Finding Relief from Psoriasis with Anthony Fernandez, MD, PhD

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Patches of scaly and discolored skin may serve as a calling card of psoriasis, but the chronic condition is far more than a cosmetic issue. It's something that can add stress and unease to day-to-day activities and bring significant physical and emotional burdens. Now, while there's no cure for psoriasis at the moment, there are steps you can take to try to better control the condition and lessen its impact on your life. We're going to talk through some of those options today with dermatologist Anthony Fernandez, who specializes in the treatment of autoimmune and inflammatory diseases such as psoriasis. Dr. Fernandez is one of the many experts at Cleveland Clinic who visit our weekly podcast to help us live healthier and happier. So with that, let's take a closer look at psoriasis and what you can do to find some relief if you have the condition. Welcome to the podcast, Dr. Fernandez. Thanks for joining us.

Dr. Anthony Fernandez:

Well, it's great to be here, John. Thanks for having me.

John Horton:

So when it comes to psoriasis, we've made incredible advances in understanding and treating the condition, but I get the sense that this remains a health issue where we still have more questions than answers.

Dr. Anthony Fernandez:

Well, you're right, John. In some respects, the more we learn about psoriasis, the more questions that we generate for future research. But we do know a lot about psoriasis, and luckily, this is translated into tremendous breakthroughs that improve the lives of our patients who have this disease.

John Horton:

Yeah, it clearly seems like we're on the right track, and I guess that's what we're going to talk about a little bit today. And I think a good place to start involves avoiding triggers for psoriasis. So if you have it, I know that's really important. So what are the most common things that spark a psoriasis flare-up?

Dr. Anthony Fernandez:

Yeah, there are common triggers for flares, no question. One of the most common triggers for psoriasis flares is developing an infection like an upper respiratory viral infection or bacterial infections, especially streptococcal infections like strep throat. Those are well-known triggers for flares. Life stressors, if you lose a job, if you have a significant breakup or lose a loved one, those significant life stressors are well known to trigger flares of disease.

John Horton:

Wow. It just kicks everything off and gets it going.

Dr. Anthony Fernandez:

Yes. Yeah, absolutely. Anything that can activate your immune system in an abnormal way can definitely trigger a flare of disease.

John Horton:

I thought I heard that injuries could even spark it.

Dr. Anthony Fernandez:

Injuries are certainly something that stresses your body and can be a trigger for flares in some individuals, and even medications. There are certain medications that we know may trigger flares of disease in patients who have known psoriasis, so there are a lot of triggers. Luckily, every time somebody is exposed to a medication that may be known to cause triggers, it doesn't mean they're going to get a trigger. And not every time you get an injury or have a significant life stressor will you develop a flare. But when people develop flares, we do try to pinpoint those types of things to see if we can identify the root cause of why their disease is becoming more active.

John Horton:

You always hear with skin, you always think of being outside and those triggers, too. Is that something that can even get it going?

Dr. Anthony Fernandez:

Well, sunburns can certainly cause flares of psoriasis. When you think about it, that's really an injury to the skin. You can be exposed to certain environmental contents, whether they're in the air or whether you come into contact with them directly in the skin. Walking around in the woods, you can become exposed to things that can cause irritation and inflammation in the skin that can then result in a flare of your disease. So there are many different things that can activate the immune system in patients with psoriasis. And when you already have psoriasis, activating the immune system in any way can come with the risk that the immune system can want to go down that path to cause psoriasis. So yeah, there are many different things that can trigger flares, but I don't want people to be scared. We definitely want people to have their optimal quality of life and do everything they want to do, but when they flare, they can take a second to think back about, well, what may have been the cause of this? And that may translate into strategies to help get things back under control.

John Horton:

Well, and those strategies are what I want to talk about with you next because, like you said, you need to live. You need to get outside, you need to do things, you need to be active, all of that. So what can people do to set up a good defense to keep their psoriasis in check?

Dr. Anthony Fernandez:

Well, the best thing they can do in a broad sense is adopt healthy lifestyle choices.

John Horton:

It's amazing how that's the solution for everything-

Dr. Anthony Fernandez:

…Yes.

John Horton:

...that we talk about on here.

Dr. Anthony Fernandez:

Absolutely. Absolutely. Easy to say, a lot of times, hard for people to do. But even if they adopt some of them, it can have tremendous benefits in control of their disease. Diet, for example — adopting something like the Mediterranean diet, an anti-inflammatory diet, that can help to keep the immune system calm. Exercise — exercise is a great way to not only manage stress but also has, of course, well-known physical and psychological benefits for people. That helps to keep the immune system calm. Managing stress, we all have stress. A lot of people think they have more stress than everyone else. That's not true. We all have stress, and finding ways to manage that stress — maybe it is exercise, maybe it's reading a book — whatever you need to find those strategies, and keeping your immune system calm is one of the benefits of being able to find ways to manage your stress.

And then, I think the other big one that a lot of us do not actually get is good quality sleep. Getting good quality sleep, seven to eight hours of true restful sleep on a nightly basis can help to keep your immune system calm and when you have psoriasis, help keep it at minimal activity.

John Horton:

It is amazing how those simple things just play a role in everything with our bodies.

Dr. Anthony Fernandez:

Yeah, and I think a lot of times, we just have to remind people about that, that a lot of simple things can have more benefits than the fancy things that they know are out there that have been marketed as trying to treat psoriasis.

John Horton:

Well, I take it those fancy things you start talking about, or the extras — moisturizers and things like that — I take it those can be effective and they might help a little bit, but you work those in around these larger picture things.

Dr. Anthony Fernandez:

That's right. And the simple things we talked about — the diet, the exercise, the managing stress — they're not just good for psoriasis, they're, of course, good for your overall health. So they have benefits well beyond psoriasis, which even underscores more so why they are so important for people to keep in mind and for really to try to adopt into their daily lives.

John Horton:

I know you mentioned diet, and the Mediterranean diet in particular. It's so amazing to me that food choices can make that much of a difference for a skin condition.

Dr. Anthony Fernandez:

Yeah, the Mediterranean diet is probably the best-studied diet in medicine. So it has documented benefits not just in psoriasis, but in many chronic inflammatory and autoimmune conditions. And that's because the Mediterranean diet really incorporates foods that have anti-inflammatory properties. They are high in nutrients and vitamins. And I think intuition, for a lot of people, they can guess what types of foods are part of the Mediterranean diet. It's a lot of fruits, a lot of vegetables, protein sources that are lean like fish and nuts. And additionally, those are foods that are low in calories. And the one thing that we know very well about psoriasis is that if you have psoriasis and you're overweight or obese, if you lose weight, your psoriasis will get better.

John Horton:

Wow.

Dr. Anthony Fernandez:

Yeah, eating foods that are low in calories can be very beneficial.

John Horton:

Well, it's always so amazing to me, the more you do these podcasts and you talk with all these different health issues, like how things like weight and health and exercise and sleep, they fit into everything that you do. And like I said, it's striking to me that you think a skin condition from an autoimmune system response that that can be somewhat handled or managed a bit just by making these smarter lifestyle choices.

Dr. Anthony Fernandez:

Absolutely. And I think, John, it's also important to recognize that really, when we think about psoriasis as an inflammatory condition, we don't just focus on the skin. We know that patients who have moderate to severe psoriasis, this is really a systemic immune problem. And so those healthy lifestyle choices, really the way they help other systemic immune-mediated diseases, when you think about it in that respect, it's not really surprising that they're so good at helping psoriasis as well, because the inflammation goes beyond just the skin. It's circulating in the blood, and it can affect other organ systems.

John Horton:

Perfectly said there. And it does drive home how, like you said, psoriasis, you see it and that's what you think of first of all. But like you said, it's far more widespread than that with what it affects.

So we've been talking about preventative triggers and preventative measures for psoriasis. Now, let's turn our attention to what can be done if you have a flare-up. What are some home remedies that people can try to just get some relief?

Dr. Anthony Fernandez:

Well, I think if you're flaring, I think first and foremost, you want to remember those simple strategies that we've been talking about, those healthy lifestyle choices. Even when your immune system is overacting, making sure that you are adopting a healthy diet, getting good sleep, exercising can help to calm it down. So that is a very important strategy even when you're flaring.

Aside from that, if you're somebody who is flaring and you don't have prescription medications around to help, then I think some things that you can think about doing is, really, you're trying to keep your skin and the symptoms associated with flaring psoriasis in the skin as calm as possible, and that's really itching and skin pain. So over-the-counter moisturizers can be very helpful in taking away itching and pain associated with the psoriasis flare. Some people like to try things like oatmeal baths. You can get natural sunlight, sunlight, light in general, has been a strategy to treat psoriasis for centuries, even before the days of modern medicine. So getting some natural sunlight — not overdoing it and getting a sunburn — but some natural sunlight can help to get rid of active inflammation in the skin. Those are probably some of the biggest home remedy strategies that I think people should think about when they're flaring.

John Horton:

Now, do you have any secrets to stop the itching? 'Cause I'm guessing that's a very frequent question that you get.

Dr. Anthony Fernandez:

It is, and I don't think I have any secrets. When you think about itching that occurs in psoriasis, it's really a reflection of that active inflammation that's going on in the skin. That's what's causing the itching. So really, to get rid of the itching, we want to address that active inflammation and try to get rid of it. So the best way to do that is with medications that can quickly get rid of that active inflammation that's going on in the skin. However, if you don't have those, then I think some of the strategies we talked about — using moisturizers — there are lotions that you can buy over the counter that have anti-itch medications in them, and there are a lot of people who find those effective when they are really struggling with itch. And then, the natural sunlight — the sunlight, really, what it does is help get rid of inflammatory cells in the skin. And when it's effective at doing that, any itching should help to subside along with that.

John Horton:

I've even read where people use something as simple as just a cold compress on it. Does that actually work or is that just-

Dr. Anthony Fernandez:

For some people it does, so certainly I think that's a safe strategy and it's fair to try. Cold compresses … even some people like to rub ice on skin areas that are itching. That's fine, and that isn't something that we worry is going to make a flare worse. I think some people find it more beneficial than others, so I think it's really a trial-and-error type of strategy.

John Horton:

Now, you hear about people talk about psoriasis spreading to other areas of the body. How does this happen and can that be prevented?

Dr. Anthony Fernandez:

That is a true statement. Psoriasis can spread. It's something called the “Koebner phenomenon.” And essentially what happens is in areas of skin that are injured or traumatized … a patient with psoriasis can develop psoriasis in those specific areas. And what we think is happening is trauma or injury activates the immune system cells in the skin in that area. And again, if you already have psoriasis, activating the immune system in any way comes with risk that those activated immune cells will begin traveling down the path that leads to psoriasis.

So over the years, I've seen people who have linear areas of psoriasis on their body because they scratch that area against a fence or something else. Or shingles — shingles is a condition where you get a rash in a very specific linear pattern — so I've seen patients who have developed shingles. And because they have psoriasis, when the shingles goes away, they end up with this linear band of psoriasis. And again, it doesn't happen every time a patient is injured or scratches themselves, but that is a well-known phenomenon that is real and can occur.

John Horton:

Now, is there anything you can do to prevent it or is it just using those same things that we've been talking about throughout?

Dr. Anthony Fernandez:

Yeah. There is no known one way or strategy that you can implement and know you're going to prevent psoriasis from occurring in areas of injuries or trauma. So I think you're exactly right. The best way to minimize it is to do everything you can to just keep your immune system calm in general. And we keep going back to the basics. It's really adopting those healthy lifestyle choices that just come along with it, keeping the immune system nice and calm and from overacting.

John Horton:

Yeah, it makes it seem … it's very approachable, 'cause there are ways to manage it, but you really have to focus on living your life that way so that way you can live your life.

Dr. Anthony Fernandez:

Yeah.

John Horton:

Well, Dr. Fernandez, you've outlined a fabulous game plan for people with psoriasis to keep the condition under control. So before we say our goodbyes, is there anything else you'd like to add for the 125 million people around the world who are living with the condition?

Dr. Anthony Fernandez:

Well, I'd just like to say that although we do have a lot of questions to answer yet about psoriasis, we know an awful lot about this disease, and we have tremendous medications available to us now that can improve the quality of our psoriasis patients' lives. And so if you're suffering with psoriasis, please go visit your local dermatologist and see how they can help you because there are many strategies out there.

John Horton:

That's a great optimistic note to end on, Dr. Fernandez. So thank you very much for joining us, and I look forward to having you back on.

Dr. Anthony Fernandez:

Thank you, John.

John Horton:

Living with psoriasis can bring challenges. There are ways to manage the condition and minimize its symptoms. The process starts with giving yourself the self-care you need. It'll make a difference.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Till next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.