Atlantan Alisha Bridges was diagnosed with psoriasis at age seven. It took her more than two decades to find a treatment that was consistently effective for her.
One of the many challenges of the condition is the visible appearance of the flares: red, itchy, flaky skin on the scalp, knees, elbows, and just about anywhere on the body.
However, the impact of psoriasis goes beyond skin deep.
Psoriasis is an autoimmune condition that, while often diagnosed between ages 20-30, may also onset later in life, according to a study published in the Journal of the American Medical Association (JAMA). Additionally, even if you have been living with psoriasis since youth, you may experience a worsening of symptoms later in life, during psoriasis’s second peak which is prominent within the age range of 50-60.
An inflammatory skin disorder that is thought to be driven by an overactive immune system, psoriasis is one of the most common immune-mediated diseases affecting adults in the U.S. People living with this chronic condition have skin cells that turn over much more quickly — within a few days rather than one month — and, instead of shedding, the skin cells pile up on the surface of the skin, according to Dr. Loyd Godwin, founder of Dermatology Physicians of Connecticut and a medical advisor to the Global Healthy Living Foundation’s HEROES program.
Psoriasis at 50-60+
“Due to the chronic nature of psoriasis and increasing life expectancy, psoriasis significantly affects older adults, and the symptoms often present with more severity. As a result, psoriasis can impact quality of life and cause psychological distress, particularly in older patient populations,” Godwin said.
“I battled with many self-esteem issues,” Bridges said of living with psoriasis since childhood. “This condition can even give rise to other health concerns, such as heart disease and depression. I want people to understand the difficulties of living with a visible condition, especially when navigating a world that does not always accept or understand diseases.”
“Discovering an effective treatment does not guarantee freedom from psoriasis indefinitely,” Bridges said. “Medications can lose their efficacy, and psoriasis can resurface with renewed intensity. It’s important to recognize that this is a lifelong condition, presenting ongoing challenges that persist unless a cure is eventually found.”
Therefore, every patient is unique, responding differently to various treatments; patient age impacts outcomes as well.
“While psoriasis is considered an autoimmune condition, the various effects of aging can cause its onset among older adults. The transition into an aging body can be stressful — both physically and emotionally — for people in their 50s and beyond,” said Nancy Mitchell, an Atlanta-based geriatric nurse. “Add to that the fact that the average senior takes at least three prescription drugs daily, and we have a host of environmental factors that could promote psoriasis flares.”
Treatment may require ongoing efforts, adjustments
“There are many different treatments for psoriasis ranging from topical, to steroids, to full body, biologic treatments,” Godwin said. “Each patient should be assessed to determine what might be the best approach for them. In older adults, treating psoriasis is challenging because these adults may also have comorbidities, meaning they may be taking one or more medications to treat other conditions. As doctors, we need to understand how a patient’s age and medical history may impact their treatment.”
There are also different types and severities of psoriasis. About 80% of all cases are plaque psoriasis, the most common type of condition across all age groups.
“For some people, psoriasis is mild and can be well-managed with topical treatments, but for others, the condition can have a profound impact on your daily life and long-term health,” Godwin said. “About 30% of people with psoriasis will develop psoriatic arthritis, an inflammatory form of arthritis, so it is very important to both manage the visible symptoms and monitor for progression of the disease.”
Light therapy is another treatment that is effective in some patients. However, it may be cost-prohibitive in some cases, according to Mitchell, who is also a contributing writer for Assisted Living Center.
“For many older adults, light therapy may be too costly to manage on retirement funds. However, topical creams may provide some relief from the itchiness and irritations associated with mild psoriasis cases ... You may need to take oral medications to reduce inflammation and discomfort from more severe cases,” she said.
“With an older patient, I try to understand their complete medical history so that I can recommend a treatment approach that works well with their other potential medications,” Godwin said. “I also monitor their quality of life and make suggestions for lifestyle adaptations they can make to reduce a flare-up of symptoms. For example, I recommend keeping the skin moist, using both creams and humidifiers. During summer, we want patients to avoid the sun and sunburn but maintain their Vitamin D levels, so supplements are a good idea.”
What to do if you think you may have psoriasis
“If you are experiencing red, itchy, flaky skin patches and thick, pitted fingernails, then I highly recommend making an appointment with a dermatologist to get assessed,” Godwin said.
Since about half of the estimated 7.5 million people living with psoriasis have symptoms on their scalp, your hair stylist or barber could also potentially be a good resource for information and assistance.
“If your stylist or barber notices something going on with your scalp, take that note seriously and get it checked out by a health professional,” Godwin said.
Scalp symptoms include fine scaling that looks like dandruff, or thick crusted plaques that cover the entire scalp, according to Godwin.
“However, in patients of color, skin discoloration may be less obvious — more violet than red — making it more challenging for patients to spot and for some physicians to diagnose accurately. It’s important for dermatologists and hair professionals — who see a lot of scalps — to recognize symptoms and bring them to the attention of the people who may not realize that they have experienced the onset of a symptom.”
“As both a barber and a person living with psoriasis, I personally understand the challenges that people face living with a visible, chronic illness. Without a healthy scalp, you can’t have healthy hair, which is why I ask my clients if they’ve noticed anything new with their hair or scalp since their last visit. If I open that conversation, it helps destigmatize talking about symptoms,” said Brittane Thames, a master barber based in Midtown.
If you are diagnosed with psoriasis, Bridges offers this advice based on her decades of navigating this condition: “You are not alone. Support can be found both online and offline. I highly recommend the National Psoriasis Foundation and the Global Healthy Living Foundation (GHLF) as valuable resources. These organizations offer a wide range of support and information for individuals with psoriasis and their caregivers, including mentorship connections, product recommendations, and assistance in finding the right dermatologist. The NPF has played a significant role in combating the stigma associated with this condition through its various programs.”
There are also online platforms, such as a Facebook support group, where patients can connect with other people dealing with psoriasis.
“Changes in your skin are not a sign of old age,” Godwin said. “Rather, they could be a sign of an inflammatory condition, which is why it is important for older adults to see a dermatologist.”
“A good resource for patients to learn more about psoriasis is the ‘Getting Clear on Psoriasis’ podcast. Stylists can learn more about how to advise their clients about scalp health at www.ghlf.org/salonHEROES,” he said.
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