It is a disease in which red, scaly patches form on the skin, usually on the elbows, knees, or scalp.
Many people with psoriasis experience pain, discomfort, and self-esteem issues that can interfere with their work and social life.
Although the exact cause of psoriasis is unknown, researchers say the disease is largely genetic.
It is caused by a combination of genes that send the immune system into overdrive, triggering the rapid growth of skin cells that form patches and lesions.
Symptoms of psoriasis
Psoriasis can vary in severity, from mild patches to severe lesions that can affect more than 5% of the skin.
There are five types of the disease: plaque psoriasis, pustular psoriasis, guttate psoriasis, inverse psoriasis, and erythrodermic psoriasis.
Some people will have one shape, while others will have two or more.
This psoriasis appears as red patches covered with scales, or accumulated dead skin cells, called plaques.
It is the most common type of psoriasis, affecting up to 90% of all people with this disease.
Most often found on the scalp, elbows, lower back, and knees, the plates will be raised and have clear edges; They can also itch, crack, or bleed.
Postular psoriasis has white pustules (or white pus-filled bumps) on the skin. In a typical cycle, the skin turns red, breaks into pustules, and then develops scales.
There are three types of pustular psoriasis:
- Von Zumbusch pustular psoriasis (which comes on abruptly and may be accompanied by fever, chills, and dehydration).
- Palmoplantar pustulosis (which appears on the soles of the feet and hands).
- Acropustulosis (a rare form of psoriasis that forms on the tips of the fingers or toes).
The word guttate comes from Latin and means “drop.” This is a type of psoriasis that is tear-shaped and red in color.
Hundreds of lesions can form on the arms, legs, and torso, although they can also appear on the face, ears, and scalp.
Guttate psoriasis is the second most common type of psoriasis, occurring in about 10% of all people with the disease.
It is more likely to appear in people who are younger than 30 years old, often after they develop an infection such as strep.
This is a type of psoriasis that appears as smooth, bright red lesions in the armpit, groin, and other areas with skin folds.
Because these regions of the body are prone to sweating and rubbing, inverse psoriasis can be particularly irritating and difficult to treat.
It is a rare occurrence psoriasis, but may require immediate treatment or even hospitalization.
The lesions look like large “leaves” rather than small spots, as if the area has been burned, and they tend to cause severe itching and pain.
An attack can trigger swelling, infection, and increased heart rate.
Some people may have one form of psoriasis, while others may have two or more.
Symptoms such as nail changes also occur, about 50% of people with psoriasis experience changes in their fingers or toenails, such as pitting (the appearance of holes in the nail), thickening and discoloration.
The areas of the body normally affected by psoriasis are:
- Hands, feet, nails.
- Elbows, knees.
- Lower back.
- Skin folds.
Diagnosis of psoriasis
There are no special diagnostic tests for psoriasis.
Instead, a dermatologist makes a psoriasis diagnosis, who will examine the skin lesions visually.
In some cases, psoriasis can resemble other types of skin conditions, such as eczema, so doctors may want to confirm the results with a biopsy.
This involves removing part of the skin and looking at the sample under a microscope, where psoriasis tends to appear “thicker” than eczema.
Doctors can also keep a detailed record of your family’s medical history, as approximately one-third of people with psoriasis have a first-degree relative who also has the disease.
They should also try to identify triggers for psoriasis which include stress , infections like strep throat, cold and dry weather, sunburn, and certain medications like lithium.
There is no psoriasis treatment for everyone, and the drugs that work for some people may not work for others.
The goal, however, is the same: to find psoriasis medications that can reduce or eliminate bothersome symptoms.
These are some of the most commonly prescribed therapies.
Moisturizers are an important factor in treating psoriasis and may be all that is needed for mild psoriasis, they reduce dryness, cracking and peeling of the skin . They also reduce the need for active treatment.
A first-line form of treatment for mild to moderate conditions is topical cream, gel, and ointment that are applied directly to the skin to reduce inflammation and slow the growth of skin cells.
Some are available over the counter, such as products with salicylic acid and coal tar as active ingredients, while others such as calcipotriene, a form of vitamin D3 such as calcipotriol (Dovonex), calcitriol (Silkis) or tacalcitol (Curatoderm), and tazarotene (zorac), a derivative of vitamin A known as a retinoid, are available.
Special lotions are available for treating the scalp. These often contain salicylic acid, coal tar, sulfur, or corticosteroids.
Vitamin D scalp applications are also available.
Various forms of phototherapy are available.
The type selected is determined by the severity and location of the patient’s psoriasis, as well as the patient’s medical history.
Narrow band UVB
This treatment is safe, highly effective, and drug-free.
The patient is in a specially designed area that contains tubes of UVB light.
The affected areas of the body are exposed to UVB radiation for a short period of time (seconds to minutes). The effects are usually noticeable after seven to ten treatments.
PUVA (ultraviolet A psoriasis)
Before treatment, patients ingest a photosensitizing tablet and the affected areas of the body are exposed to UVA rays for a short time.
Laser treatment provides a concentrated, high-dose ultraviolet B treatment for psoriatic plaques.
Because treatment is limited to only the affected areas, the laser can safely deliver higher treatment doses than conventional UVBs, allowing for faster clearance of psoriasis.
If topical medications and phototherapy don’t work, doctors may recommend taking systemic medications.
These medications can be taken orally or by injection, and include cyclosporine , which suppresses the activity of the immune system and slows cell growth.
Acitretin, an oral retinoid or form of vitamin A that slows growth, and methotrexate , a drug that was originally used as a cancer treatment, but can also slow the growth of skin cells.
Biologics contain human or animal proteins and can block certain immune cells that are involved in psoriasis.
These drugs are intended to treat patients with moderate to severe psoriasis and patients with psoriatic arthritis.
Biologics block chemical messengers in the immune system that promote inflammation called cytokines.
All three types of biological compounds block tumor necrosis factor alpha cytokines, interleukin 12, interleukin 23, and interleukin 17-A.
Biologicals are administered through an intravenous injection, and unlike traditional systemic medications that affect the entire immune system, biologics target specific parts of the immune system.
They treat psoriasis by reducing inflammation in the skin and in other parts of the body.
Selection of a specific agent is based on the patient’s medical history, the presence or absence of psoriatic arthritis, and other factors.
Biological agents we prescribe include:
Alternative and complementary therapies
Some alternative therapies, including acupuncture, massage, energy therapies, meditation, Mindfulness or Mindfulness workshops, exercise, yoga, and Tai Chi, can help relieve certain psoriasis symptoms, such as pain.
They can also help manage stress , a common psoriasis trigger.
The treatment depends on the age of the patient, the state of health and the nature of the psoriasis.
Intensive research is underway to find better treatments for psoriasis and new treatments are regularly introduced that improve the condition in some people.