Stephanie Mehlis (Northshore)
There are many triggers for psoriasis, but the most common one is something called "koebnerization" - where psoriasis will go to areas that are irritated/scratched. It's why I try to stress the importance of gentle moisturizer and not "scrubbing" the skin and "scratching" off the scales. Other things that can trigger are infections (like strep throat), stress, cold weather, and medications.

Stephanie Mehlis (Northshore)
There have never been great studies that show psoriasis is triggered by a specific food (like gluten, sugar, etc), but I certainly have patients that think something will trigger. If there seems to be an obvious trigger to your psoriasis, certainly avoid that, but it can be hard to try and eliminate everything trying to find the answer. That being said, the most important part of dealing with the chronic disease of psoriasis is being healthy - losing weight if needed, exercise, and a healthy, well balanced diet.

Stephanie Mehlis (Northshore)
Psoriasis has been linked to a specific group of chronic diseases (called metabolic syndrome) that includes diabetes, high blood pressure, high cholesterol, and obesity.

Stephanie Mehlis (Northshore)
They are two different diseases and have two different inflammatory pathways. It is very unusual to have both. However, they can sometimes look similar - both can be itchy, dry, red patches on the skin.

Stephanie Mehlis (Northshore)
There are several different types of psoriasis. The most common is plaque psoriasis and that likes to go to the scalp, elbows, and knees and often has thick, silvery scale . There are "smaller spots" of psoriasis called guttate psoriasis that has small little patches like little raindrops scattered on your skin with less scale, and that commonly is on the trunk. When psoriasis goes to the folds of your skin, like under arms or in the groin, it's called inverse psoriasis and tends to have no scale.

Stephanie Mehlis (Northshore)
Psoriasis in the scalp tends to have A LOT of scale, and when scale comes off a psoriasis plaque it bleeds very easily. It is difficult, especially because hair allows that scale to "stick" more, for that scale to get removed gently without causing open sores. I often recommend oil soaks (I like just plain coconut oil) to help loosen the scale from the hair so that it can be more gently removed. The trick is then getting that greasy oil off your hair. The best way to remove grease is putting regular shampoo on the DRY hair, then stepping into the shower to rinse it off. Then you can re-shampoo your hair and this will get rid of most of the grease from the oils.

Stephanie Mehlis (Northshore)
The stress of a hospitalization is often a trigger. Your dermatologist can certainly prescribe many different kinds of medication to help psoriasis. Topical steroids are most commonly used. For an over-the-counter remedy, I really like the moisturizers that target "dry skin" or "dry cracked heels". They tend to have gentle exfoliators with ingredients like sal acid, urea, and lactic acid that can help both the scale and itch.

Stephanie Mehlis (Northshore)
There are many medications besides Humira that are used for psoriatic arthritis. Psoriatic arthritis is difficult to treat and often needs systemic medication like shots or pills. These range from older medications like methotrexate to a recently approved new biologic (a shot like Humira) called Cosentyx. The National Psoriasis Foundation is a wonderful organization and has wonderful information about all these treatments for psoriatic arthritis and psoriasis on their website: https://www.psoriasis.org

Stephanie Mehlis (Northshore)
I recommend Vitamin D supplements if someone is low, but I don't really see a dramatic change in any of my patients on a vitamin D supplement. We also have a prescription vitamin D ointment/cream that we use very commonly with psoriasis. I tend to like ointments better - they tend to soak into the skin/penetrate the skin better, but can be a little difficult and greasy to use.

Stephanie Mehlis (Northshore)
There are vitamin D solutions that work well in the scalp, especially with a steroid solution or foam to alternate with. There are also some prescription scalp oils with a steroid that do really well if you can stand the greasiness of leaving something like that on your scalp overnight. There are also some various prescription shampoos with steroids and anthralin that can help. Sometimes just the regular dandruff shampoos like sal acid shampoo can help to decrease the scale.