Chapter List

• Introduction to Total Health for Women
• Acne
• Alcoholism
• Allergies
• Anemia
• Angina
• Appendicitis
• Arthritis
• Asthma
• Back Pain
• Bladder Infections
• Breast Cancer
• Breast Implant Complications
• Breast Lumpiness
• Bronchitis
• Cervical Cancer
• Cesarean Section
• Chronic Fatigue
• Colds and Flu
• Cold Sores
• Colorectal Cancer
• Constipation
• Depression
• Dermatitis
• Diabetes
• Diarrhea
• Eating Disorders
• Eczema
• Endometrial Cancer
• Endometriosis
• Fatigue
• Fibroids
• Fibromyalgia
• Food Allergies
• Foot Pain
• Gallstones
• Gender Discrimination
• Gum Disease
• Hair Loss
• Headache
• Hearing Loss
• Heartburn
• Heart Disease
• Heart Palpitations
• Hemorrhoids
• Hepatitis
• High Blood Pressure
• High Cholesterol
• Hiv and Aids
• Hysterectomy
• Incontinence
• Infertility
• Inflammatory Bowel Disease
• Inhibited Sexual Desire
• Insomnia
• Irritable Bowel Syndrome
• Lactose Intolerance
• Laryngitis
• Lung Cancer
• Lupus
• Menopausal Changes
• Menstrual Problems
• Motion Sickness
• Muscle Cramps
• Neck and Shoulder Pain
• Oral Cancer
• Osteoporosis
• Ovarian Cancer
• Overweight
• Painful Intercourse
• Panic Attacks
• Pelvic Inflammatory Disease
• Phlebitis
• Physical and Emotional Abuse
• Pneumonia
• Post-Pregnancy Problems
• Post-Traumatic Stress Disorder
• Premenstrual Syndrome
• Psoriasis
• Raynauds Disease
• Repetitive Strain Injury
• Rosacea
• Sexually Transmitted Diseases
• Sinusitis
• Skin Cancer
• Smoking
• Stress
• Stroke
• Temporomandibular Disorder
• Tendinitis and Bursitis
• Thyroid Disease
• Ulcers
• Unwanted Hair
• Vaginal Infections
• Varicose Veins
• Vision Problems
• Water Retention
• Yeast Infections

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Psoriasis

Psoriasis

Not Curable,
but Controllable

If you could change one part of your body, what would it be? "If I could change one thing," says Donna Egan, "absolutely, it would be my skin."

Egan, a critical care nurse from Levittown, Pennsylvania, is one of about five million Americans with psoriasis. For her and others with the disease, life can become a series of restrictions. Some women stop wearing skirts, sleeveless tops and bathing suits. Some won't date. Others have been turned away from health clubs, supermarkets and hair salons. One woman cooked a dish for a pot-luck lunch, but her co-workers barely touched it, even though they knew her disorder was not contagious. Others are even shunned by loved ones, who won't touch them.

Psoriasis can range from mild--where a few small red patches appear on the elbows or feet--to severe, with unsightly scaly areas covering the entire body. It forms when skin cells mature too quickly--in about 4 days as opposed to 28--and pile up. It's unpredictable, unattractive and even painful. Experts don't know what causes it.

America's appearance-oriented culture makes psoriasis particularly difficult for women, says Joan Shelk, R.N., clinical administrator at the Leone Center for Dermatology and Psoriasis Treatment in Arlington Heights, Illinois, who has counseled psoriasis patients for 17 years.

"Two important issues for those with psoriasis are feeling unclean and feeling ugly," she says. "This is so counter to what most women are taught. We are taught, 'You must look beautiful. You must look clean.' But with psoriasis you can't." In the context of her own health background, Shelk's view is especially poignant. "I survived cancer. It was ovarian. And I would rather go through that whole ordeal again--the radiation therapy, the surgery, everything--than suffer with psoriasis. My cancer didn't show. This shows," she says.

What It's All About

There's a genetic component to psoriasis, so both men and women run the risk of passing it on to their children, says Thomas Helm, M.D., a dermatologist in Williamsville, New York, and assistant professor of dermatology at the State University of New York at Buffalo, though the chance is less than 10 percent.

Learning to Live with Lesions Darcy Love, who works with special education students in Billings, Montana, was diagnosed with psoriasis when she was in her early twenties. It appears between her eyebrows, on her scalp, on her shins, on her elbows and on her cheeks. Now in her forties, she's learned to live with it. This is her story. I can't say it's terrible, but when people ask, it's hard. They say, "What's that?" or they use one-liners like, "Oh, the heartbreak of psoriasis." I've educated myself on what psoriasis is so when people ask, I can explain. I explain that it's not contagious. That's most important. And I also tell people, "It's too much of a good thing." And they say, "What do you mean?" Then I say that it's because the skin cells grow too fast. I was diagnosed when I was 23. I already had two kids. I didn't know at the time it was hereditary. I didn't realize the kids could have it. My youngest son has it. He got it when he was 22 years old. His whole body is involved. We talk about it. I think he deals with it better than I do. He doesn't spend a lot of time messing with it. He deals with it well. It doesn't slow him down. He wears shorts in the summertime. When I first found out that he had it, I felt guilty. I wanted it on me. I felt so bad. I really felt bad for two to three years. Now because he deals with it so well, it's easier. But anytime I hear about some remedy that may help control it, I tell him. I heard that Murphy's Oil Soap helps. So we use that when taking a shower. Sometimes I think it's stress-related, so I handle that with my exercise program. I run every day. I used to smoke and I think that aggravated it. When I quit and started exercising, my psoriasis didn't seem as bad. I know a couple of times I got off my program and it was like a red flag . . . boom. I also practice reflexology. That's where you work on the reflexes on the bottom of your feet to increase the oxygen in the bloodstream. My husband gives me foot treatments every other night. It takes about 15 minutes. The one thing I would suggest is to read and educate yourself about it. I went to the library. I got information from the National Psoriasis Foundation and the doctor. Whatever information I got, I read. And the National Psoriasis Foundation newsletter has comments from people who have it. They ask questions that you have or questions you may not be able to ask. It's a neat network. When I get frustrated I tell myself I know it's going to get better. And the people I know know what it is and they're not affected by it.

A woman's treatment options are often limited, explains Mark Lebwohl, M.D., director of the Division of Dermatology at Mount Sinai Medical Center in New York City. That's because some medications can cause birth defects, which means they're forbidden for women of childbearing age, he says. For instance, two drugs for severe psoriasis, etretinate (Tegison) and isotretinoin (Accutane), should never be taken by women who plan to have children. Another treatment, PUVA, combines a type of drug called a psoralen with exposure to ultraviolet A (UVA) light. It is also not advisable during pregnancy, but available data suggest that in cases where it was administered inadvertently, there was no significant increase in birth defects.

Taking Care of Yourself

But psoriasis doesn't have to rule your life. The first step in controlling it is to try to prevent flare-ups. Here's how.

Grease yourself up. Letting your skin dry out is just opening the door to an outbreak. Stay lubricated, says Michelle Fiore, M.D., a dermatologist and former director of the Psoriasis Medical Center in Palo Alto, California. "Use heavy moisturizers--the thicker and greasier the better." Among her over-the-counter favorites are Aquaphor, Eltra, Theraplex and Albolene. Even petroleum jelly will do the trick.

Head for the sun and sea. For many, sun is the solution, says Dr. Helm. Consult with your dermatologist about how much to get. And pay attention to cosmetics and moisturizers, says Shelk. Many contain sunscreens that may block the rays your psoriasis needs. And while your psoriasis needs sun, skin that's clear still needs to be protected. Use sunscreen on psoriasis-free areas to avoid burning.

Shave carefully. Any small trauma--a bump, bruise or scrape--can act as a starting place for psoriasis, says Dr. Fiore. For women that includes shaving their legs. "If you get a little infection of the hair follicle, that can act as the beginning of psoriasis," she says. To avoid this, shave with sharp, double-edged blades and allow moisture to absorb into the leg hair first. If you already have ingrown hairs, try shaving in the direction the hair grows, says Dr. Fiore.

Try a sports bra. Friction from bras can trigger or aggravate psoriasis, so try a sports bra. "They're generally more comfortable, and the cotton ones are great," says Shelk. She suggests buying them one size larger than usual.

Take care of your nails. Nails can be a trouble spot, so if you're prone to psoriasis, keep them cut short, don't poke things underneath to clean them, and don't push or clip the cuticles too much, says Dr. Fiore. If you want to dress up your nails a bit, try a thin coat of clear polish. Stay away from false nails. They'll stick to and pull on your natural nail, and this aggravation can trigger an outbreak of psoriasis.

Fight those folds. Skin-fold areas, particularly under the breasts, are potential trouble spots for women. Experts say bacteria and yeast create by-products that can aggravate psoriasis. To keep skin-fold areas yeast-free, try over-the-counter preparations such as Lotrimin, or to keep folds bacteria-free, use antibiotic soaps, cleansers or creams like Bactracin and Neomycin, says Dr. Fiore. Another way to protect the area under the breasts is to reduce friction. Try applying your medication and covering it with a strip of flannel, says Shelk.

Watch out for irritation. Trauma to the skin from picking, scratching, sunburn or even surgery can aggravate psoriasis and cause spots to develop at the areas of injury, says Dr. Helm. Radio headsets, ski goggles and even eyeglasses can exacerbate psoriasis on places such as the ear. Ear piercing may also bring out psoriasis.

Getting Medical Help

Preventing a psoriasis outbreak is one thing, but dealing with one after it's happened is another. Try to avoid just camouflaging it, says Dr. Helm. "The real key is aggressively nipping a flare-up in the bud with treatment before widespread involvement occurs," he says.

Treatments for psoriasis run the gamut, says Michael Zanolli, M.D., director of clinical dermatology services at the Vanderbilt Phototherapy and Skin Treatment Center in Nashville. Women with mild cases can try moisturizers, over-the-counter medications, topical steroid creams, sunbathing, coal tar applications and anthralin, a prescription medication derived from tree bark.

If those don't work, doctors may recommend phototherapy with natural sunlight or ultraviolet B, PUVA or day treatment programs, in which various combinations of therapies are used over a period of several hours in a specialized treatment center. For severe psoriasis, your doctor may try potent prescription medications such as methotrexate (Mexate), which interferes with cell replication. Other drugs such as cyclosporine may also be prescribed.

Finally, a topical vitamin D application, calcipotriene (Dovonex), is another possibility. It doesn't cause the thinning of the skin that can occur with topical steroid creams.

Be careful with steroid creams. Women's skin can be thinner than men's, says Dr. Fiore. Potent topical steroid creams sometimes can cause additional thinning, so be on the lookout for increasingly fragile skin, particularly on your face and under your breasts.

Go fragrance-free. Wearing cosmetics or fragrance on your skin during light therapy may trigger irritation, says Shelk. Wait until after your treatment to do your beauty routine.

Consider combinations. Sometimes treatments work better in combination, says Dr. Helm, so ask your doctor about possible options.

Don't do it yourself. Tanning beds are not regulated in many areas, so the wavelengths and intensity of exposure can vary greatly from one treatment to the next, says Dr. Helm. See a professional for UVA treatment.

The Art of Coping

You've got it, you're trying to treat it. But you've got to get on with your life. How do other women with the disease manage?

Try the camouflage game. Cover milder psoriasis on the arms and legs with patches such as Actiderm or Restore Dressing, which may be available over the counter at your pharmacy, says Dr. Fiore. These patches can even be used under panty hose. If you can't find the patches, flesh-colored medical tape will do.

Camouflage makeup for birthmarks can also be used. Up close, the makeup will make the scales visible, but from a distance they'll look much better, says Dr. Fiore. DermaBlend Leg and Body Cover can also be used on the face. It can be particularly good, says Shelk, because it's waterproof, so it lasts in the pool and survives hot weather. And it doesn't have to be used with a setting powder base, so it's easier to use. Look for it at the cosmetic counter at your local department store.

Wash it out. Frequent hair-washing is important to get rid of psoriasis scales. Over-the-counter medicated shampoos, especially those containing coal tar, selenium, zinc and salicylic acid, are helpful, says Dr. Fiore.

Bolster yourself. A woman's self-esteem can really plummet during a psoriasis outbreak, says Barbara Cohen, a psychotherapist in Palo Alto, California, who counsels clients with psoriasis and has it herself. Concentrate on your strengths, she says, and if you can't pull yourself out of the dumps, consider therapy.

Stay active. Participate in activities that bring you in contact with other people, experts advise. One study showed that employed people with the disease had better images of themselves and felt less stigmatized than those who did not work.

De-stress yourself. Many women feel their psoriasis is exacerbated by stress, says Elizabeth Abel, M.D., a dermatologist in Mountain View, California, and clinical associate professor of dermatology at Stanford University School of Medicine. Recognizing that stress triggers their skin condition can help people better address the problem, she says. Biofeedback and meditation are two stress-management techniques to consider.