Psoriasis is a chronic inflammatory skin condition that affects 1 million Canadians and can manifest across a patient’s lifetime. Most commonly, psoriasis has an early onset (between ages 16 and 20) or late onset (between ages 57 and 60). Although the condition does not worsen with age, psoriasis has been linked to several health conditions that can arise as part of the natural skin aging process. With increased life expectancy, the prevalence of Canadians diagnosed with psoriasis is expected to rise in the next decade. Thus, it is important to understand how skin ages and be mindful of age-related considerations to effectively manage and treat psoriasis.
1. Choose an appropriate skincare routine
With increased age, the body makes fewer protective moisturizers; skin becomes thinner, drier and less elastic. Additional factors like genetics and lifetime sun exposure put skin at increased risk of further damage among those living with psoriasis. Thus, it is particularly important for older individuals to moisturize and apply sunscreen regularly to soften the skin, help with scaling and to protect against sun damage.
Products containing ceramides, hyaluronic acid and lipids can serve as a suitable replacement for the body’s natural moisturizers. Moreover, alcohol-based products promote skin drying and should be avoided. Creams containing retinoids are thought to be the gold standard against aging. However, retinoids promote skin thinning and should be started slowly in patients with psoriasis. Similarly, some anti-aging procedures, such as chemical peels, laser resurfacing and dermabrasion may cause psoriasis plaques or lesions to appear. This is called the isomorphic phenomenon, where injury to the skin can trigger new psoriatic lesions. Always consult with your dermatologist about the safe use of moisturizing products, retinoid-containing creams and anti-aging procedures.
2. Stay on top of your ongoing treatment
Managing psoriasis in older individuals presents several challenges and should be carefully evaluated in the context of all other concurrent treatments. First, some medications may increase the risk of infections or cancer, while concurrent medications used to treat other conditions (such as high blood pressure, diabetes and cardiovascular disease) may have side-effects that worsen psoriasis symptoms1. Second, the presence of other, more life-threatening medical conditions may result in reduced prioritization and under-treatment of psoriasis symptoms. Third, age-related changes to immune and excretory systems may result in greater susceptibility to infections and reduced drug clearance, which underscores the importance of appropriate dosing. These effects are exacerbated by the lack of data on treatment options for older patients with psoriasis, adding further barriers to managing the disease. For these reasons, appropriate management of psoriasis requires careful and regular monitoring by your physician, taking careful account of kidney function, the presence of other conditions and drug interactions.
Topical medications are often used to treat older patients, because they can be applied locally and with minimal side effects compared to most oral medications. Although topical creams may be a safer option for older patients, skin thinning with age increases drug absorption and can increase the risk of side-effects. This risk is also present with oral medications, such as methotrexate and cyclosporine, which should be used with caution in older individuals. For patients that do not achieve control of psoriasis with either topical or oral agents, phototherapy may be a good option. Biologics that target inflammatory processes in the body are also a treatment option. However, until recently patients with psoriasis over 65 years old were not included in clinical trials. Future studies will illuminate the potential of these and other therapies for safe and effective use in older individuals. Despite the relative lack of clinical trial data, biologics are still extensively used, when needed, for older patients with reassuring data being gleaned from real world experience.
3. Protect your scalp
Many people choose to colour graying hair with dyes that may irritate thinning skin. To prevent psoriasis flares on the scalp, it may help to avoid shampooing your hair two days before dyeing it. This will give time for your scalp to build up natural protective oils to prevent irritation. If you do experience a psoriasis flare on your scalp, you may opt for highlights or lowlights instead of a full dye. These approaches prevent the dye product from making direct contact with the scalp and will help limit irritation and possibly avoid a flare.
4. Maintain a healthy lifestyle
Psoriasis is an inflammatory disease that can ebb and flow in its symptoms. An important aspect of managing psoriasis throughout aging is maintaining a healthy lifestyle that can reduce the number of inflammatory skin events. First, it is important to maintain a healthy and balanced diet low in processed sugars and saturated fats. You may wish to consult a dietician to adjust your diet as needed. Second, a regular exercise routine can help maintain overall health and can help manage psoriasis effectively across the lifespan. Third, consider reducing or stopping smoking and alcohol consumption, as these can both interfere with treatment and exacerbate skin symptoms. Following a healthy lifestyle can help with decreasing inflammation and maintaining a healthy weight, which will help ease psoriasis symptoms and decrease the risk of other complications (e.g., type 2 diabetes and heart disease).
5. Be mindful of other conditions
Given the chronic nature of psoriasis, individuals living with it have an increased risk of developing other conditions. Regular surveillance of your health and wellness is crucial for identifying and addressing potential complications early in their progression.
For example, about 30% of people that have psoriasis develop psoriatic arthritis, which presents with joint pain, stiffness and swelling, and may significantly impair daily function. Early treatment of psoriatic arthritis can reduce the risk of irreversible damage to joints. Additionally, a number of studies link psoriasis to metabolic syndrome, which includes high blood pressure, high cholesterol, type 2 diabetes, abdominal obesity, and heart disease2,3.
Psoriasis has also been linked to depression, which may be worse in the aging population. People with depression often experience periods of low mood, loss of interest in hobbies and daily activities, difficulty sleeping or concentrating, and changes in appetite. It is important to consult your primary care physician if you are experiencing any of these symptoms.
6. Consult your healthcare team early and often
Psoriasis is a chronic condition that requires an ongoing treatment regimen that may change over the course of the disease, particularly if other symptoms or complications arise. Be sure to regularly meet with and consult both your primary care physician and dermatologist to address any changes to your skin and overall health. This is particularly important if you are considering making adjustments to your treatment or skincare routine.