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Pushing through: Why some skin diseases get worse before they get better

Sometimes skin conditions can strike from nowhere. One minute you’re minding your own business and the next thing you know there’s an angry red rash running up your arm and/or you find yourself scratching your scalp like you’re possessed. It is like you got hit by the fast-moving psoriasis and urticaria train headed straight to miserable-ville.

Other times, skin diseases start very gradually; a small patch of flaky skin on your elbow that seems to get a little bigger by the day, for example.

When it comes to autoimmune inflammatory skin conditions like psoriasis and chronic spontaneous urticaria (CSU), the symptoms and disease vary greatly from person to person. That said, there are a few possible phases you might come to recognize… 

1) ‘Hmm, that’s weird’

Skin disease can strike at any age, although for psoriasis the mean age (as in the average, not when people turn nasty) of onset is around 15 to 20.1 (Incidentally, one study found people diagnosed before the age of 40 tended to have worse forms than those diagnosed after this time,2 but everyone is affected differently.) The lesions themselves, though, tend to be very similar from person to person. Circular, red patches covered in silvery scales3 that tend to affect the scalp, elbows, knees, and lower back, but can appear anywhere on the body (including the nails). When it comes to CSU, the raised wheals characteristic of this autoimmune skin condition can first occur at any age, but most often this is between the age of 20 and 40.4

2) ‘It’s soooo itchy’

For some people it’s the appearance of psoriasis that bothers them most. For others it’s the itching. The problem is – as with most skin conditions – the more you scratch the more inflamed skin becomes. The more inflamed it is, the itchier it will be. Before you know it you’re trapped in a vicious itch-scratch-itch cycle and you find yourself fantasizing about unzipping your skin like a jumpsuit and stepping right out of it. This is usually the stage when most people finally get around to seeing their doctor in the hope of a miracle cure that will: Just. Make. It. STOP! Both psoriasis and CSU can be extremely itchy, particularly at night when they can interrupt sleep.5 Try to resist scratching, however – as satisfying as it might feel good for two seconds, but it will just make things a whole lot worse. It’s like trying to put out a fire with gasoline, for example.

3) ‘And I thought it couldn’t get any worse…’

In some cases, skin conditions may also involve other parts of the body. Sometimes psoriasis affects the joints, for example, a painful condition known as psoriatic arthritis (PsA). In fact, it has been estimated that PsA occurs in as many as 30% of people with psoriasis.6 Around 87% of people with psoriatic arthritis also show signs of nail psoriasis, where nails become thickened, discolored and pitted.7 For people with CSU, hives can be accompanied by a painful swelling of the deeper layers of the skin known as angioedema. This can cause the lips, face, hands and feet to enlarge and unfortunately, sometimes even the skin of the genitals. Rather than itching, this tends to be accompanied by a burning sensation, which can last up to a couple of days.8 Thanks for that one, CSU. The point is, supposed ‘skin conditions’ can sometimes affect other parts of the body, and often seem to get worse before they get better.

4) ‘How long will this misery last?’

Your doctor may prescribe you medication to help manage skin symptoms and ease itching. This can help to minimize flare-ups and even clear them up completely for a while. Both psoriasis and CSU are chronic autoimmune conditions, however, so the symptoms may return. Some people notice stress can trigger flare-ups, for example. This makes sense, seeing as stress hormones can trigger the immune system to release inflammatory compounds.9,10 With time, you will no doubt come to notice your own triggers and get better at avoiding them. You’ll also work out a treatment with your doctor that works best for you.

5) ‘Well, this seems to be helping…’

There is no doubt that living with a skin condition is tough. Many get tired and simply give up, and we’re here to say that’s not the answer! Learn to become the master of your own skin. To manage the problem, start by talking with your doctor about treatment. They’ll be able to set up a plan for you and work out how to manage your symptoms. You can also find real stories from patients just like you as well as tips on Skin To Live In, such as how changing your diet may help. But mostly, you should never give up on finding a solution. It might take some time, but with the help of your doctor you’ll work out what works best for you. 

  1. Psoriasis: epidemiology, clinical features, and quality of life. R G B Langley, G G Krueger, C E M Griffiths. Ann Rheum Dis 2005;64:ii18-ii23 http://ard.bmj.com/content/64/suppl_2/ii18.full
  2. Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol1985;13:450–6. http://ard.bmj.com/content/64/suppl_2/ii18.full#ref-7
  3. Psoriatic arthritis and psoriasis: classification, clinical features, pathophysiology, immunology, genetics. Psoriasis: epidemiology, clinical features, and quality of life. R G B Langley1, G G Krueger, C E M Griffiths. Ann Rheum Dis 2005;64:ii18-ii23 http://ard.bmj.com/content/64/suppl_2/ii18.full
  4. An approach to the patient with urticaria. S J Deacock. Clin Exp Immunol. 2008 Aug; 153(2): 151–161. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492902/
  5. Factors affecting sleep quality in patients with psoriasis. Gowda S, Goldblum OM, McCall WV, Feldman SR.  J Am Acad Dermatol. 2010 Jul;63(1):114-23.  Epub 2009 Nov 26. http://www.ncbi.nlm.nih.gov/pubmed/19944485
  6. Psoriatic arthritis and psoriasis: classification, clinical features, pathophysiology, immunology, genetics. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. D D Gladman, C Antoni, P Mease, D O Clegg, P Nash. Ann Rheum Dis 2005;64:ii14-ii17. http://ard.bmj.com/content/64/suppl_2/ii14.full
  7. Nail Involvement as a Predictor of Concomitant Psoriatic Arthritis in Patients With Psoriasis. A. Langenbruch; M.A. Radtke; M. Krensel; A. Jacobi; K. Reich; M. Augustin. The British Journal of Dermatology. 2014;171(5):1123-1128. http://www.medscape.com/viewarticle/836159
  8. Urticaria and angioedema: Diagnosis and evaluation. Kevin D. Cooper. Journal of the American Academy of Dermatology. Volume 25, Issue 1, Part 2, July 1991, Pages 166–176. http://www.sciencedirect.com/science/article/pii/0190962291701844
  9. Stress as an Influencing Factor in Psoriasis. Misha M. Heller, Eric S. Lee, John Y.M. Koo. Skin Therapy Letter. 2011;16(5). http://www.medscape.com/viewarticle/742811_3
  10. J Formos Med Assoc. 2005 Apr;104(4):254-63. Stress, insomnia, and chronic idiopathic urticaria--a case-control study. Yang HY1, Sun CC, Wu YC, Wang JD. http://www.ncbi.nlm.nih.gov/pubmed/15909063

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