Last month, Kim Kardashian opened up about how extreme dieting ahead of the Met Gala triggered a flare up on the autoimmune disease psoriasis. Her 16-pound weight loss over three weeks to fit into the iconic “Happy Birthday, Mr President” dress worn by Marilyn Monroe led to skin lesions all over her body and a painful bout of psoriatic arthritis.
She joins celebrities including LeAnn Rimes, Cara Delevingne, Cyndi Lauper and Art Garfunkel in sharing her experiences with the chronic condition, which typically causes patches of dry, scaly skin and is also linked with stiff, painful joints.
Cotton Comfort looks into this this oft-misunderstood condition as the US embarks on Psoriasis Awareness Month, with World Psoriasis Day following soon after on 29 October and the UK’s Psoriasis Awareness Week running on from this.
For this month's blog, guest journalist Anita Chakraverty asked Karina Jackson, dermatology nurse consultant and trustee at leading UK charity The Psoriasis Association, and Janine Price, who has the condition, to tell us more.
Psoriasis vs Eczema – a tale of two inflammatory skin conditions
Karina Jackson dermatology nurse consultant and trustee at The Psoriasis Association
What do you feel is most misunderstood/least known to the general public about psoriasis and why?
It is still not yet well understood amongst the general public that psoriasis is more than a skin condition – it is an immune-mediated condition which causes symptoms on the skin and sometimes the joints too, causing psoriatic arthritis. The effects of psoriasis go beyond the physical symptoms of flaky, itchy skin, soreness and discomfort. The condition can also have a significant impact on a person’s quality of life, being associated with higher rates of depression and anxiety, causing shame, embarrassment and low self-esteem, and affecting day-to-day life such as clothing choices, hobbies, relationships, work and school.
Unfortunately, there is also a common misconception that psoriasis is contagious. It isn’t. Psoriasis cannot be passed from person to person. As it sounds similar it is sometimes confused with cirrhosis - which is a completely different condition affecting the liver!
What would you say are the main differences between psoriasis and eczema?
There are certain similarities between psoriasis and eczema – both are inflammatory conditions caused by a disruption within the immune system and both affect the skin, causing dryness, scaling, redness and itch – they are, however, distinct conditions, look different in their presentation and have a different set of associated health conditions.
Psoriasis is a condition in which overactive immune T-cells lead to an overproduction of skin cells, causing raised red plaques to appear on the skin. With eczema, the skin’s barrier function is not as effective as it should be. Moisture is lost from the skin, allowing bacteria or irritants to pass through more easily and this, in combination with disrupted immune cells in the skin, results in an inflamed skin rash or red patches that can crack and weep.
Eczema is more common than psoriasis, affecting approximately 1 in 10 adults in the UK, as opposed to around 1 in 50 for psoriasis. Eczema is also more common in children than psoriasis, primarily being seen in the under 5s and affecting around 1 in 5 children in the UK.
Finally, while both eczema and psoriasis can appear red and flaky, they tend to affect different areas of the body, with eczema tending to appear inside the elbows and knees (the crook), on the face, neck and hands, whereas psoriasis appears more frequently on the outside of the elbows and knees, as well as on the scalp and lower back.
How can different types of clothing and fabrics make a difference to the lives of people with psoriasis?
As with most aspects of living with psoriasis, there are no hard and fast rules about types of clothing or fabric that will apply to everyone who is living with the condition. For each person, finding the right clothing for psoriasis and/or preferred fabrics is somewhat a matter of trial and error. However, some people may find that certain types of fabric irritate their psoriasis or exacerbate the itch caused by the condition and so wish to avoid these.
Generally speaking, wearing light clothing and dressing in more breathable fabrics, such as cotton, can help to reduce sweating and irritation in the summer months. In winter, if wearing wool or knitted jumpers then it may be helpful to have a cotton layer underneath, against the skin. With genital psoriasis, loose-fitting cotton or silk undergarments are often preferable to nylon. Cotton clothing, underwear and bedding may also be more comfortable, particularly for children who are living with psoriasis.
Beyond the physical comfort aspect, we also know that choice of clothing can be a significant consideration for many people who are living with psoriasis due to the fact that it is a visible condition. Some people feel more confident in showing their skin than others, and this can be affected by the severity of psoriasis and whereabouts it occurs on the body, which is different from person to person. As such, clothing choices can make a big difference to the lives of people with psoriasis in terms of confidence and self-esteem.
What else in terms of lifestyle can make a key difference to the lives of those with the condition?
There are a number of lifestyle factors that can make a difference for people who are living with psoriasis, but the extent of their impact can vary from person to person. Anecdotally, we have heard from people who feel their psoriasis has a dietary trigger or that dietary changes have impacted the severity of their condition. Unfortunately, there is currently little robust evidence to support any specific dietary changes that can impact the severity of psoriasis, and certainly nothing that is guaranteed to work for everyone. However, current advice is to have a healthy, balanced diet and generally healthy lifestyle to help manage weight and avoid obesity, which can worsen psoriasis.
We know alcohol and smoking can exacerbate the symptoms of psoriasis for some people, so drinking in moderation and stopping or cutting down on smoking can be beneficial for psoriasis. We also know that stress is a common trigger for flare-ups of psoriasis so identifying healthy practices for managing stress is recommended such as exercise, mindfulness, meditation, and talking therapies.
Janine Price talks about living with psoriasis
Can you describe how psoriasis affects your daily life?
Psoriasis affects daily life as it often limits activities I could do during a flare up. It’s had a negative impact on my mental health and lowers my mood. The itch often disturbs sleep which has an effect on the above, causing a vicious circle.
What do you feel is most misunderstood about the condition by the general public?
The general public often are unaware and sometimes stare or act as if you may have something contagious. I was once asked if I had something contagious while swimming with my daughter at a leisure centre, I was very embarrassed and upset and left. This caused me to stop going swimming publicly.
I wear light clothing so any flakes that may fall from my scalp or ears would be less noticeable.
Cotton clothing is a must as polyester makes the itch worse.
What else in your lifestyle would you say affects your psoriasis?
I became inactive because of my psoriasis and feeling embarrassed, having poor mental health and low confidence. This led to weight gain and doesn’t help mental health or confidence.
Much has been done to raise awareness of psoriasis but there is so much more that can be done.
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