating for Psoriasis Made Simple

From eatingwell.com

Skin-health pros share simple tips for managing psoriasis with a healthy diet 

KEY POINTS 

• Diet alone won’t cure psoriasis, but an anti-inflammatory diet can help to lessen symptoms.
• Foods like fatty fish, legumes, nuts, fruits and vegetables should be included into most meals.
• Added sugars, ultra-processed foods and alcohol can trigger flare-ups and should be limited.

Having a psoriasis diagnosis can leave you with lots of questions, including whether changing your diet can provide relief from scaly, itchy spots. Everyone is unique, so working with a health care provider is critical to managing this condition. That said, nutrition can certainly play a role in psoriasis management. 

“Psoriasis is driven by inflammation, so while food isn’t a cure, an anti-inflammatory eating pattern may help support overall symptom management,” says Samaria Garrett, M.S., RDN. Foods rich in omega-3s and antioxidants—like fatty fish, colourful fruits and veggies, nuts and beans—can help counter the inflammatory response that leads to redness, burning, itching or irritation. Here’s how an anti-inflammatory lifestyle can help reduce the risk of pesky flare-ups, plus practical insights for adopting a psoriasis-friendly diet. 

Credit: Photography: Carson Downing, Props: Breanna Ghazali, Food: Annie Probst

Start with an Anti-Inflammatory Mindset

Psoriasis is an inflammatory skin disease that happens when your immune system attacks its own skin cells, causing them to multiply too quickly. This overproduction of skin cells leads to the trademark scaly psoriasis patches. “One of the main underlying factors in psoriasis is inflammation, and our dietary pattern is a major factor in the levels of inflammation in the body,” says Kellie Blake, RDN, LD, IFNCP. 

Eating plenty of anti-inflammatory foods is one piece of the psoriasis-management puzzle. “Eating more nutrient-dense foods can help support the body’s natural defences, reduce overall inflammation and improve other conditions that often occur alongside psoriasis, such as cardiovascular disease and insulin resistance,” says Garrett. Specifically, it’s best to incorporate foods rich in omega-3 fatty acids, fibre, prebiotics and probiotics, as these help counter inflammation and support gut health. “I encourage my psoriasis clients to focus on fibre-rich foods at every meal to promote healthy gut microbiome balance as well as the healthy elimination of toxins through stool,” says Blake.

Foods to Eat More Often

Curious what those anti-inflammatory and psoriasis-friendly foods are? Both experts and research recommend eating these foods more often if you have psoriasis:

• Fatty fish like salmon, mackerel and sardines that are rich in omega-3s and vitamin E.
• Colourful fruits and vegetables like spinach, kale and berries that are full of antioxidants.
• Legumes like beans, chickpeas and lentils with anti-inflammatory peptides.
• Nuts and seeds like flaxseed, almonds and chia seeds that are rich in heart-healthy fats, antioxidants and soluble fibre.
• Herbs and spices like turmeric, ginger, garlic and cinnamon with bioactive compounds like curcumin, gingerol and polyphenols.
• Fermented foods like yogurt, kefir and sauerkraut that are rich in gut-healthy probiotics.

Eating a variety of these foods daily ensures you get plenty of fibre, probiotics, healthy fats and prebiotics to combat inflammation. “Fibre-rich eating patterns support gut health, which is important because emerging research suggests a strong gut-skin connection in inflammatory skin conditions like psoriasis,” says Garrett. These foods are also full of antioxidants like vitamin E, vitamin C and carotenoids, which are linked with lower risk of psoriasis.

Foods to Limit

Everyone’s triggers are different, but the following foods are more likely to cause a psoriasis flare-up:

• High-added-sugar foods like candy, cake, cookies and soda, which can exacerbate oxidative stress.
• Ultra-processed foods like chips, packaged snacks, refined-grain products and processed meats, which can contribute to inflammation and cardiometabolic risk.
• Alcoholic beverages, especially beer, which can worsen psoriatic lesions and increase risk of psoriasis.

That’s not to say you can never have these foods or drinks, but be mindful of how often they show up in your diet and symptoms you may experience, and aim to prioritize anti-inflammatory foods instead. 

Building a Psoriasis-Friendly Plate

How should you structure your plate to make sure you’re getting a good balance of psoriasis-friendly foods? Blake has a simple recipe: “About half of the plate should be covered with colourful vegetables and fruits, one-quarter of the plate should have protein, and one-quarter should have complex carbohydrates.” This ensures you get a balance of fibre-rich foods, protein and carbs to promote a healthy gut and stable blood sugars.

A psoriasis-friendly plate should optimally include:

• Proteins (¼ plate): Opt for a mix of animal and plant-based proteins like fatty fish, beans, strained (Greek-style) yogurt, nuts and poultry to get omega-3s, probiotics and/or fibre without excess saturated fat. 
• Complex Carbs (¼ plate): Prioritise whole grains like whole-wheat bread, oats and quinoa to prevent blood sugar spikes and boost your intake of essential minerals.
• Vegetables & Fruits (½ plate): Any whole fruits and veggies are great, but prioritize a range of rich-coloured ones like berries, dark leafy greens and tomatoes. These are especially rich in antioxidants.

Easy Ways to Get Started This Week

If these changes feel overwhelming or you don’t know where to get started, we have you covered. Here are a few actionable ways to move toward a psoriasis-friendly diet this week:

• Add a vegetable to one meal per day: Start off by prioritizing a veggie at one meal every day. Vegetables like spinach, kale, carrots, tomatoes and broccoli are loaded with antioxidants and fibre. Consider buying pre-chopped, frozen or ready-to-eat versions to make it easier to eat them daily.
• Try one new bean-based meal: If beans aren’t already a staple in your diet, try including a bean salad, rice and beans, or a vegetarian chili. These little legumes are full of fibre, antioxidants and plant protein, plus they play a central part in dietary patterns shown to improve psoriasis symptoms.
• Pick a night to have salmon for dinner: Salmon is packed with omega-3 fatty acids, and it’s easy to find at most supermarkets. If salmon isn’t your thing, try another omega-3-rich fish like mackerel, sardines, herring or trout.
• Pack nuts, yogurt and fruit for snacks: Snacks are another opportunity to boost your nutrient intake. Nuts, yogurt and fruit make for convenient snacks that provide vitamin E, protein, probiotics and fibre to combat inflammation and stabilize blood sugars.

Psoriasis Myths Busted

Should you cut out gluten, dairy or nightshades if you have psoriasis?

“I see people [with psoriasis] eliminate dairy, gluten, nightshades, sugar and several other foods all at once,” says Garrett. However, this level of restriction can do more harm than good. “Unless there’s a medical reason to avoid a food or clear evidence that it reduces symptoms, restriction to that extent is often unnecessary and can make eating feel stressful and restrictive,” she adds. Plus, there isn’t conclusive research demonstrating that cutting these foods out helps with psoriasis. “The diet with the strongest evidence for psoriasis, the Mediterranean diet, includes nightshade-containing foods like tomatoes,” says Blake. It also includes dairy and gluten-containing products.

Does diet really matter if you’re on psoriasis medication?

Diet typically can’t single-handedly treat psoriasis, but it is an important part of an overall treatment plan, even if you’re on medication. For one, inflammation is at the heart of psoriasis, and what you eat plays a role in your body’s inflammatory response. Also, having psoriasis increases your risk of cardiovascular disease, non-alcoholic fatty liver disease, metabolic syndrome, fatigue and certain types of cancer. A healthy diet can help lower your risk of developing these health issues in a way that psoriasis medication alone cannot.

Does alcohol really affect psoriasis?

“Although everyone is different, alcohol (in all forms) does seem to be a major psoriasis trigger,” warns Blake. “Alcohol promotes inflammation, causes increased intestinal permeability, acts directly on skin cells, induces nutrient deficiencies and makes psoriasis medications less effective,” says Blake. It also increases the risk of common comorbidities like psoriatic arthritis, cardiovascular disease, cancer and liver disease. So, yes, alcohol really does affect psoriasis and should be avoided as much as possible for disease management.

Can you cure psoriasis by healing your gut?

“There is a very strong gut-skin connection, but research is still determining what a ‘healthy’ gut microbiome consists of,” says Garrett. After all, your gut is made up of trillions of microorganisms, so there’s a lot to learn about this complex community. “Programs promising gut healing can be a slippery slope and not always backed by evidence,” she adds. Be weary of supposed quick fixes—like supplements, gut detox programs or restrictive diets—that may not be safe or effective.

Our Expert Take

Medications are the main treatment for psoriasis, but don’t underestimate the benefits of adopting an anti-inflammatory diet. Research shows that eating more fruits, veggies, nuts, fish and legumes can help make psoriasis symptoms more manageable. That said, “Nutrition can be a valuable tool, but it isn’t a replacement for medical treatment,” says Garrett. When in doubt, speak with your health care provider for individualized support managing your symptoms.

https://www.eatingwell.com/nutrition-basics-for-psoriasis-12005771

3 Afternoon Habits That Can Impact Your Sleep If You Have Psoriasis

From eatingwell.com

Why skipping the happy hour drinks and other afternoon choices could play a key role in getting better sleep with psoriasis 

KEY POINTS

• Psoriasis symptoms, including itching skin, can create a cycle of difficulty sleeping.
• Flare-ups can be triggered by afternoon stress, skipping moisturizer or consuming alcohol at happy hour.
• Establishing a sleep routine and working with health care professionals can help manage symptoms.

Managing psoriasis can feel overwhelming at times—including at night. With all the itching and discomfort involved, this inflammatory skin condition can easily interfere with a solid night of rest. Research shows that more than 75% of people with psoriasis also have some type of sleep disorder.

“Poor sleep and psoriasis can become a cycle,” says Samaria Garrett, M.S., RDN. “Itching and discomfort make it hard to sleep, and then lack of sleep can leave the body feeling more stressed and inflamed,” Garrett says.

Interestingly, your afternoon habits may have more of an influence on this cycle than you realize. Here are three afternoon habits that can impact your sleep if you have psoriasis. 

1. Ignoring Late-Day Stress Levels

Living a high-stress life can cause problems for most people, including those with psoriasis. There’s even a bidirectional relationship between the two. Stress can increase the risk of psoriasis flares and worsen symptoms. At the same time, psoriasis can also make you feel stressed.

“People living with psoriasis often have stress associated with managing the disease, which keeps stress levels elevated,” says dermatologist Aleta Simmons, M.D.

This can lead to a cycle of stress and psoriasis flare-ups that is difficult to manage and impacts quality of life, including sleep. People with psoriasis are also often caught in an itch-scratch cycle that tends to be worse at night. And when sleep is disrupted by constant itching, stress can worsen. 

Missing out on sleep doesn’t help matters, either. “During sleep, our bodies are resting and preparing,” Simmons says. “We need adequate sleep nightly as a part of a healthy lifestyle and prevention and management of chronic diseases like psoriasis.”

2. Skipping Moisturizer

If you hop in the shower after an afternoon workout class, it’s a good idea to make time to moisturize afterward. Keeping the skin moisturized is a simple yet important way to ease psoriasis symptoms like itchy, flaking skin or prevent a flare up, which can impact your sleep. Moisturizer helps seal in water, which not only relieves dry skin but can also help the skin heal. Moisturizers that contain ceramides can be effective, since they help maintain and restore the skin barrier, Simmons says. “When the skin barrier is not being treated, psoriasis can worsen, leading to increased itching and stress, which impacts sleep greatly,” Simmons says. She recommends moisturizing twice a day—after bathing and before sleeping.

3. Having a Few Drinks at Happy Hour

Credit:

Getty Images. EatingWell design

Drinking alcohol is associated with more severe psoriasis and a reduced response to psoriasis treatments. Alcohol consumption also puts people with psoriasis at higher risk for other conditions like cancer, arthritis and heart disease.

“Psoriasis is an inflammatory condition, and alcohol tends to add fuel to the fire,” Garrett says. “While everyone’s triggers are different, many people notice their scalp and skin become more irritated, inflamed or difficult to manage after drinking, especially in larger amounts.”

Additionally, alcohol is known to have a negative impact on sleep. While you might fall asleep more quickly, drinking alcohol often makes it harder to stay asleep and get the type of deep and restorative sleep your body needs for skin repair. “For someone already dealing with itching, discomfort or night-time psoriasis symptoms, alcohol can make for a pretty restless night,” Garrett says. 

Habits to Help with Sleep and Psoriasis

• Establish a healthy sleep routine. Try to get at least seven hours of sleep each night. Aim to go to sleep and wake up at the same time each day and avoid screen time at least an hour or two before bed.
• Seek help from professionals. “See a dermatologist for treatment and management of psoriasis, which will improve itching that disturbs sleep,” Simmons says. If you’re having trouble sleeping, see a physician who specializes in sleep disorders. For anxiety, depression or other mental health challenges, see a therapist, psychologist or psychiatrist.
• Live a healthy lifestyle. “Psoriasis is an inflammatory condition, so it’s important to look at the bigger picture,” Garrett says. “Prioritizing sleep, managing stress, staying active, limiting alcohol and eating nourishing foods to support the gut microbiome can all support overall health and may help people better manage their symptoms.”
• Stay on top of the basics. “Staying on top of medical treatments, gently moisturizing the skin following a warm shower and following a consistent sleep routine can make a meaningful difference,” Garrett says.

Our Expert Take

When you have psoriasis, securing a solid night of rest goes beyond your evening routine. Many afternoon habits deserve some much-needed attention, too. This includes finding ways to keep your stress in check throughout the afternoon, applying a quality moisturizer when needed—especially after showering—and watching your alcohol intake at happy hour. Sleeping well is important for managing psoriasis symptoms and avoiding a flare-up. So if you’re struggling to sleep well, consider discussing the problem with your dermatologist or a sleep specialist.

https://www.eatingwell.com/afternoon-habits-that-impact-your-sleep-with-psoriasis-12003954