Managing Skin Problems Associated with Psoriatic Arthritis
Psoriatic arthritis is a type of arthritis that can affect those who have a diagnosis of Psoriasis. Psoriasis is characterized by red patchy skin covered with silvery scales; dry cracked skin; itching skin; burning and tenderness; thickened or pitted nails. In the case of Psoriatic Arthritis, swollen, stiff, aching joints are additional symptoms.
The joint pain, swelling and stiffness associated with psoriatic arthritis, can affect all parts of the body. While there is no cure for psoriatic arthritis, there are medical protocols designed to help manage the disease and control the symptoms, but these usually address issues associated with the bones and joints to prevent the condition from becoming disabling and do not specifically address skin conditions associated with Psoriasis.
Managing the symptoms of Psoriatic Arthritis can be complex, and caring for the skin is critical. Those with psoriatic arthritis will present with the same challenging skin conditions as those with other types of psoriasis (which usually affects only the skin). For more information on different types of psoriasis, see our article Types of Psoriasis
Caring for the Skin
Psoriasis affects the body’s immune system which begins to attack healthy cells and tissue resulting in an abnormal immune response – this causes an overproduction of skin cells. The accumulated skin cells form patches of rough, dry, scaly skin that can appear anywhere, but most commonly show on the knees, elbows, hands, feet and scalp. Psoriasis can also affect the nails, especially in those with Psoriatic Arthritis.
80-90% of those with Psoriatic Arthritis have nail problems
Treatment plans for psoriasis are designed to:
- Inhibit the abnormal growth of skin cells
- Remove rough scales and smooth the skin
There are dozens of treatment options, but they tend to fall into two key categories – topical treatments and light therapy:
Topical Treatments – ideal for mild cases of psoriasis or when used in combination with other treatment therapies. These include, but are not limited to:
Topical Corticosteroids – powerful anti-inflammatory medication designed to slow the rate of cellular turnover which reduces inflammation and relieves itching.
Topical Retinoids – A derivitative of Vitamin A, it is designed to normalize the overgrowth of skin cells and decrease inflammation. Like most medicated treatments, retinoids come in different strengths and can be irritating to the skin. Retinoids must also be used with care since they cause sensitivity to ultraviolet light. Sunscreen is a must when using Retinoids.
Salicylic Acid – This promotes the removal of dead skin cells and reduces cell build-up (scaling). Effective on its own for mild cases of Psoriasis, but is more effective when used with other topical treatments.
Coal Tar – This old remedy is an effective way to reduce scaling, itching and inflammation. Coal tar is a byproduct of petroleum products and coal. Available in soaps, shampoos, creams and oils, this is an over the counter product that has very few side effects other than its strong smell and dark color (it’s made from coal) that may stain linens and clothing.
Moisturizers – this is clearly not a medical treatment but proper use of the right type of moisturizer on skin affected with Psoriasis will help combat dryness, seal in the skin’s natural moisture and help control itching an scaling.
Light Therapy – also called phototherapy, uses ultraviolet light to slow cellular turnover, reduce scaling and inflammation. Light therapy is a simple, yet effective treatment, but it must be administered under the supervision of a medical doctor. There are many forms of light therapy, some of which include:
Sunlight. When exposed to ultraviolet light the abnormal cells in the skin die. This slows the growth of skin cells and reduces scaling and inflammation. Effective treatment includes small doses of sunlight each day to avoid inflaming or irritating the skin.
UVB Phototherapy. Also called broadband UVB, this can be used to treat psoriasis that is resistant to topical treatments.
Narrow Band UVB Therapy. Narrow band UVB therapy is considered more effective than broadband UVB treatment. It is usually administered 2 – 3 times a week until the skin shows signs of improvement, then maintenance sessions are performed on a weekly basis.
PUVA. Also called Photochemotherapy, this uses a light sensing medication along with UVB light to enhance the efficacy of the UVB light. This is considered a more aggressive treatment therapy and is usually reserved for those with difficult or resistant cases of psoriasis. There are side effects of this treatment which include headache, nausea, burning and itching. There may also be long-term side effects such as wrinkles, freckles, and increased risk of skin cancer, including melanoma.
Excimer Laser. Used for mild to moderate cases of psoriasis, this laser treatment uses powerful, targeted beams of UVB light to treat only the affected skin and does not harm the surrounding healthy skin. The powerful, targeted beams means less treatment sessions than traditional phototherapy, but redness and blistering can be a side effect of this treatment.
There are also a myriad of home remedies that work for many people – read our article on Treating Psoriasis Naturally for more information on how to management the skin condition associated with Psoriatic Arthritis. Also for those with Psoriatic Arthritis, nail care is a special concern, learn more about how to care for your nails in our article on Healthy Nair Care at Home.