November 21, 2012


I have an unpleasant rash around my ankles that has become thickened and crusted. I’m trying natural oils and creams, but am having difficulty clearing it. I’m beginning to believe it may be psoriasis. Do you have suggestions for me as to how best to manage psoriasis?

The most important factor in the treatment of any condition is that it must be correctly diagnosed. Once your doctor has confirmed the diagnosis, treatment regimes are available with their supporting evidence. From your description, it’s possible that you have psoriasis, but your dermatologist may take a tiny biopsy to confirm this. 

The application of so-called natural remedies is not without the risk of consequences, which could include a hypersensitivity reaction with a contact dermatitis that, if chronic, could cause scaly thickening and itching. Even washing detergent inadequately rinsed from your socks could cause some reaction, as could chemicals in shoes or sandals worn without socks. Of course, sensitivity to plant chemicals can also occur.

2012 1533 page29Psoriasis is an inflammatory process of the skin that typically occurs in patches that form a crusty scale that is silvery when scratched. The patches are reddish and form often on the scalp, shins, and extensor surfaces of the forearms. It’s quite common, affecting about one in 50 people of European extraction, but less so in Asians and Africans. It’s usually an adult-onset condition. There may be two types of psoriasis: a familial type, which has definite genetic characteristics; and a second group that doesn’t have the genetic markers.

The course of psoriasis varies, with early onset being associated with more troublesome symptoms. While inflammation is a feature, there’s also a change in the skin cells as they undergo increased division. Which of these two changes is the cause and which is the effect is not certain. The disease seems to wax and wane, so that at any one time, up to one in 10 people who have had a diagnosis of psoriasis may be completely clear, and some people may go symptom-free for up to five years.

Chronic irritation, such as scratching, can cause a flare-up, as may infection, anxiety, and even some medications, including malarials, beta blockers (used in hypertension), and even lithium (used in bipolar disorders). People coming off a course of cortisone also may find that their psoriasis rebounds.

There’s a widespread form of psoriasis called guttate psoriasis, in which small, scaly spots of psoriasis may cover the body. This is more often seen in younger patients.

Most cases of psoriasis are not severe, so treatment must be tailored to the severity and therefore vary. Traditional treatments are ointments that soften the scale; these are often better tolerated than tar-based dithranol, which causes irritation and burning while it normalizes the skin-cell division. Vitamin D preparations and corticosteroids have been used with moderate improvement in some cases. Ultraviolet (UV) light appears to improve the psoriasis, and the UVB rays seem to be the active ones. While UV light comes in sunshine, too much can either burn or be associated with increased risk of skin cancer.

Severe cases of psoriasis were found to respond dramatically to “psoralens.” These chemicals bind to the cellular DNA, and then when activated by ultraviolet light cause cellular changes that result in the clearance of psoriasis in 75 percent of people with the condition. The condition, however, is prone to recur, and long-term treatments with psoralens and UV rays increase the risk of skin cancers much the way sunburn does. Other chemicals, such as chemotherapy or retinoids, which are vitamin A derivatives, may be prescribed. 

Psoriasis is a difficult disease to manage, but thankfully it’s not life-threatening in the vast majority of situations. The risk-to-benefit ratio of treatments needs to be carefully weighed, and your best chance of a good outcome is from the care of a well-qualified, careful skin specialist. 

Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or e-mail them to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matters of your health.

Allan R. Handysides, a board-certified gynecologist, is the director of the Health Ministries department of the General Conference. Peter N. Landless, a board-certified nuclear cardiologist, is an associate director of the Health Ministries department of the General Conference. This article was published November 22, 2012.