Common Questions About Late-onset Psoriasis

Psoriasis is a chronic condition that often appears between the ages of 15 and 35. Yet some people don’t develop symptoms until they are in middle age. Doctors call this late-onset psoriasis and it differs from early-onset psoriasis in several ways.

Research has shown that when psoriasis starts later in life, a different set of genes are involved than when the condition appears earlier. There are also differences in how the disease progresses. Older people with psoriasis are more likely to experience anxiety and depression and commonly have a form of psoriasis that includes painful white blisters on the hands and feet.

For people with plaque or nail psoriasis, a primary care doctor can diagnose and treat the condition. People with unusual symptoms may need to see a dermatologist to rule out other conditions that can be mistaken for psoriasis. These include eczema, fungal infections, drug reactions, pityriasis rubra pilaris, and a form of skin cancer called cutaneous T cell lymphoma.

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Researchers believe late-onset psoriasis is caused by a combination of genes and other factors such as stress, skin injuries, previous infections, and certain medicines. For example, beta blockers, the medicine used to treat high blood pressure and heart conditions, can make psoriasis worse. Smoking, alcohol, and poor diet can also increase the risk of psoriasis.

The National Psoriasis Foundation (NPF) recommends topical ointments for older adults with mild psoriasis. These include over-the-counter products like coal tar and salicylic acid, and prescription treatments such as retinoids, steroid creams, and forms of vitamin D. For older adults with severe psoriasis, the NPF recommends phototherapy or biologic drugs, but only with careful monitoring.

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At present, there is limited data about the safety of biologic and systemic treatments for seniors. Conditions common among older adults — kidney, heart and liver diseases, dementia, diabetes, and obesity — can increase the risks of potential side effects and drug interactions. And because biologic treatments target the immune system, they may also be less safe for people with weakened immune systems.

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While home remedies will not make psoriasis go away, many people with mild to moderate psoriasis manage their symptoms using natural and alternative remedies. Tea tree oil and apple cider vinegar can relieve itching and loosen plaques — especially in scalp psoriasis. An oatmeal bath or Epsom salts can soothe irritated skin. Adding omega-3 fatty acids to your diet can help reduce inflammation.

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Psoriasis is a chronic relapsing condition; it may come and go over time, but there is no cure. If you think you have psoriasis, talk to your doctor about treatments to help manage the condition. This is important because untreated psoriasis can affect quality of life; one study found that one-fifth of older adults with psoriasis had depression.

Download the HealthCentral Psoriasis Physician Discussion Guide.