While the beauty world is clamouring over skin tone diversity — an important banner that many makeup and skin-care brands are taking up — there's one thing that the industry isn't really talking about: skin condition visibility. Common conditions like eczema and psoriasis remain hidden in the shadows for the most part, the products shelved near the floor of the skin-care aisle below all the on-trend mists and sheet masks.
But in 2018, that's changing. Already this year fast fashion brand Missguided released a campaign titled #InYourOwnSkin that featured models with skin conditions like albinism and psoriasis, and back in February, CoverGirl signed a model with vitiligo to front its biggest foundation launch to date. It's a start to making people who have these conditions feel welcome and wanted in the beauty space.
In particular, 7.5 million Americans are affected by psoriasis, according to the National Psoriasis Foundation. And a quick Google search will show that there is an overwhelming amount of information out there, but not all of it is reliable (hey, the Internet isn't perfect). So, we spoke with David Nieves, MD, board certified dermatologist and expert in treating psoriasis, and Joshua Zeichner, MD, director of cosmetic and clinical research at Mount Sinai Hospital, to learn more about the autoimmune disease. Ahead, everything to know about psoriasis, whether you have it or not.
First Things First, What Is Psoriasis?
Psoriasis is an autoimmune disease that appears on the skin as plaques (red, dry skin). With autoimmune conditions, the immune system, which is responsible for warding off infections and disease, is overactive, attacking harmless cells within the body and causing inflammation. In psoriasis, this manifests as an overproduction of new cells. The excess cells build up and appear on the skin as lesions. The severity varies from person to person, but psoriasis can form in small scales or as a much larger flare-up. While scientists can't pinpoint what exactly causes psoriasis, it can be linked to genetics and environmental factors, like stress.
Psoriasis can develop anywhere on the skin (from your face to your palms and even your genitals), but it's most common on the elbows and knees. But don't think about self-diagnosing based on a WebMD scroll; it's important to see a board-certified dermatologist for a proper examination, especially because there isn't just one type of psoriasis. There are seven different types: plaque, scalp, nail, guttate (which is typically triggered by bacterial infections), inverse (smooth, red patches primarily in the armpits, genital area, or under the breasts), pustular (pus-filled blisters), and erythrodermic (a red, peeling rash on the entire body). Plaque is the most common, and Dr. Nieves describes it as "scaly, pink, or red plaques of skin."
It's also important to note that psoriasis is not something that can be spread by touching. "[People] often worry that psoriasis is contagious. It isn't," says Dr. Nieves. "It may run in families, but that's due to genetics."
Flare-ups of psoriasis can come and go, based on triggers. If you have psoriasis, it's critical to know what outside factors and habits can affect your condition. "Psoriasis can be exacerbated by cold weather and stress," says Dr. Nieves. Dr. Zeichner adds that cigarette smoking has also been shown to make the skin condition worse. While there are people who feel making diet changes, like eliminating dairy or sugar, make their psoriasis better, there has been no research to support this. Other triggers include medications such as lithium, antimalarials, or heart medicines like quinidine.
There is no cure for psoriasis, but there are treatments available. The right treatment for you depends on factors like how much of your body is affected and preference. Your doctor might prescribe anti-inflammatory creams, pills, and injections to improve both the appearance and itch of a flare-up. There's also ultraviolet light phototherapy, which slows the growth of affected skin cells by exposing the skin to an artificial UVB light source for a set length of time on a consistent basis. And before you say: Isn't too much sunlight bad? The risks of skin cancer are low with this treatment because UV exposure is closely controlled, but it's important to get regular skin checkups while undergoing phototherapy to catch any concerns early.
For psoriasis on the scalp and hairline, Dr. Zeichner recommends anti-dandruff shampoos, like Dove Dermacare Clean & Fresh Anti-Dandruff Shampoo. These formulas are meant to fight the overgrowth of malassezia yeast, which worsens psoriasis in addition to causing flakes. Whatever treatment you choose, it's likely multiple treatments will be required over time as psoriasis is chronic and can reappear.
When it comes to covering up your psoriasis with cosmetics, that's your choice. Just be careful when it comes to taking it off. "When removing makeup, it's important to avoid over-scrubbing, because it can lead to irritation of the skin," says Dr. Zeichner. In general, it's important to treat psoriasis with care by using cleansers and moisturisers made for sensitive skin on the regular.
Other Things To Consider
Although it is rare for cases to be life-threatening, people with psoriasis can develop psoriatic arthritis, which needs to be treated more carefully. "Psoriatic arthritis occurs in about 20-30% of people with psoriasis," says Dr. Nieves. "If untreated it can cause permanent joint destruction, leading to disability and deformity."
But the biggest side effect is the lowered self-esteem of those dealing with psoriasis. The National Psoriasis Foundation found that nearly 60 percent of women said psoriasis "interferes with their qualities of life." With the pressures of social media and society's beauty ideals, women are ashamed of exposing or even talking about their psoriasis, leaving them at risk for depression or worsening the stress that causes psoriasis in the first place — a self-fulfilling prophecy. This unseen effect is what inspires people like photographer Holly Dillion to launch initiatives like Get Your Skin Out to bring awareness and normalise the skin condition.
For more information on psoriasis, visit the NHS website.