In most research that has studied a person’s diet and its impact on psoriasis, he explains, the sample sizes tend to be small, so the data is limited. Further, many people who participated in these studies continued to take their prescribed psoriasis medication in addition to changing their diet as part of the research. For these types of experiments, people are asked to make detailed logs of their behaviors, which may encourage them to take their medications as prescribed without skipping doses, Dr. Feldman says—and when it feels like a researcher is “watching” you via your logs, you may be more inclined to take your meds consistently. “So while it might look like the dietary intervention was beneficial, it may have been beneficial only in that it caused people to take their other medicines better,” Dr. Feldman says.Unfortunately, because of the way many of these studies have been designed, it’s really hard to conclude which changes, including diet changes, are responsible for certain outcomes, like worsened or improved symptoms. That doesn’t mean it’s out of the question that certain diet changes can have a beneficial impact on psoriasis—it just means that more research that addresses these issues needs to be done so scientists have more solid data to work with.With that said, it’s really unlikely that there will ever be one “psoriasis diet” to help each person with the condition. “You’re not going to cure psoriasis with diet—this is a chronic disease,” Dr. Feldman says. “But if you find that when you eat certain things they seem to exacerbate your psoriasis, avoiding those things makes entirely good sense.”So far, there are two main diet approaches for people with psoriasis: additive diets and subtractive diets. With an additive diet, you’d focus on consuming more of a specific food or nutrient. With a subtractive diet, you’d slowly remove certain foods or nutrients.This is tricky territory. Any time you make a diet change, especially if you have a chronic health condition, it’s best to talk to your doctor or a registered dietitian who is familiar with the disease, so they can guide you through the process and help you avoid risky side effects, like lower energy, unintended weight loss, or nutrient deficiencies.Here’s a closer look at some popular diet changes people make when they have psoriasis—and what the science says about each one so far:Anti-inflammatory dietPsoriasis lesions are set off by inflammation in the body, so it makes sense to assume that “anti-inflammatory” foods could help tame that irregular immune response. Researchers believe that foods with certain nutrients may reduce oxidative stress in your body, a process that contributes to inflammation, but it’s an area of research that is still being explored. A typical list of “anti-inflammatory” foods is pretty expansive and diverse, including berries, green leafy vegetables, nuts, fatty fish, tomatoes, and so much more. The theory is that these foods may prevent inflammation from starting in the first place or reduce its impact.For example, a fat called eicosapentaenoic acid (EPA) that is found in fatty fish like salmon is thought to help reduce the number of inflammatory chemicals in the body, according to Dermatology Online Journal1. However, in the case of psoriasis, researchers are still unsure if consuming EPA has much of an effect on a person’s symptoms. Many studies looking at EPA and psoriasis specifically involve using fish oil supplements instead of whole fatty fish, which may not offer the same theorized benefit. Dr. Feldman’s team found that fish oil studies have really conflicting results: Some people saw no improvement, some said their psoriasis got better, and others said their psoriasis actually got worse.
Christina Perri has not had an easy year. In July of 2020, the singer-songwriter shared that she was expecting another child with her husband, comedian Paul Costabile. The couple was overjoyed; this would be their rainbow baby after experiencing a pregnancy loss at 11 weeks in January of 2020. But in November of 2020, in her third trimester, Perri was hospitalized with pregnancy complications. Two weeks later, she and her family shared the devastating news that they had lost their daughter. “She was born silent, after fighting so hard to make it to our world,” Perri, who had been 33 weeks along, wrote at the time.The ensuing grief, she says, was unimaginable. By and large, Perri retreated from her public life, sharing occasional, emotional updates with her fans on social media. But with the anniversary of her family’s loss coming up, she feels ready to speak about what she’s been through—both to shed light on the earth-shattering, incomprehensible heartbreak of stillbirth and to share the memory of the daughter she lost with the world.Starting with her name: Rosie.“This is my first time talking about it,” Perri tells me over Zoom from her home in Los Angeles. “I have done so much work to be able to talk about it. I feel not just ready to talk about it—I want to. I want to be that voice.”Perri’s voice is, of course, what made her famous, beginning with her breakout hit “Jar of Hearts” more than a decade ago. Now, she’s using it to aid in her healing by releasing an album of lullabies on November 24th—the anniversary of the day Rosie died—called Songs for Rosie, an achingly beautiful tribute to a painfully short life. (In the lead-up to the release, Perri debuted her cover of “Here Comes the Sun,” the album’s first single.)“This record means the most to me because it carries forever the narrative—the correct narrative—that she exists,” says Perri. It also builds upon Perri’s legacy of commemorating her love for her children via song.In 2019, to celebrate her older daughter Carmella’s first birthday, Perri released an album of lullabies and sing-alongs titled Songs for Carmella. The companion album for Rosie had long been in her mind. “I want to make a lullaby record for every baby,” she says, “so the whole time I was pregnant with Rosie I kept a track list on my phone of songs I planned to [sing to her].” The song selections took on a heart-wrenching new meaning after Rosie’s passing—like “Smile,” which repeats the directive to ”smile, though your heart is breaking,” a challenging missive for anyone parenting an energetic preschooler after losing a baby—and drove Perri on her mission to record the songs. It was now imperative for her to build something concrete to honor Rosie’s life. “There was a moment where I was like should I [make the album]? And then I was like, oh, I absolutely should,” she says. “I have Songs for Carmella, and this is the same album cover. It uses the same font. It’s the second volume. Because Rosie is my daughter. And she will remain part of our family forever.”
Prodrome: This is the “pre-headache” phase where you may start to see some warning signs like neck stiffness, mood changes, and frequent yawning. The prodrome phase can happen about 24 to 48 hours before the headache starts. Approximately 30% of people who get migraine experience these pre-headache symptoms.Aura: Up to 20% of people with migraine will experience sensory changes known as an aura. Most commonly, an aura changes how you see things, so you might notice sparkles, dots, flashing lights, wavy lines, or blind spots in your vision. Aside from affecting your eyes, an aura can make you feel numb, tingly, and cause ringing in your ears. These symptoms usually disappear just before the pain in the head begins. Headaches that occur with auras are known as “migraine with aura,” and headaches that don’t are known as “migraine without aura”Attack: This is when the actual migraine head pain hits—and you may also have nausea, vomiting, and sensitivity to light or sound, as we mentioned above.Postdrome: After an attack ends, some people get a “migraine hangover,” meaning they feel depleted, fatigued, and just out-of-it for a day or so. Postdrome is more common than prodrome, with roughly 80% of people who deal with migraine getting to this stage.The entire sequence can last anywhere from eight hours to three days, depending on how many stages you experience, the severity of the migraine, and whether you treat your migraine symptoms.What are the best migraine treatments for relief?Migraine treatment is very individualized, so you’ll want to speak with your doctor about how to find the best option for you and your symptoms. In some cases, your doctor may refer you to a neurologist, who better understands the intricacies of brain disorders.“When patients have headaches that are not being well-controlled, we take into account their medical history, what other medical problems they may have, and what the possible side effects of each medication are,” Anne Csere, D.O., an assistant professor in the Department of Neurology, Pain, and Headache Medicine at the University of South Florida, tells SELF. For example, certain migraine treatments are not recommended for people who plan to become pregnant or who have a history of heart disease, she explains. Price is also an important factor because some medications are expensive and not covered by insurance.Here’s a breakdown of the most common treatment options for migraine relief:Abortive medicationsAbortive medications are designed to stop migraine once it has started, and these can include both prescription and over-the-counter drugs. “The important thing with these medications is to take them soon after the headache starts,” says Dr. Csere. “These medications work best early in the migraine’s phase.”Abortive medications include OTC pain relievers you probably already have on hand, like ibuprofen, naproxen sodium, and acetaminophen. Your doctor might recommend taking one of these medications with caffeine if you aren’t sensitive to it because it causes your blood vessels to contract, which can help relieve some of your pain. (This also makes the medications more effective).
One thing to note: If your MS tends to cause numbness, tingling, or other sensory problems in your upper body, free weights may not be safe because you could drop them or lift them incorrectly and injure yourself. If that’s the case, you may want to start by using elastic bands, weight machines, or doing bodyweight exercises.Lower-body strengtheningExercises that target the muscles in your lower body can be particularly helpful for people with multiple sclerosis since the disease can affect the lower limbs7. Lunges, squats, leg presses, and deadlifts are all moves you can do to strengthen your lower body. Even though you may be working on lower-body moves, the guidance on doing bodyweight workouts instead of holding free weights remains true if you have upper body sensory problems due to your MS, since you’ll need to use your upper body to hold the weights.Progressive strength trainingProgressive strength training is very similar to resistance training, except that the weight or resistance is progressively increased over time as you become stronger. This can be done by using heavier dumbbells or barbells, adding to the weight stack, or using less-stretchy resistance bands, depending on your comfort level. Studies show that progressive strength training may help people with MS improve their physical ability8 by doing things like walking more quickly or getting out of a chair faster.Dr. Burke has her patients with MS lift the heaviest weights possible during an exercise session to help them build muscle. “You want to overload the muscle to get it stronger, and if you’re not challenging the muscle, it won’t get stronger,” Dr. Burke says. By slowly adding weight until you hit your max, you can find out where that max actually is and work to improve it.For example, if you can do six reps of a move with a 10-pound weight before you get tired, Dr. Burke recommends trying just three reps with a 20-pound weight. Then, take a break and do another three reps.You can do progressive strength training any time you would strength train, and the guidance about avoiding free weights if you’re prone to upper body symptoms also applies. To start, you might want to consider working with a physical therapist so you can learn proper form and minimize your risk for injuries.Functional movementFunctional movements are exercises that recruit multiple muscle groups at the same time (for example, a push-up, which uses your core, chest, and back muscles). Another benefit of functional movement is that some of the exercises, like squats, mimic motions we do in our daily lives9 (like standing up from or sitting down in a chair). Functional movement can be very helpful, then, for people with MS, because it trains the muscles to continue performing daily tasks effectively. You can perform functional movements with or without weights, and they can be incorporated into a strength/resistance routine easily (most strength moves are, in fact, functional movements). Other examples of functional movements include standing rows, squats, and multidirectional lunges.Stretching for MSDaily stretching can be really beneficial when you have MS since it increases range of motion, improves flexibility, and decreases spasticity, according to NCHPAD. Aim to stretch for 10 to 15 minutes per day, focusing on spastic muscles. Move slowly to give your muscles time to respond to the stretch and hold each exercise for 20 to 60 seconds, if possible. Stretching shouldn’t be painful, so if it is, you may need to decrease your range of motion. Yoga and Tai Chi, which we’ll discuss later, are two great forms of stretching.Water aerobicsWater aerobics fall somewhere in between resistance and aerobic exercise: you are getting your heart rate up due to constant motion from moves like jumping and moving your arms, but the water is a force for you to work against, providing resistance. For these reasons, water aerobics is one of the best exercises you can do if you have MS. “It’s a great mode of exercise because of the buoyancy, which makes it easier for you to move,” Bobryk says. “You can get a great strength workout in the water and you get a great aerobic workout.”
Keep in mind that your treatment options may change over time based on new research and newly available therapies. Make sure you have ongoing conversations with your doctor about which treatment options may be best for you.Autoimmune diseasesWhen you have an autoimmune disease, like psoriasis, your immune system goes a bit haywire and mistakenly attacks healthy cells4, often setting off mysterious symptoms before you get to the bottom of it. There are more than 80 autoimmune conditions that impact different parts of the body, including everything from multiple sclerosis to arthritis to celiac disease to type 1 diabetes4.And some of these diseases are more likely to affect people who already have psoriasis. For example, Crohn’s disease and ulcerative colitis, both autoimmune conditions that affect the gastrointestinal tract, are more common in people with psoriasis compared to those without it. However, researchers don’t know why this happens, and with many of these conditions, it is impossible to say which came first or if one caused another.“There’s no specific answer to the ‘chicken-and-egg’ question,” Shivani Kaushik5, M.D., an assistant professor at the Rutgers Center for Dermatology, tells SELF. One possible theory, according to Dr. Kaushik, is that many autoimmune conditions, including psoriasis, Crohn’s disease, and ulcerative colitis, may be linked because they all cause inflammation in the body. “For many patients who have extensive psoriasis, there is no doubt that they have inflammation going on inside as well,” she says, as opposed to the inflammation you only see on the outside of the skin.There is no surefire way to avoid developing multiple autoimmune disorders, but keeping your psoriasis in check by regularly taking your medications, such as biologics to target the immune system directly, and getting in touch with your doctor if you have new or worsening flare-ups can help you create a plan to keep inflammation under control.Psoriatic arthritisPsoriatic arthritis (PsA), while technically also an autoimmune condition6, has a more specific connection to psoriasis than other autoimmune diseases. Psoriatic arthritis most commonly shows up 7 to 10 years after the onset of psoriasis symptoms7, and happens when the immune system starts to attack healthy joints and/or tendons causing inflammation, pain, swelling and stiffness in the hands, knees, wrists, ankles and feet.The two conditions are inextricably linked, but the connection isn’t totally clear to experts yet. Having psoriasis doesn’t necessarily cause psoriatic arthritis. Only about 20 to 30% of people with psoriasis are eventually diagnosed with psoriatic arthritis8 and a small number of people with psoriatic arthritis have no preexisting psoriasis symptoms9.“We do know certain kinds of psoriasis patients tend to have higher chances of developing psoriatic arthritis,” including scalp psoriasis and inverse psoriasis, according to Samar Gupta11, M.D., an associate professor at the University of Michigan Medical School and the chief of VA clinical rheumatology and medical education.So, it’s crucial to communicate any joint pain to your doctor if you have psoriasis, since early detection can help you start treatment sooner, which can help prevent psoriatic arthritis-related joint damage.Cardiovascular diseaseThere’s a lot of research showing that chronic inflammation may cause fat and cholesterol buildup, called plaques, in your arteries12. Over time, and if you have a lot of buildup, plaques can burst and eventually lead to a stroke or heart attack. Reducing overall inflammation is really important when it comes to reducing your heart disease risk, Dr. Menter says, and one way you can do that is by controlling your psoriasis with medication.
“I usually recommend treating scalp psoriasis from the outside first,” says Dr. Bhutani, explaining that she often prescribes topical corticosteroids first. Although topical treatments are very effective for short-term management of scalp psoriasis flare ups, if the symptoms are severe or if the plaques spread to other areas of the body, additional treatment may be needed.“If we’ve given it a good go with the topicals and we’re still not getting enough relief, I will talk to patients about systemic therapies, where we treat the psoriasis from the inside out,” says Dr. Bhutani. “Because scalp psoriasis is so visible, I won’t wait too long to initiate systemic therapy if someone is really affected by their psoriasis.” (Dr. Bhutani notes this approach is of special consideration for some people of color, whose hair can be damaged from frequent hair-washing required with using topical treatments.) Keep in mind that your treatment options may change over time based on new research and newly available therapies. Make sure you have ongoing conversations with your doctor about which treatment options may be best for you.Do scalp psoriasis home remedies work?How you take care of your hair and scalp can have a big impact on your scalp psoriasis flare ups. In addition to the treatment plan your doctor recommends, you may want to try some of the following tips at home12:Skip styling tools when possible: Since heat can further dry out your scalp and exacerbate symptoms, it’s best to avoid blow drying or curling and straightening tools if you can. When brushing your hair, use gentle pressure to avoid further irritation. If you have natural hair and are used to consistent styling that requires heat, talk to your dermatologist or stylist to figure out a plan that reduces the risk of potential flare ups while maintaining the health of your hair.Avoid the tight up-do: If you have longer hair and have hair loss, you may also want to avoid pulling it back tightly in a ponytail, since that can pull on the already-fragile scalp and possibly lead to more hair loss. If you must pull your hair back, keep the hair low and loose to prevent excess tugging.Choose hair products wisely: Using certain hair products, such as hair dyes, can also be irritating to your scalp. Ask your dermatologist for brand recommendations or if there are ways your stylist can dye your hair that might be more gentle on your scalp.Adjust your shower routine: Try alternating between your medicated psoriasis shampoo with a gentler cleansing wash to avoid drying out your scalp. When shampooing, be careful not to scrub or rub your scalp too vigorously. Using a moisturizing conditioner can also help prevent your hair from breaking, possibly reducing excess hair loss.Stop scratching: Understandably, this can be really hard when the itching becomes unbearable. Noticing all of the times you scratch is the first step, says Dr. Bhutani. Once you’re aware of how often you’re scratching, try distraction techniques. “Every time you feel an itch, you can use a fidget spinner, squeeze a stress ball, or chew gum,” she suggests.And, of course, do your best to be mindful of your triggers to avoid scalp psoriasis flare ups as much as possible. “I tell patients to think about what is triggering their skin—things like stress,” says Dr. Bhutani. That might be easier said than done, but keeping a journal of things like your meals, weather, work events, and other daily activities can help you identify the things that make your scalp psoriasis feel worse, or help you realize when flares might happen so you can be ready with the right treatment.Sources1. Centers for Disease Control and Prevention, What is Psoriasis?2. Mayo Clinic, Psoriasis3. American Academy of Dermatology Association, Scalp Psoriasis: Causes4. Psoriasis: Targets and Therapy, Management of Scalp Psoriasis: Current Perspectives5. University of California San Francisco, Tina Bhutani, M.D.6. American Academy of Dermatology Association, Scalp Psoriasis: Symptoms7. American Academy of Dermatology Association, Can You Get Psoriasis If You Have Skin of Color?8. International Journal of Molecular Sciences, The Genetic Basis of Psoriasis9. Cleveland Clinic, Psoriasis10. Mayo Clinic, Dandruff11. American Academy of Dermatology Association Scalp Psoriasis: Shampoos, Scale Softeners, and Other Treatments12. American Academy of Dermatology Association: Hair Styling Tips That Can Reduce Flares of Scalp PsoriasisRelated:
If there are no psoriatic arthritis findings present on the X-rays, your doctor can order additional tests to rule out other conditions, like rheumatoid arthritis and gout since both can cause joint pain and inflammation similarly to psoriatic arthritis. This is helpful in situations where people have less severe forms of psoriatic arthritis that aren’t easily detected on X-rays.Lab testsTo rule out gout, your doctor can perform a joint fluid test. By using a needle to extract a small amount of fluid from a swollen, tender, or stiff joint, your doctor can look for the presence of uric acid crystals, which indicates that you may have gout.Blood testsBlood tests cannot positively identify psoriatic arthritis, but they can still be helpful for ruling out other types of inflammatory arthritis. Some blood tests can identify inflammation in the body, for example, one test looks for C-reactive protein, a blood marker of inflammation14. The presence of C-reactive protein may help support a psoriatic arthritis diagnosis.Rheumatoid factorNearly everyone who is evaluated for psoriatic arthritis will have their blood tested for rheumatoid factor (RF), a protein produced by the immune system that attacks healthy joints. People with rheumatoid arthritis will often test positive for the RF antibody. People with psoriatic arthritis generally test negative for the RF antibody. (It’s not a guarantee, though: about 20 percent of people who do have rheumatoid arthritis test negative for RF15.) To test for RF, a health care worker will take a vial of blood using a small needle—you don’t have to do anything to prepare, and it usually only takes a few minutes.Screening testsSometimes, physicians ask people to complete screening tests to assess the patient’s risk for developing psoriatic arthritis. For example, people with psoriasis may be asked to complete16 these tests, which are self-reported questionnaires covering topics like joint pain and morning stiffness. These can help physicians refer people to a rheumatologist for further psoriatic arthritis testing and possible diagnosis. Screening tests aren’t perfect— they’re most likely only moderately accurate—but they may help doctors identify early-stage disease, which is easier to treat.Psoriatic arthritis diagnostic criteriaFinally, in order to confirm a psoriatic arthritis diagnosis, your doctor can use a criteria checklist. Since 2006, doctors have used a test designed by a group of rheumatologists known as the CASPAR—classification criteria of psoriatic arthritis— for this purpose. The CASPAR test assigns point values to different symptoms and signs, as follows:The presence of skin psoriasis (2 points, 1 point for having it previously or having a family history but not having it yourself)Nail lesions, pitting, or pulling away from the nail bed (1 point)Swollen toe or nail (1 point)RF negative (1 point)Juxta-articular bone formation (in other words, a bone formation near a joint) (1 point)People who score at least three points are considered to have psoriatic arthritis.Psoriatic arthritis treatmentPsoriatic arthritis treatment is highly variable, depending on the severity of your case, how many joints are affected by the condition, whether you have psoriasis, and your personal preferences. “The treatment is very individualized,” Dr. Gupta says. Treatment can both help ease the severity of symptoms and prevent the disease from getting worse. Usually, doctors will recommend medication combined with lifestyle treatment for the best symptom management.Psoriatic arthritis medicationPsoriatic arthritis medication functions like a ladder: If the first treatment doesn’t combat your symptoms, you stop taking it and climb up to the next rung. People with mild cases of psoriatic arthritis might just treat symptoms as they occur. Then, if those don’t work, you may be prescribed a more powerful drug. Here are the commonly used psoriatic arthritis medications: