Psoriasis-friendly skincare routine

From rte.ie/lifestyle

There’s no such thing as one-size-fits-all when it comes to a skincare routine – particularly those of us with skin conditions.

Whether it be eczema, psoriasis or simply sensitive skin – finding a routine that won’t exacerbate flare-ups but still supports hydration and healing is crucial.

According to the HSE, psoriasis is a skin condition that causes red patches of skin which are dry and flaky. On white skin the patches can look pink or red, and the scales white or silvery. On brown and black skin the patches can look pink, red, purple or dark brown, and the scales may look grey, white or silvery.

In recognition of Psoriasis Action Month this August, we hear from dermatologists and holistic skin experts on how to manage flare-ups and build the best routine.

Start simple – less is more

The urge to overhaul your skincare when psoriasis appears is completely understandable. But instead of piling on products, the experts advise taking a step back.

"When the skin becomes imbalanced it can be tempting to introduce a slew of new products at once in an attempt to resolve the problem," says naturopathic herbalist at Neal’s Yard Remedies Tipper Lewis.

"In fact, simplifying your routine may be the very thing your skin needs. I think of it like a holiday for your skin helping it to rest and reboot."

The most important thing is ensuring your skin barrier isn’t damaged.

"The first and most important step is to restore and protect the skin barrier, which is compromised in people with psoriasis," says dermatologist and Chinese medicine specialist Dr Mazin Al-Khafaji.

"Many individuals inadvertently worsen their condition in an effort to remove the characteristic thick scales – often by over-washing or using unsuitable products."

What to avoid and what to embrace

Reading the product labels is an arduous task for anyone suffering with a skin condition, and it’s not always clear what irritants are in there.

"Avoid anything that may irritate or inflame compromised skin. This includes synthetic fragrances, harsh exfoliants and foaming cleansers containing sodium lauryl sulphate [SLS] – a known irritant that strips the skin and disrupts the barrier," says Al-Khafaji.

Instead, barrier-supportive ingredients like ceramides, calendula, aloe vera, oat extracts and chamomile all get a green light.

"Look for products with anti-inflammatory properties, such as ceramides, natural plant oils and gentle botanical emulsifiers," he says.

On top of that, choosing certified organic skincare ensures products won’t include many possible sensitisers such as petroleum-derived ingredients, synthetic fragrances or sulphates like sodium lauryl sulphate.

And don’t overlook your bath.

"A simple home remedy to try is salt bathing," says Lewis, "[it’s] a combination of around 500g Epsom salts and natural sea salt in a warm bath.

"You might also consider adding a herbal infusion – such as chamomile or lavender to soothe the skin, marigold to support natural skin restoration, or chickweed to help relieve itching."

How to exfoliate

When thick plaques build up, exfoliation may seem like a quick fix, but experts urge extreme caution. "It may be tempting to scrub the skin, but this can cause damage," warns Lewis.

She suggests using a massage mitt made from flax or hemp fibre, "gently brushed over the skin to lift off dead cells."

Al-Khafaji is even more conservative, noting that "physical exfoliation should generally be avoided. Scrubs, loofahs or abrasive brushes can easily trigger the Koebner phenomenon, where even minor skin trauma leads to the formation of new psoriatic lesions."

Instead, he recommends naturally derived chemical exfoliants – such as fruit acids or urea-based preparations – but only for specific areas and always followed by a rich emollient.

Change your routine with the weather

Weather matters. In fact, the season may influence the severity of your symptoms more than you think.

"During the summer months our skin is exposed to sunlight – UVB – and the air is more humid, which some people may find helpful," says Lewis. "Spending more time outdoors may promote relaxation, which in turn has a positive effect on the skin."

Winter, however, is more challenging. "Psoriasis often worsens in colder months when the air is dry, and sunlight is limited," says Al-Khafaji.

"Use richer creams or ointments, avoid long hot baths, and consider using a humidifier to offset the drying effects of central heating."

How to tailor your lifestyle

Some routines marketed as "helpful" may actually be making things worse, like over-washing and using long-term prescription steroids.

"While topical steroids can temporarily suppress inflammation, they do not address the root cause," says Al-Khafaji. "Over time, they thin the skin, impair its natural defences and often lead to rebound flares."

While someone’s diet and gut is often been linked to skin health, stress has also been flagged as a symptom of worsening skin conditions.

"[If you’re stressed] support your zen with herbal tea or tinctures," says Lewis. "Try soothing essential oils in a diffuser, like bergamot, lavender, cedarwood or immortelle."

But natural doesn’t always mean best. "Some so-called natural products – including high concentration of essential oils or over-the-counter herbal creams – can actually worsen the condition," says Al-Khafaji.

Even with this greater knowledge of how you should adjust your skincare routine, lifestyle changes aren’t always enough to eradicate symptoms. "Psoriasis is not simply a case of dry skin – it is a complex, immunologically active disease that requires targeted, informed care," says Al-Khafaji.

So, before making any drastic changes to your routine, it’s best to consult your doctor or a dermatologist.

https://www.rte.ie/lifestyle/living/2025/0808/1527475-psoriasis-friendly-skincare-routine/ 

Understanding the pain of psoriasis

From newsday.co.tt

AUGUST marks Psoriasis Awareness Month and consultant dermatologist in private practice, Dr Marilyn Suite told Newsday that psoriasis is estimated to affect about two per cent of the world’s population.

Suite explained that psoriasis is an inflammatory condition caused by the rapid multiplication of skin cells and is believed to be autoimmune in nature.

“The body’s immune system starts to be ‘overactive’ in the skin and often the joints as well,” she said. She added that psoriasis also has a genetic basis, noting, “You are more likely to have psoriasis if one of your parents has it.” Importantly, she clarified that it is not an infection and cannot be spread from person to person.

According to Suite, public awareness remains low. “The general public perhaps is unaware of psoriasis and one of the first questions I am asked after making the diagnosis is, ‘How did I get this, doctor?’” she said. “They should be assured that it is not something they ‘caught’ but it is a genetic tendency.”

When asked about the prevalence of psoriasis in Trinidad and Tobago, Suite explained that while exact national figures are unavailable, one study found that approximately five per cent of new patients seen at the dermatology clinic at Port of Spain General Hospital during the study period had psoriasis.

The doctor pointed out that the condition affects any age group including children. In TT, it appears to affect persons of East Indian descent more than those of African descent and men are more often affected than women.

As for the diagnosis of psoriasis, Suite explained that it “is usually easily made if the rash presents in its typical way but sometimes a skin biopsy may be needed to confirm the diagnosis.”

Types of psoriasis

Suite also outlined the different types of psoriasis and how they present. “The most common type of psoriasis is called plaque psoriasis,” she said. “This presents as thick, scaly raised areas of skin (plaques) that may be red in colour, but in darker skins, may be shades of brown, brownish-red or gray. The scales are often silvery or white. The rash may not be itchy but most people experience itching of varying intensity.” She added that plaques, when very inflamed, can become painful and may bleed. “When the lesions heal, they may leave discoloured spots that take some time to fade,” Suite explained adding that any part of the skin may be involved, including palms and soles as well as the scalp and nails.

She described guttate psoriasis (the word ‘gutta’ is Latin for drop) as presenting as small, drop-like spots that may appear suddenly, often after a throat infection. “It is seen mainly in younger patients and tends to clear quickly with treatment,” noting that those patients may go on to develop classical plaque psoriasis later in life.

Psoriasis is estimated to affect about two per cent of the world’s population.

She pointed out that psoriasis may also show up in areas like the underarms, groin and beneath the breasts in a form called inverse or flexural psoriasis, which appears as flat, red or brown, shiny with well-marked out edges.

Another type, pustular psoriasis, involves tiny pus-filled blisters that may affect only the hands and feet or may become generalised.

Psoriasis may rapidly involve the entire skin with generalised redness, scaling and soreness. “This is called erythrodermic psoriasis and patients may be very ill with fever and chills,” explained Suite. “They may lose a lot of fluid through the skin and become dehydrated. This situation requires hospitalisation” she emphasised.

Physical and emotional challenges

The doctor added that joints are affected in about 30 per cent of psoriasis cases. “While the skin rash usually presents first, some persons may have joint involvement before the rash appears. The joints become swollen and painful and if untreated, may later develop deformities.”

In addition to the physical symptoms, Suite highlighted the significant emotional and lifestyle challenges that people with psoriasis often face.

“Like any chronic disease, psoriasis can impact quality of life depending on its severity and the areas of the body that are affected – although even mild psoriasis may be distressing.”

Itching and pain, or the thick scaling that can occur may hamper daily activities, work, school, social interaction and relationships. Joint pain or disability may further limit mobility or the ability to handle certain tasks. Suite added that individuals may experience “stigmatisation and embarrassment because of the appearance of the skin and they may be less likely to be employed in certain occupations.”

Asked if there are any lifestyle factors or triggers that can worsen symptoms of psoriasis, the seasoned dermatologist explained that psoriasis is now recognised as a multisystem disease. “This means that there is an association with changes in other organs apart from the skin and joints” she said. People with psoriasis are more likely to have cardiovascular disease including heart attacks and strokes, high blood pressure, high lipid levels (cholesterol and triglycerides), diabetes and are more likely to be overweight or obese. “It is therefore necessary to try to control these factors by adopting a healthy lifestyle which includes exercise and a healthy diet,” she advised.

Suite further noted that stress is another significant trigger. “Stress can worsen psoriasis,” she said, adding that living with the condition can itself lead to anxiety, depression, and in some cases, even thoughts of suicide. Managing emotional well-being is therefore a vital part of overall care.

“Psoriasis tends to occur at the site of injury of the skin” she noted, “so it may develop in cuts or bruises or surgical scars.” Heavy alcohol intake and smoking are also believed to be triggers for psoriasis. Some of the drugs that may provoke psoriasis include lithium (a psychiatric drug), antimalarials and some high blood pressure drugs.

Available treatment

When it comes to treatment, Suite said most cases of psoriasis of the skin are treated with steroid creams or ointments, prescribed based on the patient’s age and the location of the rash. “These reduce inflammation and stop the skin cells from multiplying rapidly and should be used under a doctor’s supervision.

“Oral or intramuscular injected steroids should be avoided because while psoriasis may clear quickly, the patient could experience rebound or worsening of the psoriasis and may develop pustular or erythrodermic psoriasis.”

The doctor related that calcipotriene or calcipotriol ointment, which is derived from vitamin D, was developed specially for psoriasis but it is no longer available in TT. However, she noted that other drugs called retinoids and calcineurin inhibitors are also used and are available. “Salicylic acid and coal tar are older ointments which are still useful to help thick plaques. Dithranol cream or ointment is not available locally but is used a lot in the UK,” she said.

She advised that if psoriasis is unresponsive to topical treatments and is extensive, the person should be referred to a dermatologist. “The dermatologist is likely to prescribe treatments by mouth or by injection,” Suite stated adding that they include drugs like methotrexate, cyclosporine, retinoids (vitamin A derivatives) and the newer injectable biologic drugs such as infliximab, etanercept, adalimumab, ustekinumab, guselkumab and several others. “The biologic drugs are expensive and are not usually the first line of treatment, but they are available in TT, some are available at public hospitals.”

She hopes they will become cheaper in time so that all patients with severe or unresponsive psoriasis can benefit.

The doctor added that natural sunlight can help psoriasis provided the individual does not get sunburnt. Relating that light treatment in the form of PUVA (oral psoralen and ultraviolet A) and narrow band UVB (ultraviolet B) can be used with or without oral treatments, Suite added, “Excimer laser is used to treat specific lesions since it targets smaller areas. Some local dermatology clinics in the private sector have these modalities. Broadband UVA is also used.”

So is psoriasis curable? As Suite explained, “Psoriasis is a life-long condition which is subject to relapses. It is treatable but not curable and requires the patient to be compliant and follow up with his/her doctor.”

However, there is hope. “One can live an active, normal life and one may prevent flares by adopting a healthy lifestyle, controlling the comorbidities described above and managing stress,” Suite advised.

https://newsday.co.tt/2025/08/05/understanding-the-pain-of-psoriasis/ 

The Long Road to Clearer Skin

From healthcentral.com

After years of trial and error—and painful symptoms—Max Lomboy found a psoriasis treatment that worked. Here’s how he got there 

If you live with psoriasis, you know that landing on the right treatment can be a complete game-changer for your skin. But chances are, you also know that finding the magic med isn’t always easy. It can be a journey of trial and error that’s often made longer by having to navigate a complex healthcare system, as 41-year-old Max Lomboy learned firsthand after he was diagnosed with psoriasis five years ago.

It’s Just a Rash

It all started when he noticed a small, silver dollar-sized patch on his back. Thinking it was a scab—it wasn’t painful—Max, who lives in Cedar Park, TX, tried to pick it off, but it came right back. A Google search led him to conclude that he had ringworm (which is often marked by a small, round rash), which he tried to manage with over-the-counter topicals. When those didn’t work, he knew it was time to see a dermatologist.

Max was shocked when the dermatologist told him the patch was psoriasis, a chronic inflammatory skin condition with no cure. “It didn’t run in my family. I didn’t know what triggered it,” recalls Max, who was living in San Francisco at the time. Still, he figured it would be relatively easy to deal with using prescription topicals, since the patch was small and not uncomfortable. “I almost thought of it as an embarrassing tattoo. No one’s really gonna see it, so I don’t have to think about it too much,” he says, noting that it may have been more challenging if he didn’t already have a serious girlfriend, since he’d have to explain the patch to potential new partners.

A Total Body Takeover

Things took a turn about six months later when new psoriasis patches began forming over Max’s body in rapid succession. “I don’t know if stress was a trigger, but it just went nuts. Patches started showing up everywhere, from the top of my scalp to the soles of my feet,” he says. They also started getting bigger—the largest one was the size of a baseball—and becoming painful and irritated. “I would sit down, and a patch would split and bleed,” he says. “I felt like I was in a horror movie, and it was taking over.”

When Max went back to his dermatologist, he was told that his psoriasis body surface area (BSA) coverage was 80%, putting him in the category of severe psoriasis. His insurance provider had required him to try and fail on a topical treatment before agreeing to cover Otezla (apremilast), an oral med for moderate to severe psoriasis that works by works by calming down the body’s overactive immune systems.

The prescription kept his psoriasis from getting worse, but it didn’t make it improve. And it made him feel nauseous. Seeking another solution, he was able to get coverage for UVB phototherapy, but that didn’t help either. “My body ended up having a really poor reaction and it created more psoriasis plaques,” Max recalls. “I didn’t know what to do.”

Embarrassing complications began arising at work, too. Max worked as a bank branch manager, and one of his fingernails fell off while he was talking with a customer. “They made a joke that I had press-on nails,” recalls Max, who tried his best to shrug it off in the moment. But inwardly, he was both mortified and worried. “I was like oh my god, what’s happening to me? People thought I was either not hygienic or seriously sick,” he says. Shortly after, he decided to take some time off to focus on getting his skin under control, using the paid time off (PTO) he had accrued since he couldn’t get disability coverage.

Fighting for Treatment

                                                                                           GettyImages/SeventyFour

Around this time, Max recalls learning about biologic treatments for psoriasis and asking his dermatologist if he qualified. “When I mentioned it to my doctor, they said I had to go through certain [treatment] stages first. But it had been a year and a half, and I was literally bleeding in my chair while we were talking,” he says.

Max’s cousin, who had previously worked in a dermatologist’s office, suggested that Max ask his dermatologist for a sample dose of a popular injectable biologic medicine and pay for it out of pocket. It cost him a few thousand dollars, “but my cousin told me that if the medication showed results, I could take that to my insurer,” and convince them to cover it, he says.

To Max’s great relief, the biologic worked. “Within that week I noticed my plaques started to get softer. After another week, they just looked like areas of discoloration. Maybe a month after that, my nails started to come back,” he says. With proof that the drug was helping him, his insurer finally agreed to pay for it. He was thrilled to be able to trade his regimen of pills and creams for a single, every-other-month injection.

But within a few months Max started to notice signs that his psoriasis was on the verge of roaring back. He’d start to notice new plaques forming on his scalp the week before he was due for another injection, suggesting that his psoriasis inflammation was ramping up towards the end of his dosage cycle. “When I’d go for a haircut, I’d always be nervous because I’d have to explain to the barber what it was and that it wasn’t contagious,” he recalls. Terrified of returning to a full-blown flare, he knew he was in desperate need of a treatment adjustment.

Finding Real Relief

Max had moved from San Francisco to Cedar Park, TX, while he was on the first biologic. His search for a dermatologist in his new town led him to Donna Hart, M.D., who treats psoriasis patients at Westlake Dermatology near his home. Dr. Hart recommended switching Max to Skyrizi (risankizumab), another type of injectable biologic that she’s seen work on psoriasis patients with his similar symptom and severity profile.

Like his previous biologic, Max needed to get an injection every eight weeks. But unlike the old med, his symptoms went away—and stayed almost completely controlled until he was due for his next one. “The week before my next cycle, I’ll notice some very slight psoriasis in my scalp. But it just looks like dry scalp,” he says.

That was three years ago, and happily, the treatment regimen has kept Max’s psoriasis in check ever since. He’s both thrilled and relieved that his skin looks and feels better, and that he’s no longer on the exhausting hunt for a treatment that’s both effective and affordable. But he’s still stunned by how much he had to go through to get to this point. “It feels almost criminal that someone has to do those daily oral meds before trying this newer option,” he says.

His Advice for You

Max is convinced that his psoriasis would have improved much faster if he’d been able to access his current medication sooner. “I don’t think anyone was trying to act malicious, they just wanted to keep costs low,” he says of his provider in San Francisco. Still, he says that the experience serves as a testament to the importance of persisting being your own advocate when you have psoriasis—or any chronic condition that you’re struggling to manage.

“You have to keep going when you hear no. You have to ask questions, ask for recommendations, do your research, and try to talk to people who’ve gone through it,” he says. “There is a light at the end of the tunnel, and something will work for you.”

https://www.healthcentral.com/condition/psoriasis/long-road-to-clearer-skin

How to Manage the Heart Disease Risk of Psoriatic Arthritis

 From everydayhealth.com

If you live with psoriatic arthritis (PsA), you’re well aware of its impact on your joints, including symptoms like stiffness and swelling, as well as the persistent fatigue it can cause. 

But PsA can also affect your heart, and while it may not cause any noticeable symptoms, the condition comes with an increased risk of heart disease and stroke.

That’s because psoriatic arthritis isn’t just a joint problem: It’s a systemic inflammatory condition, meaning that inflammation affects the entire body. And inflammation plays a major role in the development of atherosclerosis (hardening and narrowing of the arteries), the root cause of most heart disease.

But there are steps you can take to improve your heart health — and the good news is that many of them include some of the same things you’re doing to manage your PsA.

Keep reading to better understand the connection between psoriatic arthritis and heart health and get expert advice on how to reduce the likelihood of heart disease, including heart attack and stroke.

The Link Between Psoriatic Arthritis and Heart Disease

Psoriatic arthritis belongs to a family of conditions called psoriatic disease, which also includes psoriasis, a chronic skin condition. Both involve an overactive immune system that causes widespread inflammation.

“This inflammation doesn’t just affect the joints or skin,” says Michael Garshick, MD, a cardio-rheumatologist at NYU Langone Health in New York City. A lot of the same immune cells and pro-inflammatory proteins that are upregulated in psoriatic disease are also involved in the development of atherosclerosis,” he says. 

“In general, psoriasis and PsA are put together when we discuss heart disease risk. That’s mostly because there are many more patients with psoriasis compared to psoriatic arthritis, and the studies on heart disease and PsA haven't been as robust,” says Dr. Garshick. It’s estimated that about 1 in 4 people with psoriasis also have PsA.

In general, people with psoriatic disease have a cardiovascular risk similar to those with moderate to severe psoriasis, says Garshick. “So if you have really only mild psoriasis, but you have psoriatic arthritis, that upgrades the risk of a higher risk of cardiovascular disease than if you didn't have psoriatic arthritis,” he says.

Whether it's psoriasis or psoriatic arthritis, it’s believed the combination of inflammation caused by the conditions and the fact that most patients with psoriatic disease have a higher risk of the traditional cardiometabolic risk factors — like hypertension, hyperlipidemia (high cholesterol), type 2 diabetes, obesity, and smoking — promotes cardiovascular disease, says Garshick.

PsA Inflammation Impacts Heart

Experts believe that heart disease and psoriasis and PsA may share inflammatory pathways that drive the progression of both diseases.

“Although psoriasis plaques are different from plaques in the arteries, the inflammation that makes the skin red and flaky is similar to the kind of inflammation that causes blockages in the arteries,” says Joel Gelfand, MD, the director of the psoriasis and phototherapy treatment centre at Penn Medicine in Philadelphia.

In fact, a lot of the same immune cells and pro-inflammatory cytokines that are upregulated in psoriasis or psoriatic disease are also part of the disease process in atherosclerosis, specifically cytokines or proteins such as TNF-alpha, says Garshick.

Atherosclerosis is the build-up of fats and cholesterol in and on the artery walls, called plaque. The build-up limits blood flow and can eventually lead to heart attack or stroke.

There’s a really big overlap between the disease processes driving psoriasis and atherosclerosis, says Garshick. “There's even evidence from genetic studies suggesting that in patients who have atherosclerosis, that may promote worsening psoriatic disease, so we think it’s a bidirectional relationship,” he says.

Higher Risk of Traditional Heart Disease Risk Factors

People with PsA are more likely to also have traditional heart disease risk factors, including high blood pressure, type 2 diabetes, obesity, and smoking.

“It’s really a synergy,” says Dr. Garshick. “It’s the combination of systemic inflammation and the higher rates of these common risk factors that increases the overall cardiovascular risk.”

Indeed, the PsA inflammation could contribute to or worsen cardiovascular disease risk factors, including the following: 

• Insulin Resistance Inflammatory chemicals interfere with how the body uses insulin, leading to higher blood sugar and an increased risk of type 2 diabetes, a major heart disease risk factor. 
• High Cholesterol Inflammation disrupts normal fat metabolism, raising triglycerides and lowering “good” HDL cholesterol, contributing to clogged arteries.
• Hormone Imbalance From Fat Tissue (Adipokines) The hormones leptin and resistin are elevated in PsA and promote more inflammation and artery damage.

“In general, the higher prevalence of atherosclerosis in the psoriatic patient population is a contribution from both underlying systemic inflammation and traditional cardiovascular risk factors,” says Garshick.

How to Manage Heart Disease Risk

“Unfortunately, there’s good evidence to suggest that cardiovascular risk factors are both underrecognized and undertreated in people with PsA,” says Garshick.

According to the most up-to-date recommendations, more aggressive heart disease risk management is needed in PsA to reduce morbidity and early death, he says.

Identify Controllable Risk Factors

People should have a cardiovascular disease assessment when they are first diagnosed with PsA, per the new recommendations by the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN).

“For patients with psoriatic disease, that would include checking lipids, blood pressure, and blood sugar levels, and, if they’re elevated, to either treat, or refer to their primary care doctor or a preventive cardiologist office,” says Garshick.

A preventive cardiologist may be especially helpful if you are reluctant to start medication, have trouble tolerating drugs like statins, or when you want more personalization, he adds.

Many people assume that because they’re regularly seeing a rheumatologist or dermatologist, their heart health is also being monitored, but that’s not always the case. 

Garshick recommends taking a proactive approach and making sure you know your numbers for cholesterol and blood pressure.

Discuss Drug Choices for Psoriatic Arthritis

Effective treatment of inflammation is key to improving PsA symptoms and slowing the disease process, but does that help reduce the risk of heart disease?

“There’s observational data suggesting that treating psoriatic disease may reduce cardiovascular risk, but randomized controlled trials haven’t definitively proven that yet,” says Garshick.

There has been concern that some drugs used to manage PsA may actually increase heart-related risks, says Garshick.

There were concerns about a couple of biologics used for PsA, including TNF-alpha inhibitors, which include adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade), and IL-23 inhibitors, which include guselkumab (Tremfya) and risankizumab (Skyrizi), but recent evidence shows they are generally safe, he says. 

On the other hand, Janus kinase (JAK) inhibitors, a new kind of disease-modifying drug (DMARD), do come with heart risks. The JAK inhibitors approved to treat PsA include tofacitinib (Xeljanz) and upadacitinib (Rinvoq).

“These medications come with a black box warning from the FDA for cardiovascular and clotting events. They also tend to raise LDL, or ‘bad,’ cholesterol, but that doesn’t fully explain the risk,” he says.

Because of this, the preventive cardiologist and the rheumatologist need to have a conversation before a patient is started on a JAK inhibitor, to make sure it’s the best choice and that cardiovascular risks are managed appropriately, says Garshick.

Maintain a Heart-Healthy Lifestyle

The experts in the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network recommend the following lifestyle changes to manage your heart disease risk if you have psoriatic arthritis. 

• Be physically active. Aim for regular moderate to vigorous exercise to boost both your physical and mental health. Exercise can reduce psoriasis and joint symptoms, improve your mood, and help you sleep better. If skin discomfort, joint pain, or fatigue makes it hard to exercise, start small and talk to your doctor about ways to stay active comfortably.
• Eat a healthy, balanced diet. Choose nutrient-rich foods like vegetables, fruits, lean proteins, and whole grains. Avoid high-sugar, high-fat, and processed foods that can increase inflammation.
• Aim for a healthy weight. Any loss of excess weight — even a small amount — can reduce joint pain, lower inflammation, and improve your response to psoriasis treatments. If diet and exercise aren’t enough, weight loss medications like GLP-1 agonists may be an option.
• Quit smoking. Smoking increases your risk of developing psoriasis and can make symptoms worse. It may also make treatments less effective and raise your risk of heart disease. One of the best things you can do for your skin, joints, and overall health is to stop smoking.

The Takeaway

• Psoriatic arthritis increases your risk of heart disease caused by widespread inflammation and related conditions like high blood pressure, diabetes, and obesity.
• Regular screening for heart disease risk factors is essential and should begin at diagnosis.
• Management of PsA with the appropriate medications may reduce cardiovascular risk, but some medications may increase it. Discuss your treatment options with your doctor.
• A heart-healthy lifestyle, including exercise, a balanced diet, weight management, and smoking cessation, can significantly improve both joint health and heart health.
• 
  
• https://www.everydayhealth.com/rheumatic-conditions/how-to-manage-heart-disease-risk-in-psoriatic-arthritis/

Hope for tough-to-treat genital psoriasis

From medicalrepublic.com.au

A new case series shows rapid remission in men with treatment-resistant pustular genital psoriasis, highlighting a potential alternative to biologics

Genital pustular psoriasis is a rare and diagnostically challenging variant of psoriasis that remains under-recognised in clinical practice, say researchers.

Their new retrospective case series published in JEADV Clinical Practice presents compelling evidence supporting the use of apremilast, an oral phosphodiesterase-4 (PDE4) inhibitor, as a viable treatment option in male patients with this difficult-to-manage and treatment-resistant condition.

“Genital pustular psoriasis is a rare and often underdiagnosed condition that can significantly affect both physical comfort and quality of life, often leading to psychological and sexual dysfunction,” the researchers wrote.

“This subtype of psoriasis presents unique diagnostic and therapeutic challenges, as it is frequently unresponsive to conventional topical treatments, necessitating the use of systemic therapies.

“Exclusive genital psoriasis is found in only 2%−5% of psoriasis patients, and pustular involvement is even more exceptional.”

Apremilast targets the inflammatory pathways central to psoriasis by reducing pro-inflammatory cytokines.

Previous studies have demonstrated the effectiveness of apremilast in treating challenging cases, such as plaque psoriasis in special areas, genital psoriasis or palmoplantar pustular psoriasis, indicating its potential for other refractory forms of the condition.

This short case series included six men aged 21 to 47 years, who presented with persistent, recurrent circinate balanitis or balanoposthitis localised to the glans penis or the glans and prepuce.

Histopathological findings showed intraepidermal neutrophilic micro-abscesses and parakeratosis – features suggestive of pustular psoriasis, although fully formed pustules were often absent.

Each patient had undergone comprehensive diagnostic evaluation to rule out sexually transmitted infections and reactive arthritis.

All tests, including bacterial, viral, mycological swabs and syphilis serology, returned negative, and no patient exhibited systemic symptoms of reactive arthritis or extragenital psoriatic involvement.

All six patients had failed multiple standard treatments, including potent topical corticosteroids, tacrolimus, acitretin, methotrexate, and ciclosporin. These therapeutic limitations, coupled with the sensitivity of the genital area and the psychological impact of the condition, posed significant clinical management challenges, the researchers said.

While biologic therapies such as ixekizumab were known to be effective for genital psoriasis, they were often inaccessible to patients with limited or localised disease, highlighting a critical therapeutic gap, they said.

Patients in the study were started on apremilast following a standard six-day titration schedule, aiming for a maintenance dose of 30mg twice daily. One patient required a reduction to 30mg once daily due to migraines, but all patients tolerated the treatment well. Follow-up periods ranged from one to three months.

All six patients achieved complete clinical remission within this timeframe. Adverse effects were minimal and self-limiting, with mild diarrhea being the most frequently reported symptom. No patients required additional therapies, and none developed new psoriatic lesions or psoriatic arthritis during follow-up.

The authors emphasised the importance of clinicopathologic correlation, especially in genital psoriasis where the histological presentation may be subtle and clinical features such as ring-shaped (circinate) lesions could provide critical diagnostic clues.

Given the inflammatory but localised nature of the disease, apremilast’s ability to modulate proinflammatory cytokine production through PDE4 inhibition appeared to be particularly well suited for these cases, the researchers said.

While the small sample size and retrospective design of the study limit its generalisability, the consistency and speed of response in all patients point to apremilast as a highly promising treatment for refractory genital pustular psoriasis. Its favourable safety profile, ease of oral administration, and lack of serious systemic side effects made it especially appropriate for use in sensitive anatomical locations.

The researchers said their case series added to the growing body of evidence supporting the use of apremilast in psoriasis variants that were difficult to treat with conventional therapies.

They said clinicians should consider its use in appropriately selected patients, particularly those who do not meet eligibility for biologic agents or who are at risk of adverse events from traditional systemic immunosuppressants.

“Apremilast appears to be an effective and well-tolerated treatment for refractory genital psoriasis with pustular features, offering a promising therapeutic option for this rare and challenging condition,” they concluded.

“This case series suggests that apremilast can help patients achieve complete remission in a relatively short time with minimal side effects.

“In diagnosing psoriatic circinate balanitis, it is crucial to consider conditions like circinate pustular balanitis associated with Reiter’s syndrome, as well as infectious causes such as Herpes Simplex Virus, Candida albicans, group A and B streptococci and syphilis. Histology alone cannot differentiate between Reiter’s syndrome and psoriatic circinate balanitis.”

The researchers conceded the small sample size and retrospective nature of their study limited the generalisability of the findings.

“Nevertheless, increased clinical awareness and histological confirmation are essential for accurate diagnosis and effective treatment,” they wrote.

“Early recognition can help prevent misdiagnosis and inappropriate treatment, ultimately improving patient outcomes.

“This case series demonstrates that apremilast is a valuable treatment for refractory genital psoriasis with pustular features.

“Although further studies with larger cohorts and randomised controlled trials are needed to confirm the efficacy and safety of apremilast, the current findings highlight its potential for patients who have failed other treatments.”

https://www.medicalrepublic.com.au/hope-for-tough-to-treat-genital-psoriasis/118813