Psoriasis (sore-EYE-ah-sis) is a medical condition that occurs when skin cells grow too quickly. Faulty signals in the immune system cause new skin cells to form in days rather than weeks. The body does not shed these excess skin cells, so the cells pile up on the surface of the skin and lesions form.
What are the signs and symptoms ?
The lesions vary in appearance with the type of psoriasis. There are five types of psoriasis: Plaque, guttate, pustular, inverse, and erythrodermic. About 80% of people living with psoriasis have plaque (plak) psoriasis, also called “psoriasis vulgaris.” Plaque psoriasis causes patches of thick, scaly skin that may be white, silvery, or red. Called plaques (plax), these patches can develop anywhere on the skin. The most common areas to find plaques are the elbows, knees, lower back, and scalp.
Psoriasis also can affect the nails. About 50% of people who develop psoriasis see changes in their fingernails and/or toenails. If the nails begin to pull away from the nail bed or develop pitting, ridges, or a yellowish-orange color, this could be a sign of psoriatic (sore-EE-at-ic) arthritis. Without treatment, psoriatic arthritis can progress and become debilitating. It is important to see a dermatologist if nail changes begin or joint pain develops. Early treatment can prevent joint deterioration.
What causes Psoriasis ?
Psoriasis is not contagious. You cannot get psoriasis from touching someone who has psoriasis, swimming in the same pool, or even intimate contact. Psoriasis is much more complex.
So complex, in fact, scientists are still studying what happens when psoriasis develops. We know that the person’s immune system and genes play key roles. In studying the immune system, scientists discovered that when a person has psoriasis, the T cells (a type of white blood cell that fights unwanted invaders such as bacteria and viruses) mistakenly trigger a reaction in the skin cells. This is why you may hear psoriasis referred to as a “T cell-mediated disease.”
This reaction activates a series of events, causing new skin cells to form in days rather than weeks. The reason T cells trigger this reaction seems to lie in our DNA. People who develop psoriasis inherit genes that cause psoriasis. Unlike some autoimmune conditions, it appears that many genes are involved in psoriasis.
Scientists are still trying to identify all of the genes involved. One of the genes that has been identified is called PSORS1 (SORE-ESS-1). This is one of several genes that regulates how the immune system fights infection.
Scientists also have learned that not everyone who inherits genes for psoriasis gets psoriasis. For psoriasis to appear, it seems that a person must inherit the “right” mix of genes and be exposed to a trigger. Some common triggers are a stressful life event, skin injury, and having strep throat. Many people say that that their psoriasis first appeared after experiencing one of these. Triggers are not universal. What triggers psoriasis in one person may not cause psoriasis to develop in another.
Who gets Psoriasis ?
People worldwide develop psoriasis. In the United States, nearly 7 million people have psoriasis and about 150,000 new cases are diagnosed each year. Studies indicate that psoriasis develops about equally in males and females. Research also shows that Caucasians develop psoriasis more frequently than other races. A study conducted in the United States found the prevalence was 2.5% in Caucasians and 1.3% in African Americans.
A family history of psoriasis seems to increase the risk of developing psoriasis. It is important to know that a family history of psoriasis does not guarantee that someone will develop psoriasis.
When do people get Psoriasis ?
Psoriasis can begin at any age, from infancy through the golden years. There are, however, times when psoriasis is most likely to develop. Most people first see psoriasis between 15 and 30 years of age. About 75% develop psoriasis before they turn 40. Another common time for psoriasis to begin is between 50 and 60 years of age.
Does Psoriasis affect quality of life ?
For some people, psoriasis is a nuisance. Others find that psoriasis affects every aspect of their daily life. The unpredictable nature of psoriasis may be the reason. Psoriasis is a chronic (lifelong) medical condition. Some people have frequent flare-ups that occur weekly or monthly. Others have occasional flare-ups.
When psoriasis flares, it can cause severe itching and pain. Sometimes the skin cracks and bleeds. When trying to sleep, cracking and bleeding skin can wake a person frequently and cause sleep deprivation. A lack of sleep can make it difficult to focus at school or work. Sometimes a flare-up requires a visit to a dermatologist for additional treatment. Time must be taken from school or work to visit the doctor and get treatment.
These cycles of flare-ups and remissions often lead to feelings of sadness, despair, guilt and anger as well as low self-esteem. Depression is higher in people who have psoriasis than in the general population. Feelings of embarrassment also are common.
Knowledge is power
As psoriasis is a life-long condition, it is important to take an active role in managing it. Learning more about psoriasis, seeing a dermatologist to discuss treatment options, and developing a healthy lifestyle can help people live life to the fullest.
What Psoriasis looks like ?
There are five types of psoriasis. Each has its own unique signs
(what is seen) and symptoms (what is felt by the person):
Plaque Psoriasis
About 80% of people living with psoriasis have plaque psoriasis, which also is called “psoriasis vulgaris.” “Vulgaris” means “common.”
How to recognize plaque psoriasis :
* Raised and thickened patches of reddish skin, called “plaques,” which are covered by silvery-white scales.
* Plaques most often appear on the elbows, knees, scalp, chest, and lower back. However, they can appear anywhere on the body, including the genitals.
* Plaques vary in size and can appear as distinct patches or join together to cover a large area.
* In the early stages, the psoriasis may be unnoticeable. The skin may itch and/or a burning sensation may be present.
* Plaque psoriasis usually first appears as small red bumps. Bumps gradually enlarge, and scales form. While the top scales flake off easily and often, scales below the surface stick together. The small red bumps develop into plaques (reddish areas of raised and thickened skin).
* Skin discomfort. The skin is dry and may be painful. Skin can itch, burn, bleed, and crack. In severe cases, the discomfort can make it difficult to sleep and focus on everyday activities.
Guttate Psoriasis
About 10% of people who get psoriasis develop guttate psoriasis, making this the second most common type.
Guttate psoriasis most frequently develops in children and young adults who have a history of streptococcal (strep) infections. A mild case of guttate psoriasis may disappear without treatment, and the person may never have another outbreak of psoriasis. Some children experience flare-ups for a number of years. It also is possible for the psoriasis to appear later in life as plaque psoriasis.
In some cases, guttate psoriasis is severe and disabling, and treatment may require oral medication or injections.
How to recognize guttate psoriasis :
* Drop-sized, red dots form — usually on the trunk, arms, and legs. Lesions occasionally form on the scalp, face, and ears.
* Lesions widespread.
* Appears quickly, usually a few days after a strep throat or other trigger, such as a cold, tonsillitis, chicken pox, skin injury, or taking certain medications.
* Can first appear as another form of psoriasis, such as plaque psoriasis, and turn into guttate psoriasis.
Pustular Psoriasis
This type of psoriasis occurs in less than 5% of people who develop psoriasis and primarily occurs in adults. It may be the first sign of psoriasis or develop from plaque psoriasis. Pustular psoriasis can be triggered by infections, sunburn, or medications such as lithium and systemic cortisones. There are two forms of pustular psoriasis: localized and generalized.
How to recognize localized pustular psoriasis :
* Psoriasis confined to certain areas (localized), usually the palms and soles. This is known as “palmoplantar psoriasis.”
* Skin red, swollen, and dotted with pus-filled lesions.
* Pus-filled lesions dry, leaving behind brown dots and/or scale.
* Affected areas tender and sore. Using hands or walking often painful.
Generalized Pustular Psoriasis is a rare and severe form of psoriasis that can be life-threatening, especially for older adults. Hospitalization may be required. Generalized pustular psoriasis may be triggered by an infection such as strep throat, suddenly stopping steroids, pregnancy, and taking certain medications such as lithium or systemic cortisone.
How to recognize generalized pustular psoriasis :
* Widespread areas of fiery-red swollen skin covered with small, white, pus-filled blisters
* Person feels exhausted and ill
* Fever
* Chills
* Severe itching
* Rapid pulse rate
* Loss of appetite
* Muscle weakness
* Anemia
Inverse Psoriasis
Not common, inverse psoriasis also is called “skin-fold,” “flexural,” or “genital” psoriasis. This type of psoriasis can be severe and incapacitating.
How to recognize inverse psoriasis :
* Red and inflamed plaques that only occur in skin folds — armpits, in the genital area, between the buttocks, and under the breasts.
* Scale usually does not form, and the lesions are shiny and smooth.
* Skin very tender.
* Lesion easily irritated, especially by rubbing and perspiration.
* More prevalent in people who are overweight.
* Many people have another type of psoriasis elsewhere on the body.
Erythrodermic Psoriasis
Also known as “exfoliative” psoriasis, this is the least common type. It occurs in about 1% or 2% of people who develop psoriasis. Erythrodermic psoriasis can be life-threatening because the skin loses its protective functions. The skin may not be able to safeguard against heat and fluid loss nor prevent harmful bacteria and other substances from entering the body. Patients are usually hospitalized and given intravenous fluids. Body temperature regulation may be required.
Erythrodermic psoriasis may occur suddenly in a person who has never had psoriasis or evolve from plaque psoriasis. Triggers include infection, emotional stress, alcoholism, and certain medications such as lithium, anti-malarial drugs, and a strong coal tar preparation. It also may be triggered by excessive use of potent corticosteroids, which is why it is important to use corticosteroids as instructed. Suddenly stopping a psoriasis medication, such as cyclosporine or methotrexate, also can trigger erythrodermic psoriasis.
How to recognize erythrodermic psoriasis :
* Severe redness & shedding of the skin that covers a large portion of the body.
* Skin looks as if it has been burned.
* Fluctuating body temperature, especially on very hot or cold days.
* Accelerated heart rate due to increased blood flow to the skin — can complicate heart disease and cause heart failure.
* Severe itching and pain.
Psoriasis Treatment
Currently, there is no cure for psoriasis. However, there are many treatment options that can clear psoriasis for a period of time. Each treatment has advantages and disadvantages, and what works for one patient may not be effective for another. Board-certified dermatologists have the medical training and experience needed to determine the most appropriate treatments for each patient.
Diagnosis
There are several forms of psoriasis, and each form has unique characteristics that allow dermatologists to visually identify psoriasis to determine what type, or types, of psoriasis is present. Sometimes a skin biopsy will be performed to confirm the diagnosis.
To choose the most appropriate treatment method, dermatologists consider several factors :
* Type of psoriasis
* Severity (the amount of skin affected)
* Where psoriasis is located
* Patient’s age and medical history
* Effects psoriasis has on patient’s overall physical and emotional
well-being
Types of Treatment
Psoriasis treatments fall into 3 categories :
* Topical (applied to the skin) – Mild to moderate psoriasis
* Phototherapy (light, usually ultraviolet, applied to the skin) – Moderate to severe psoriasis
* Systemic(taken orally or by injection or infusion) – Moderate, severe or disabling psoriasis
While each of these therapies is effective, there are also drawbacks.
Some topicals are messy and may stain clothing and skin. Phototherapy can require 2 to 5 weekly visits to a dermatologist’s office or psoriasis clinic for several weeks. Many of the systemic medications have serious side effects and must be combined or rotated with other therapies to maximize effectiveness and minimize side effects. Research is being conducted to find therapies that provide safe, effective, easy-to-use treatment options that provide long-term relief.
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