Psoriasis
- Introduction—What Is Psoriasis?
- Causes of Psoriasis
- Symptoms of Psoriasis
- Diagnosis of Psoriasis
- Complications of Psoriasis
- Treatment of Psoriasis
- Discussing Psoriasis With Your Doctor
- Additional Information and Resources for Psoriasis
Introduction—What Is Psoriasis?
Psoriasis is a lifelong inflammatory skin disease for which there is currently no cure. In the United States, as many as 7.5 million people have been diagnosed with psoriasis and it affects men and women about equally.
Symptoms of psoriasis usually appear between the ages of 15 and 35 years old6739 and often include red patches of skin covered by scales. These patches are called psoriatic plaques. Psoriasis can vary from mild disease, in which a person has isolated patches, to severe disease, in which lesions cover most of the body. These represent the extremes of the disease; most cases fall somewhere in between.1578, 1576, 1577, 1638
In some cases, fingernails and toenails are affected, which can cause pitting of the nail or may lead to the nail lifting or crumbling.6709 Depending on its severity, psoriasis can be a minor irritation of the skin or it can be painful and disabling.
Causes of Psoriasis
Psoriasis is not contagious. It is not caused by a bacteria or virus and is not transmitted through contact of any kind. The exact cause of psoriasis is unknown, but it is believed that a combination of several factors contribute to the development of the disease. These contributing factors include genetics (passed down through families), immune system malfunction, and environmental effects, which may trigger or worsen disease.1576, 1577, 1578
Psoriasis affects men and women about equally, but research has suggested that ethnic origin may be a factor. Psoriasis is more common among whites of northern European descent than among African Americans or Asians.1619, 6713, 6714, 1576, 6738, 1618 About one-third of people who have psoriasis have a family history of the disease.
Research has suggested that psoriasis may be linked to an overactive immune system, which causes skin cells to grow faster than usual. In skin that is not affected by psoriasis, the cells grow and reach the skin’s surface every 28 to 30 days. In skin that has psoriasis, skin cells grow more rapidly, within about 3 to 4 days. The overproduction of skin cells causes them to pile up on the skin, resulting in plaques and lesions. 6739
Some people who have a family history of psoriasis never develop the disease. Instead, research suggests that psoriasis is often triggered by some form of external event, which may include stress, skin injury, and reaction to certain medications or cold winter weather. 6712
Symptoms of Psoriasis
Most people with psoriasis are able to lead normal, productive lives, but sometimes the disease can be frustrating, even stressful. 6739
There are several different types of psoriasis, each with unique signs and symptoms.
Plaque Psoriasis
Plaque psoriasis is the most common form of the disease, affecting approximately 80% of psoriasis patients. Also known as “psoriasis vulgaris,” plaque psoriasis is characterized by red, raised, itchy patches of skin that vary in diameter from coin-sized to palm-sized or even larger. These patches are usually round or oval in shape, but can be irregular in shape, and are covered by silvery white scales. 6717 Patches may appear anywhere on the body, but most frequently occur on the scalp (approximately 50% of psoriasis patients have patches on the scalp) and are also common on elbows, knees, the base of the back, the navel, and the genitals.6712, 1619
Nail Psoriasis
Nail psoriasis affects as many as 50% of patients with psoriasis. 1628 It produces a variety of changes in the appearance of fingernails and toenails, which include discoloring under the nail (brown or yellow), pitting of the nails, lines going across the nails, thickening of the skin under the nail, and loosening and crumbling of the nail.6709, 1638
Intertriginous or Inverse Psoriasis
Intertriginous psoriasis commonly occurs at the same time as plaque psoriasis. This form of psoriasis most frequently affects the armpits, groin, under the breasts, and in the skin fold areas of the genitals and buttocks. It appears as red, smooth, moist, nonscaling areas of inflamed skin, which can be infected with bacteria.6717
Guttate Psoriasis
Guttate psoriasis accounts for nearly 18% of psoriasis cases. Most often, guttate psoriasis starts in childhood and young adulthood, and, while there can be other triggers, it commonly occurs after an upper respiratory infection. Guttate psoriasis appears as numerous small, droplet-shaped spots and patches ranging in diameter from 0.1 cm to 1.0 cm. This form of psoriasis generally affects the trunk area of the body and is less frequently found on the palms of the hands and soles of the feet. 6717, 6718
Erythrodermic Psoriasis
Erythrodermic psoriasis is the least common form of the disease, occurring in 1% to 2% of all cases. Rather than the distinct red patches that are seen with other types of psoriasis, this type of the disease causes large areas of the skin to become red and scaly. This reddening is often accompanied by severe itching or burning and pain. This type of psoriasis is significantly more common in men than women, and serious health complications can be associated with this form of the disease.6717
Pustular Psoriasis
Pustular psoriasis appears as red, pus-filled blisters on the skin. The blisters are often found on hands, feet, and fingertips. The blisters tend to dry up in a few days, but may reappear every few days or weeks. This type of psoriasis is more common in women than men and accounts for less than 2% of cases. 6718
Diagnosis of Psoriasis
Because psoriasis is a lifelong condition that can progress over time, it is important to get an accurate diagnosis and to understand the challenges and risks that accompany the disease. Although there is no specific diagnostic test for psoriasis, if you are experiencing psoriasis-like symptoms, you may wish to consult a dermatologist. The dermatologist will discuss your symptoms with you and may ask you questions about your family medical history to find out if anyone in your family has or has had psoriasis.
If your psoriasis symptoms are present it may be easier for the dermatologist to make a diagnosis. In some cases, the dermatologist may decide to take a biopsy, or sample of the affected skin, to examine under a microscope in order to make an accurate diagnosis and to rule out other types of skin conditions. 6739
Complications of Psoriasis
Scientific research has suggested that patients with psoriasis may have a higher risk of developing heart disease, diabetes, high blood pressure, and certain types of cancer.1596, 463 Psoriasis patients may also experience skin infections and psoriatic arthritis as a result of the disease.
Skin Damage
Psoriasis causes the skin to itch and flake. Hard scratching and skin abrasions caused by psoriasis may allow bacteria to enter, leading to skin infections. Abrasions, cuts, and scratches can also trigger the formation of additional plaques and lesions. 6736
Psoriatic Arthritis
About 10% to 30% of people with psoriasis may develop psoriatic arthritis. Psoriatic arthritis is similar to rheumatoid arthritis but generally milder. In psoriatic arthritis, the joints and the soft tissue around them become inflamed and stiff. Psoriatic arthritis can affect the fingers and toes and may involve the, neck, lower back, knees, and ankles. In severe cases, psoriatic arthritis can be disabling and cause irreversible damage to joints. If you have skin symptoms and develop pain and stiffness in your joints, talk to your doctor.6739
Treatment of Psoriasis
Psoriasis is a lifelong disease that has no specific cure. However, proper treatment may offer relief of symptoms, and may allow patients to maintain their quality of life.
People with psoriasis face the challenge of finding the right treatment among many choices. Each treatment has its advantages and disadvantages. A treatment that works for one patient may not be effective for another. Treatment decisions will be based on the severity of your condition and your response to previous treatment. Take the time to discuss the benefits and risks of available treatment options with your doctor before deciding on a treatment that is right for you.
Topical Therapies
Topical treatments, such as ointments and creams, are often used to treat signs and symptoms of mild to moderate psoriasis.8099 These include:
Anthralin
Coal tar
Corticosteroids
Moisturizers
Retinoids
Salicylic acid
Light Therapy
Light therapy, also called phototherapy, involves the use of natural or artificial light. The easiest way to employ light therapy is to expose the skin to the sun. Research has shown that moderate amounts of sunlight can improve symptoms of plaque psoriasis. The key is moderation, however, since sunburn can actually worsen psoriasis symptoms and put you at greater risk for skin cancer.
Psoralen UVA (PUVA) therapy is aUS Food and Drug Administration approved treatment that a physician will administer.4455 Psoralen is an oral and topical medication taken before exposure to ultraviolet A (UVA) light. This therapy helps to suppress the growth of skin cells in severe psoriasis. However, long-term treatment is not recommended since increased exposure to UV light can increase the risk of skin cancer.
Often physicians will use combination light therapy. This therapy combines UV light treatments with medications such as retinoids, coal tar, or anthralin.6746 The Goeckerman regimen, introduced in 1925 by Dr. William H. Goeckerman of the Mayo Clinic, combines the application of crude coal tar in an ointment base with exposure to ultraviolet B (UVB) light and is used for the treatment of mild to severe psoriasis. This treatment usually requires 3 to 4 weeks of therapy and is provided in a hospital or day treatment program. Other forms of this therapy are also used and are provided in a doctor’s office. Unfortunately, although the Goeckerman regimen is safe and effective, it is time-consuming, expensive, and can be messy and have a offensive smell. In addition, many patients may see a gradual return of their psoriasis to its original state after a year or so.6785
Oral Medication
Retinoids: the oral form of the vitamins D and A
Anti-inflammatory medications
Biologics
Some biologic medications can be used for the treatment of psoriasis. Biologics act to block the disease by targeting the immune system.
Nonmedication Treatments
Skin and Scalp Care
Keeping the skin clean, moisturized, and regularly exfoliated can help to relieve symptoms of psoriasis. Take lukewarm baths, and use soap that is made from fats and oils or that contains moisturizing oils. Apply a heavy, oil-based moisturizer to your skin after baths to prevent dry skin and reduce scaling. Moderate sun exposure can also help alleviate psoriasis symptoms. Always apply a sunscreen of at least SPF 15 to your skin, since too much sun can cause a burn. Not only does sunburn increase your risk for skin cancer, but it can also trigger psoriasis symptoms. 6734
For psoriasis of the scalp, there are medicated shampoos available, either over the counter or by prescription from your doctor. Such shampoos typically contain coal tar or cortisone, though some contain salicylic acid.
Nail Care
Whether you are gardening, exercising, cleaning, or washing dishes, protect your nails by wearing gloves and shoes. You can buy gloves specifically made for gardening, household chores, biking, and even lifting heavy objects. There are also water shoes available to wear at the beach or in the water.
Make sure your fingernails and toenails are kept short. They should be cut and filed down regularly.
The nail symptoms caused by psoriasis can leave nails vulnerable to bacterial and fungal infections. Crumbling and separating nails may expose the nail bed to injury. Therefore, it is very important to keep nails clean. Hands and feet should be washed with an oil-based soap that contains a moisturizer, and hands, feet, and the area around your nails should also be dried thoroughly.
Healthy-Weight Maintenance
Being overweight causes skin folds and therefore can increase your risk of inverse psoriasis, as plaques often appear in skin folds and creases. Make sure you follow a diet rich in fruits and vegetables, whole grains, and lean meats, as well as omega-3 fatty acids (e.g., salmon, soybean oil, spinach). If you combine exercise with a healthy diet, you can maintain your weight. It is important to consult with your physician before you begin any kind of exercise program. Eating healthy and exercising regularly can help keep your psoriasis symptoms under control. 7999
Stress Management
Stress can trigger psoriasis symptoms. 6736 The symptoms of psoriasis can also be a source of stress, embarrassment, and frustration for some people. It is therefore important for psoriasis patients to find healthy ways to cope with symptoms and to manage stress.
Some people choose to relieve stress through techniques such as meditation, massage, or yoga. Such relaxation techniques can help you focus your mind and relieve your stress. Others find relief in openly discussing their condition.
I’m Worried That My Psoriasis Will Harm My Social Life. What Can I Do?
Since psoriasis is a condition that affects your appearance, it can also affect how you feel about yourself and how you think others will perceive you. But there are things you can do to maintain an active social life, such as using a cosmetic cover-up to camouflage symptoms and learning to talk openly about your condition.
Cosmetic Cover-up
If you feel embarrassed about your psoriasis symptoms but do not want them to keep you from attending social events, cosmetic cover-ups are available that are formulated to hide skin symptoms. These cover-ups are available in a selection of colors. A sales clerk or cosmetic representative can even teach you how to apply it. It is important to check with your doctor before applying any cosmetic cover-ups to affected skin. They can be used for most types of psoriasis, but can cause further irritation in some types, such as pustular or erythrodermic psoriasis.
Some methods of managing nail symptoms include scraping and filing deformed nails and covering discolored nails with nail polish. You can also hide symptoms with certain types of clothing (e.g., long-sleeved shirts, turtlenecks, hats) or use moisturizers regularly in order to help improve the appearance of skin.
Open Communication
Psoriasis symptoms may make it difficult to attend social events or interact with others because they may seem afraid or may not understand your condition. Learning to talk openly and honestly about the disease may make others feel more comfortable with it and take away some of your own fear and anxiety.
Skin symptoms may also interfere with dating and long-term relationships. You may feel self-conscious or worry that your partner will find you unattractive. Such fears and misunderstandings can be avoided through communication. Explain that your condition is not contagious. Be direct. This will put you both at ease, and your partner will appreciate your honesty.
If you still feel uncomfortable talking about your condition with others, join a psoriasis support group, talk with a loved one, or write your thoughts in a journal. Look to loved ones who can help you regain or maintain a healthy self-image by giving you feedback and support.
It is important to know that you are not alone. Joining a support group with others who share your condition can also be an effective way to cope with stress. But if you decide to do so, you must be comfortable discussing your symptoms and feelings about your condition and be ready to listen to others. If you are not yet comfortable with this, individual counseling may be better for you. Your doctor may be able to recommend a therapist.
Reach out to others when you are feeling stressed or depressed about your condition. Having a support system of loved ones to talk to and who can lend a hand can help you cope better with your condition. Being open about your psoriasis at work and in personal relationships may help you to avoid the feelings of embarrassment or alienation that can sometimes lead to stress.
Discussing Psoriasis With Your Doctor
Your dermatologist will need to know about the effectiveness of your past treatments, as well as how psoriasis is affecting your quality of life. It’s often a good idea to write down any questions you want to ask your dermatologist before your appointment so you won’t forget to ask them during your visit. Your dermatologist will ask questions to help determine the most effective psoriasis treatment for you. If you don’t understand your doctor’s answers, don’t be afraid to ask for further explanation.
What treatments are you taking or have you taken in the past?
How satisfied are you with the results of these treatments?
How itchy, sore, painful, or stinging has your skin felt?
How embarrassed or self-conscious has your skin condition made you feel?
How much has your skin condition created problems with your partner, close friends, or relatives?
How much has your skin condition affected your social or leisure activities?
How much has your skin condition interfered with work or your studies?
How much has your skin condition or your treatments influenced the clothes you wear?
What are you looking for a new treatment to provide?
Additional Information and Resources for Psoriasis
Support Groups
There are a number of support groups for people with psoriatic diseases throughout the country. Visit the National Psoriasis Foundation website to find support groups and services in your area:
http://support.psoriasis.org/home/
Or, you can contact them at the following address:
6600 SW 92nd Ave., Suite 300
National Psoriasis Foundation
Portland, OR 97223-7195
Phone: 503.244.7404 or 800.723.9166
Fax: 503.245.0626
E-mail: getinfo@psoriasis.org
Research
American Academy of Dermatology: http://www.aad.org
This site offers up-to-date content and articles on research and treatments for psoriasis as well as many other conditions that affect the skin.
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): http://www.niams.nih.gov
The NIAMS site is affiliated with the US Department of Health & Human Services and features articles and information about treatment and clinical research as well as support and patient education for people with psoriasis.
Web Links
Psoriasis is a disease that is affects millions of Americans. There are many resources available for patients who need support with understanding psoriasis and its treatment. The following sites may prove helpful in understanding your condition:
Psoriatic Diseases.com: http://www.psoriaticdiseases.com This patient education site provides information about treating, managing, and living with psoriasis and psoriatic arthritis.
The National Psoriasis Foundation: http://www.psoriasis.org This site offers information about both psoriasis and psoriatic arthritis, including treatment, coping, lifestyle tips, and additional resources.
The Mayo Clinic on psoriasis: http://www.mayoclinic.com The Mayo Clinic site features information about symptoms, diagnosis, and treatment for psoriasis.
This concludes the discussion of the topic Psoriasis. We encourage you to read other topics on the MEDVERSATIONTM website.
Content on this page was last changed on January 13, 2010.
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