Kim Kardashian’s psoriasis: role of stress in skin condition

By Deborah Kotz, Globe Staff

When a celebrity like Kim Kardashian develops a blotchy skin condition, it can have career-ending consequences. At least that’s what Kardashian, who announced her diagnosis of psoriasis on her reality show Sunday night, would have us believe.

“Psoriasis! I cannot have psoriasis,” she told the dermatologist who diagnosed her. “People don’t understand the pressure on me to look perfect.” But her doctor said all that stress and pressure may be what’s fueling the autoimmune disorder, advising her to slow her frenetic pace and frequent cross-country travels.

(Perhaps she can at least take a break from taping her show the next time she sees the doctor.)

Kardashian looked even more shocked after hearing that her condition isn’t curable since, her doctor told her, “you can’t alter the genetics.” Kardashian’s mother also has the condition, which the National Psoriasis Foundation says affects 7.5 million Americans.

Dr. Emmy Graber, assistant professor of dermatology at BU School of Medicine, examined Kardashian’s blotchy legs and torso on the video posted above and said it looks like she has the less common psoriasis variety called guttate, which comes on suddenly and spreads rapidly over the body -- often after a bout of strep throat or excessive stress.

“In many cases,” she said, “it won’t recur after treatment.” That differs from the plaque form, which usually causes large scaly lesions on the knees and elbows and tends to flare again and again.

Treatment for either variety includes steroid creams to quell the immune reaction or light therapy, where patients come to the doctor’s office two to three times a week to stand for a few minutes in front of a light box that emits ultraviolet rays.

Graber said no one knows exactly how the UV rays alleviate the condition, but some patients -- especially with the guttate type -- find that the rash clears quickly after a few weeks. “Some people find just being outdoors in the sun with their affected skin areas exposed helps,” said Graber.

Lifestyle changes are also key to reducing flare-ups. Kardashian and others with psoriasis would benefit from getting a proper amount of sleep, eating a balanced diet, avoiding excess alcohol, and, yes, minimizing stress.

More persistent psoriasis can be treated with newer drugs like etanercept or infliximab that target specific immune system chemicals that produce inflammation. But these powerful injections cost more than the steroid creams and light therapy and pose a greater risk of side effects, including infections and liver injury.