What is the definition of Psoriasis?
Psoriasis is a chronic autoimmune disorder affecting the skin that increases the growth rate of skin cells, causing inflamed, itchy, reddened patches with silvery scales, usually on the scalp, elbows, knees, trunk, and back. Psoriasis appears in cycles, with periods of remission followed by flare-ups that can last from weeks to months, and can also be associated with arthritis.
There are several types of psoriasis, including plaque psoriasis, nail psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, erythrodermic psoriasis, and psoriatic arthritis.
Plaque psoriasis – Plaque psoriasis is the most common form of psoriasis, which causes raised, reddened dry skin patches with silvery scales on the scalp, elbows, knees, trunk, and back that may be itchy or sore.
Nail psoriasis – Nail psoriasis appears as abnormal, discolored nails that have pitting (indentations). Severe cases of nail psoriasis may cause nails to detach from the nail bed (onycholysis) or nail disintegration.
Guttate psoriasis – Guttate psoriasis mainly affects children and young adults and is caused by a bacterial infection, such as upper respiratory infections like strep throat, that triggers small, drop-shaped psoriatic patches on the arms, trunk, and legs.
Inverse psoriasis – Inverse psoriasis is characterized by smooth, reddened skin patches in the skin folds of the breasts, groin, and buttocks caused by fungal infections that are worsened by sweating and friction.
Pustular psoriasis – Pustular psoriasis is a rare form of psoriasis that is characterized by generalized patches filled with pus, which usually appear on the palms of the hands and the soles of the feet.
Erythrodermic psoriasis – Erythrodermic psoriasis is the least common type of psoriasis and is characterized by red, peeling rash covering the whole body that itches or burns. This type of psoriasis can be caused by a severe sunburn or taking corticosteroids.
Psoriatic arthritis – Psoriatic arthritis affects the joints, causing stiffness, swelling, and pain that can further cause progressive or permanent joint damage. Psoriatic arthritis affects 10-20% of individuals with psoriasis.
What are the alternative names for Psoriasis?
There are several alternative names for psoriasis, including erythrodermic psoriasis, generalized pustular psoriasis, guttate psoriasis, inverse psoriasis, nail psoriasis, plaque psoriasis, psoriatic arthritis, psoriatic disease, and pustular psoriasis.
What are the causes for Psoriasis?
While the specific cause of psoriasis is unknown, the disease is believed to be an autoimmune disorder, meaning that it is caused by the body’s immune system attacking normal cells in a manner that causes increases the rate of turnover of skin cells, causing the skin to shed every 3-to-4 days, resulting in the reddened, scaly skin patches.
Researchers further believe that psoriasis my be genetic, as nearly half of patients with psoriasis have family members with the disease.
Psoriasis may also be triggered by environmental factors, such as certain medications (corticosteroids, lithium, high blood pressure medications, and antimalarial drugs), cold, dry weather, infections, skin injury, such as severe sunburn, stress, smoking and exposure to secondhand smoke, and excessive alcohol intake.
What are the symptoms for Psoriasis?
Symptoms of psoriasis can vary by individual and the type of psoriasis.
In general, symptoms of psoriasis can come and go, as the disease is characterized by periods of remission followed by flare-ups. During flare-ups, reddened, dry skin patches covered in thick, silvery scales appear, usually on the elbows, arms, knees, abdomen, and back, that may cause itching, burning, or bleeding. The sizes of the psoriasis patches can range from being very small (spots) to covering large areas of the body.
Nearly half of patients with psoriasis have abnormal, thickened nails that are pitted or ridged. Psoriasis can also affect the mouth or genitals. Some patients with psoriatic arthritis may also have stiff, swollen, and painful joints.
What are the current treatments for Psoriasis?
Since there is no cure for psoriasis, treatment is focused on reducing the inflammation and slowing down the rapid skin growth responsible for the psoriatic patches as well as removing the patches.
Treatments for psoriasis depend on many factors, such as the type of psoriasis and its severity, the patient’s age, overall health, the disease progression and response to medications, and preferred medications and therapies.
Treatments for psoriasis usually includes topical therapy (corticosteroids, Vitamin D analogues, retinoids, calcineurin inhibitors, salicylic acid, coal tar, Goeckerman therapy, and anthralin), light therapy, other oral or injected medications, biologics, and alternative medications and therapies.
Treatments for psoriasis usually begin with topical and light therapies, and then progress to systemic therapies.
Topical therapy – Topical therapy for psoriasis includes corticosteroids, Vitamin D analogues, retinoids, calcineurin inhibitors, salicylic acid, coal tar, Goeckerman therapy, and anthralin.
Corticosteroids – Corticosteroids can help reduce the inflammation of psoriasis and can be administered as a cream, ointment, gel, or foam and include the medications, triamcinolone (Acetonide, Trianex) and clobestasol (Temovate).
Vitamin D analogues – Vitamin D analogues (calcipotriene and calcitriol) are synthetic forms of Vitamin D that help decrease the rate of skin growth in psoriasis and may be combined with corticosteroids ointments or creams.
Retinoids – Retinoids (Tazarotend gel or cream) are derived from Vitamin A and can improve skin conditions in psoriasis.
Calcineurin inhibitors – Calcineurin inhibitors (Tacrolims and pimecrolimus ) help to reduce inflammation and plaque formation in psoriasis.
Salicylic acid – Salicylic acid can be administered via shampoos and scalp solutions to treat scalp psoriasis.
Coal tar – Coal tar helps to reduce the inflammation, itching, and scaling associated with psoriasis and can be administered via shampoo, cream, or oil.
Goeckerman therapy – Goeckerman therapy is a combination therapy of coal tar combined with light therapy that is more effective for psoriasis than either treatment alone.
Anthralin – Anthralin is a tar cream that can help to decrease the skin growth in psoriasis as well as remove the scales.
Light therapy – Light therapy is commonly the first line of treatment for moderate-to-severe psoriasis and can be used in combination with other treatments. Several types of light therapy can be used in the treatment of psoriasis, including sunlight, UVB broadband, UVB narrowband, Psoralen plus ultraviolet A (PUVA), and excimer laser therapy.
Sunlight – Daily exposure to sunlight (heliotherapy) may improve psoriasis.
UVB broadband – UVB broadband light therapy can be administered in controlled doses to treat psoriasis patches, body-wide psoriasis, or psoriasis that has not improved with topical therapy.
UVB narrowband – UVB narrowband may work better than UVB broadband and can be used two or three times a week to improve skin in psoriasis.
Psoralen plus ultraviolet A (PUVA) – This therapy for psoriasis uses both light therapy and medication to make the skin more receptive to treatment.
Excimer laser – This light therapy uses more powerful UVB light directed at only the affected skin in psoriasis.
Other oral or injected drugs – If psoriasis does not respond to topical or light therapies or is severe, other oral or injected drugs may be administered, and include methotrexate (Trexall) for psoriatic arthritis, the immunosuppressant, cyclosporine (Neoral), biologics (etanercept , infliximab , adalimumab , ustekinumab , secukinumab , and ixekizumab , which use the body’s immune system to improve psoriasis, and medications that are given when other drugs cannot be used, such as thioguanine (Tabloid), hydroxyurea (Droxia, Hydrea), and apremilast (Otezla).
Alternative medicine – Alternative therapies for psoriasis are focused on helping to ease the symptoms and may include dietary supplements, special diets, herbs, and creams and include aloe extract cream (reduces inflammation, redness, itching, and scaling), fish oil supplements (may reduce amount of psoriasis or scaling when combined with UVB therapy), Oregon grape (barberry; may reduce psoriasis severity), and essential oils to reduce stress and anxiety. However, it is always important to speak with your doctor first before using any alternative therapies.
As some patients may become resistant to some treatments for psoriasis, their doctor may periodically switch treatments.
What are the support groups for Psoriasis?
There are several online, local, national, and international support groups for psoriasis, including the following:
National Psoriasis Foundation Talk Psoriasis Support Community - https://www.psoriasis.org/talk-psoriasis
Psoriasis Speaks - https://www.psoriasis.com/
Talk Psoriasis by Inspire - https://www.inspire.com/groups/talk-psoriasis/
What is the outlook (prognosis) for Psoriasis?
Psoriasis is a chronic condition characterized by periods of remission followed by flare-ups that may last for weeks or month. While there is no cure for psoriasis, many treatments are available to help control the condition.
What are the possible complications for Psoriasis?
Individuals with psoriasis have a greater risk of developing eye conditions, such as conjunctivitis, blepharitis, or uveitis (red, inflamed eyes), obesity, type 2 diabetes, high blood pressure (hypertension), cardiovascular disease, other immune diseases, such as Crohn’s disease (inflammatory bowel disease; IBD), celiac disease, sclerosis, and mental health illnesses, such as depression.
When should I contact a medical professional for Psoriasis?
If you experienced any symptoms of psoriasis such as the appearance of reddened, thickened, raised skin plaques that may cause itching, burning, or bleeding, and that do not improve with over-the-counter medications, or if you experience joint swelling, pain, or stiffness, make an appointment with your doctor or a dermatologist as soon as possible.
How do I prevent Psoriasis?
While psoriasis cannot be prevented, it is possible to help reduce and control its flare-ups by controlling stress and anxiety, avoiding sunburn and cold, dry weather, and using appropriate skin moisturizers.