How to Effectively Manage Skin Symptoms of Psoriatic Arthritis

Psoriatic arthritis is a complication of the skin condition psoriasis, which starts in your immune system. For reasons unknown, if you have psoriasis, your immune system is on high alert and attacks healthy tissues, such as your skin and the cartilage in your joints.

Approximately 2-3% of the world’s population experiences psoriasis. A third of them have psoriatic arthritis. 

Because psoriasis shares some symptoms with other skin conditions, including eczema, you may not even realize you have it until your fingers and toes start to swell or ache from psoriatic arthritis. Or, you may develop stiff joints before you notice skin plaques. Arthritis and skin lesions can also appear simultaneously.

At Dermatology Institute & Skin Care Center in Santa Monica, California, our founder, dermatologist Paul Yamauchi, MD, PhD, specializes in treating the skin manifestations of psoriatic arthritis (PA). If you have PA, the following are some ways to keep your skin looking and feeling healthy.

Topical creams

If you have mild to moderate skin psoriasis, you may be able to control the itch and discomfort with topical medications. Some options include:

• Hydrocortisone (mild corticosteroid)
• Dovonex® (vitamin D)
• Tazorac® (vitamin A)

Topical treatments subdue swelling and redness as well as minimize discomfort.

Oral medications

Sometimes a topical treatment isn’t enough to treat psoriasis plaques. If you need more help, we recommend oral medications that work systemically. Some choices are:

• Methotrexate — immunosuppressant
• Cyclosporine — immunosuppressant
• Soriatane® — vitamin A derivative

The immunosuppressant drugs help your body subdue inflammation and resolve plaques as well as joint stiffness. Vitamin A derivatives help you turn over skin cells to keep it smoother and healthier. 

Ultraviolet light and laser therapy

For severe cases, we recommend Lumenis® B-Clear laser and light therapy. With B-Clear, we direct therapeutic, narrow-band ultraviolet (UV) B light on the plaques and rashes. 

The high-tech system allows us to customize the treatment to your skin type and level of disease. In most cases, light therapy clears your plaques in 6-10 treatment sessions over 3-5 weeks. Each treatment takes around 20 minutes, depending on the area targeted. 

Biologics

If you have PA as well as skin psoriasis, you may benefit from biologics. Biologics address PA at its source; in your immune system. 

They’re made up of living organisms and their cells, such monoclonal antibodies and fusion proteins. When injected or infused into your bloodstream, biologics block interactions between immune cells and inflammatory pathways, helping to shut down your body’s overactive immune response. Biologics that we recommend include:

• Cosentyx®
• Taltz®
• Tremfya®
• Skyrizi®
• Stelara® 

If you don’t respond to one biologic, you may respond to another. Biologics are usually a last-resort treatment and are only recommended if you aren't helped by oral or topical therapies. An advantage of biologics is that they address PA symptoms while also improving your skin.

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