How to Manage Psoriasis as You Age

Psoriasis is a lifelong condition. Although psoriasis doesn’t get worse over time, you may experience whole-body challenges ­— from aging skin to related health conditions — that may signal a need to adjust your psoriasis treatment as you get older. Here’s what you need to know about managing psoriasis as you age.

Skin Aging and Psoriasis

With age, skin loses its elasticity and becomes thinner and drier, increasing the appearance of wrinkles. Beyond genetics, the No. 1 factor impacting skin aging is sun damage. Skin that’s been chronically damaged by the sun may also be harder to treat during psoriasis flares.

While medical-grade ultraviolet (UV) B treatment can help psoriasis by targeting skin inflammation, tanning beds and chronic exposure to natural sunlight expose skin to a more powerful, full-spectrum UV light that damages skin and increases the risk of premature skin aging and cancer. Overexposure to this type of UV light “can prevent us from appropriately treating areas with psoriasis, because the surrounding skin has been so heavily sun damaged,” says Rashmi Unwala, MD, a dermatologist specializing in psoriasis at the Cleveland Clinic in Ohio.

It’s essential to use a broad-spectrum SPF 30 sunscreen on exposed skin every time you head outside. “Sun exposure is a leading driver of skin thinning and damage with aging, so we recommend sun protection to allow people to use the medications that they will benefit from,” says Dr. Unwala.

Oil production also naturally slows with age, contributing to the drier skin and wrinkles. Using a gentle anti-aging moisturizer boosts the skin’s hydration to reduce the appearance of fine lines and wrinkles, and a skin cream or moisturizer can also help soothe irritated and dry skin during a psoriasis flare. Ask your dermatologist to recommend ingredients to look for when choosing skin-care products.

One of the most important factors of both psoriasis and skin aging is smoking. If you smoke, talk to your doctor for tips on quitting.

Cosmetic Products and Procedures for Aging

Retinol (a derivative of vitamin A) is one of the most common ingredients in skin aging treatments. Research shows it may indeed be effective at combating fine lines associated with natural aging, likely because it helps the skin retain water and boosts collagen production. Retinol is also used to treat psoriasis by slowing rapidly growing skin and decreasing scales.

A number of retinols, both topical and oral, are approved by the U.S. Food and Drug Administration (FDA) for the treatment of psoriasis. Just be sure to talk to your doctor before using an over-the-counter retinol cream. “It’s a balance, because it might be a little irritating,” says Unwala. Follow your doctor’s instructions for applying any new product or medication to your skin. You may need to test the product out a couple of times per day first on a small patch of skin for four or five days.

Avoid harsh exfoliating products, such as loofahs, body beads, and motorized brushes, to scrub off dead skin. “That would be traumatizing for active areas of psoriasis,” says Unwala. Traumatizing active psoriasis can not only worsen symptoms but also possibly lead to secondary bacterial infection. Instead of harsh or exfoliating products, opt for gentle, fragrance-free, nonsoap cleansers, which won’t irritate sensitive skin. Cleansers and moisturizers with coal tar and salicylic acid, in particular, may help when you’re having a psoriasis flare.

Other anti-aging treatments, such as Botox and face-lifts, are generally safe for people with psoriasis. Just be careful with laser treatments, microneedling, or microdermabrasion. These induce very targeted damage to promote wound healing and strengthening of the skin, and any damage to the skin can worsen psoriasis lesions. “You want to have your psoriasis under good control before getting any of these treatments,” says Unwala.

Managing Psoriasis and Hair Changes With Age

You may want to color your hair — possibly for the first time — as you notice your first grays. Be sure your psoriasis is under control before you hit the salon. “In general, we recommend not doing any chemical procedures on your hair when you have active psoriasis,” says Unwala.

If you’re not currently experiencing a psoriasis flare, getting your hair colored is usually considered safe. Just be sure to tell your stylist if you feel burning or pain. Also try to avoid braids or extensions, which pull on the hair and irritate the scalp. “If hair is too tight, it can make psoriasis worse, because trauma worsens psoriasis,” says Unwala.

The Link Between Psoriasis and Health Conditions With Age

Skin and hair changes aren’t the only things you should be aware of as you get older. “There’s a strong connection between psoriasis and internal health,” says Unwala. Having psoriasis may put you at higher risk of certain health conditions that are more common with age.

Metabolic syndrome and heart disease

According to a review published in 2018, numerous studies have strongly linked psoriasis to metabolic syndrome, a collection of conditions that includes abdominal obesity, high blood pressure, high cholesterol, type 2 diabetes, insulin resistance, and nonalcoholic fatty liver disease. The risk of being diagnosed with metabolic syndrome increases with age, and having it ups the risk of heart disease, according to another study from 2018.

“We can consider [psoriasis] as a risk factor for heart disease, just as we think of family history, smoking, and gender as risk factors,” says Unwala. Metabolic syndrome, she explains, involves inflammation in the bloodstream, and psoriasis is an inflammatory disease. Certain drugs used to treat metabolic syndrome, including blood pressure medications, may also trigger psoriasis flares.

The good news is that treating psoriasis can help reduce your risk of heart disease. “Treatment of skin results in overall improvement of health, which is especially important for an older population at higher risk of heart disease,” says Unwala. Making lifestyle changes, such as eating a healthy diet and exercising regularly, can also help keep your heart healthy and lower your risk of metabolic syndrome.

Osteoporosis

A study published in 2019 linked psoriatic conditions to lower bone mineral density, which can lead to bone loss and osteoporosis later in life. Having metabolic syndrome further increases the risk of osteoporosis, according to a study from 2016. To help reduce this risk, the Bone Health & Osteoporosis Foundation recommends getting plenty of calcium and vitamin D and performing weight-bearing exercises.

Depression

Psoriasis also has a strong connection to depression, according to the National Psoriasis Foundation (NPF). Depression is a common — but not normal — part of getting older, whether or not you’ve been diagnosed with psoriasis.

There are many effective treatments for depression, so be sure to tell your doctor about any signs of depression you’ve experienced. These may include persistent feelings of sadness, hopelessness, or worthlessness; loss of interest in your favorite activities; difficulty sleeping or concentrating; irritability; and changes in appetite or weight.

Psoriatic arthritis

Psoriatic arthritis is an inflammatory condition involving joint pain and stiffness that affects about 30 percent of people who have psoriasis, according to the NPF. Although it typically begins between the ages of 30 and 50, it can be diagnosed at any age.

Keep in mind that there are many causes of joint pain with age beyond psoriatic arthritis, and treatments vary depending on the kind of arthritis you have. “You often need a specialist to determine what type of arthritis you have,” says Unwala.

How Menopause May Affect Psoriasis

Menopause is defined as going a full year without having a period. It usually happens in your late 40s to early 50s, with symptoms of perimenopause beginning up to 14 years earlier.

During perimenopause, estrogen, progesterone, and testosterone levels gradually decline, leading to potentially exhausting symptoms, such as hot flashes and night sweats. This period of time can also be stressful in general, as you may struggle to care for children and aging parents while taking on new responsibilities at work. And stress is a known trigger of psoriasis flares. All of these factors have an effect on overall health and may increase the risk of conditions that are separately linked to psoriasis, including osteoporosis, mood changes, and heart disease.

You may also find that you have more psoriasis flares around the time you go through menopause. “It is possible that hormonal changes of menopause can contribute to psoriasis,” says Unwala.

Staying Healthy As You Age

A few steps can help reduce your risk of osteoporosis, depression, and heart disease as you age. First and foremost, maintain a healthy diet. That means focusing on fresh vegetables, fruits, whole grains, fish, and lean meat and dairy, while limiting processed foods, sodium, and added sugar. The National Institute on Aging recommends consuming 1,000 to 1,200 milligrams of calcium every day, depending on your age and sex, to build bone strength. Talk to your doctor or a registered dietitian to see what’s right for you.

Exercise also helps keep your bones and heart strong, reducing the risk of both osteoporosis and heart disease. Staying active additionally reduces the risk of depression, especially if you choose an activity that involves a lot of socializing, such as tennis or a swim class. As a bonus, exercise reduces the risk of dementia and supports cognitive function with age, including memory, comprehension, and problem-solving skills.

Lastly, be sure to discuss not just your skin but also your whole physical and mental health with your dermatologist. Let your doctor know if you’re struggling to maintain a healthy diet, stay active, or quit smoking. “A lot of people don’t realize they’re at risk and may have gone many years without seeing a general practitioner,” says Unwala. “We feel that one of our roles is to make those connections for people.”

Adjusting Your Psoriasis Treatment Plan With Age

Many medications to treat psoriasis are considered safe as you get older, including corticosteroids, vitamin D analogues, tazarotene (Tazorac), acitretin (Soriatane), apremilast (Otezla), methotrexate (Trexall), and some biologics. Your doctor may be more cautious with topical steroids though, because both aging and topical steroids cause the skin to thin. Let your doctor know if your skin appears more transparent (which can signal thinning) or if it bruises easier, has purple spots, or has visible blood vessels.

Most importantly, make sure your dermatologist knows about every medication you’re taking and any other diagnoses you’ve received. Some psoriasis medications aren’t safe for people with liver disease, kidney disease, or heart failure, all of which are more common in people over 65. Other medications, including biologics, may not be appropriate if you have certain infections, including hepatitis B, which is more common in older adults who were born before a hepatitis B vaccination existed.

Cancer is also more common with age. It’s important to let your doctor know if you’ve been diagnosed with any kind of cancer. “Your dermatologist needs to know, because it will affect treatments for psoriasis,” says Unwala.

While your treatment may change as you age, it’s important to keep in mind that psoriasis treatments have very likely improved drastically since you were first diagnosed. “The vast majority of people we treat have skin that’s close to clear on some of these medications,” says Unwala. “We have really effective tools now. It’s a new world for psoriasis treatments, and it’s very exciting.”