Psoriasis is an autoimmune condition which causes the rapid development of cells on the skin. This overgrowth can result in dense, scaly plaques, which can itch or cause discomfort.
Various types of psoriasis differ, depending on the size of the scales and their position on the body. More than 8 million people in the USA have psoriasis.
Environmental causes also cause the psoriasis symptoms to flare up. Although a person can not cure such symptoms, recent developments in the treatment of psoriasis mean they can reduce the number of flares and their frequency.
In this article we describe the various types of psoriasis, their symptoms and how to treat them.
Symptoms
Psoriasis ‘ main symptoms are red, flaky, crusty spots, which may cover them with easy-shed, silvery scales. These could also trigger an extreme scratching or burning sensation.
Symptoms of psoriasis develop in flares that occur as these clear up for different lengths of time with periods of remission in between. The duration of remission last an average of 1–12 months at a time.
Though, the length of both flares and recovery cycles can be difficult to predict.
Symptoms range from mild to severe, and may occur differently depending on the psoriasis type.
According to the National Psoriasis Foundation:
- mild psoriasis covers less than 3% of the body
- moderate psoriasis covers 3–10% of the body
- severe psoriasis covers in excess of 10% of the body
Plaques may grow anywhere but commonly occur on the elbows, knees, lower back and scalp as small patches.
Types
Many types of psoriasis exist, as listed below.
Plaque psoriasis
Plaque psoriasis occurs in about 80–90 percent of people with psoriasis. This usually shows red lesions as swollen, inflamed, lined with silvery, white scales, mostly on the elbows, knees, scalp, and lower back.
Inverse psoriasis
Inverse psoriasis develops in the following areas:
- the armpits
- the groin
- under the breasts
- other skin folds, such as around the genitals and buttocks
Inverse psoriasis has red lesions, usually without the psoriasis in plaque sizes. The lesions could be smooth and glittering.
Irritation caused by rubbing and sweating can worsen this form of psoriasis because of its position in skin folds and tender areas. It is more common in overweight people, and those with deep skin folds.
Erythrodermic psoriasis
Erythrodermic psoriasis is an particularly inflammatory but uncommon form which can cause large areas of fiery redness across the body’s surface.
People with unstable plaque psoriasis can develop erythrodermic psoriasis, where lesions don’t have clearly defined edges. Exfoliation, or skin peeling, serious itching, and discomfort may also be present.
The erythrodermic psoriasis interferes with the chemical balance of the body. This intervention can result in loss of protein and fluid, which can lead to severe illness.
There may also be edema, or swelling due to fluid retention. The complication should probably develop around the ankles. It may be difficult for the body to regulate its temperature which can induce shivering.
Erythrodermic psoriasis can also lead to congestive heart failure and pneumonia.
The symptoms of psoriasis erythroderma can be severe. Anyone showing signs of this condition will see a doctor immediately.
If symptoms are serious, people with erythrodermic psoriasis may spend time at hospital.
Guttate psoriasis
Guttate psoriasis frequently starts in infancy or adolescence. It appears on the skin as tiny, red, single spots. Typically the patches are not as dark or crusty as the plaque psoriasis lesions.
There are a number of conditions that may cause guttate psoriasis including:
- upper respiratory infections
- streptococcal infections
- tonsillitis
- stress
- injury to the skin
- certain medications, including antimalarials, lithium, and beta-blockers.
Guttate psoriasis can resolve and never return without treatment.
Pustular psoriasis
Pustular psoriasis affects adults more than children, and represents less than 5 percent of cases of psoriasis.
This occurs as white pustules, or non-infectious pus blisters, which cover red skin. Of example, it can impact certain areas of the body, the hands and feet, or most of the body. It is not an illness, but infectious.
Pustular psoriasis appears to have a period in which skin reddening is accompanied by the development of pustules and scaling.
Although psoriasis can develop anywhere on the human body, some of the most common areas are described below.
Complications
Psoriasis can give rise to other health problems. While some people believe it to be a skin disease, psoriasis can also affect bones, muscles, and the metabolic system.
Psoriatic arthritis
Up to 30 percent of psoriasis patients experience joint inflammation with arthritis symptoms, known as psoriatic arthritis.
This form of psoriasis causes the joints to become inflamed and increasingly weakened. It most often occurs when people are between the ages of 30 and 50 years.
Other complications
Those with psoriasis can experience social exclusion, problems with their appearance and low self-esteem. This can affect on their overall quality of life along with the physical discomfort, scratching, and pain of psoriasis.
Depression and anxiety may contribute to the social and physical demands of this chronic disease. People with psoriasis are at twice as high a risk of depression as those who don’t have the disease.
Psoriasis may also lead to an increased risk of cardiovascular disease, metabolic syndrome, diabetes, and certain types of cancer, including cancers of the head and neck, and digestive tract tumours.
Causes
While it is still uncertain the cause of psoriasis, scientists believe it is an autoimmune disease.
Autoimmune diseases affect the immune system, which develops T cells against infectious agents to protect the body.
In people with psoriasis, triggers that contribute to their genes giving the immune system instructions to destroy the wrong cells. T cells respond to a stimulus like they fight an infection or heal a wound. They make chemicals which cause inflammation.
This autoimmune condition, in psoriasis, contributes to excessive skin cell growth. Skin cells typically take about 21–28 days to replace themselves. They take about 2–6 days, however, for people with psoriasis.
In each patient with psoriasis, triggers will be different but common triggers include:
- stress and anxiety
- injuries to the skin
- infections
- hormonal changes
Medications that can trigger a psoriasis flare include:
- lithium
- antimalarials
- quinidine
- indomethacin
Several people associate psoriasis with allergies, diet, and environment but these ideas have not yet been supported by any evidence.
Psoriasis is not infectious, substantially. Understanding this can help people with the disease deal with the more difficult socializing sections.
Risk factors
Some factors increase the risk of a person developing psoriasis.
These factors include:
- having cardiovascular disease and metabolic syndrome
- trauma to the skin
- family history of the condition
Approximately 1 in 3 individuals with a close relative having psoriasis will also acquire the disease. When one parent has psoriasis, the risk of their child having the disease is 10 percent. If both parents have psoriasis, this risk increases to 50 percent.
This familial connection suggests a genetic dimension underlying it. The disease’s signs may not appear, however, unless an environmental factor causes it to become active. At least 10 percent of the population may have the psoriasis-causing gene, but only 2-3 percent of people do develop it.
Psoriasis can flare up among younger people following an infection, especially strep throat. Symptoms will become apparent in 33–50 per cent of young people with psoriasis 2–6 weeks after an earache or respiratory infection. Common infections with the respiratory system include strep throat, bronchitis and tonsillitis.
Psoriasis is common in both males and females alike. It can start at any turn but between 15–35 years it is most popular. The average start time is 28 years.
About 10–15% of people with psoriasis develop the disease before they age 10.
Diagnosis
Blood tests can not prove psoriasis.
A person who has a recurring rash that doesn’t cure psoriasis with over- the-counter (OTC) treatments may want to talk to a doctor. Recognizing and treating symptoms early on often improves long-term psoriasis outcomes.
A doctor will examine the symptoms and ask about family history and personal history. You may also have a skin biopsy done to rule out other diseases, such as eczema.
Treatement
If a doctor discovers a psoriasis, the form and severity of the disorder may depend on the diagnosis. Medications and phototherapy are main choices.
People with psoriasis should use emollients when taking other medications, to keep the skin moisturized. Such measure may help to reduce scratching and discomfort, and may reduce the number of lesions or plaques that occur.
Medications
In people with psoriasis there is a variety of topical, oral, and injected drugs.
Many OTC remedies that help to relieve the very mild psoriasis symptoms. Including:
- Oal tar: This may help to soothe plaque psoriasis, scratching, and scalp, palm and sole lesions. People may use coal tar alone or in addition to another treatment.
- Creams with hydrocortisone: These reduce inflammation and soothe itching.
- Salicylic acid: This, often in people with scalp psoriasis, can help reduce swelling and dissolve scales.
- Anti-itch agents: products containing calamine, hydrocortisone, camphor or menthol may be included.
Topical therapies
People directly apply the topical treatments to the skin. Usually, it is the first-line treatment for mild to moderate symptoms aimed at slowing the growth of skin cells, reducing inflammation and calming itching or discomfort.
All treatment are available on prescription or over the counter and include nonsteroids and steroids.
- Corticosteroids: They have been used by people for decades to combat psoriasis. Many different steroids, such as gels, foams, creams, sprays, and ointments are available. Here the National Psoriasis Foundation provides a guide to recognizing the effects of corticosteroids.
- Synthetic vitamin D: This is often used as a corticosteroid by humans. It can help flatten plaques, slow skin cell development and remove scales.
- Retinoids: This is synthetic vitamin A, which can help slow skin cell growth, minimize redness and soothe itching. Tarazotene, a topical retinoid, is commonly combined with corticosteroid medication, or UVB light therapy.
- Pimecrolimus cream and tacrolimus ointment: These are eczema remedies that may be prescribed by a doctor to help with symptoms of reverse and plaque psoriasis. Users also pair these with a steroid course.
Systemic therapies
Systemic treatments operate through the entire body system, and are prescribed by doctors for people with moderate to severe psoriasis and psoriatic arthritis. They diminish the severity of sickness and the regularity of flares.
Biologics: These are medicines focused on proteins that are derived from living cells. Biologics target the psoriasis and psoriatic arthritis induced T cells and inflammatory proteins.
At least 10 biologics have been approved by the US Food and Drug Administration (FDA). Those include etanercept, adalimumab, and infliximab.
Biology is successful, and its benefits far outweigh its risks.
When pursuing biological care, however, people should consider costs, and it is wise to speak to an insurance provider about possible protection.
Methotrexate: Doctors prescribe this for psoriasis that is extremely severe and limits everyday activity and does not lead to any other medications. Methotrexate is involved in the treatment of psoriatic arthritis, erythrodermic, palmoplantar, and nail psoriasis.
Cyclosporine: This is usually prescribed by doctors to avoid organ rejection following transplants. But it can also help people with severe psoriasis presentations of the following types:
- plaque
- guttate
- erythrodermic
- generalized pustular
- palmoplantar
Oral retinoids: People with severe psoriasis can take a drug called acitretin which works against the bodywide effects of the disease. It does not impair immune function, making acitretin healthier for HIV-positive people also with severe psoriasis.
People with psoriasis of all forms except the inverse psoriasis may benefit from oral retinoids.
Off-label medications
Doctors may prescribe certain off-label drugs if symptoms have not been resolved by the standard FDA-approved drugs, or if the individual has another condition that prevents the use of specific drugs.
Active off label psoriasis solutions include:
- azathioprine
- 6-thioguanine
- fumaric acid esters
- hydroxyurea
- tacrolimus
Phototherapy
Phototherapy requires daily exposure of the skin under medical supervision to ultraviolet light. The light will slow the growth of cells, suppress immune activity and decrease irritation.
People can use a lightbox or handheld device to conduct phototherapy at home, if their initial treatment is successful.
Before exposure some people might need to take psoralen pills to make their skin more sensitive to light.
Phototherapy should not be used by anyone who has coexisting conditions that make them sensitive to light, such as lupus or previous cases of skin cancer.
Home remedies
Psoriasis flares can not be prevented, but some techniques can help to reduce the likelihood of incidence of a flare.
Tips include:
- reducing stress with yoga, exercise, meditation, or all of these
- eating a balanced diet and maintaining a healthy weight
- recognizing and avoiding food triggers
- joining a support group or blog to talk to others with similar experiences
- not smoking or drinking alcohol to excess
Home remedies for reducing itching include:
- Keeping the skin moisturized. A dermatologist can recommend a suitable product.
- Taking a cold shower for up to 10 minutes or using a cold pack. Avoid hot showers, as they can dry the skin
While psoriasis can be isolating and painful, people have many ways to control symptoms and improve the disease’s immune response.
Question:
Is psoriasis similar to eczema? How do I know the difference?
Answer:
Eczema and psoriasis may seem similar in their early stages with each appearing to be swollen, inflamed areas of the skin that itch.
With time, it will become very clear what kind of disease you have, because psoriasis will manifest in specific areas, such as the elbows and knees, as well as forming silvery scales. Eczema tends to get inflamed due to an irritant and will not develop the silvery scales typical of plaques with psoriasis.
In either case, people should find a dermatologist for diagnosis and treatment as the emotional toll of scratching, sleeplessness and appearance can affect not only the daily life but may also make the condition worse.
Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
