Genital psoriasis might explain those dry, itchy genitals — but don't let it interfere with your sex life

From insider.com

Genital psoriasis is a form of psoriasis that causes red, itchy patches around the genital area.

Symptoms of genital psoriasis can appear on the tip of the penis, buttocks, and inner thighs.

Topical treatments can minimize symptoms and reduce the frequency of outbreaks.

Psoriasis is a chronic skin condition that causes red, itchy patches or bumps on the skin. It can develop anywhere on the body, including the genitals. About 63% of adults with psoriasis may experience genital psoriasis at least once in their lifetime.

"Genital psoriasis can occur anywhere on the genitals, but the tip of the penis and in folds of skin are the most common locations," says Jeffrey M. Cohen, MD, assistant professor of dermatology at Yale School of Medicine. It can also affect the crease between the buttocks, skin above the genitals, and inner and upper thigh areas.

There are many ways to treat genital psoriasis, but mild topical corticosteroids are the first line of treatment. Here's how you can recognize, treat, and avoid irritating genital psoriasis.

What is genital psoriasis?

Genital psoriasis is a form of inverse psoriasis, which commonly occurs in skin folds such as the underarms, under the breasts, and around the genital area.

"[It] generally presents as pink somewhat raised areas. Sometimes, these can be scaly, and other times, they may not be. The spots tend to be itchy, but they can also feel irritated," says Cohen.

Thick, scaly patches called plaques can also appear on the affected area, which are either red with silvery or white build-up (for lighter skin tones) or purple, grey, or dark brown (for darker skin tones). You may experience discomfort, pain, itching, and cracking of the skin. 

Treatments for psoriasis vary from one person to another, and some individuals might need a combination of treatments to reduce their symptoms.

Important: Almost 50% of genital psoriasis patients don't discuss symptoms with their physicians due to shyness and fear of judgment, which may result in under-treatment. Genital psoriasis is common in psoriasis patients and is nothing to be ashamed of. 

"Studies have shown that for many patients, genital psoriasis interferes with their sex lives, for reasons such as embarrassment or discomfort, but there is no health risk (for either partner) if someone with genital psoriasis has sex," says Cohen.

Genital psoriasis might also be mistaken for eczema or fungal infection. "It is important to note that several skin conditions can look quite similar in the genital region, and a diagnosis of genital psoriasis should be made by a board-certified dermatologist," says Cohen.

What triggers genital psoriasis? 

Psoriasis develops due to an overreaction of the body's immune response, which causes inflammation. As a result, new skin cells grow too fast and move to the surface, manifesting in reddish and itchy bumps.

Here are some tips to avoid irritation and further discomfort from genital psoriasis:

• Avoid scratching or repeatedly touching the affected area.
• Use treatment as prescribed by the dermatologist.
• Wear breathable underwear as tight-fitting clothing can cause friction.
• Use a mild, fragrance-free cleanser and moisturizer to clean the genital area and minimize chafing. Keep in mind that these products are not meant to be used inside the genitals and they're only for the surrounding external area.
• Cleanse the outer genital area before and after sex, and if applicable, use a lubricated condom.
• Avoid sex if the skin on or around the genitals is raw. 

"Scratching or touching psoriasis cannot cause it to spread from one part of the body to another. It is also important to note that psoriasis is not at all contagious to others," says Cohen.

How do you treat psoriasis of the genital area?

There are plenty of treatment plans for genital psoriasis, and what works for one person might not work for another. Although it is a chronic condition that reduces the quality of life, proper treatment can improve it.

About 70% to 80% of cases of psoriasis are mild, requiring only topical treatments. They can come in the form of corticosteroids, which are creams and ointments that reduce inflammation when applied to the skin, or nonsteroidal agents, medications that don't contain or are not steroids, like calcineurin inhibitors that suppress the immune system and reduce symptoms.

Biologics, or medications that target specific parts of the immune system, can be very effective for many types of psoriasis and generally come in the form of a pill, injection, or intravenous infusion. "Good moisturizers, such as Vaseline, are also helpful for patients with genital psoriasis," says Cohen.

Psoriasis doesn't go away and is present for someone's entire life. "However, some people experience long periods of time when psoriasis is not active," says Cohen. Following a treatment plan closely can reduce symptoms and avoiding certain irritants can help improve your genital psoriasis. 

Insider's takeaway

Genital psoriasis is a chronic skin condition that can develop anywhere on the genitals, buttocks, and thigh areas. Symptoms include red and itchy patches of skin that may or may not be scaly. 

To avoid discomfort and irritation, moisturize the affected area and wear breathable underwear. Genital psoriasis is treated with topical medications and biologics (aka medications that target the cause of psoriasis), so talk to your healthcare provider to discuss the best treatment plan for you. 

https://www.insider.com/genital-psoriasis

Best Diet Plan for Psoriasis Patients

From programminginsider.com

Every dermatologist, physician and nutritionist agree that a healthy and balanced diet is mandatory for every patient. The reason behind this is that the food we intake into our body is directly linked to our health and status of well-being. Every patient must have a healthy diet that consists of proteins, whole grains, fruits and vegetables.

You should avoid the food that is fried and processed whenever possible. The food without oil fat helps the hurt to keep lower the risk of its diseases and diabetes. Specially the patients with psoriasis disease always have a risk of getting ailments in their skin.

It is known that every patient is different and therefore their diet should also be different and different in manner. However, it is not certainly known that this diet plan will cure your, but it will help you reducing the frequency of your disease.

Nuts and grains

According to many doctors, it is Easy and must be included as a part of healthy diet which is good for your heart. Nuts are good for her health and healthy substances are present in nuts at a very great amount.

Nuts contain the good kind of fats, also known as, unsaturated fats. It is also enriched in fibre and contains Omega 3 fatty acids that are found in fish which can help you to lower your cholesterol.

Vitamin E that helps you to stop the development of Plaques in your arteries are in abundance in nuts and grains.

Everyone wants to be healthy but a healthy diet cannot be alone responsible for getting good effect on psoriasis disease, but you must also apply psoriasis cream that is very healthy for your skin type.

Fruits and vegetables

Rather a person be diseased or healthy but he or she must include fruit and vegetables in their daily livelihoods.

These fruits help us to fight with chronic inflammation. Fruits like strawberries, blueberries, apples, oranges and cherries are very useful in these diseases. To keep your heart and skin healthy you must have leafy greens vegetables such as spinach, kale, greens and others vegetables like carrots, sweet potatoes, avocados and squash in their daily dieting routine.

These kinds of foods are recommended because they contain a very high level of natural antioxidants which act as protective compounds that are found in plants. The antioxidants and polyphenols play a very important role in the reduction of inflammation in the body and mainly affect the sufferers of this disease.

Lean meats and fish

Eating lean white meat and chicken is always recommended as a part of nutritious diet. Whereas, if you its red meat then you must avoid meats that are fattier and cuts too, as they lead to Inflammation.

If you add fish to your diet, then it would be considered a great addition. Fish contains high concentrations of high-quality proteins, Omega 3 fatty acids, vitamins and minerals. Fish oils also reduce the inflammation of the body and support our immune system. The risk of heart attack and stroke is also be lowered by eating fish.

https://programminginsider.com/best-diet-plan-for-psoriasis-patients/

What a COVID Vaccine Means for People With Psoriasis

From everydayhealth.com

By Howard Chang

Just like the rest of the world, I’m excited about the rollout of the new COVID-19 vaccines. When I saw news footage of the first hospital workers getting their immunizations, a sense of relief washed over me. Help is on the way.

The pandemic has upended my life and disrupted my family; my most recent disappointment was not being able to visit my mom in Southern California for her eightieth birthday. With a vaccine I envision being able to see my parents sooner rather than later. My daughter should be able to return to the University of California in Riverside, which announced plans to hold in-person instruction in the fall.

At the same time, I’ve wondered if the vaccines are safe for me, a person living with psoriasis taking an immune-modulating biologic, Skyrizi.

The new vaccines are astonishingly effective and safe for patients with psoriasis, dermatologists say.

COVID-19 Vaccine Safety and Psoriasis

I’m encouraged that my dermatologist and two national psoriasis organizations agree that it’s safe for me to receive a COVID-19 vaccine.

At my December teledermatology appointment my doctor advised me to get a vaccine when it becomes available to me. She assured me that the new mRNA (messenger RNA) vaccines produced by Pfizer and Moderna are not live vaccines (that is, the kind made with weakened forms of the coronavirus), which can be an issue for people who take biologics.

In fact, she said there is nothing that would stop me from getting a COVID-19 vaccine, including having psoriasis or taking a biologic.

I asked if my psoriasis put me into a high-priority group that would go to the front of the line for COVID-19 vaccination. She replied it did not, based on the current rollout priorities in our community. People with psoriasis have not been shown to be at higher risk for contracting COVID-19 or having greater complications if infected.

Her recommendation aligned with what I read from the International Psoriasis Council (IPC) and the National Psoriasis Foundation (NPF).

The IPC posted a statement on COVID-19 vaccines and psoriasis, acknowledging that “Many people with psoriasis have raised concerns about potential adverse effects of vaccines on their skin disease.” In response to those concerns the IPC lists six practical considerations, including that “there is no evidence that vaccines affect psoriasis onset or severity.”

The NPF’s COVID-19 Task Force also issued a statement on COVID-19 vaccines. Joel Gelfand, MD, professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine in Philadelphia, and co-chair of the NPF COVID-19 Task Force, stated, “The new mRNA vaccines are an astonishingly 95 percent effective in preventing COVID-19 and are extremely safe. We recommend that patients with psoriatic disease get the vaccine as soon as it is available to them.”

Dr. Gelfand also confirmed what my doctor told me about taking the vaccine while being treated with a biologic: “Patients may continue their oral or biologic psoriasis or psoriatic arthritis treatment without interruption when receiving these immunizations.”

Remaining Patient During the COVID-19 Vaccine Rollout

An effective and safe vaccine represents so much more to me than not getting sick with COVID-19. While I’ve tried to stay strong and appear unaffected, my excitement at the arrival of the vaccines revealed just how much this crisis has worn on me. I see the vaccine as the beginning of the end to the pandemic.

Of course, I wish that I could immediately go back to life the way it was before the pandemic, but it will take time. I’m still not sure when I will be able to get my shot. While initial vaccine shipments have arrived, vaccinations in my county are rolling out more slowly due to limited dose availability. County officials are urging patience, which is something that I know I will continue to need in high supply.

Even after I get vaccinated, the Centres for Disease Control and Prevention (CDC) says that I will still need to follow its safety recommendations including wearing masks, maintaining physical distance of six feet from others, and washing hands.

The Pfizer and Moderna COVID-19 vaccines require two doses spaced three to four weeks apart and take time to build immunity. Until researchers have a clearer understanding of whether it’s possible for people who are vaccinated to pass the virus to others, I want to stay vigilant in following safety protocols. It will take months for enough people to be vaccinated to halt the spread of the virus.

What a COVID-19 Vaccine Means to Me

Still, I look forward to a time when the pandemic is not dominating my thoughts and life.

My emotional health would no doubt improve with a COVID-19 vaccine. Viral infections, especially those accompanied by a fever, trigger my psoriasis to flare severely.

My great fear with COVID-19 is not death, but having it greatly worsen my current health conditions. While I can’t be certain I won’t get a sore arm, a headache, or another common vaccine side effect as outlined by the CDC, I feel it’s still better than getting COVID-19.

The potential benefits of a COVID-19 vaccine make me optimistic that we will all emerge from the shadow of the coronavirus.

https://www.everydayhealth.com/columns/howard-chang-the-itch-to-beat-psoriasis/what-a-covid-vaccine-means-for-me-and-my-psoriasis/

Control Post-Workout Psoriasis Flare-Ups With This 3-Step Routine

From livestrong.com

Working up a good sweat during an intense bout of exercise can feel cleansing and invigorating. But if you're living with psoriasis, that post-workout endorphin rush can be overshadowed by an uncomfortable flare-up.

While you'll want to follow the specific recommendations of your doctor, you probably shouldn't cut exercise out of your day-to-day routine. After all, regular workouts can bust stress and keep your weight in check, both of which may help control psoriasis. Indeed, an October 2018 review in ​Cureus​ recommends exercise as an adjunct treatment for the skin condition.

To combat exercise-related psoriasis irritation, stick to a post-workout routine that can help soothe your sensitive skin.

Keep your skin moisturized throughout the day to help prevent a post-workout psoriasis flare-up.

Image Credit: FreshSplash/E+/GettyImages

How Exercise Affects Psoriasis

Generally, psoriasis shows up as dry, red patches on the skin that may itch, burn or hurt, according to Harvard Health Publishing. Like many other skin conditions, though, the severity of psoriasis varies from person to person.

It can also show up nearly anywhere on the body, including the torso, arms, legs, elbows, knees and even nails, depending on the type of psoriasis you have.

As a result, the type of exercise you do can be more or less painful for your skin, depending on where your psoriasis is located on your body, Joshua Zeichner, MD, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City, tells LIVESTRONG.com.

For instance, the chlorine in a pool can dry your skin, making it more prone to flare-ups, while running or jogging can cause your skin to rub together, causing chaffing and inflammation, particularly on your inner thighs and underarms, Dr. Zeichner says.

"When you exercise, blood vessels dilate, allowing for greater circulation of oxygen and nutrients to your muscles and skin," he says. "This may lead to redness of the skin and, in some cases, can make psoriasis more itchy."

However, that doesn't mean people with psoriasis should skip their favourite swimming or running workouts. Actually, vigorous exercise might actually help reduce the risk of psoriasis, according to an August 2012 study in JAMA Dermatology. The thinking is that people who exercise this way have less overall inflammation.

So, how can you counteract the drying effects of some workouts? The answer lies in a diligent post-workout skincare routine. Follow these three steps after each sweat session to help soothe your psoriasis flare-ups.

Your 3-Step Post-Workout Routine to Manage Psoriasis Flares

Step 1: Take a Warm Shower, and Keep It Brief

Showering too often can cause skin dryness. But if you exercise every day, that's kind of inevitable, right? Luckily, there are a few shower guidelines you can follow to help prevent your psoriasis from feeling painful, itchy or dry.

While you may love a super-hot shower after a gruelling workout, keep the water lukewarm, Dr. Zeichner says. Keeping steam in the bathroom will help prevent dryness, too, so keep your bathroom door closed and avoid using a fan, recommends the American Academy of Dermatology (AAD). Also, limit your shower to five or 10 minutes.

Afterward, avoid rubbing your skin dry with your towel, Dr. Zeichner says. Instead, pat or blot your skin gently with a clean towel to avoid extra friction on your skin, especially in the areas you may have itchy or painful psoriasis patches.

Step 2: Use a Gentle Body Wash

While you're in the shower, avoid harsh cleansers, soaps or body wash products, Dr. Zeichner says. If you have any doctor- or dermatologist-recommended products, you'll definitely want to use those on your psoriasis.

If not, choose cleansers that don't dry your skin. Avoid ingredients like alcohol, alpha-hydroxy acid (AHA), retinoids and fragrance, per the AAD. These ingredients can dry out your skin's natural oils, causing more itchiness, redness or a burning feeling.

"Make sure to use a gentle, hydrating cleanser that won't strip the skin or disrupt the outer skin layer," Dr. Zeichner says.

When searching for a cleanser, look for products that have the National Psoriasis Foundation's Seal of Recognition. These cleansers have been tested and are safe to use on psoriasis.

Step 3: Apply a Hydrating Moisturizer ASAP

Once you've stepped out of the shower and dried off, apply a hydrating moisturizer on your psoriasis (and whole body, if you'd like) within five minutes post-shower, Dr. Zeichner says. This will help lock in hydration and prevent dryness.

Avoid moisturizers with fragrance or other harsh ingredients, like those noted above for body wash. Prioritize products your dermatologist or doctor recommends, then supplement with psoriasis-friendly products at your local drug store if you wish.

Look for lotions or creams that help prevent itching and repair skin, recommends the National Psoriasis Foundation. Some brands even make psoriasis-specific moisturizers that are free of harmful or harsh ingredients.

https://www.livestrong.com/article/13731399-post-workout-psoriasis/

Psoriasis Is More Than Skin Deep

From thestar.com.my

Psoriasis is often perceived as just a skin problem by many.

This chronic condition, which causes red, flaky and crusty patches covered with silvery scales on the skin, is usually considered a cosmetic or aesthetic issue.

However, consultant dermatologist Dr Ch’ng Chin Chwen says: “It can be disfiguring and disabling.

“Even if it is just on the skin, for some people, it can affect their palms and soles. If this is severe and the skin cracks, it can affect how a person walks and works, especially for those people who need to work with their hands, e.g. bakers and nurses.”

She notes that for patients whose nails are significantly affected, it can even affect their ability to pick up things as their nails can be too painful to do so.

“And not to mention that psoriasis can also affect the genitals of a patient – you can imagine how this can affect a male patient in their marriage and their social life,” she adds.

While some psoriasis patches cause no additional sensation or feeling, some can be very itchy, and even painful as mentioned above.

Some patients may also bleed easily after scratching their affected skin.

This, in addition to the constant shedding of skin flakes with uncontrolled or untreated psoriasis, can cause the patient embarrassment and might lead to stigmatisation.

Other than skin

Consultant dermatologist Dr Peter Ch’ng points out that psoriasis is a systemic, immune-mediated, inflammatory disease.

“This means that we know it is due to our immune system and it causes inflammation.

“It predominantly affects the skin and joints,” he says.

Psoriasis in the joints – known as psoriatic arthritis – can occur before skin symptoms for some patients.

Dr Chin Chwen shares: “There is an old study done in 1987, which shows that one in five patients with psoriatic arthritis will have significant deformity affecting their daily function.

“And if you follow up patients for 10 years, more than half of them will have five or more deformed joints.”

In addition, psoriasis is associated with abdominal obesity, high cholesterol and triglyceride levels, high blood pressure, diabetes, inflammatory bowel disease (especially ulcerative colitis), cancer and venous thromboembolism, as well as lung and kidney disease.

As some of these conditions are risk factors for heart disease and stroke, this means that psoriasis patients are also at higher risk for these two conditions.

Mental health is another aspect that can be significantly impacted, potentially affecting a person’s social and working or schooling life.

The visibility of the condition and public ignorance can combine to create stigmatisation of the patient.

This can in turn lead to depression, social isolation, and even suicidal tendencies, as well as seriously impacting on the patient’s career or studies.

“The stigmatisation, the loss of work, and also schooling etc, will affect the patient’s heath significantly,” notes Dr Chin Chwen.

While the skin symptoms of psoriasis are its most prominent feature, this inflammatory disease also affects other organs in the body. — Johnson & Johnson Malaysia

Diagnosed by sight

Psoriasis is often diagnosed by examination alone.

“It is actually based on, number one, appearance; number two, distribution, which means which part of the skin is involved; and also, a lot of the time, progression – we need to ask the patient what the skin looked like before and after, and even better if there are photos,” she explains.

Psoriasis can appear anywhere on the body, although it commonly affects the scalp, ears, elbows, knees, umbilicus, back and areas of friction like the waist where a belt rests against.

It can be classified into a number of types according to appearance.

The most common types include plaque psoriasis, which appears as thick scaly patches on the skin; erythrodemic psoriasis, which can cover up to 90% of the body in red patches; pustular psoriasis, where the affected areas are covered with pus-filled blisters or pustules; and guttate psoriasis, which appears as multiple teardrop-shaped patches.

“The problem is, patients aren’t confined to one type of psoriasis,” says Dr Chin Chwen, adding that psoriasis can change from one type to another over time.

While psoriasis can occur at any age, it typically manifests in adulthood. Sometimes, the symptoms are triggered by a particular incident, such as stress, trauma, an infection, or overindulgence in alcohol or tobacco.

Guttate psoriasis, for example, typically occurs after an episode of streptococcal throat infection.

She adds: “There are many environmental factors that can worsen psoriasis, e.g. trauma – sometimes patients can have a fall and then they will develop psoriasis plaques on the site of trauma.

“It is not uncommon for a patient to go for surgery and subsequently develop psoriasis plaques on the site of surgery.

“Any form of stress, whether it is mental or physical, can trigger the onset of psoriasis.”

She notes that while psoriasis is gene-related, the method of inheritance is complex with multiple genes involved.

“The (method of) inheritance is not completely understood up to today, as every now and then, scientists discover a new gene that is associated with psoriasis.”

Lifestyle and medication

While there is no cure for psoriasis, it can be controlled.

According to Dr Chin Chwen, the first priority is to live healthily.

“Generally, a healthy lifestyle helps to control the psoriasis better. “Stop smoking; reduce – or even stop – alcohol; eat a better diet; do regular exercise; manage the weight, especially for those who are overweight; and wherever possible, try various methods – whether it’s music or yoga or whatever – to reduce stress.

“And of course, see your dermatologist, discuss your problems and take the recommended treatments,” she says.

She notes that treatment is usually tailored to each patient based on their condition and circumstances.

“Individualised treatment is very important. So we will actually treat each person based on the severity of the disease, the type of psoriasis, when the patient presented, their general health status – whether the patient has diabetes, high blood pressure, etc – and of course, how much the psoriasis burdens a person,” she says.

She notes that: “Psoriasis can burden everyone differently. For example, a person who needs to go out, socialise and meet clients in their workplace, psoriasis involving their hand is important to them, because they have to take it out to shake hands.

“For an influencer or celebrity, even a small psoriasis plaque on the face or a visible area will impact the person very much, because it will affect their work.”

Treatment for psoriasis consists of topical agents, phototherapy and systemic treatments.

Topical agents are creams, ointments, soaps and shampoos, which are all applied directly onto the psoriasis patches.

According to Dr Chin Chwen, these include tar, steroids, acids, calcipotriol (vitamin D) and calcineurin inhibitors.

Meanwhile, phototherapy utilises UVA (ultraviolet A) and UVB (ultraviolet B) light, and is usually administered two to three times a week.

For systemic therapy, she shares that there are standard immuno-suppressants such as methotrexate, acitretin and cyclosporine, which are given to patients with severe disease; small molecules, which are not yet available in Malaysia; and biologics.

A targeted approach

Biologics are medicines made from whole or parts of living organisms, which target a specific part of the immune system.

There are just under a dozen biologics on the market for the treatment of psoriasis, with the majority available in Malaysia.

One of the latest to be introduced here is the monoclonal antibody Tremfya, also known by its generic name guselkumab. Tremfya is the first biologic to target and block interleukin-23 (IL-23), and is approved for use in adult patients with moderate to severe plaque psoriasis.

IL-23 is a cytokine – a small protein involved in cell signalling – that is involved in inflammation (to help fight invading microorganisms) and the formation of blood vessels.

Dr Peter explains that our immune system is like an army, with IL-23 being one of the “messenger soldiers”.

In psoriasis, he says: “This IL-23 goes crazy – when there’s nothing and it’s very peaceful, it suddenly goes and tells the general that there are enemies coming and that the army needs to fight.

“So the general will start asking all the soldiers to get ready and start to fight, causing a lot of inflammation.”

Thus, blocking this “messenger soldier” will help decrease unnecessary inflammation in the body that results in psoriatic symptoms.

He notes that a number of studies have already been done on the effectiveness of Tremfya.

One study known as Voyage 1, looked at the Psoriasis Area and Severity Index (Pasi).

The results showed that 84.3% of participants had a Pasi score of 90 for up to about four years.

This means that over four out of five patients in the phase 3 clinical trial had 90% of their psoriatic patches cleared after taking the biologic. And this was maintained for about four years with regular administration of the injectable drug.

In fact, 57.1% of patients had a Pasi score of 100, meaning that they were totally cleared of their symptoms up to four years after they first started taking the biologic.

However, Dr Peter notes that Tremfya is not a cure for psoriasis as IL-23 is only one “soldier”.

“We know that you can capture one, but after some time, there may be another crazy ‘soldier’, so you have to continuously capture all these problematic ‘soldiers’,” he says.

He adds that Tremfya has a good safety profile, especially when it comes to opportunistic diseases like tuberculosis that were a concern with older psoriasis biologics. And one advantage to the targeted approach is that our immune system as a whole is still functional.

“Which means that if a real enemy comes, you can still fight the enemy, the infection,” he says.

Another advantage to Tremfya, he points out, is that it only needs to be injected once every eight weeks. Like other recent biologics, it can also be self-administered.

As biologics are generally the most expensive of all psoriasis treatments, Johnson & Johnson Malaysia has a patient access programme to help make Tremfya more accessible to psoriasis patients.

Patients can utilise the programme via their dermatologist.

The company, which owns Janssen Pharmaceuticals that produces the biologic, has also launched the Pso Much More patient awareness programme.

Says Johnson & Johnson Malaysia managing director Chin Keat Chyuan: “Through this programme, we seek to help patients better understand their medical condition and know how they may effectively manage it with clinically-proven treatment options.

“The awareness programme is themed PsO Much More because psoriasis is so much more than a skin disease. It also affects patients’ wellbeing from a social and psychological aspect, which is beyond skin deep.”

Both Dr Chin Chwen and Dr Peter were speaking to the media at the virtual launch of Tremfya in Malaysia.

https://www.thestar.com.my/lifestyle/health/2021/01/25/psoriasis-is-more-than-skin-deep

6 Things People of Colour Need to Know About Psoriasis

From healthcentral.com

Psoriasis plaques can affect anyone, but there are some surprising differences based on skin tone

Psoriasis is a disease that doesn’t discriminate. It affects people of all ages, genders, religions, socioeconomic status, and—yes—race. For expert insight on how the condition impacts people from Black, Asian, and Hispanic communities, we turned to three board-certified dermatologists, who helped break down the different ways in which race and psoriasis are interconnected. Here are six of their findings—from how common psoriasis is for different ethnicities to the treatment options available for darker skin.

1. It’s not uncommon.

We know that more than eight million Americans have psoriasis, but what do the numbers look like when you break it down by race? And how important is it that we do take race into account in the first place? According to Pooja Sodha, M.D., director of the Center for Laser and Cosmetic Dermatology at George Washington University in Washington, D.C., the answer to the latter question is very important.

“Prevalence data tells us what population is more affected with a skin condition, and it helps a great deal when it comes to guiding disease research,” she says. “Amongst those 20 years and older, psoriasis affects about 3 percent of the U.S. population, and by race, Caucasians have the highest prevalence at 2.5 percent to 3.6 percent, followed by African Americans at 1.3 percent to 1.9 percent, and Hispanics at less than 1.6 percent.”

According to Robert Finney, M.D., clinical instructor of dermatology at NYU Langone Health in New York City, we don’t yet know why the stats are what they are. What we do know, however, is that “racial composition, genetics, and environmental conditions likely all play a role,” he says.

Dr. Sodha agrees, explaining that psoriasis is mediated by both genetic and environmental factors. For instance, given the mixed ancestry of African Americans, this may explain the intermediate rate of psoriasis seen amongst this group, she says.

2. It often goes undiagnosed.

Psoriasis is likely to be under- or misdiagnosed in African Americans and people with skin of colour. For instance, according to Dr. Sodha, these patients are 52% less likely to report having been given a psoriasis diagnosis by a physician. There are a few reasons for this, like the fact that people of colour are 40% less likely than whites to report having seen a dermatologist for care. “They also report three million fewer overall out-patient visits for psoriasis,” Dr. Sodha notes. “And population studies of psoriasis patients show that African Americans tend to report lower income and fewer years of education, which likely affects access and utilization of healthcare, thereby delaying diagnosis, leading to disease progression and delayed initiation of treatment.”

Experts—and patients—agree that this is where education and normalizing conversations about skin conditions within diverse communities will help. “My hope is that dermatologists are exposed to a diverse range of skin tones when they’re trained and educated, as well as in residency," says patient advocate Reena Ruparelia of @psoriasis_thoughts. “This will ensure that patients get the best care and the peace that comes with a formal diagnosis.”

3. Symptoms are the same but can look different.

“Symptoms of psoriasis do not vary by skin tone,” says Dr. Finney. And yet, despite having the same symptoms (i.e. scaly, thick patches of skin, itching, etc.) psoriasis can look somewhat different on deeper skin tones. “On dark skin, the plaques may appear purple or grayish and thicker compared to the pink-red scaly plaques that appear on Caucasian skin,” explains Dr. Finney. “And once healed, psoriasis may leave behind dark or light skin patches, which are more apparent in people of colour.”

Additionally, Dr. Sodha says that redness is typically less apparent in those with darker skin, though you’ll still see thickened, scaly patches of skin just like anyone else with plaque psoriasis. “Patients with darker skin types are frequently troubled by light and dark discoloration [a.k.a. hyperpigmentation] of the skin after treatment that can take months to resolve or, in some cases, be permanent,” adds Dr. Finney.

4. Psoriasis cases tend to be more severe.

For people with psoriasis, research shows that the condition impacts nearly every aspect of their life—what medicines they take, what they eat…even what they wear. Dr. Sodha says that people with skin of colour appear to have more “extensive psoriasis at the time of diagnosis, with more surface area involvement.” To this point: A study in the Journal of the American Academy of Dermatology (JAAD) found that Asians and Hispanics are both more likely to have more severe psoriasis than Caucasian counterparts.

The same study says that Asians have reported having greater body surface area involvement compared to Caucasians with psoriasis, though the reason for this is still unknown. But one theory is that disparities in access to health care, as well as ethnic differences in utilization of dermatology services, could contribute to differences in severity. Ultimately, we need more diverse studies done in order to determine why and how psoriasis outcomes are so different across skin colours.

5. Treatments are equally effective.

Treatment for psoriasis is typically the same across the board for all races, however, there are certain factors, like hair type, that may affect a physician’s suggested treatment plan for a patient with say, scalp psoriasis. “Hair care practices in African American patients are very different than those in Caucasian patients, so this can influence how we treat scalp psoriasis,” says Joshua Zeichner M.D., who serves as the director of Cosmetic & Clinical Research in Dermatology at Mount Sinai Hospital in New York City. “It’s important to tailor a prescription regimen to the personal needs and preferences of the patient—for instance, if someone is only washing their hair once per week or every other week, we can't necessarily use the same [scalp psoriasis] treatments as we would if they were washing daily, as over-washing can lead to increased dryness and damage to the hair itself.”

As for skin tone, Dr. Sodha says there are no off-limit treatments. “We follow the same algorithm of treatment using topical therapies for less severe disease, followed by light therapy and systemic treatments for patients needing a more aggressive approach.” Dr. Finney agrees: “Treatments in psoriasis are the same across all ethnic groups—the only minor difference is that when light treatment is chosen, higher doses may be required in darker skin tones due to the increased amount of melanin present in the skin,” he says.

6. Scarring is more prevalent in dark skin.

As previously mentioned, psoriasis patients with darker skin tones are more susceptible to post-inflammatory hyperpigmentation or scarring than their Caucasian counterparts. This simply means that when a person with darker skin has a flare-up of psoriasis, it will leave behind discoloration on the skin even after the rash itself has healed. Unfortunately, the best way to avoid scarring is to avoid flare-ups altogether, though we know that’s not always realistic. A few things you can do to prevent scarring include not scratching, moisturizing often, and protecting your skin from the sun, as we know sun damage is a surefire way to make scarring worse.

https://www.healthcentral.com/article/psoriasis-dark-skin-of-color

‘I’m a Dermatologist, and These Are the Most Common Questions People Ask Me About Psoriasis’

From wellandgood.com

“There is a huge gap between what people think they know about psoriasis and what psoriasis actually is,” says Rachel Nazarian, MD, a board-certified dermatologist practicing in New York City. With that in mind, it makes sense that she gets a lot of questions from her psoriasis patients about what is going on with their skin.

Considering the condition affects nearly 8 million Americans—and most derms see it every day in their practices—it’s time to dispel some of that confusion. To help, we asked Dr. Nazarian and other dermatologists to answer the four most common questions they regularly get about psoriasis. The most important piece of knowledge? “It is nothing to be embarrassed about,” says Dr. Nazarian.

1. What is psoriasis, really?

“Psoriasis is the overgrowth of the top layer of skin cells in the epidermis, and is thought to be brought about by an immune reaction in the skin,” says Mona Gohara, MD, a board-certified dermatologist based in New Haven, Connecticut. It can show up in a lot of different ways, which can make it hard to spot if you don’t have the trained eye of a board-certified dermatologist to help you.

“The classic version is represented by a well-demarcated red rash with a very characteristic silvery scaling,” says Dr. Nazarian. “Textbook psoriasis tends to affect the elbows, the knees, the butt, the scalp, and even the nails.” However, there’s no definitive way to know how psoriasis will appear for you.

In fact, people who have psoriatic biomarkers (that is, medical indicators that you have or are at risk for the condition) can even experience psoriatic arthritis, which differs from the skin condition in that it is inflammation in the joints that causes stiffness and even swelling in areas such as the fingers and toes. All of this to say, it’s important to talk to a board-certified dermatologist to ensure you get a proper diagnosis.

2. Did psoriasis happen because of my lifestyle habits?

When patients first get diagnosed with psoriasis, Dr. Nazarian says that they often try to correlate it with something that they have done ‘wrong.’ “They think it’s because they ate something new, or wore the wrong sweater, or travelled to a different climate,” she says. In reality, psoriasis is genetic. “Either you have genes that will expose you to having this at some point in your life, or you don’t. You can’t play the blame game [if you have psoriasis],” says Dr. Nazarian.

Typically, most people begin to see psoriasis in their teens and 20s. While lifestyle habits don’t cause psoriasis, if you’re genetically predisposed, then habits like binge drinking, smoking, and weight fluctuations can cause flare-ups. Additionally, certain biomarkers can make psoriasis more prevalent, so Dr. Nazarian recommends keeping your cholesterol and blood pressure down to lower your risk.

3. Is it contagious?

No. “Psoriasis is not at all contagious,” says Dr. Nazarian. “There is nothing to worry about if you’re around someone who has psoriasis—you can’t spread this from person to person.”

That said, it is possible to spread psoriasis to different places on your own body. “If you traumatize the skin, you can induce a lesion,” says Dr. Nazarian. “So let’s say you have psoriasis on your knees and elbows but have never had a flare-up on your shoulder. If you scratch your shoulder and irritate the area, you may have a new patch pop up there due to the trauma you’ve induced.” As such, take caution to prevent impact-induced patches from cropping up if you do get diagnosed by a doctor with psoriasis.

4. How do I make it go away?

The best treatment for your psoriasis is the one decided upon with your doctor—but there are now more options available than ever before. “This is such a fortunate time for people who are suffering from psoriasis, because we have really, really evolved when it comes to treatments,” says Dr. Nazarian. “We have biologic treatments, which target some of the inflammatory factors, using antibodies to suppress the immune system in the psoriatic pathway, and that won’t affect the rest of your body so there are minimal side effects.” Biologics essentially function by keeping the part of the immune system that is responsible for causing a proliferation of skin cells to be halted, while allowing the rest of the immune system to function as it usually would. These biologics are prescribed by doctors, but administered via at-home injections (usually four times a year).

In addition, oral retinoids can be prescribed to slow quickly growing cells and reduce swelling in psoriasis patients, and UV light therapy has also been shown to slow the rate of skin cell growth. “If [your psoriasis is] not that severe, you can treat it with cream as needed,” Dr. Nazarian adds. One derm-approved pick for easing psoriasis symptoms on your skin? Eucerin Advanced Repair Lotion ($10), which moisturizes, soothes, and exfoliates in a single application.

https://www.wellandgood.com/most-common-questions-psoriasis/

Low fitness linked to higher psoriasis risk later in life

From eurekalert.org

In a major register-based study, scientists at University of Gothenburg, Sweden, have now demonstrated a connection between inferior physical fitness in young adults and elevated risk of the autoimmune disease psoriasis. For the male recruits to compulsory military training who were rated as the least fit, the risk of developing psoriasis later was 35 percent higher than for the fittest.

The study was based on data on more than 1.2 million men conscripted, aged 18, into the Swedish Armed Forces between the years 1968 and 2005. During the enrolment process, all these young men underwent the same fitness test on an exercise bicycle. The researchers divided the data, according to how fit the men were, into three levels (low, medium, and high fitness). They then merged the data with other registers, using Sweden's National Patient Register to obtain diagnostic codes for psoriasis and the joint disease psoriatic arthritis. The men who had already received one of these diagnoses before conscription were excluded from the study.

Later in life, between the ages of 37 and 51, just over 23,000 of the conscripts developed psoriasis or psoriatic arthritis. In the low-fitness group, 2.5 percent developed one or both of these diseases, while only 1.7 percent in the high-fitness group did so. In calculating this risk differential, the scientists adjusted for other risk factors, such as body mass index (BMI).

Association not causal

Thus, the less fit the men were when they were recruited, the higher the proportion of them who later fell ill with psoriasis or psoriatic arthritis. In the low-fitness group, the risk of developing psoriasis was 35 percent higher, and that of developing psoriatic arthritis 44 percent higher, than in the high-fitness group.

"We show that there's an association between lower fitness and raised risk of developing psoriasis and psoriatic arthritis, but we don't show a causal connection. So we can't say that these health conditions can be prevented by exercising," says the study's first author Marta Laskowski, a doctoral student in dermatology at the University of Gothenburg and resident physician (specialist trainee) at Sahlgrenska University Hospital.

Group in need of monitoring

The group of men who were least fit was also the smallest: just under 48,000 or 3.9 percent of all the conscripts in the study. This is a group that healthcare services should try to monitor regularly.

"Low fitness was already known to boost the risk of incurring cardiovascular disease, and psoriasis as such is linked to raised cardiovascular disease risk, too. The results from our study confirm the reasons for assessing people's fitness early in life, to identify individuals at a higher risk for adverse health outcomes later in life," Laskowski says.

Previous research has indicated that, in general, people with psoriasis are less fit than those without it who engage in an equal amount of physical activity. However, the reasons for this difference have not been fully clarified.

"One weakness of our study is that we weren't been able to monitor the trends of the men's fitness during the intervening years, between their conscription and the disease onset. We're also lacking data on smoking, which is a known risk factor for psoriasis," Laskowski explains.

Scaly skin patches

Some 300,000 Swedes have psoriasis in a mild, moderate, or severe form. It is a chronic, systemic inflammatory disease that affects women as often as men. What triggers its onset is not entirely clear, but heredity is known to play a large part in combination with external factors. The most common type, plaque psoriasis, causes reddened, flaking, and itchy skin lesions ("plaques").

Psoriasis sufferers also often have other diseases. Some 30 percent get the inflammatory joint condition known as psoriatic arthritis. Examples of other known comorbidities are obesity, cardiovascular disease, diabetes, and depression.

In recent years, treatment options have substantially improved. Today, besides ointments with local effects, there are drugs that have systemic effects. Recent years have also seen the emergence of efficacious biological agents that modulate the signalling cascade in the inflammatory process that drives psoriasis.

https://eurekalert.org/pub_releases/2021-01/uog-lfl011221.php

Is Vitamin D Deficiency the Reason for Your Flaky Scalp?

From hellogiggles.com

By Kelsey Haywood Lucas

Three experts explain how it can mess with your skin, hair, and overall health

It can often take a lot of time and research to get to the bottom of a mysterious skin concern—but sometimes it just happens accidentally, like the day my dermatologist casually alerted me to my vitamin D deficiency based on nothing but the clues I dropped during a routine exam.

I was in her office for my regular mole check, rambling away while she carefully reviewed every freckle on my body. I told her how I'd been handling quarantine life and how much I missed eating cheese (I was on a dairy-free diet at the time). We chatted about my family, job, and I shared this embarrassing new development where every time I scratched my head, I ended up with flakes in my hair and dead skin under my nails. 

"How's your vitamin D?" she asked immediately. (Apparently, it was the combination of my very dry skin, the mention of a low-calcium diet, the assumption that I was spending a lot of time indoors, and the sudden onset of dandruff that raised the alarm.)

I wasn't sure—it had been a while since I'd had it checked. The next day I went to the lab for a quick blood panel and sure enough, my vitamin D level was "three points away from precipitating calcium outside of [my] bones, which is not good."

I immediately started supplementing my vitamin D and zinc, made a few swaps to my hair care routine (it now incorporates a lot of apple cider vinegar, like a Bragg ACV Rinse and this build-up balancing ACV shampoo by Acure), and my dandruff has mostly disappeared.

Prior to that appointment, I knew vitamin D was important for healthy bones and overall immunity—but I had no idea it was so strongly linked to systemic skin concerns like psoriasis, eczema, dandruff, and inflammation. To be clear, vitamin D is certainly not a cure for any of these conditions—but if it helped my scalp, it might help yours, too. 

To find out more about the connection between vitamin D and skin health, I spoke to two top dermatologists and a holistic nutritionist. If you're dealing with dandruff or a scaly scalp, here's how to determine if you should supplement with vitamin D.

What are the major types of scalp flaking—and what causes them?

There are two common conditions that account for the majority of flaky, scaly scalp concerns: dandruff (which is a form of eczema) and psoriasis (which is a chronic autoimmune condition). 

1. Dandruff and seborrheic dermatitis

The first type is dandruff, a form of eczema that can advance into a more severe condition called seborrheic dermatitis. "This is the most common cause of a flaky scalp," says Corey Hartman, M.D., FAAD, a board-certified dermatologist and an assistant clinical professor of dermatology at the University of Alabama School of Medicine. "It is caused by a yeast that is present on everyone's scalp as part of the normal flora. The yeast, called Malassezia, feeds on the skin's sebum—which is why seborrheic dermatitis is most common on oil-rich areas of the body." He explains that Malassezia sets up an inflammatory reaction in the skin that results in flaking, redness, itching, and greasy patches. 

Dr. Hartman also points out that darker-skinned individuals with curly hair are especially prone to seborrheic dermatitis since they're more likely to apply oil to the scalp to manage their hair (as opposed to those with straight hair, who typically wash excess oil away frequently). "I find that many patients with curly hair experience scaly scalp and then apply more oil in an attempt to control the problem—not realizing that they are making the problem worse by further feeding the yeast."

While we know that seborrheic dermatitis involves Malassezia and an irregular response of the immune system, the exact cause is still unclear—and it's believed that a range of other triggers can play a role. "It can sometimes be triggered by a change in temperature," says Eva Simmons-O'Brien, M.D., a board-certified dermatologist and assistant professor of internal medicine at the Johns Hopkins University School of Medicine. "For others, it's the winter months when it's colder outside and there's less humidity in the air." She says others might be more susceptible to dandruff or seborrheic dermatitis when they're under a lot of stress or have used a new hair product (like a hair spray or dye) that causes irritation or sensitivity. 

So, how do you know if your flakes fall in the dandruff and/or seborrheic dermatitis department? "You'll see them—on your shoulders, on your sweater, even in your eyebrows or on your glasses," says Dr. Simmons O'Brien. "You might scratch a bit and feel them coming off. But you won't experience any discomfort from it."

And that takes us to the next condition—psoriasis—which is a lot more uncomfortable.

2. Psoriasis

"Scalp psoriasis is a common inflammatory condition that causes itchy, scaly plaques on the scalp," says Dr. Hartman. "It's caused by an immune dysregulation in the skin that causes skin cells to be produced too quickly and build up into thick plaques." He says that psoriasis can affect the skin on any part of the body and can also affect the joints, which results in psoriatic arthritis. Symptoms of scalp psoriasis include scaly red patches, silvery-white sales, dandruff-like flaking, dry scalp, itching, burning, and hair loss. 

In addition to causing those very challenging symptoms, psoriasis can also lead to further complications. "It's an inflammatory condition where the skin has a very difficult time hanging onto hydration, so there's a lot of transepidermal water loss," says Dr. Simmons-O'Brien. "The uppermost layer of the skin, called the stratum corneum, is basically at risk for being injured and invaded by bacteria and viruses in those areas of the psoriatic lesions." The tell-tale sign of psoriasis is the presence of those lesions—raised areas of skin that are often pink or red. (It's important to note, though, that if you are a person of colour, the lesions may not be pink or red, but could actually match your skin tone, be hyperpigmented, or could take on a scaly, grey-taupe appearance.) "They may also feel very tender and sensitive, or they might itch and burn," says Dr. Simmons-O'Brien. "And they often bleed easily when using a brush or shampooing the area." 

What is vitamin D and how can it improve scalp health? 

While vitamin D is most commonly associated with calcium and bone health, it's an extremely important vitamin that functions as a hormone and affects multiple organ systems throughout the body—including the skin—and has been shown to reduce inflammation and help control infections. 

"It's been well established that inflammatory conditions of the skin, like eczema and psoriasis, are often associated with—and are made worse by—vitamin D deficiency," says Dr. Simmons-O'Brien. "If you have a flaky scalp, and particularly if you have psoriasis, taking vitamin D is going to help bolster the immune health of the scalp, decrease inflammation, help retain hydration, and help the skin fend off yeast or bacterial organisms." The way the vitamin D is administered matters, though—so you may need to talk to a doc to discuss whether topical treatments or supplements are right for you.

The skin benefits of vitamin D aren't limited to the scalp, of course: You'll likely be interested to know that vitamin D prevents skin aging and helps in skin cell growth, repair, and metabolism, too. One study showed that the use of oral vitamin D not only has great potential in clearing psoriatic skin lesions but also decreases the risk for cardiovascular disease and other disease morbidities. 

Of course, if you're dealing with a scalp health issue, vitamin D isn't going to be a one-stop solution to your problems—instead, think of it as the first step to getting your overall skin health in better shape as you target the situation with other treatments. "While vitamin D will not cure seborrheic dermatitis or scalp psoriasis, it can help to strengthen the immune system, which would then indirectly affect the skin in a positive way," confirms Dr. Hartman.

Who should be taking a vitamin D supplement—and how much?

In a word? You. (But how much, exactly, will vary.) "It has been reported that as many as 41% of adults in the United States are deficient in vitamin D," says Dr. Hartman. (Some signs of deficiency include frequent illnesses and infections, fatigue, bone and back pain, depression, poor wound healing, bone loss, hair loss, and muscle pain.)

"Everyone should be taking a vitamin D supplement to ensure that levels are optimal, but especially those with darker skin or who eat a diet low in fish and dairy, use sunscreen frequently, rarely spend time outside, or are elderly or overweight," says Dr. Hartman. (You should find yourself on this list because you do wear SPF every single time you step outside...right? Right.)

As a baseline, the National Institutes of Health recommends 600 IU daily for women between the ages of 19 and 50. (If you're in another category, you can check out the full RDA chart here.) "However, for well-health optimization, most dermatologists suggest that individuals between the ages of 19 and 50 take a minimum of 1,000 to 2,000 IUs daily," says Dr. Simmons-O'Brien. (This is especially important if you know for sure you're deficient in vitamin D or if you check off any boxes for risk factors—more on those later.)

Dr. Simmons-O'Brien, for example, often recommends 2,000 IU daily to her patients who are 12 and older. "That's to maintain a good value," she says. "If it's anything less than that, it's essentially just not enough because the value drops very easily and it takes a while to get to where it needs to be." 

So, the most accurate way to plan your perfect dosage is to work with a doctor to have your levels checked.  

When and why should you check vitamin D levels with a blood test?  

Credit: Getty Images

Ok, so nobody loves running to the doctor for a blood test, but hear me out: Getting your levels checked is the most sure-fire way to supplement appropriately and safely, and there are lots of good reasons for doing it.

"If you're experiencing a flaky scalp, I would recommend that you first get vitamin D levels checked to determine what's going on before running out and relying on any single course of treatment, like a dandruff shampoo," says Dr. Simmons-O'Brien. She recommends a "village approach" that utilizes multiple methods of prevention and treatment working in tandem together: supplementing with vitamin D to set a healthy internal foundation, using quality topical products to manage the yeast or bacteria overgrowth, and then possibly seeing a dermatologist for prescription treatment if needed.

It's especially important to get a blood test if you have risk factors or signs of vitamin D deficiency. Depending on your levels, your doctor may recommend a dosage beyond the standard supplementation protocol. (For example, I started with two weeks of a high-dose, prescription vitamin D to get my levels up and then switched over to a daily maintenance dose.)  

And on the other side, accidentally overcompensating with vitamin D can be dangerous. According to Harvard's T.H. Chan School of Public Health, vitamin D toxicity (which can cause weight loss, irregular heartbeat, and heart and kidney damage) most often occurs from taking supplements—which is why it's not recommended to take more than 4,000 IU daily unless monitored by a doctor. By knowing your true vitamin D level, you'll be able to supplement in the safest way possible. 

Simply ask your primary care doc or dermatologist to run your levels. (And since you're getting blood drawn anyway, they'll likely recommend running a few other tests—like zinc—to get a better snapshot of your overall wellness.) 

The standard acceptable range of vitamin D is between 30 to 100 ng/ml, but Dr. Simmons-O'Brien says it's best to aim for a minimum of 5o to 60 ng/ml to create a healthy cushion—partly because it's winter and levels are likely to be lower, and partly because we're in a pandemic and your immune system will benefit greatly from sufficient vitamin D, which is important for staying healthy in general. 

When's the best time to take a vitamin D supplement?

Dr. Hartman recommends taking your vitamin D supplement in the morning after a high-fat snack to enhance absorption (good news for all you fried-egg-over-avocado-toast fans). "Vitamin D is a fat-soluble vitamin, so it's dissolved best in your bloodstream when paired with high-fat foods," he says, adding that taking vitamin D at the same time every day is also recommended for both consistency and convenience. 

"Another reason to take the supplement early in the day is that several studies have shown it may affect sleep," Dr. Hartman says. "High levels of vitamin D have been linked to lower levels of melatonin, the sleep hormone." (And because we believe in protecting beauty sleep at *all* costs, it's best not to mess with it.) 

Additionally, Dr. Simmons-O'Brien recommends popping a probiotic along with your vitamin D. "Healthy gut flora enhance the absorption of vitamin D, so it's a good idea to also be taking a high-quality, multi-strain probiotic to get the most out of your vitamin D supplement." (Try Seed, a daily 24-strain broad-spectrum probiotic and prebiotic.)

Are there other ways to get vitamin D besides supplements?

You can get a limited amount of vitamin D through your diet: Dr. Simmons-O'Brien recommends fatty fish in particular (try salmon, swordfish, tuna, sardines, and cod liver oil). "Beef liver, eggs, and fortified dairy are also decent sources of vitamin D," says Jessica Waller, CNS, a holistic nutritionist. "If you're plant-based, mushrooms and fortified plant-based kinds of milk are your best bets. Look for a non-dairy milk that specifically states they're fortified with vitamin D3."

Just remember that diet alone is rarely (and honestly, probably never) a sufficient way to get your daily value of vitamin D. Topical vitamin D treatment exists, too, in the form of calcipotriol—but it's available by prescription only, so Dr. Simmons-O'Brien suggests working with a doctor to determine if it's right for you.

And when it comes to getting vitamin D the old-fashioned way—from the sun? Pass, please. "It takes a significant amount of sun exposure to produce enough vitamin D to be useful, and this sun exposure comes with increased risk of skin cancer and premature skin aging," says Dr. Hartman. "We have too many other safe means of obtaining vitamin D that don't contribute to a risk of malignancy." Dr. Simmons-O'Brien also points out that for people with darker skin (those who have skin types three, four, five, and six on the Fitzpatrick scale)—it's almost impossible to get sufficient vitamin D through sun exposure since the sun will bypass the layer of skin where vitamin D should be made.

"That's why people of colour are often deficient in vitamin D—those with darker skin types are not able to make it in their skin, so they never have adequate storage levels of vitamin D," she explains. "If you are light brown, medium brown, or darker complected, you'll definitely need to rely on supplementation in addition to diet."

What are the best vitamin D supplements?

Best 2,000 IU vitamin D supplement:

Thorne Vitamin D/K2 Liquid

$25

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Amazon

"The Thorne Vitamin D/K2 Liquid offers vitamin D suspended in medium-chain triglyceride (MCT) oil and combined with K2, which helps with absorption," says Waller. "Because vitamin D is a fat-soluble vitamin, it's more bioavailable when taken with an oil." She adds that vitamin K2 is also essential for vitamin D metabolism—and most of our K2 is made by gut bacteria. "If you have any microbiome issues, your K2 production may be decreased, so it's helpful to have a safety net."

Best 5,000 IU vitamin D supplement:

Designs for Health Liposomal Vitamin D Supreme

$19.96

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"The Designs for Health Liposomal Vitamin D Supreme supplement combines vitamin D with vitamins K1 and K2," says Dr. Hartman. "By combining vitamins K and D in liposomes, tiny fat spheres used as carriers for vitamin D, the synergy of the two vitamins enhance each other's effects to promote bone and heart health."

Best 10,000 IU vitamin D for deficiency:

Pure Encapsulations Vitamin D3 250 mcg

$25.10

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Pure Encapsulations

Both dermatologists recommended the Pure Encapsulations brand, which offers hypoallergenic options free from eight common allergen categories. "For those severely deficient in vitamin D, I recommend Pure Encapsulations D3 250 McG (10,000 IU)," says Dr. Hartman. Remember: When supplementing in high doses for a deficiency, it's important that you work closely with a doctor to monitor your vitamin D levels.

Best vitamin D for kids

Carlson Labs Kid's Super Daily D3 + K2

$11.99

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Thrive Market

Looking for a supplement for a little one in your life? (The AAP recommends 400 IU of vitamin D daily for all breastfed babies under one-year-old, while some kids might benefit from continued use—so if your child has eczema, for example, talk to your paediatrician.) "Carlson Labs' Kid's Super Daily D3 + K2 is a great option for children who are vitamin D deficient," says Dr. Hartman. "It only contains D3, vitamin K2, and medium-chain triglycerides (MCTs) as the carrier oil, making it a healthier choice for a child than brands who add sugar."

https://hellogiggles.com/hair/how-often-should-you-get-haircut/