Everything You Need to Know About Psoriasis
Psoriasis is a fairly common skin disease caused by a problem within the immune system. This disease is chronic, which means it lasts a long time. It can last as long as a lifetime with symptoms that come and go. Certain triggers can worsen these symptoms. The symptoms tend to go through cycles of flaring for weeks or months and then going into remission or subsiding. Psoriasis most frequently impacts the knees, elbows, and scalp. Understanding the basics of psoriasis can make it easier to recognize the problem and seek a remedy to assuage the symptoms.
What is Psoriasis?
The skin disease known as psoriasis is responsible for causing patches that are red, itchy, and scaly. They occur most commonly on the elbows, knees, and scalp; less frequently they appear on the trunk, face, hands, feet, and neck. Less common varieties may impact the nails, mouth, or the area surrounding the genitals. This skin disorder causes the skin cells to multiply faster than normal; as much as ten times faster, in fact. (1) This is what causes the skin to build up into patches of bumpy red with a covering of white scales. While it has no cure, there are treatments available to aid in the management of symptoms. Lifestyle habit changes can also help, as can coping strategies.
According to a study in the Journal of the American Academy of Dermatology, roughly 7.4 million Americans suffer from psoriasis. The World Psoriasis Day consortium's findings have 2-3% of the world's population, or 125 million people the world over, as diagnosed with psoriasis. Not a problem of cosmetics, roughly 60% of Americans with psoriasis reported the disease as a significant problem in everyday life. (2)
Causes and Triggers
While no one is certain of the precise cause of psoriasis, experts hold that it is a combination of elements. Inflammation stems from something gone wrong with immune systems, triggering the too-rapid growth of new skin cells. Under normal circumstances, the body replaces its skin cells within a timeframe of 10-30 days. Psoriasis speeds up this process, growing new cells every three to four days. This buildup of old cells as they are replaced by new cells creates the silvery scales.
Various elements can trigger a person's psoriasis into an outbreak. These include emotional stress, medications such as beta-blockers for blood pressure and the antimalarial medication hydroxychloroquine, strep infections, and scrapes, cuts, or surgery. (3) Other triggers are infection, allergies, weather, and diet.
Types of Psoriasis
Knowledge of the type of psoriasis a person has allows them to work with their doctor in making a plan of treatment. Generally, people only have a single type of psoriasis at a time. On some occasions, when symptoms fade away, a new trigger causes a different form of psoriasis to develop. There are seven varieties of psoriasis. (4)
The most prevalent form of psoriasis, it affects 80-90% of those with psoriasis by developing plaques. Look for it in the outside of the elbow, the face, folds of the skin, hands and feet, knees, and scalp. It may also form on any portion of the skin where there has been damage or injury, such as sunburn, infection, scrape, or tattoo. Generally, when people speak of psoriasis, they are indicating plaque psoriasis.
Often starting in young adults or children, this rare form of psoriasis occurs in fewer than 2% of all cases. It causes small spots that are pink or red to appear on the skin of the trunk, thighs, scalp, and upper arms. This variety of psoriasis can recede within several weeks, even when the patient has not sought treatment. On other occasions, the spots are stubborn, requiring treatment.
Another uncommon variant of psoriasis, pustular psoriasis tends to appear in adults. It is responsible for forming pus-filled bumps, or pustules, that are surrounded by reddish skin. While they may appear infectious, they are not. In its rare cases, this type can show up on a particular part of the body. Hands and feet are one example. When it covers most of the body, it is known as generalized pustular psoriasis. This occurrence can be quite serious and should result in immediate medical attention. Its symptoms include nausea, chills, fever, muscle weakness, and an increased heart rate. Things that may trigger this type of psoriasis include topical medicine, sudden cessation of systemic drugs, pregnancy, stress, infection, chemical exposure, and lack of sunscreen leading to too much ultraviolet light.
This type of psoriasis is generally found in the armpits, beneath the breasts, the groin, or folds of skin surrounding the genitals or buttocks. The symptoms of inverse psoriasis include a worsening with sweating and chafing and patches of bright red skin that are shiny and smooth. These do not have the scales so typically found in plaque psoriasis. Triggers include sweating, friction, and fungal infections.
This least common type of psoriasis is extremely serious. It spreads over the majority of the body, causing fiery widespread swathes of skin with an appearance of having been burned. Symptoms also include an increased heart rate, alterations in body temperature, and severe peeling, itching, or burning. These symptoms may require treatment at a hospital. Erythrodermic psoriasis can be the cause of severe illness from loss of protein and fluids. Its victims may also develop an infection, congestive heart failure, or pneumonia. The triggers of this rare variant of psoriasis include allergic drug reactions, infections, severe sunburn, sudden cessation of systemic psoriasis treatment, and medications such as lithium, cortisone, and antimalarial drugs. It may also occur with hard-to-control psoriasis.
Symptoms of Psoriasis
The symptoms of this skin disorder vary according to the type each person has. The most common variety is plaque psoriasis. Its main symptom is plaques of reddish skin, frequently covered with scales of a silvery hue. Such plaques may itch or be painful. Sometimes they crack, causing them to bleed. In the most severe cases of plaque psoriasis, the plaques grow, merging to cover large patches. Another symptom is a disorder of the toenails and fingernails. This features discoloration or pitting of nails. Nails can even crumble or become detached from the nail beds. A final common symptom is plaques of crust or scales on the scalp.
When people have psoriasis, they may also develop a variety of arthritis known as psoriatic arthritis. The symptoms of this include swelling and pain in the joints. According to the National Psoriasis Foundation, an estimated 10-30% of those with psoriasis also suffer from psoriatic arthritis.
As many as half of the people who have psoriasis also experience changes to the nails. Nail psoriasis is still more frequent in occurrence in those who have developed psoriatic arthritis. Symptoms are pitted nails, nails that are tender or painful, separation of the bed and the nail, chalk-like material beneath the nails, and color changes, such as yellowish-brown. With nail psoriasis, people have a heightened risk of fungal infections.
In this condition, a person has both psoriasis and joint inflammation, or arthritis. In almost three-fourths of cases, people have had psoriasis for around ten years prior to developing psoriatic arthritis. Roughly 90% of people with this condition also have changes to the nails. Symptoms are stiff and painful joints that worsen after rest, such as in the morning upon waking; swelling of fingers and toes until they are sausage-like, and joints that are warm and possibly discolored.
Treatment options depend on the type and severity of the psoriasis. While some can manage the symptoms of psoriasis by avoiding triggers and the use of over-the-counter corticosteroid creams, others may need prescribed medications. Options include:
- Topical Treatments
- Systemic Medications
- Light Therapy
- Psoriasis Medications
- Immune System Suppressants Recognizing the type and severity of the psoriasis symptoms that have appeared helps to communicate with a health professional about diagnosis and treatment options. Psoriasis can make life difficult, but certain steps and treatments assist in making it more manageable once again. While the flare-ups can be discouraging and lead to a downward spiral of the skin disease causing stress which worsens the skin disease, breaking the cycle is possible.
- (1) Psoriasis, CDC, https://www.cdc.gov/psoriasis/index.htm
- (2) Psoriasis prevalence among adults in the United States, Journal of the American Academy of Dermatology, https://www.jaad.org/article/S0190-9622(13)01268-1/fulltext
- (3) Psoriasis, WebM, https://www.webmd.com/skin-problems-and-treatments/psoriasis/understanding-psoriasis-basics
- (4) 7 Types of Psoriasis, WebMD, https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-types
- (5) What are the symptoms of plaque psoriasis, Medical News Today, https://www.medicalnewstoday.com/articles/323225#treatment-and-diagnosis