Ask the Expert
You've got questions? We've got answers—from the leading psoriasis and psoriatic arthritis experts around the United States who serve on the National Psoriasis Foundation Medical Board.
Alternative treatment
Q: Has anyone heard of acupuncture being used to treat psoriasis?
A: Yes, I have heard of acupuncture being used for psoriasis with some success and have indeed personally observed this in China. However, with the excellent creams and ointments together with various wavelengths of ultraviolet light and oral medications we have available, in most instances psoriasis should be significantly improved. If not, be sure to consult with an expert in acupuncture—someone who has had experience in treating psoriasis.
Associated diseases & conditions
Q: I am a 34-year-old woman who has been using clobetasol propionate cream for the past approximately 10 years to treat my guttate psoriasis. I was recently diagnosed as a "glaucoma suspect" and am curious if perhaps there is an association between long-term clobetasol propionate cream use and glaucoma. If there is an association between the two, can you suggest any other medication(s) that I can discuss with my doctor to treat my psoriasis?
A: Prolonged use of topical steroids around the eyes can result in glaucoma as well as cataracts. Superpotent topical steroids should not be used around the eyes. Psoriasis patients with guttate psoriasis tend to have a very good response to increasing increments of ultraviolet B light. In general, it is impractical to treat patients with moderate to severe psoriasis with topical steroids.
Q: I have heard that the colon affects psoriasis. What research has been done to prove any connection between colon conditions and psoriasis?
A: I know of no correlation between colonic health and pathology with psoriasis.
Q: I have had psoriasis for 20 years (since age 7). I also tend to catch illnesses easily (colds, flu). Is there any connection between the immune system causing psoriasis and resistance to illness?
A: Actually, patients with psoriasis have a statistically significant protection from a variety of infections (Henseler T and Christophers E, Journal of the American Academy of Dermatology 1995; 32:982-986). However the magnitude of this effect is relatively small (approximately 5% reduction). This is thought to be due to the proficiency of T lymphocytes found in psoriasis skin lesions (so-called Th1 lymphocytes) in clearing infected cells. The fact that your case goes against this trend is not surprising, as there is much variation between individuals, and the study quoted averages over thousands of people.
Q: Can having severe psoriasis cause dehydration? I have all the signs of dehydration and it seems no matter how much fluid I drink, I am still dehydrated.
A: Psoriasis can definitely increase the loss of water across the skin, which is the major source of water loss in the body to begin with. You should use emollients liberally, as they help to reduce water loss across the skin. However, if you drink coffee, tea or alcohol, these can also cause dehydration.
Psoriasis on specific skin sites
Q: Can psoriasis occur in the ears and cause hearing loss?
A: Lesions of psoriasis in and around the ear, particularly in the ear canal, can cause an accumulation of scaling. This scaling, when combined with normal ear wax, can sometimes produce the physical blockage of the external ear canal leading to some decrease in hearing. The simple cleaning of the ear canal with the home use of an ear syringe or having the ear canals cleaned professionally by a physician will alleviate this problem.
Triggers
Q: My mother had a breast biopsy and the doctor used lidocaine. She recently developed psoriasis. Have you heard of individuals reacting to this drug and developing psoriasis?
A: I have not heard of anyone "reacting" to lidocaine with psoriasis. However, individuals with a tendency toward psoriasis may not manifest it until triggered, and stress may be a trigger for psoriasis. More likely, the physical and psychological stress of having a breast biopsy "triggered" that latent tendency for developing psoriasis.
Youth
Q: Can a person's psoriasis have any affect on an immunization, such as a measles vaccination, so that the person is not protected from the disease?
A: Although psoriasis is considered an immune disorder, there is no evidence that it causes an immune deficiency or affects the ability to handle infections. A child with psoriasis who gets a measles vaccination is expected to mount a normal immune response.