Is the elevated CRP and ESR related to psoriasis?

Question

Hello doctor,

I am reaching out for my 36-year-old husband, who has been living with psoriasis for 5 years. His condition started with small red patches on his scalp but has now spread to his elbows, back, and chest. His recent lab reports show elevated CRP at 12 mg/L and ESR at 40 mm/hr. He is experiencing severe itching, flaking, and pain, especially at night. He used to apply Calcipotriol ointment, which worked initially but now seems ineffective. Is the elevated CRP and ESR related to my psoriasis? What should I do now?

Please Help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Psoriasis can be challenging to manage, especially when it progresses. Let me guide you through his symptoms and lab results. Understanding the connection between psoriasis and elevated CRP (C-reactive protein), or ESR (erythrocyte sedimentation rate):

CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) are markers of inflammation in the body.
Elevated levels, such as his CRP at 12 mg/L and ESR at 40 mm/hr, indicate active inflammation, which is common in moderate to severe psoriasis.
Psoriasis is not just a skin condition. It is a systemic inflammatory disease. The elevated markers suggest his psoriasis may be more active or that there could be underlying psoriatic arthritis (PsA) or other systemic involvement.
Signs of PsA: Joint pain, swelling, stiffness (especially in the morning). If he has joint symptoms, it is essential to discuss these with a doctor immediately.

Why Calcipotriol ointment may no longer be effective-

Topical treatments like Calcipotriol are effective for mild psoriasis but may lose their effectiveness as the condition worsens or when plaques become more extensive. This indicates that your husband might need a more comprehensive treatment plan.

Recommended next steps-

Consult a dermatologist or rheumatologist: Your husband likely needs systemic treatment or advanced therapy. Ask about biologics (e.g., Adalimumab, Secukinumab, Ustekinumab) or oral systemic medications (e.g., Methotrexate, Cyclosporine, or Apremilast). These target the inflammation driving psoriasis at its root.

Short-term symptom relief:

Severe itching and flaking: Moisturizers with urea or salicylic acid can help soften plaques.
Over-the-counter hydrocortisone or stronger steroid creams (prescription) can reduce inflammation.
Antihistamines (e.g., Cetirizine) may help reduce itching at night.
Pain: Cold compresses or oatmeal baths can soothe irritated skin.

Lifestyle adjustments:

Diet: Anti-inflammatory diets (rich in fruits, vegetables, fatty fish, and whole grains) may help reduce flare-ups. Avoid triggers like alcohol, processed foods, and sugar.
Stress management: Stress is a common trigger for psoriasis. Techniques like mindfulness, yoga, or counseling can help.

Monitor for psoriatic arthritis: Ask if he has joint pain, tenderness, or stiffness. If yes, early treatment is crucial to prevent joint damage.

When to seek immediate help: If he develops joint pain, swelling, or if his skin condition worsens rapidly (e.g., widespread redness or pustules), seek urgent medical attention. These may indicate a severe form of psoriasis (e.g., erythrodermic or pustular psoriasis) or systemic involvement.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.