What you should know about psoriatic arthritis rashes?

True to the name, PsA is a type of arthritis affecting people with a skin condition called psoriasis. One of the most common symptoms of the condition is a thick, discolored rash known as PsA rash.

Knowing more about PsA may help you manage the condition — including rashes — more effectively.

Causes and triggers

PsA occurs when the immune system mistakenly starts attacking the body’s own tissues. It is a long-term condition that can come and go. Stress, injuries, or other infections may have a role in triggering it. Those with PsA may also experience a rash on the skin.

A common trigger for this rash is a skin injury, such as a cut, scrape, or bug bite. About 10–14 days after the skin injury, there may be a flare-up of symptoms in the same location.

This is why it’s important to treat skin injuries as soon as they happen, keep the wound clean and bandaged until the injury heals, and consult a healthcare professional if the injury worsens.

In addition, in a 2021 case study, researchers reported that PsA was triggered by SARS-CoV-2 infection, the virus that causes COVID-19, but this study involved only one person, and more research is needed to understand the link between these two conditions.

Symptoms

PsA rash may appear anywhere on the body, but it mostly appears on the elbows, knees, scalp, and lower back. It appears as thickened skin with flaky white or silvery patches, known as plaques. On lighter skin tones, this may appear red or pink, while on darker skin it can appear dark brown or purple and be harder to see than on lighter skin.

An itching or burning sensation often accompanies the rash, along with pain or tenderness. PsA rashes are not transmissible, which means the infection does not pass from one person to another. A flare-up can last for days or months at a time.

Treatments

Like psoriasis, the severity of the condition can change from person to person, but early diagnosis and treatment can help slow the condition’s progress. Depending on the severity of the PsA rash, there are several treatment options available, some of which are listed below:

Topical creams and ointments

There are several over-the-counter(OTC) options that can help to soothe the skin. Emollients (moisturizers that soften dry and flaky skin) with brand names such as Eucerin and Aquafor reduce dryness and itching, coal tar helps relieve itching on the scalp, and products with salicylic acid help reduce debris and excess protein on the skin.

Though intended for general prevention or lighter breakouts of the condition, the benefit of OTC creams is that they have minimal side effects, and you can use them more frequently.

Prescription treatments often use corticosteroids to fight plaque buildup on the skin and suppress the immune response. Some examples of corticosteroids include:

• hydrocortisone (Cortef)
• betamethasone (Diprolene)
• prednisolone (Orapred)

They are known to effectively ease the pain and itchiness associated with PsA rash. Note that long-term use can lead to thinning of the skin, making it more prone to injury.

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Oral medication

The most common oral prescription medication for treating PsA rash contains corticosteroids, which mimic an anti-inflammatory hormone called cortisol. Corticosteroids are known to reduce inflammation effectively. Corticosteroids can also be injected directly into the affected site.

Doctors do not recommend long-term use of corticosteroids due to side effects. 

Disease-modifying antirheumatic drugs (DMARDs) keep symptoms at bay by suppressing the chemicals in your body that cause inflammation. The reduction in inflammation can help prevent joint damage. You can take DMARDs in the form of pills or injections. Some examples include:

• methotrexate (Trexall)
• hydroxychloroquine sulfate (Plaquenil)
• leflunomide (Arava)

DMARDs can help treat moderate to severe cases of PsA rash. Side effects of DMARDs can include:

• loss of appetite
• nausea
• diarrhea
• abdominal pain
• increased risk of infections

Biologic response modifiers are more targeted than DMARDs and work by interrupting the signal of immune messages to decrease or stop inflammation. Examples of these include:

• secukinumab (Cosentyx)
• infliximab (Remicade)
• ustekinumab (Stelara)
• adalimumab (Humira)

Like DMARDs, they are helpful for people with more severe symptoms, with side effects that include:

• fatigue
• low blood pressure
• fever
• chills
• nausea

Light therapy

Light therapy, also known as phototherapy, involves exposing the affected skin to UVA and UVB light machines to help reduce the inflammation of the rash. This therapy requires taking a drug that makes your body more sensitive to light.

Stress management

As stress is one of the primary triggers of PsA, it’s a good idea to include stress reduction measures in your daily life. Yoga, meditation, and breathing techniques are known to reduce stress effectively.

There are also several forms of psychotherapy, such as cognitive behavioral therapy, which studies in a 2021 review have shown can help reduce stress-related disorders and enhance mental health. 

General skin regimen for psoriatic rashes

It’s important to keep skin with psoriasis as moisturized as possible using moisturizers, colloidal oatmeal baths, and mild soaps. Note that it’s important not to scratch PsA rashes because they can further inflame the skin or cause infection. Smoking, drinking alcohol, and a diet lacking in nutrients are also known to worsen the condition.

When to contact a healthcare professional

If you have pain, swelling, or stiffness in your joints that persists, you should speak with a healthcare professional. You should consider having yearly checkups if you receive a diagnosis of PsA rashes. 

If left untreated, PsA can damage joints, so you should continue to talk with a healthcare professional about your condition. 

You may consider seeing healthcare professional like a dermatologist, who treats skin conditions, and a rheumatologist, who specializes in arthritis and other immune-related diseases.    

Summary

OTC and prescription ointments, creams, and oral medications may help manage PsA rashes well. You can talk with a healthcare professional, such as a dermatologist, to find a suitable treatment plan.

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