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Psoriasis

  • Plaque Psoriasis
    Psoriasis is believed to be hereditary. It is believed that at least 10 percent of the general population inherits one or more of the genes that create a predisposition to psoriasis. However, only 2 percent to 3 percent of the population develops the disease. It is believed that both the predisposition to psoriasis plus becoming exposed to specific external factors known as "triggers" causes the disease to appear.
  • Plaque Psoriasis
    Guttate psoriasis appears in small red spots on the skin. It is the second most common form of psoriasis. The spots often appear on the torso and limbs, but they can also occur on the face and scalp. They are usually not as thick as plaque psoriasis, but they may develop into plaque psoriasis over time.
  • Pustular Psoriasis
    One of the most inflamed forms of psoriasis, erythrodermic psoriasis looks like fiery, red skin covering large areas of the body that shed in white sheets instead of flakes. This form of psoriasis is usually very itchy and may cause some pain. Triggers for erythrodermic psoriasis include severe sunburn, infection, pneumonia, medications or abrupt withdrawal of systemic psoriasis treatment.
  • Erythrodermic Psoriasis
    Erythrodermic psoriasis is a severe form of psoriasis that leads to widespread, fiery redness over most of the body. It can cause severe itching and pain. Skin can come off in this type of psoriasis. It is rare, occurring only in 3 percent of psoriasis sufferers. It generally appears on people who have unstable plaque psoriasis.

About

Psoriasis

Psoriasis is an autoimmune disease that causes raised, red, scaly patches to appear on the skin. Psoriasis is a chronic disease. Psoriasis is not contagious. Psoriasis can also be associated with arthritis, and less commonly with an increased risk of cardiovascular disease.

There are five types of psoriasis. The type of psoriasis will determine the most appropriate treatment. The types are:

  • Plaque psoriasis— the most common form of the disease, it appears as raised, red patches covered with silvery scale, which usually appear on the scalp, knees, elbows and lower back.
  • Guttate psoriasis— appears as small, dot-like lesions, often starting in childhood or young adulthood. This type of psoriasis can be triggered by a strep infection. Guttate is the second-most common type of psoriasis and affects about 10 percent of psoriasis sufferers.
  • Inverse psoriasis— appears as very red lesions in body folds, typically behind the knees, under the arms or in the groin, and it may appear smooth and shiny. It often accompanies another type of psoriasis.
  • Pustular psoriasis— appears as white pustules or blisters surrounded by red skin. The pustules contain white blood cells, but it is not an infection, nor is it contagious. It most commonly occurs on the hands or feet.
  • Erythrodermic psoriasis—a severe form of psoriasis, it leads to redness over most of the body. It can cause severe itching and pain. This type of psoriasis can cause skin to peel off in sheets and patients can become very sick. It is rare, occurring only in 3 percent of psoriasis sufferers. It generally affects people who have unstable plaque psoriasis.

Causes

Psoriasis is believed to be hereditary with at least 10 percent of the general population inheriting one or more of the genes that create a predisposition to psoriasis. However, only 2-3 percent of the population develop the disease. It is thought that both the predisposition to psoriasis plus exposure to specific external factors, known as “triggers", causes the disease to appear.

Psoriasis triggers are not universal. What may cause one person's psoriasis to become active, may not affect another. Known psoriasis triggers include:

  • Stress
  • Skin injury
  • Certain medications, such as lithium, antimalarials, Inderal, Quinidine, Indomethacin, beta-blockers
  • Infection

Risk Factors

Because of its hereditary component, people with a family history are at higher risk of developing psoriasis. In the United States, about 7.5 million people have psoriasis. Most people, about 80 percent, have plaque psoriasis.

Psoriasis can begin at any age, but most patients develop it between 15 and 30 years of age, or between 50 and 60 years of age. Caucasians are more commonly affected by psoriasis.

Diagnosis

Physical examination of the skin, including the scalp, and fingernails can reveal classic findings of psoriasis. Additionally, information regarding family history of psoriasis and personal history of recent infections or medication changes will be helpful in the diagnosis. In rarer forms of psoriasis, like inverse psoriasis, a biopsy of the affected skin may need to be taken for evaluation by a pathologist.

*Source:

American Academy of Dermatology National Psoriasis Foundation

Treatment

Treatment

Treating psoriasis has benefits. Treatment can reduce signs and symptoms of psoriasis, which usually makes a person feel better. With treatment, some people see their skin completely clear. Treatment can even improve a person's quality of life.

Work with your doctor to find a treatment—or treatments—that reduce or eliminate your symptoms. What works for one person with psoriasis might not work for another. There are multiple options available for treatment which include:

  • Biologics— are prescription drugs used for moderate to severe that has not responded to other treatments. They are given by injection or intravenous (IV) infusion. There are risks and side effects associated with the use of biologics which will need to be discussed with your dermatologist.
  • Systemics— are either oral or injectable prescription drugs that work throughout the body. They are usually used for individuals with moderate to severe psoriasis and psoriatic arthritis. Systemic medications are also used in those who are not responsive or are unable to take topical medications or UV light therapy.
  • Ultraviolet B (UVB) Phototherapy— also referred to as light therapy, involves consistent exposure of the skin to ultraviolet light on a regular basis and under medical supervision. Treatments are done in a doctor's office or psoriasis clinic or at home with phototherapy unit.
  • Excimer Laser Therapy— was recently approved by the Food and Drug Administration (FDA) for treating chronic, localized psoriasis plaqus. It emits a high-intensity beam of ultraviolet light B (UVB). The excimer laser can target select areas of the skin affected by mild to moderate psoriasis, and research indicates it is a particularly effective treatment for scalp psoriasis.
  • Pulsed dye laser— is approved for treating chronic, localized plaques. Using a dye and different wavelength of light than the excimer laser or other UVB-based treatments, pulsed dye lasers destroy the tiny blood vessels that contribute to the formation of psoriasis lesions.
  • Oral Treatments— improve symptoms of psoriasis by inhibiting specific molecules associated with inflammation. These medications selectively target molecules inside immune cells. By adjusting the complicated processes of inflammation within the cell, these treatments correct the overactive immune response that causes inflammation in people with psoriasis and psoriatic arthritis, leading to improvement in redness and scaliness as well as joint tenderness and swelling.
  • Topicals— are applied to the skin and are usually the first treatment to try when diagnosed with psoriasis. Topicals can be purchased over the counter or by prescription and include substances such as corticosteroids, salicylic acid, coal tar, aloe vera, jojoba, zinc pyrithione and capsaicin.
  • Complementary and Alternative — are often sought by patients with chronic conditions because they can help with preventative care and pain management. Some of these include diet and nutrition, herbal remedies, mind and body therapies, alternative therapies, exercise, yoga, and Thai Chi. Much of the evidence supporting complementary and alternative therapies for psoriasis and psoriatic arthritis is anecdotal. Increasingly, researchers have studied complementary and alternative therapies particularly in looking at drug interactions, dietary outcomes and safety. Most complementary and alternative therapies are safe. However, some can interfere with your treatments prescribed by your doctor. Always talk to your doctor or consult with a licensed health care professional before adding any complementary and alternative treatments to your treatment plan for psoriasis and psoriatic arthritis.

Prevention

Living with psoriasis has unique challenges. The good news is health care providers are becoming more aware of the impact psoriasis can have on a person's quality of life. The best way to prevent flare ups is to avoid known triggers, such as stress or foods. You should also work with your dermatologist to manage the symptoms.

*Source:

American Academy of Dermatology
National Psoriasis Foundation

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FAQs

What Is Psoriasis?

Psoriasis is a skin disease that causes scaling and inflammation (pain, swelling, heat, and redness). Skin cells grow deep in the skin and slowly rise to the surface. This process is called cell turnover, and it takes about a month. With psoriasis, it can happen in just a few days because the cells rise too fast and pile up on the surface.

Most psoriasis causes patches of thick, red skin with silvery scales. These patches can itch or feel sore. They are often found on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet. But they can show up other places such as fingernails, toenails, genitals, and inside the mouth.

Who Gets Psoriasis?

Anyone can get psoriasis, but it occurs more often in adults. In many cases, there is a family history of psoriasis. Certain genes have been linked to the disease. Men and women get psoriasis at about the same rate.

What Causes Psoriasis?

Psoriasis begins in the immune system, mainly with a type of white blood cell called a T cell. T cells help protect the body against infection and disease. With psoriasis, T cells are put into action by mistake. They become so active that they set off other immune responses. This leads to swelling and fast turnover of skin cells. People with psoriasis may notice that sometimes the skin gets better and sometimes it gets worse. Things that can cause the skin to get worse include:

  • Infections.
  • Stress.
  • Changes in weather that dry the skin.
  • Certain medicines.

How Is Psoriasis Diagnosed?

Psoriasis can be hard to diagnose because it can look like other skin diseases. The doctor might need to look at a small skin sample under a microscope.

How Is Psoriasis Treated?

Treatment depends on:

  • How serious the disease is.
  • The size of the psoriasis patches.
  • The type of psoriasis.
  • How the patient reacts to certain treatments.

All treatments don't work the same for everyone. Doctors may switch treatments if one doesn't work, if there is a bad reaction, or if the treatment stops working.

Topical Treatment: Treatments applied right on the skin (creams, ointments) may help. These treatments can:

  • Help reduce inflammation and skin cell turnover
  • Suppress the immune system
  • Help the skin peel and unclog pores
  • Soothe the skin.

Light Therapy:Natural ultraviolet light from the sun and artificial ultraviolet light are used to treat psoriasis. One treatment, called PUVA, uses a combination of a drug that makes skin more sensitive to light and ultraviolet A light.

Systemic Treatment: If the psoriasis is severe, doctors might prescribe drugs or give medicine through a shot. This is called systemic treatment. Antibiotics are not used to treat psoriasis unless bacteria make the psoriasis worse.

Combination Therapy: When you combine topical (put on the skin), light, and systemic treatments, you can often use lower doses of each. Combination therapy can also lead to better results.

What Are Some Promising Areas of Psoriasis Research?

Doctors are learning more about psoriasis by studying:

  • Genes
  • New treatments that help skin not react to the immune system
  • The association of psoriasis with other conditions such as obesity, high blood pressure, and diabetes.

*Source:

National Institute of Arthritis and Muscoloskeletal and Skin Diseases

Videos

Psoriasis Videos