It’s often cold, dry air that contributes to itchy, dry, flaky skin and drives us to grab the hydrocortisone-based anti-itch ointment out of the lower drawer of the bathroom vanity. Dry skin that is not associated with a more serious underlying dermatological condition is not a basis for not flying, unless the itching is so bad it becomes an in-flight distraction!
But what about more serious skin conditions? Psoriasis, for example, is a common inflammatory condition that is easily identified by red, scaly plaques. It isn’t contagious, but it is an autoimmune disorder that accelerates the growth of skin cells that can multiply and develop into colonies of discolored skin known as “plaques.” These communities of skin cells just continue to congregate instead of shedding after their growth process is done.
Interestingly, psoriasis is not a well-understood dermatological process. The problem lies with a type of white blood cells called T-cells, which are vital parts of our immune system that do their job by fighting off bacteria, viruses, and other foreign bodies that make it through the skin’s defensive barriers. However, like a rogue cyborg gone bad a la Terminator Arnold Schwarzenegger’s Cyberdyne Systems T-800 with artificial intelligence and a very mean disposition, T-cells get confused by psoriasis, and the body responds to the confusion by bumping up the manufacturing rate of new skin cells, which make their appearance as plaques and scales.
There is a genetic link (those pesky genes, again, always making their way into the equation somehow!), so a family history can make you more likely to develop the condition somewhere down the road, but an absent family history doesn’t preclude the chance of acquiring psoriasis. Although the genetic link with family history is not always a smoking gun, environmental triggers are also players in the game. Surprise! Cold and dry weather is right up there as a precursor. Shorter periods of daylight and lower humidity during winter months can cause psoriasis outbreaks. It is that cold air and lower humidity that lead to the dry and flaky skin, which segues into the plaque and itchy symptoms. Not too surprisingly, the other bad actors in the cast of characters include illness that triggers an immune system response. Upper respiratory illnesses—flu, sore throat, or bronchitis—seem to predispose to psoriasis in some patients. Likewise, minor injuries that call out the T-cells—a hand cut from a slip of the knife while cutting potatoes for the casserole, a scratch from an overly playful kitty, or way too long at the beach without sunscreen can lead to a visit to the dermatologist.
As far as the FAA is concerned with psoriasis, “there’s an app for that,” so to speak. A CACI (Condition AMEs Can Issue) is available that streamlines the review process for pilots and allows an AME to issue a medical to the pilot at the time of the FAA physical exam. You will need a clinical progress note from your treating physician showing that the condition is stable with no significant limitations of symptoms, mild to moderate severity, and no co-morbid conditions, in this case, psoriatic arthritis, which has a separate worksheet. Many of the immune checkpoint inhibitors are included among the acceptable treatments and counteract the work of T-cells to prevent damage to healthy cells while working against the involved culprit cells. A favorable progress note from your treating provider, evidence of the subtype of psoriasis, and acceptable medication with a good response can result in an office issuance and a normal duration medical certificate.
