available data suggest that skincare strategies should consider racial/ethnic differences when selecting treatment regimens in patients with psoriasis.
CONCLUSION
The available literature published on skin care in psoriasis is limited compared to other common skin conditions with known barrier defects. Patients with psoriasis, including those with SOC, may underuse effective skin care as a management tool for their disease. The most commonly recommended skin care for psoriasis includes emollients/moisturizers, keratolytic agents, thermal water, and skincare products (eg, gentle cleansers with low pH). Topical moisturizers have shown a number of benefits in psoriasis, such as improvements in hydration, overall skin appearance, increased attainment of PASI-50, decreased desquamation, and delayed relapse. As demonstrated by the underuse of skin care in the management of psoriasis, increased awareness of the importance of skin care and appropriate hair care in patients with SOC is needed among clinicians and patients to improve outcomes.
DISCLOSURES
The authors disclose receipt of an unrestricted educational grant
from CeraVe USA for support with the research of this work and
also received consultancy fees for their work on this project. All
the authors developed the manuscript, reviewed it, and agreed
with its content.
REFERENCES
1. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70(3):512-516. doi: 10.1016/j. jaad.2013.11.013
2. Kimmel GW, Lebwohl M. Psoriasis: overview and diagnosis. Evidence-Based Psoriasis. 2018;1-16. doi: 10.1007/978-3-319-90107-7_1
3. Orsmond A, Bereza-Malcolm L, Lynch T, March L, Xue M. Skin Barrier Dysregulation in Psoriasis. Int J Mol Sci. 2021;22(19):10841. doi: 10.3390/ ijms221910841
4. Kaufman BP, Alexis AF. Psoriasis in skin of color: insights into the epidemiology, clinical presentation, genetics, quality-of-life impact, and treatment of psoriasis in non-white racial/ethnic groups. Am J Clin Dermatol. 2018;19(3):405-423. doi: 10.1007/s40257-017-0332-7
5. Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7(11):16-24.
6. Takeshita J, Augustin M, de Jong EMGJ, et al. Health-related quality of life differs by race/ethnicity in North American patients with psoriasis: results from PSOLAR. J Invest Dermatol. 2022;142(9):2528-2531. doi: 10.1016/j. jid.2022.02.013
7. Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826-850. doi: 10.1016/j.jaad.2008.02.039.
8. Hsu S, Papp KA, Lebwohl MG, et al. Consensus guidelines for the management of plaque psoriasis. Arch Dermatol. 2012;148(1):95-102. doi: 10.1001/ archdermatol.2011.1410
9. Elmets CA, Korman NJ, Prater EF, et al. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021;84(2):432-470. doi: 10.1016/j.jaad.2020.07.087
10. Eichenfield LF, Paller AS, Tom WL, et al. Pediatric psoriasis: Evolving perspectives. Pediatr Dermatol. 2018;35(2):170-181. doi: 10.1111/pde.13382
11. Beck KM, Yang EJ, Sanchez IM, Liao W. Treatment of genital psoriasis: a systematic review. Dermatol Ther (Heidelb). 2018;8(4):509-525. doi: 10.1007/ s13555-018-0257-y
12. Trevelyan EG, Robinson N. Delphi methodology in health research: how to do it? Eur J Integrative Med. 2015;7(4):423-428. doi: 10.1016/j.eujim.2015.07.002
13. McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016;38(3):655-662. doi: 10.1007/s11096-016- 0257-x
14. Luger T, Seite S, Humbert P, Krutmann J, Triller R, Dreno B. Recommendations for adjunctive basic skin care in patients with psoriasis. Eur J Dermatol. 2014;24(2):194-200. doi: 10.1684/ejd.2014.2294
15. Wolf R, Orion E, Ruocco E, Ruocco V. Abnormal epidermal barrier in the pathogenesis of psoriasis. Clin Dermatol. 2012;30(3):323-328. doi: 10.1016/j. clindermatol.2011.08.022
16. Capon F, Semprini S, Chimenti S, et al. Fine mapping of the PSORS4 psoriasis susceptibility region on chromosome 1q21. J Invest Dermatol. 2001;116(5):728- 730. doi: 10.1046/j.1523-1747.2001.01311.x
17. Chen H, Toh TK, Szeverenyi I, et al. Association of skin barrier genes within the PSORS4 locus is enriched in Singaporean Chinese with early-onset psoriasis. J Invest Dermatol. 2009;129(3):606-614. doi: 10.1038/jid.2008.273
18. Shah SK, Arthur A, Yang YC, Stevens S, Alexis AF. A retrospective study to investigate racial and ethnic variations in the treatment of psoriasis with etanercept. J Drugs Dermatol. 2011;10(8):866-872.
19. National Psoriasis Foundation. Statistics. https://www.psoriasis.org/content/ statistics. Accessed April 12, 2022.
20. Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003-2004. J Am Acad Dermatol. 2009;60(2):218-224. doi: 10.1016/j.jaad.2008.09.022.
21. McMichael AJ, Vachiramon V, Guzman-Sanchez DA, Camacho F. Psoriasis in African-Americans: a caregivers' survey. J Drugs Dermatol. 2012;11(4):478-482.
22. Yan D, Afifi L, Jeon C, Cordoro KM, Liao W. A cross-sectional study of the distribution of psoriasis subtypes in different ethno-racial groups. Dermatol Online J. 2018;24(7):13030/qt5z21q4k2.
23. Fluhr JW, Cavallotti C, Berardesca E. Emollients, moisturizers, and keratolytic agents in psoriasis. Clin Dermatol. 2008;26(4):380-386. doi: 10.1016/j. clindermatol.2008.01.015
24. Draelos ZD. Moisturizing cream ameliorates dryness and desquamation in participants not receiving topical psoriasis treatment. Cutis. 2008;82(3):211-216.
25. Del Rosso JQ. Ceramide- and keratolytic-containing body cleanser and cream application in patients with psoriasis: outcomes from a consumer usage study. J Clin Aesthet Dermatol. 2019;12(7):18-21.
26. Wan DC, Wong VW, Longaker MT, Yang GP, Wei FC. Moisturizing different racial skin types. J Clin Aesthet Dermatol. 2014;7(6):25-32.
27. Nakajima K, Terao M, Takaishi M, et al. Barrier abnormality due to ceramide deficiency leads to psoriasiform inflammation in a mouse model. J Invest Dermatol. 2013;133(11):2555-2565. doi: 10.1038/jid.2013.199
28. Cho Y, Lew BL, Seong K, Kim NI. An inverse relationship between ceramide synthesis and clinical severity in patients with psoriasis. J Korean Med Sci. 2004;19(6):859-863. doi: 10.3346/jkms.2004.19.6.859
29. Hong KK, Cho HR, Ju WC, Cho Y, Kim NI. A study on altered expression of serine palmitoyltransferase and ceramidase in psoriatic skin lesion. J Korean Med Sci. 2007;22(5):862-867. doi: 10.3346/jkms.2007.22.5.862
30. Liu M, Li X, Chen XY, Xue F, Zheng J. Topical application of a linoleic acidceramide containing moisturizer exhibit therapeutic and preventive benefits for psoriasis vulgaris: a randomized controlled trial. Dermatol Ther. 2015;28(6):373- 382. doi: 10.1111/dth.12259
31. Lueangarun S, Tragulplaingam P, Sugkraroek S, Tempark T. The 24-hr, 28-day, and 7-day post-moisturizing efficacy of ceramides 1, 3, 6-II containing moisturizing cream compared with hydrophilic cream on skin dryness and barrier disruption in senile xerosis treatment. Dermatol Ther. 2019;32(6):e13090. doi: 10.1111/ dth.13090
32. Li X, Yang Q, Zheng J, et al. Efficacy and safety of a topical moisturizer containing linoleic acid and ceramide for mild-to-moderate psoriasis vulgaris: A multicenter randomized controlled trial. Dermatol Ther. 2020;33(6):e14263. doi: 10.1111/ dth.14263
33. Man MQ, Ye L, Hu L, Jeong S, Elias PM, Lv C. Improvements in epidermal function prevent relapse of psoriasis: a self-controlled study. Clin Exp Dermatol. 2019;44(6):654-657. doi: 10.1111/ced.13888
34. Bray JK, Cline A, McMichael AJ, Feldman SR. Differences in healthcare barriers based on racial and/or ethnic background for patients with psoriasis. J Dermatolog Treat. 2021;32(6):590-594. doi: 10.1080/09546634.2019. 1687824
35. Alexis AF, Woolery-Lloyd H, Williams K, et al. Racial/ethnic variations in skin barrier: implications for skin care recommendations in skin of color. J Drugs Dermatol. 2021;20(9):932-938. doi: 10.36849/jdd.6312
2. Kimmel GW, Lebwohl M. Psoriasis: overview and diagnosis. Evidence-Based Psoriasis. 2018;1-16. doi: 10.1007/978-3-319-90107-7_1
3. Orsmond A, Bereza-Malcolm L, Lynch T, March L, Xue M. Skin Barrier Dysregulation in Psoriasis. Int J Mol Sci. 2021;22(19):10841. doi: 10.3390/ ijms221910841
4. Kaufman BP, Alexis AF. Psoriasis in skin of color: insights into the epidemiology, clinical presentation, genetics, quality-of-life impact, and treatment of psoriasis in non-white racial/ethnic groups. Am J Clin Dermatol. 2018;19(3):405-423. doi: 10.1007/s40257-017-0332-7
5. Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014;7(11):16-24.
6. Takeshita J, Augustin M, de Jong EMGJ, et al. Health-related quality of life differs by race/ethnicity in North American patients with psoriasis: results from PSOLAR. J Invest Dermatol. 2022;142(9):2528-2531. doi: 10.1016/j. jid.2022.02.013
7. Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826-850. doi: 10.1016/j.jaad.2008.02.039.
8. Hsu S, Papp KA, Lebwohl MG, et al. Consensus guidelines for the management of plaque psoriasis. Arch Dermatol. 2012;148(1):95-102. doi: 10.1001/ archdermatol.2011.1410
9. Elmets CA, Korman NJ, Prater EF, et al. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021;84(2):432-470. doi: 10.1016/j.jaad.2020.07.087
10. Eichenfield LF, Paller AS, Tom WL, et al. Pediatric psoriasis: Evolving perspectives. Pediatr Dermatol. 2018;35(2):170-181. doi: 10.1111/pde.13382
11. Beck KM, Yang EJ, Sanchez IM, Liao W. Treatment of genital psoriasis: a systematic review. Dermatol Ther (Heidelb). 2018;8(4):509-525. doi: 10.1007/ s13555-018-0257-y
12. Trevelyan EG, Robinson N. Delphi methodology in health research: how to do it? Eur J Integrative Med. 2015;7(4):423-428. doi: 10.1016/j.eujim.2015.07.002
13. McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016;38(3):655-662. doi: 10.1007/s11096-016- 0257-x
14. Luger T, Seite S, Humbert P, Krutmann J, Triller R, Dreno B. Recommendations for adjunctive basic skin care in patients with psoriasis. Eur J Dermatol. 2014;24(2):194-200. doi: 10.1684/ejd.2014.2294
15. Wolf R, Orion E, Ruocco E, Ruocco V. Abnormal epidermal barrier in the pathogenesis of psoriasis. Clin Dermatol. 2012;30(3):323-328. doi: 10.1016/j. clindermatol.2011.08.022
16. Capon F, Semprini S, Chimenti S, et al. Fine mapping of the PSORS4 psoriasis susceptibility region on chromosome 1q21. J Invest Dermatol. 2001;116(5):728- 730. doi: 10.1046/j.1523-1747.2001.01311.x
17. Chen H, Toh TK, Szeverenyi I, et al. Association of skin barrier genes within the PSORS4 locus is enriched in Singaporean Chinese with early-onset psoriasis. J Invest Dermatol. 2009;129(3):606-614. doi: 10.1038/jid.2008.273
18. Shah SK, Arthur A, Yang YC, Stevens S, Alexis AF. A retrospective study to investigate racial and ethnic variations in the treatment of psoriasis with etanercept. J Drugs Dermatol. 2011;10(8):866-872.
19. National Psoriasis Foundation. Statistics. https://www.psoriasis.org/content/ statistics. Accessed April 12, 2022.
20. Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003-2004. J Am Acad Dermatol. 2009;60(2):218-224. doi: 10.1016/j.jaad.2008.09.022.
21. McMichael AJ, Vachiramon V, Guzman-Sanchez DA, Camacho F. Psoriasis in African-Americans: a caregivers' survey. J Drugs Dermatol. 2012;11(4):478-482.
22. Yan D, Afifi L, Jeon C, Cordoro KM, Liao W. A cross-sectional study of the distribution of psoriasis subtypes in different ethno-racial groups. Dermatol Online J. 2018;24(7):13030/qt5z21q4k2.
23. Fluhr JW, Cavallotti C, Berardesca E. Emollients, moisturizers, and keratolytic agents in psoriasis. Clin Dermatol. 2008;26(4):380-386. doi: 10.1016/j. clindermatol.2008.01.015
24. Draelos ZD. Moisturizing cream ameliorates dryness and desquamation in participants not receiving topical psoriasis treatment. Cutis. 2008;82(3):211-216.
25. Del Rosso JQ. Ceramide- and keratolytic-containing body cleanser and cream application in patients with psoriasis: outcomes from a consumer usage study. J Clin Aesthet Dermatol. 2019;12(7):18-21.
26. Wan DC, Wong VW, Longaker MT, Yang GP, Wei FC. Moisturizing different racial skin types. J Clin Aesthet Dermatol. 2014;7(6):25-32.
27. Nakajima K, Terao M, Takaishi M, et al. Barrier abnormality due to ceramide deficiency leads to psoriasiform inflammation in a mouse model. J Invest Dermatol. 2013;133(11):2555-2565. doi: 10.1038/jid.2013.199
28. Cho Y, Lew BL, Seong K, Kim NI. An inverse relationship between ceramide synthesis and clinical severity in patients with psoriasis. J Korean Med Sci. 2004;19(6):859-863. doi: 10.3346/jkms.2004.19.6.859
29. Hong KK, Cho HR, Ju WC, Cho Y, Kim NI. A study on altered expression of serine palmitoyltransferase and ceramidase in psoriatic skin lesion. J Korean Med Sci. 2007;22(5):862-867. doi: 10.3346/jkms.2007.22.5.862
30. Liu M, Li X, Chen XY, Xue F, Zheng J. Topical application of a linoleic acidceramide containing moisturizer exhibit therapeutic and preventive benefits for psoriasis vulgaris: a randomized controlled trial. Dermatol Ther. 2015;28(6):373- 382. doi: 10.1111/dth.12259
31. Lueangarun S, Tragulplaingam P, Sugkraroek S, Tempark T. The 24-hr, 28-day, and 7-day post-moisturizing efficacy of ceramides 1, 3, 6-II containing moisturizing cream compared with hydrophilic cream on skin dryness and barrier disruption in senile xerosis treatment. Dermatol Ther. 2019;32(6):e13090. doi: 10.1111/ dth.13090
32. Li X, Yang Q, Zheng J, et al. Efficacy and safety of a topical moisturizer containing linoleic acid and ceramide for mild-to-moderate psoriasis vulgaris: A multicenter randomized controlled trial. Dermatol Ther. 2020;33(6):e14263. doi: 10.1111/ dth.14263
33. Man MQ, Ye L, Hu L, Jeong S, Elias PM, Lv C. Improvements in epidermal function prevent relapse of psoriasis: a self-controlled study. Clin Exp Dermatol. 2019;44(6):654-657. doi: 10.1111/ced.13888
34. Bray JK, Cline A, McMichael AJ, Feldman SR. Differences in healthcare barriers based on racial and/or ethnic background for patients with psoriasis. J Dermatolog Treat. 2021;32(6):590-594. doi: 10.1080/09546634.2019. 1687824
35. Alexis AF, Woolery-Lloyd H, Williams K, et al. Racial/ethnic variations in skin barrier: implications for skin care recommendations in skin of color. J Drugs Dermatol. 2021;20(9):932-938. doi: 10.36849/jdd.6312
AUTHOR CORRESPONDENCE
Anneke Andriessen PhD anneke.a@tiscali.nl
