Low stress resilience may increase psoriasis risk

From labonline.com.au

Young adults who find it harder to cope with stress are more likely to develop psoriasis later in life, according to a large register-based study from the University of Gothenburg. The study is based on data from more than 1.6 million Swedish men who enlisted for military service between 1968 and 2005.

As part of the enlistment process, all the men underwent psychological assessment in accordance with the same strict template. Based on this assessment, the researchers divided up the data on the men’s stress resilience into three levels. A fifth (20.4%) of those who enlisted were placed in the lowest group and a further fifth (21.5%) were placed in the highest group. More than half were placed in the intermediate group. Data relating to the men was cross-checked with other registers, with the National Patient Register used to obtain the diagnosis codes for psoriasis and the joint disease psoriatic arthritis.

Around 36,000 of the men developed psoriasis or psoriatic arthritis later in life, with low stress resilience found to involve a 31% higher risk of developing psoriasis compared to high stress resilience. More severe cases of psoriasis and psoriatic arthritis were also found to be clearly linked to stress; for in-patient diagnoses, low stress resilience meant a 79% higher risk of psoriasis and a 53% higher risk of psoriatic arthritis compared to high stress resilience.

The study’s results, published in the Journal of the European Academy of Dermatology and Venereology, thus support the hypothesis that sensitivity to stress is a risk factor for psoriasis. As psoriasis is a chronic inflammatory systemic disease, this link to stress could be due to an increased inflammatory response in the body.

“We have shown that lower stress resilience in adolescence is a potential risk factor for psoriasis, at least for men,” said lead author Marta Laskowski, a doctoral student in dermatology at the University of Gothenburg and a resident physician at Sahlgrenska University Hospital. “Our results suggest that those with psoriasis have a hereditary psychological sensitivity. It is therefore important that healthcare professionals also pay attention to the mental wellbeing of patients with psoriasis.”

When estimating the increased risk, the researchers adjusted for other risk factors such as BMI and socioeconomic factors. However, the study could only be adjusted indirectly for smoking, which is a well-known risk factor for psoriasis. One weakness of the study is that stress resilience was only tested on one occasion, at the time of enlistment when the men were 18 years old.

“Stress resilience can vary throughout life; however, we have not had the opportunity to investigate these changes,” Laskowski noted.

https://www.labonline.com.au/content/life-scientist/news/low-stress-resilience-may-increase-psoriasis-risk-716344878 

Suffering From Eczema And Psoriasis? Follow These Hand Washing Tips From A Doctor

From thehealthsite.com

Handwashing With A Skin Condition

While it is important to wash your hands thoroughly to keep germs and infections away, skin conditions like eczema or psoriasis do not require rigorous and aggressive washing of hands, as it can aggravate the condition. Read on to find out all about it.

Why Should You Wash Your Hands?

Handwashing prevents the spread of germs and bacteria that can cause illnesses, allergies, and diseases. According to Dr Rinky Kapoor, consultant dermatologist, cosmetic dermatologist and dermato-surgeon at The Esthetic Clinics, maintaining good hand hygiene can reduce the risk of respiratory infections, gastrointestinal illnesses, and other contagious diseases.

Dry Skin And Other Conditions

The doctor said that individuals with dry skin or conditions -- such as eczema or psoriasis -- should exercise caution, as excessive hand washing can lead to skin damage and soreness. In fact, even for individuals with healthy skin, overuse of soaps and hand sanitisers can cause dry skin and crack formation.

How Does Handwashing Damage The Skin?

Dr Kapoor explained that over washing of hands can aggravate conditions such as eczema and psoriasis, as regular exposure to harsh soaps and hot water can strip the skin of its natural oils, making it susceptible to dryness and irritation. "This can then trigger flare-ups of eczema and psoriasis. Moreover, handwashing also disrupts the balance of bacteria on the skin, which is necessary for maintaining healthy skin barrier function. When this balance is disrupted, it can further aggravate existing skin conditions."

What Is The Solution?

The dermatologist suggested using gentle cleansers and lukewarm water to wash hands, and moisturising them regularly to keep the skin healthy without any irritation or inflammation.

Hand Washing Tips For Eczema, Psoriasis

Choose gentle, fragrance-free soap or a cleanser designed for sensitive skin. Look for moisturising ingredients like glycerine or ceramides to hydrate and guard the skin barrier. After washing your hands, gently pat them dry with a soft towel. Consider applying a thick emollient cream immediately after to lock-in moisture and to keep the skin hydrated, the expert suggested. 

Avoid Hot Water

It is crucial to avoid hot water when washing the hands, as it strips away natural oils from the skin and worsens the symptoms of eczema and psoriasis. It is advisable to use doctor-recommended products to avoid any side effects.

https://www.thehealthsite.com/photo-gallery/suffering-from-eczema-and-psoriasis-follow-these-hand-washing-tips-from-a-doctor-1095258/freepik-handwashing-tips-skin-conditions-7-1095259/

How Are DMARDs Used to Treat Psoriatic Arthritis?

From healthcentral.com

These disease-modifying medications can be highly effective, with a few considerations 

DMARDs (disease-modifying anti-rheumatic drugs) are used in psoriatic arthritis (PsA) treatment to reduce inflammation, slow joint damage, and improve symptoms like pain and stiffness. If your doctor has prescribed a DMARD as part of your treatment plan, you probably have some questions about what DMARDs are, how they work, and whether there are any side effects to worry about. Here’s what you need to know.

How DMARDs Work for Psoriatic Arthritis

DMARDs are often referred to as immunosuppressants or immunomodulators because they change the way your immune system works. In simple terms, when you have psoriatic arthritis, your immune system goes off track and mistakenly attacks your body’s healthy tissues. While the exact mechanism of action is still being explored, scientists believe that DMARDs target at least one inflammatory pathway, helping to tamp down uncontrolled inflammation.

Unlike commonly used over-the-counter medications such as non-steroidal anti-inflammatory drugs (NSAIDs), DMARDs can reduce the symptoms of psoriatic arthritis while also slowing down the disease to prevent further damage.

Types of DMARDs Used for Psoriatic Arthritis

Historically, when you think about DMARDs for psoriatic arthritis, you are usually referring to conventional systemic DMARDs (such as methotrexate), according to Laura Coates, Ph.D., an associate professor and researcher of psoriatic arthritis at the University of Oxford in England.

Because newer classes of PsA medications (such as biologics) are also disease-modifying and anti-rheumatic, you may also see biologic medications denoted as bDMARDs. In addition, some of the newer targeted synthetic medications are denoted as tsDMARDs (apremilast, tofacitinib). “I think of the targeted synthetic DMARDs as being more similar to biologics than to methotrexate as far as cost, novelty, and effectiveness,” Coates says.

The list of conventional DMARDs that are commonly used for psoriatic arthritis include:

• Arava (leflunomide)

• Azulfidine (sulfasalazine)

• Cyclosporine and Tacrolimus (calcineurin inhibitors)

• Rheumatrex, Trexall, Rasuvo, Otrexup (methotrexate)

Which DMARD Is Right for Your Psoriatic Arthritis?

                                                  Getty Images/WLADIMIR BULGAR/SCIENCE PHOTO LIBRARY

Which treatment is right for you will be a decision based on close collaboration between you and your provider. It depends on a variety of factors, according to Elizabeth Schulman, M.D., attending physician at the Hospital for Special Surgery and an assistant professor of medicine at Weill Cornell Medical College in New York City. “Today, the first line of treatment for PsA is biologics for most cases,” says Dr. Schulman. “We really only use methotrexate as a first line of treatment when it is contraindicated, for example if someone is fearful of the side effects of a biologic, or if there is a comorbidity that would prevent them from using a biologic.”

The choice of medications can also depend on the specifics of your disease. “As an example, methotrexate is not approved for axial disease [inflammation related to the spine],” explains Dr. Schulman.

Costs may also come into play in the decision-making. For example, conventional DMARDs are often less expensive than the new biologics that are available. And patient preference matters. DMARDs can be taken as a pill, which can be helpful for those uncomfortable with injections. According to Dr. Schulman, “DMARDs are not our usual standard of care, but they are still in our toolbox.”

Side Effects of DMARDs

“All drugs have significant specific side effects and DMARDs are no exception,” says Coates. For example, DMARDs can lower the ability of your immune system to fight infections. According to the American College of Rheumatology, other side effects of DMARDs include:

• Abnormal blood counts

• Diarrhoea

• Dizziness

• Elevated liver function tests

• Gastrointestinal upset

• Hair loss

• Hypertension

• Mouth sores

• Rash

What if the DMARD You're On Isn't Working?

If your DMARD isn’t providing symptom relief, talking to your provider is a great first step. Even if you are experiencing side effects, your provider may be able to adjust your dose or timing of your medication or add a supplement (such as folate) to help reduce the side effects.

How long do you need to wait to decide if it is working? According to the National Psoriasis Foundation, if you don’t meet your target goal with your treatment in three months, it’s time to discuss other treatment options with your doctor. If you do need to change treatment, don’t worry, there are more therapies available than ever before for psoriatic arthritis.

Takeaways

Disease modifying antirheumatic drugs (DMARDs) have been a cornerstone of psoriatic arthritis treatment for many years. Due to their long history, they are often called traditional or conventional DMARDs. There are newer disease modifying medications now available and those are also sometimes referred to as disease modifying drugs, but they are often denoted as bDMARDs or tsDMARDs.

There are known side effects of traditional DMARDs but these are also well-understood medications. If you are prescribed a DMARD and it isn’t working for you, there is always the option to change medications or add a new treatment to the one you are taking. Your provider will help you understand the benefits and risks of all your medications. Together you will decide the best treatment for you.

https://www.healthcentral.com/condition/psoriatic-arthritis/dmards-for-psoriatic-arthritis

How to Tell the Difference Between Psoriasis and Skin Cancer

From healthcentral.com

The conditions are quite different, but in some cases, they may look similar. Here’s how to distinguish between them 

Discovering a new rash or growth on your skin can be nerve-wracking. The spectrum of possible answers to the question “What is it?” ranges from absolutely nothing to an inflammatory condition like psoriasis, to skin cancer. And after Googling it, you might think it’s all three. So, how can you figure it out? When it comes to psoriasis and skin cancer, while the two diseases are very different, to the untrained eye, appearances may look similar. Here’s what you need to know about the similarities and differences between psoriasis and skin cancer.

Types of Psoriasis and Skin Cancer

Psoriasis and skin cancer both have multiple variants that present differently, which can complicate their diagnosis.

Types of Psoriasis

• Plaque Psoriasis

• Guttate Psoriasis

• Pustular Psoriasis

• Inverse Psoriasis

• Erythrodermic Psoriasis

Types of Skin Cancer

• Basal Cell Carcinoma (BCC)

• Squamous Cell Carcinoma (SCC)

• Melanoma

• Dermatofibrosarcoma protuberans (DFSP)

• Merkel cell carcinoma

• Sebaceous carcinoma

Comparing the Appearance of Psoriasis and Skin Cancer

                                                Side by side comparison of psoriasis (left) and skin cancer (right). 

                                                GettyImages/RUTH JENKINSON (left), GettyImages/Irena Sowinska (right)

In most cases, psoriasis and skin cancer look distinct, says Lisa Rhodes, M.D., a dermatologist at Westlake Dermatology in Austin, TX. For example, melanoma appears as an abnormal mole; strikingly different from any type of psoriasis. However, in some instances, psoriasis and skin cancer can have similar symptoms. “Psoriasis is a red, scaly plaque of skin,” explains Dr. Rhodes. “Basal cell carcinoma and squamous cell carcinoma can also be red and scaly.” This raised, red, and scaly characteristic is the most correlated symptom between the two conditions. Plaque psoriasis and squamous cell carcinoma are most likely to present in this way.

According to the AAD, precancerous skin growths called actinic keratoses (AKs) look like dry, scaly patches or spots on the skin. They’re caused by sun exposure and can develop into SCC over time, per the AAD.

When trying to discern skin cancer from psoriasis, a few key traits can tip you off:

• Shape: “Typically plaque psoriasis is broader than it is raised,” Dr. Hwang notes. “Skin cancers generally look more like bumps, or little hills.”

• Surface Area: While psoriasis can be limited to one or two areas on the body, it generally spans large areas, whereas skin cancer is limited to one isolated area or lesion, Dr. Hwang notes. “The broad nature and coverage of psoriasis would very rarely happen in cancer.”

• Speed of Growth: “Skin cancers tend to be small and grow slowly,” Dr. Hwang adds. “Psoriasis can develop quickly over a few months and cover a whole region.”

How Psoriasis and Skin Cancer Are Diagnosed

Both conditions are typically diagnosed with a physical exam—a dermatologist will look at your skin with a dermatoscope, a tool that uses magnification and light—and a medical history. Your clinician will ask about your symptoms, overall health, family history, and recent life events and stressors that may play a role in either psoriasis or skin cancer, explains Samuel Hwang, M.D., Ph.D., professor and chair of dermatology at UC Davis Health in Sacramento, CA.

More often than not, a licensed dermatologist can tell just by examining your skin whether you’re dealing with psoriasis or skin cancer, Dr. Hwang says. They are trained to spot different types of skin cancer and use the ABCDEs of melanoma to diagnose a skin spot—asymmetry, border, colour, diameter, evolving.

If the cause of your skin growth or rash isn’t apparent, your doctor will take a sample of the skin and send it to a lab for testing, called a biopsy. “Psoriasis and skin cancer look different on a biopsy,” Dr. Hwang explains. This will allow your doctor to make an accurate diagnosis and ensure that you get the proper care.

How Psoriasis and Skin Cancer Are Treated

The importance of a correct diagnosis can’t be overstated, in large part because the treatments for psoriasis or skin cancer are drastically different. Whatever you’re dealing with, you’ll want to receive treatment sooner rather than later to improve symptoms and avoid complications.

Psoriasis Treatment

If you do have psoriasis, the treatment option your doctor chooses will depend on the severity, type, how your body responds to certain medications, as well as your lifestyle. Psoriasis is a chronic condition, so while treatment can keep symptoms at bay for long periods of time, it’s normal to still experience flare-ups from time to time, especially when you encounter triggers like stress.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), psoriasis treatments include:

• Topical medications including corticosteroids, vitamin D-based therapies, retinoids, and coal tar

• Oral retinoids

• Phototherapy

• Oral immunosuppressants including methotrexate and phosphodiesterase 4 (PDE4) inhibitors

• Injectable immunomodulating medications called biologics

Skin Cancer Treatment

Skin cancer treatment is also tailored to the type of cancer you have and the stage at diagnosis—in other words, whether it’s in an early stage and confined to the top layer of the skin, or at a later stage and already spread to other areas. In general, skin cancer treatment may consist of the following, per the National Cancer Institute:

• Surgery, of which there are many different types depending on depth and size

• Radiation therapy

• Chemotherapy

• Photodynamic therapy, which uses a drug that concentrates in cancer cells and is activated by a laser light

• Immunotherapy, including drugs called PD-1 inhibitors (which reprogram the body’s immune system to fight the cancer), topical imiquimod therapy, and injected interferon

• Targeted therapies that identify and attack specific cancer cells

Risk Factors

Both skin conditions have their own set of risk factors. Fortunately, Dr. Hwang notes that there is no evidence that having psoriasis or skin cancer increases one's risk of developing the other.

Psoriasis Risk Factors

What sparks the immune system to overreact and cause psoriasis is still a bit of a mystery. Experts believe that a combination of genetics and environmental factors come together to create the perfect storm, resulting in psoriasis, according to NIAMS. However, a few traits seem to increase a person’s risk of developing the condition:

• A family history of psoriasis

• The presence of specific genes linked to psoriasis

• Smoking cigarettes

• Obesity

• Certain medications

• Infections, including strep and HIV

Skin Cancer Risk Factors

No one is immune to skin cancer—anyone can get it. Exposure to UV rays from the sun (or artificial sources, like tanning beds) can contribute to skin cancer development, even if you don’t have any other risk factors, according to the CDC. By using sun protection and avoiding sunburn, you can mitigate your risk of developing melanoma or any other type of skin cancer. Per the CDC, other factors that increase your risk include:

• Light skin colour

• Skin that burns, freckles, reddens easily, or hurts in the sun

• Blue or green eyes

• Light natural hair colour (blonde or red)

• A large number of moles

• A family history of skin cancer

• A personal history of skin cancer

• Older age

• Certain genes or conditions linked to melanoma risk

What Happens if Psoriasis and Skin Cancer Are Left Untreated?

Getting treatment is essential for both of these skin diseases, as the consequences of leaving them untreated can range from unpleasant to fatal. And because treatment for both psoriasis and skin cancer is most effective in early stages, don’t delay in seeing your doctor for an accurate diagnosis and treatment plan.

Untreated Psoriasis

The biggest issue with leaving psoriasis untreated is that you have to deal with the uncomfortable symptoms, which can disrupt your day-to-day life. “More than 60% of people with psoriasis have very significant itching, so it’s uncomfortable,” Dr. Hwang says. Itchy lesions can also predispose a person to infection, Dr. Rhodes adds. On top of that, the chronic inflammation caused by psoriasis can cause other symptoms, like fatigue, so you may also feel unwell overall. The treatments we have for psoriasis “are very good at removing pain and inflammation,” says Dr. Hwang. “They can help people feel much better.”

Obvious patches of psoriasis on your skin or a flaking scalp can also impact one’s self-esteem. “The visual symptoms are alarming to people and generally considered not cosmetically appealing, so it does have an impact on one's self-image and willingness to go out,” Dr. Hwang notes. “There’s a higher incidence of depression in people with psoriasis, too.”

Untreated Skin Cancer

If you don’t treat skin cancer, it will likely continue to grow. “Skin cancer can be locally destructive and even metastasize if left untreated,” Dr. Rhodes says. Metastasis is a significant concern with melanoma and some rarer forms of skin cancer, but not so much with BCC and SCC, Dr. Hwang notes. “The most common types of skin cancers tend to just grow and get bigger and require more extensive surgeries to remove, some of which can be disfiguring if you don't find it when it's small,” he explains. “If very large areas of skin are involved, surgery can be complex and quite invasive—some people even need skull and bone removed.”

Outlook

Psoriasis and skin cancer are both skin conditions that require a proper diagnosis and treatment to keep you healthy long-term. While psoriasis cannot be cured, it can be managed with the right medications. “We have excellent treatments for psoriasis with new ones approved every year,” Dr. Rhodes notes. “And skin cancer, if caught early enough, is easily treated,” she adds. That’s why it’s imperative to keep tabs on your skin and call your doctor if you notice any new growths or lesions, or think that something old has changed in shape, colour, or size. A clinician can investigate anything that seems suspicious and help you get to the bottom of it.

https://www.healthcentral.com/condition/psoriasis/psoriasis-or-skin-cancer?ap=nl2060&rhid=&mui=&lid=141093361&mkt_tok=NTQxLUdLWi0yNDMAAAGTOm_az0Zu7KWIb9iG8ep7p7AmoS6-g9D6H4w1DIdFDTtcoSSpaErOvGD0CY2HOy6mnvwje1HZT80eEmot5efhGksff1YTEWfD96Lq3C0V13VCDR0

It Took Me Years to Find the Right Psoriatic Arthritis Medication

From verywellhealth.com

By Leslie Beth Herbert

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

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

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

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

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

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

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

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

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

A SIGN OF HOPE: A MEDICATION ACTUALLY HELPED

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

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

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

PAYING ATTENTION TO IGNORED SYMPTOMS

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

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

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

PAVING THE PATH FOR A LIFE WITH A CHRONIC ILLNESS

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

Meet The Author

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

Courtesy of Laura Beth Herbert

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