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Know Your Skin: Psoriasis Symptoms & Treatment Options

April 6, 2016 11:59 AM with Dr. Stephanie Mehlis

Dealing with dry skin isn’t uncommon, but when the issue is recurrent and the patches more apparent, you may be dealing with psoriasis. Approximately 7.5 million people in the United States have this most common chronic auto immune disease, which has several subtypes, and is commonly recognized by reddened skin covered with white scales (plaque psoriasis). While there is no cure, dermatologists like Stephanie Mehlis, MD, can help you find the best treatment options for managing your symptoms. She will be taking your questions on diagnosing and treating psoriasis, as well as discussing the latest therapies and studies in the works.


Stephanie Mehlis (NorthShore 9933 Woods Drive) - 10:45 AM:
My name is Dr. Stephanie Mehlis and I have been practicing Dermatology at NorthShore since 2007. In my practice I see largely psoriasis patients in addition to atopic dermatitis, acne, roscea, etc. I am also the Director of the Dermatology Clinical Trials Unit and have been involved in 50+ clinical trials over the past 9 years. I look forward to answering your questions and discussing the latest therapies and studies.

Kathryn (Moderator) - 12:00 PM:
Our psoriasis chat is now open! You can submit questions at any time during the chat.

  BiBi (Chicago, IL) - 12:01 PM:
What triggers psoriasis?
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.

  Cynthia (Chicago Il) - 12:06 PM:
Does your diet affect psoriasis?
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.

  Adriana (Evanston, IL) - 12:10 PM:
Is psoriasis related to diabetes?
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.

  Melissa (Wheeling, IL) - 12:15 PM:
What is the difference between psoriasis and eczema? Is it possible to have both?
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.

  Asia (Des Plaines, IL) - 12:19 PM:
Can one person have different subtypes of psoriasis or different types of skin dryness and scaly skin on different areas of the body?
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.

  Anonymous (Skokie, IL) - 12:27 PM:
I have psoriasis on my scalp. I try not to wash my hair more than twice a week, however sometimes after working out, I notice I develop painful sores; is this common with psoriasis?
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.

  Suzanne (Chicago, IL) - 12:34 PM:
Are there any particular recommendations for helping relieve symptoms? I wonder if my skin can be restored to a healthier condition after some flairs while I was in rehab for a total hip replacement. One outbreak was rather intense.
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.

  Wendi (Chicago, IL) - 12:42 PM:
My husband has arthritic psoriasis, and has been taking Humira, and things have not improved. Are there any other options we can look into?
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:

  Nkeonye (Chicago Il) - 12:51 PM:
Do Vitamin D supplements affect psoriasis? Is ointment or cream better?
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.

  Kosha (IL) - 12:53 PM:
I have only scalp psoriasis, and steroids and tar treatments have failed. Are there any other topical meds I could try? Thanks Dr. Kosha
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.

  Kay (Chicago, IL) - 12:59 PM:
My son has psoriasis (and arthritis), and his medication isn't working. Are there other treatment options to try? Could diet have any effect?

Stephanie Mehlis (NorthShore) - 1:15 PM:
Treating children with medications that suppress your immune system is definitely a discussion to have with your dermatologist, and depends a lot on the extent of the disease. There are medications like methotrexate, humira, and enbrel, that can be prescribed by your dermatologist that are not FDA approved for children. There have been studies, though , demonstrating that they are both safe and effective in kids ranging from 4-17.

Kathryn (Moderator) - 1:16 PM:
This will be the end of our chat. Thank you for all of your questions. If you would like to find out more about psoriasis, or schedule an appointment with a specialist like Dr. Mehlis, contact the Department of Dermatology

This chat has ended.

Thank you very much for your participation.