Psoriasis Treatment Risks, Emotional Impact, Sea, Salt, and Sun

by Food and Drug Administration (FDA)

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Reducing Treatment Risks

Biologics, other systemic drugs, and phototherapy are powerful treatments with increased risks, says Lindstrom.

Biologics may raise the risk for developing cancer and serious bacterial or fungal infections that spread throughout the body (sepsis).

Cyclosporine can damage the kidneys, methotrexate puts the liver and lungs at risk, and phototherapy can cause skin cancer. To reduce these risks, doctors often put patients on "rotational therapy." "The thought is by moving from one therapy to another therapy over time, the risk to any individual organ is reduced," says Lindstrom.

"We also try to choose a drug with an appropriate benefit-risk ratio," she says. For mild psoriasis, a topical steroid may be appropriate. For more severe disease, where it becomes impractical to apply topicals over a large surface area several times a day, a patient may need a systemic treatment.

Most of the highly effective treatments for psoriasis affect the immune system in some way. For steroid drugs, which have been around for more than 50 years, the risks are well known. But less is known about the long-term side effects of newer drugs, such as the biologics. The safety and side effects of biologics and other immune-suppressing drugs to treat psoriasis continue to be monitored by drug manufacturers and the FDA.

Emotional Impact

For many people, dealing with the emotional impact of psoriasis can be as challenging as treating the disease.

Bird says that mothers have pulled their children away from her on the subway, and some people, horrified by her skin lesions, have asked her if she has AIDS. As her disease has evolved over 30 years, so has Bird's way of dealing with these reactions. In her teens, she'd tell people she had leprosy just for the shock value, she says. Today, Bird is open about the disease but still relies on her defiant attitude to "steel myself for the experience" of going to the beach. "I love to swim," she says. But Bird knows that without covering herself up in a public place, she "runs the risk of people just rubbernecking."

"When I'm feeling forgiving, I try to ignore them," she says, "but when I'm angry, I think 'didn't your mother teach you not to stare?'"

Bird advises others with psoriasis to find out what works best for them to cope with the emotional effects of the disease. Going to therapy has helped her, she says. So has leading a support group for psoriasis sufferers. "It's important for people to work on their emotional well-being," says Bird, "however they choose — whether it's meditation, yoga, or putting on long pants and going out dancing."

The Future of Psoriasis Treatment

Researchers continue to look for reasons why immune cells overreact and what genes may be responsible for psoriasis, hoping to find better treatments, and eventually a cure. Psoriasis research is aided by the visibility of the symptoms on the skin.

"You can see the disease," says Leonardi. "You don't have to do invasive testing to see the effects of therapy." Psoriasis research has a "tremendous spillover into other fields besides dermatology," he adds. "There is a huge need for drugs to suppress the immune system without the side effects."

Multiple sclerosis, Crohn's disease, rheumatoid arthritis, and type 1 diabetes are just a few of the diseases that may also benefit from psoriasis research.

Sea, Salt, and Sun

Some psoriasis sufferers have tried salt water to relieve their itchy or painful skin. Some have even made pilgrimages to the world's saltiest lake, the Dead Sea.

"The Dead Sea is excellent for psoriatic treatment," says Lawrence C. Parish, M.D., clinical professor of dermatology and cutaneous biology at Jefferson Medical College of Thomas Jefferson University in Philadelphia. "But no one knows if the water itself has merit or whether the sun is the important part." As the lowest point on the planet, the Dead Sea region has unique weather and receives a distinctive spectrum of ultraviolet light from the sun.

Soaking in bath water containing Dead Sea salts or Epsom salts may have limited value. "It can help remove the scales of psoriasis and make people feel better," says Parish, "but no one has shown these salts to have a therapeutic effect."

Whether at the Dead Sea or anywhere else, sunlight can have a positive effect on psoriasis. "But be reasonable about it," Parish says. "A little bit of sun is fine." He advises wearing a wide-brimmed hat and applying sunscreen several times a day. "Anyone who wears makeup knows if you put it on at 8 o'clock in the morning, it doesn't last until 8 at night," he says, and neither does sunscreen.

About the Author

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