Smart Answers to 7 Silly Questions People Might Ask About Your Psoriasis

We’re obviously not going to say it’s the worst part of having psoriasis, but regularly fielding other people’s awkward questions about your skin condition can get more than a little old. (“Is psoriasis contagious?” Grrrr. Also, no.) Sure, those inquiries usually come from a good place—or at least a genuinely curious one—but sometimes they’re just plain superfluous, or downright silly. In the spirit of being prepared, here are seven questions you might someday be asked about your psoriasis (if you haven’t already), along with smart answers to arm yourself with. Next time your boyfriend’s mom delves into a skin-terrogation right at the dinner table, you’ll be ready.

Is psoriasis contagious?

Definitely not! You can’t “catch” psoriasis like you would something like scabies—it’s an autoimmune condition, not an infection. “Psoriasis is rooted in an immune response to environmental triggers, and your genes can make you predisposed to developing it,” explains Francisca Kartono, a dermatologist in Brighton, MI. Common environmental triggers that cause psoriasis to flare-up include bacterial infections (most notably strep), respiratory viruses, stress, medications, or repeated friction on the skin.

That’s the same thing Kim Kardashian has, right?

Not necessarily. While Kim K. did famously reveal that she has psoriasis on a 2011 episode of Keeping Up With the Kardashians, and has shared relatable photos of her flare-ups ever since, not all psoriasis is the same. In fact, there are five different types of psoriasis, each with its own symptoms, causes, and treatments. The most common (80 to 90 percent of cases) is plaque psoriasis, which involves red patches with silvery white scales, often on the elbows, knees, and scalp. Guttate psoriasis is a variant commonly triggered by an infection like strep or the flu; it often appears as spots sprinkled down the torso and extremities. A third type is pustular psoriasis, which involves painful white blisters, often localized on the palms and soles. The fourth: inverse psoriasis, dark or discolored patches that lack the typical scales of psoriasis and appear in folds prone to sweat, like the armpits or under the breasts. The last variant is rare: In erythrodermic psoriasis, inflammation is so severe that 80 percent or more of the body is covered and a person may feel sick and dehydrated and require urgent care.

Isn’t psoriasis basically the same as eczema?

Although they’re both inflammatory skin diseases and that can involve itchy red patchiness, “eczema and psoriasis are totally different diagnoses,” says Angela Weatherall, a dermatologist in Boca Raton, FL. Eczema is much more common, affecting about 30 million Americans vs. 8 million for psoriasis. It usually starts when you’re very young and involves extremely itchy rashes that tend to crop up in bendy nooks, like the crooks of elbows and knees. It may involve having a compromised skin barrier, which allows external triggers like detergents and fabrics to penetrate. Psoriasis tends to develop a bit later (most commonly between ages 15 and 25) and involves thicker, larger red patches that often burn, or just mildly itch. These are more likely to be located on the outside of knees and elbows, as well as other parts of the body, including the face and scalp. One telltale sign: Psoriasis patches often involve silvery scaling and cracking that you won’t see with eczema.

Have you tried cutting out gluten and dairy?

The most annoying part of this question is that it assumes that cutting out potential food culprits is an idea that didn’t already cross your mind (while of course anyone with a chronic condition has obviously heard of the concept before). While proponents of elimination diets loooove to recommend them, only a small number of people see major improvements in their psoriasis by cutting out major categories of food (often because it turns out they also have celiac disease, which doctors can test for). That said, of course eating clean can benefit your skin’s health and reduce overall inflammation. “I tell my patients there is definitely a skin-gut connection,” Dr. Kartono says, who recommends a diet that is rich in fruits, vegetables, fish, lean meats and low in dairy, sugar, and processed foods. “A healthier microbiome in your gut helps when you have too much inflammation in your body and skin, as is the case with psoriasis.”

At least it’s nothing serious, right?

While psoriasis might come off as “just a skin condition,” it’s much more than skin deep. “Psoriasis is a systemic disease, not just a skin disease,” says Mary Ruth Buchness, a dermatologist in NYC. “It’s associated with an increase in inflammation in the body, which is a risk factor for heart disease. It’s also associated with metabolic syndrome, which includes high blood pressure, obesity, high blood lipids, and insulin resistance.” It also has links to other conditions that can be quite serious. “About 30 percent of people with psoriasis also develop psoriatic arthritis, which can lead to pain, stiffness, and deformities of their joints,” Dr. Weatherall says. People with psoriasis are also twice as likely to become depressed than those without, according to the National Psoriasis Foundation, because of the way flare-ups can affect self-esteem, relationships, ability to sleep, and quality of life.

Have you tried XXX moisturizer?

Your friend is so passionate when asking if you’ve tried her favorite, life-changing potion—if only it were as easy as cracking open that jar. Many people assume psoriasis is a dry-skin issue that can be treated with moisture, thanks to its scaliness, but while the right lotion can play an important role in treatment, hydration alone is not enough. “It’s not dryness that leads to the scaling, it’s the retention of too many layers of skin,” Dr. Kartono says. “In psoriasis, skin cells turn over too quickly, and instead of being shed, remain on the skin surface.” What you want to do is move those cells along—so rather than slather on extra-rich creams, she recommends using an exfoliating moisturizer like AmLactin or CeraVe SA, along with a prescription steroid cream as a one-two punch: “The acids help de-scale the skin so the steroid can penetrate better.”

Isn’t there a prescription that cures it?

Oh sure, there’s a miraculous cure that you (not to mention Kim Kardashian!) just haven’t bothered to try! Sigh. “We do not currently have a cure for psoriasis,” Dr. Weatherall confirms. There are, however, treatments that can be very effective when you and your doctor find the right combination, which may include topicals, phototherapy, oral medications and systemic “biologic” treatments, as well as integrative medicine (which focuses on factors like diet and stress reduction). “In recent years, the biologic therapies have proved to be very effective for moderate to severe psoriasis patients and have been a real breakthrough in treatment,” she adds. “Many people can reach long-lasting remission and stay clear on the therapies we do currently have and have an excellent quality of life while living with this disease.”