Treating psoriasis can involve drugs, ointments, diet

DEAR DR. GOTT: To the reader who wrote in to your column regarding her grandson’s psoriasis: Try a naturopathic doctor who focuses on diet. I went to a dermatologist for years with a horrible case of psoriasis. I have used steroidal creams, took cortisone injections (one time directly to the soles of my feet, one of my more painful experiences), and gave myself weekly shots in the abdomen. I even had an infusion treatment and countless “trial medications” in trying to reclaim normal skin that would not crack and bleed. When my dermatologist suggested I save my sperm and go in for light chemo, I went looking for other opinions.

The diet and supplements that the naturopathic doctor gave me aimed at rebuilding my liver and kidneys, as they had been damaged by extended use of an over-the-counter medication that I should have known better than to take for so long. He was the first doctor to go through a comprehensive history with me and changing my diet to include restrictions while also including more fruits and vegetables was a lot easier to swallow than another medication with many side effects and little testing.

I hope you can pass this along and that it helps others. I’ve never written to an advice columnist, but I understand the pain and frustration of having your own skin go into complete rebellion, and I couldn’t pass up the chance to help.

DEAR READER: Psoriasis is a common autoimmune condition. There are several forms (plaque, guttate, inverse, scalp, nail, pustular and erythrodermic), but each affects the life cycle of skin cells.

Plaque psoriasis is the most common form. It causes dry, raised, red skin lesions with silver/white scales (plaque). They can be painful and/or itchy and may occur anywhere on the body, including in the mouth.

Guttate psoriasis is most common in those under 30 years of age. It is typically triggered by a bacterial infection and characterized by water-drop-shaped sores covered by a fine scale on the scalp, arms, legs and trunk. It may resolve after a single outbreak or may recur, especially in the presence of ongoing respiratory infection.

Inverse psoriasis causes areas of smooth, red, inflamed skin, primarily in the armpits, groin, under the breasts and around the genitals and buttocks. It is worsened by sweating and friction and is more commonly seen in overweight individuals.

Scalp psoriasis is similar in appearance to plaque psoriasis and may cause dandrufflike flakes. As the name states, it occurs on the scalp, especially the hairline. It can also extend beyond the hairline. It may be sore or itchy and bleed when picked.

Nail psoriasis can affect both the finger and toenails. It results in abnormal nail growth, discoloration and pitting. Some people may experience onycholysis (nail lifting from the bed); severe cases may cause the nail to crumble.

Pustular psoriasis is uncommon. It may appear on widespread patches over the body or on the hands, feet or fingertips. It typically develops quickly. Within hours of the skin becoming red and tender, pus-filled blisters appear. Fatigue, fever, chills and severe itching may also present. The blisters often dry within a day or two, but the cycle may recur every few days or weeks.

Erythrodermic psoriasis is the least common form of psoriasis and can cover the entire body. It causes a red, peeling rash that may itch or burn severely. Certain medications such as corticosteroids, sunburn or other forms of poorly controlled psoriasis can trigger it.

There is also a condition known as psoriatic arthritis. Between 6 percent and 30 percent of all psoriasis sufferers will develop one of the several forms that can range from mild to severe and may result in permanent damage and deformity.

Psoriasis can typically be diagnosed by visually examining the lesions. Rarely, if there is some doubt, a skin biopsy may be performed.

There are many treatment options available to include topical creams, lotions and steroids, oral and injectable steroids or other immunosuppressant drugs, and various forms of light therapy.

Home treatments include daily bathing with oil, colloidal oatmeal or Epsom salts in lukewarm water with mild soap. When drying, blot the skin rather than rubbing. Then apply a moisturizer. For people with dry skin, oils may be best.

To the best of my knowledge, there is no approved diet for psoriasis sufferers; however, eating plenty of fruits, vegetables and whole grains, while limiting sugars and fats, is recommended. This diet is recommended for most health conditions because it may boost immunity and is the most ideal manner in which to get all the vital nutrients the body needs.