What Is Psoriasis? Causes, Types, Symptoms & Treatment – All You Need To Know

What is Psoriasis
Editor's Note: This article has been recently updated with latest information and research studies.
 

What is Psoriasis?

Psoriasis is a common, immune-mediated skin disease with red, scaly patches which often itch. The disease varies from minor patches to severe complete body coverage. The most common type of psoriasis is a plaque with red and white patches which can be found on a top layer of the skin. It appears as a silvery-white and mainly occur in elbow and knees but also in any area.

Psoriasis is not entirely a skin disorder but it develops when the immune system makes overproduction of the new skin cell. Although the disease is not contagious, it increases* the risk of diabetes, cancers and cardiovascular diseases. It can get easily worsen due to climate, stress, dry skins and infection. Currently, there is no cure* for the disease but to control. It is a long-term skin chronic skin conditions as it has a recurrent nature which make is unable to treat*.

What are the Types of Psoriasis

There are basically 6 types of Psoriasis seen to affect people from different ages. The names and a brief description of each type are given below:

  • Plaque Psoriasis: Also known as Psoriasis Vulgaris is the most common type of psoriasis that is seen to affect people. It involves the emergence of red inflamed patches over the skin (mostly over the elbows, scalp, and knees). These patches are often a bit itchy and painful.
  • Guttate Psoriasis: It involves the formation of red inflamed dots over the skin (mostly over the chest and on the back). This form of psoriasis is seen to affect people below the age of 30.
  • Pustular Psoriasis: It involves the emergence of several white pustules that are surrounded by red skin. It is mostly seen to appear over the palms but can also appear on other parts of the body such as the chest, back, and ankles.
  • Inverse Psoriasis: This form of psoriasis involves the formation of red non-inflamed lesions over the skin. It is mostly seen to appear over the armpits and on the groin.
  • Erythrodermic Psoriasis: This is the least common and the most severe form of psoriasis. It involves the formation of several inflamed lesions in the body along with widespread redness. These lesions are often very itchy and painful.
  • Nail Psoriasis: This type of psoriasis usually affects people who already have some form of psoriasis in them. It involves the alteration of size and shape of both finger and toe nails.

Oral Psoriasis

  • It is a rare form of psoriasis and commonly involve in mouth and skin. It is also known as mouth psoriasis. It appear as white or grey-yellow plaques. Fissure tongue is the most common form of oral psoriasis. When psoriasis occur in the lining of the mouth, it becomes asymptomatic. Some of the symptoms of mouth psoriasis are recurring attack of skin rash on mouth, red patches, red plaques, bleeding skin from scratching, itching and emotional distress.

Psoriasis Arthritis

It has a painful inflammation of joints especially in finger and toenail which can result in sausage-shape swelling. It can also affect hips, knee and spine joints. It is mostly associated with nail and skin psoriasis. There are five types of psoriasis arthritis.

  • Symmetric Psoriasis Arthritis – Mild condition that affect the same joints
  • Asymmetric Psoriasis Arthritis – Involve one to three joints but does not affect matching pair of joints on both sides of the body.
  • Distal Interphalangeal Predominant (DIP) – Include small joints on the fingers and toes.
  • Spondylitis – Affects spinal column and cause inflammation and stiffness in the back, neck and pelvic area.
  • Arthritis Mutilans – Uncommon arthritis that affect small joints as well as lower back and neck pain.

Scalp Psoriasis

It is common skin order that has reddish, scaly patches on the scalp. It is not contagious but it can spread from the scalp to forehead and at the back of the neck to behind the ears. There is no known cause of scalp psoriasis and assumption is that immune system gone wrong producing skin cells rapidly and forming patches. It is a mild skin condition but in the long term could affect skin infections and hair loss.

What are the Risk Factors for Psoriasis?

Psoriasis is not contagious. It is usually triggered within a person through a number of factors working individually or simultaneously. The factors that are often associated with the development of Psoriasis are as follows

  • Smoking: Besides being one of the prime causes behind increased rates of heart attack and lung cancer, smoking is also held responsible for contributing to the development of psoriasis. Recent studies lead by distinguished doctors and researchers have shown that a smoker possesses higher risk of developing psoriasis compared to a person who does not smoke. Smokers are usually vulnerable to a particular type of psoriasis known as the Pustular Psoriasis. This type of psoriasis involves the emergence of few painfully inflamed pustules beneath the feet and on the palms. Since psoriasis is an autoimmune disease, smoking increases* the risk of developing psoriasis by inflicting damage to the immune system. The nicotine from cigarette smoking is found to cause alteration in regular proliferation of certain immune cells (such as T-cells) and thus can trigger an outbreak of psoriasis.
  • Skin Injuries: Certain skin infections, cuts or bruises and deep sunburn are often associated with the development of Psoriasis.
  • Stress: Emotional stress due to certain events such as the sudden death of a beloved one or an important upcoming exam can affect a person’s mental condition and thus initiate psoriasis within a person. A job that is physically demanding (such as construction working) can also trigger psoriasis.
  • Infections: A particular infection known as the Streptococcal Infection is often found to trigger the development of psoriasis within a person. Streptococcal infection leads to a particular type of psoriasis known as the Guttate Psoriasis. This psoriasis leads to the emergence of small inflamed spots over the skin and is mostly seen to occur among young people.
  • Family History: Psoriasis can also be inherited from parents by the children. There are few cases and medical statistics that suggest that if one of the parents has Psoriasis, then there is 10% probability that the child born will also develop psoriasis. This probability jumps to 50% if both the parents are psoriasis patients.
  • Obesity: There is no evidence which suggests that psoriasis is often triggered due to obesity. Though there is some evidence that suggests a possible link between obesity and psoriasis. Among the psoriasis patients who have an overweight problem, an attempt to reduce* their body weight through regular exercises was proven to be quite helpful for them. Psoriasis patients suffered less from the lesions in their skin and reported to experience lesser pain when they succeeded in reducing* a substantial amount of excess body weight.
  • HIV Patients: Many HIV patients who are in an advanced stage of HIV can develop severe forms of psoriasis. There is a higher possibility that HIV positive psoriasis patients will also develop psoriatic arthritis.

Why Does Psoriasis Come Back Again?

Psoriasis, as already mentioned, cannot be completely eradicated from the body. It may go into remission once the underlying trigger or symptom is dealt with but because of its genetic nature, it can quickly rear its head again if the patient becomes exposed to another trigger such as dry, cold weather; infections; injuries; certain medication; excessive smoking/drinking etc.

What are the Symptoms of Psoriasis?

Psoriasis symptoms are vary depending on the condition of the disease. In a mild condition, small rashes appear on the skin. On the other hand, in a moderate and severe condition, red patches can be seen with silvery top scale on the skin.

Often psoriasis causes swollen joint and tender and becomes painful. This is known as psoriasis arthritis. The condition also affects finger and toe nails which exhibit small pits. Symptoms of psoriasis often disappear without treatment and flare up again. It is easier to diagnose by looking at it.

Guidelines to Manage The Symptoms of Psoriasis

Here are some steps to follow and practices to observe in order to deal with your psoriasis effectively and smartly:

  • Psoriasis can be aggravated by dry conditions which causes itchiness and irritation on the skin. Therefore, moisture is your best aid in dealing with itchy skin. By using moisturizing products including emollients, you will get rid of the itchiness which would otherwise lead to scratching that in turn would make your psoriasis much more noticeable.
  • Short, regular exposures to natural sunlight are needed by psoriasis patients to build up their vitamin D levels since it is good at combating flare ups of psoriasis symptoms. Obviously, extended contact with direct sunlight requires the use of sun screen but direct contact with sunlight of about 10 minutes at a time is good enough to maintain healthy levels of vitamin D necessary for tackling psoriasis.
  • You should also discipline yourself into not picking on the scabs and dried skin that results due to psoriasis. Only after adequately softening the affected areas through moisturizing should you remove* the crusted parts of the skin. It is an impulsive reaction to remove* dead skin but you may inadvertently damage the healing skin below it and make your condition worse if you do this. While removing* this skin, even after softening it, stop immediately if you feel opposition or discomfort in the region since it indicates that you’re damaging good skin as well. It is best to consult a dermatologist before trying to remove* your skin on your own since they can teach you the right way of doing this.
  • Be ready to try out several different treatments for psoriasis because there is no one-size-fits-all method of dealing with it. In fact, you may even require a combination of treatments to get the symptoms under control. What works for one person suffering from psoriasis may not be effective for you, so you may have to spend some time and effort while discovering a treatment plan that suits you in particular. UV therapy can also be employed but it is an in-office, costly procedure which should only be considered a last resort.
  • If you feel hindered in your daily activities due to psoriasis symptoms you should consider using outfits and body makeup to conceal them so that you are able to conduct daily business with normalcy. You can also join support groups to discuss your daily experiences with those who suffer from the condition as well if you find it difficult to cope with it on your own.

Other Symptoms

Symptoms of psoriasis are different and vary from type to type. Major common symptom include

  • Usually found in elbow, knee and low back as bright red patches as well as loose silvery scales
  • There is bleeding when skin is picked or scraped off
  • Itching, it can be severe in some psoriasis
  • Discolored and pitted nails
  • Joint pain and swelling, tenderness
  • Patches appear after a cut and a burn

What Causes Psoriasis?

Genetics
It can be found that one-third of the patient suffering from psoriasis has a family history of the disease. The underlying cause is that genes mutation causes cells to function differently.

Immune System
The main cause of immune system is white blood cells also known as T cells become overactive. It attacks and multiplies on the skin rapidly that they start to stack up on the surface of the skin. In addition, normal T cell produces chemical that heals the skin. However, in psoriasis, it produces a large amount excessive chemical that causes inflammation of skin and joints.

Environmental

Often psoriasis can be related to environmental factors. Common factors are

  • Weather – Expose to direct sunlight and cold in winter can cause the rash and worsen in cold weather.
  • Skin Injury – Abrasion, sun burn, drug and viral rashes are injuries that can be followed up by psoriasis. It may take two to six weeks for the disease to develop and known as Koebner phenomenon.

Stress

Psychological stress is one of the factors to cause psoriasis. Even though the exact cause of stress related to the disease is unknown, daily stressful life can often trigger psoriasis to flare up.

Infection

It is one of the factors that flare up psoriasis. The disease is severe in people with HIV and often it exhibits the symptoms of the disease.

Low vitamins

Vitamins D is the medication to treat* psoriasis. However, low in vitamin C flare up psoriasis.

Drug

Medications such as beta blockers, lithium, Indocin, chloroquine are drugs that induce and flare up psoriasis.

Overview on Causes of Psoriasis

Psoriasis is a skin condition characterized by overachieving skin cells – they mature five times faster than normal skin cells and unlike the latter, which slough off naturally, these overactive cells continue to pile up on the surface of the skin, at a rate comparable to snow piling up in a snowdrift. There are a number of reasons why this happens but this abnormal behavior of the skin’s cells is believed to be related to both genetics and environmental triggers that cause the immune system to mistakenly kick into action – thus resulting in psoriasis.

Immune System

Originally, this condition was believed by dermatologists to be a hyperproliferative disease meaning that it was just an abnormality in which the skin produced excessive quantities of skin. So the treatments at that time were targeting this problem. In ’79, however, there was a chance discovery of the relation between the immune system and psoriasis when patients undergoing bone marrow transplants for treating other diseases were given medication to suppress* their immune system which resulted in their psoriasis going away.

Ever since then, dermatologists have known that a malfunction or abnormality in the immune system is responsible for psoriasis. Specifically, T cells – a classification of white blood cells, are at the center of it. They overgrow and attack the region of skin affected by psoriasis. They are often observed beneath the plaque when psoriasis is biopsied.
While the usual function of the immune system is to protect the body from foreign invaders, in a person who suffers from psoriasis, the immune system encourages inflammation and rapid growth of skin cells. Cytokines, which are proteins that the immune system uses to communicate, get their signals scrambled, which causes the skin cells to keep piling up leading to a thickened skin, inflammation and increased blood flow.

It is for this reason that many recent treatments for psoriasis aim to inactivate or contain T cell activity which is responsible for the skin’s hyperproliferation. It isn’t clearly understood what exactly is responsible for triggering T cell activity or their overzealousness, but genes are thought to play a part.

Role of Genes

One in ten people have genes which make them more prone to getting psoriasis. In spite of this, people who suffer from psoriasis usually don’t have any family history with the condition. So even though there is undeniably a genetic connection, it isn’t clear cut.

Neither is it a simple genetic program such as blue or green eyes that are passed hereditarily in a family, nor a strict genetic disease such as cystic fibrosis. At best, it can be thought of as a tendency towards the condition, which is caused by a number of genetic changes. For instance, erroneous DNA chemical can lead to absent, misplaced or misshapen proteins.

In order to actually get psoriasis, the person must possess a combination of several genes. This combination is being studied by researchers to identify all the genes which are necessary. If they are successful, the causes of the condition will become far more apparent.

There is a considerable proportion of the population which has genes which puts them at a risk of psoriasis. But only 2-3 percent of this proportion actually develops psoriasis, because along with a genetic predisposition, specific triggers are also needed to fully amplify the tendency of getting the condition.

What Triggers Psoriasis?

There are plenty of external factors responsible for worsening the symptoms of psoriasis. Once you are aware of them, you can work to minimize you exposure and thus reduce* the risk of worsening your skin condition.

  • Stress: Psoriasis patients frequently report particularly bad outbreaks of the conditions symptoms during times of hardship or crisis which lends credibility to the belief that stress is a trigger for the condition.
  • Injuries: Injuries to the skin – skin trauma – such as cuts, burns, bruises, bumps, tattoos, vaccinations etc. can aggravate the symptoms of psoriasis at the injury site. “Koebner phenomenon” is the name given to this condition.
  • Infections: Some infections such as tonsillitis or strep throat can lead to guttate or other forms of psoriasis. Those suffering from HIV may also suffer from aggravated symptoms of the condition.
  • Certain Medications: Medicines such as lithium (used to treat* bipolar disorder), malaria drugs as well as certain beta-blockers (used for treating hypertension, heart disease and a number of heart arrhythmias, can lead to aggravation of the symptoms of psoriasis.
  • Cold Weather: Cold weather accompanied by a dry spell can cause the skin to dry out which increases* the risk of aggravation of psoriasis. Conversely, hot and sunny weather seems to limit psoriasis symptoms in most people.
  • Smoking: A number of experts believe that smoking can lead to a flare up of psoriasis symptoms.
  • Heavy Alcohol Consumption: Excessive consumption of alcohol, in men at least, is thought to increase* the chances of aggravation of psoriasis.

There are plenty of treatments – medicinal, light and alternative – available for dealing with various types of this condition but it can be challenging to cope with the stress at times, especially if it covers large portions of your body. You should consider learning as much as you can about psoriasis triggers so you are better able to prevent flare ups and thus maintain normalcy even while undergoing treatment.

What are the Treatments for Psoriasis?

Depending on the stages of the disease, psoriasis are able to treat* with a simple cream or lotion to injection and light therapy. It is best to consult with dermatologist or rheumatologist to treat* psoriasis and psoriasis arthritis.

Biologic Drugs

The drug is the protein-based culture in the laboratory. Biologic treat* specific target areas of the disease instead of having an impact on the entire immune system in a traditional way. It attacks and blocks T-cells which play a major role in developing psoriasis. It is taken by injection of IV fusion. At the same time, every drug has its own side effect. For biologic flu-like symptoms, respiratory infections, as well as injection site reactions, can be found.

Systemic Medication

This medication is used by taking as an injection or oral treatment and work throughout the body.

Light Therapy

This therapy exposes the skin to ultraviolet light on a regular basis with supervision. It is also known as photo therapy. It slows the growth of the affected skin cells.

Topical Treatment

These treatments include lotion or cream applied to the effective areas. The medication is available both over-the-counter as well as prescribed by physicians. It slows down, reduces* inflammation and normalizes excessive reproduction.

Prevention Tips

There is no prevention for psoriasis but there are home treatments that could reduce* the flare-ups and improve* the symptoms.

  • Limit Alcohol: Limit your alcohol consumption as too much alcohol consumption can flare up psoriasis.
  • Treatments: Take regular treatment according to physicians recommendations.
  • Smoking: Avoid smoking as it can worsen your condition.

Psoriasis is a skin condition that alters the life cycle of skin cells. It is a fairly common condition that affects about 3% of the world’s population. It causes skin cells to build up quickly on the skin’s surface forming thick, red patches with silvery scales. Psoriasis usually causes itching on the affected areas due to dryness but it can also be painful sometimes. The disease is chronic or long-lasting and persistent. Sometimes, the symptoms get better but it can also worsen due to several reasons like hot weather and other skin conditions. The main goal of psoriasis treatments is to slow down the growth of skin cells cut there is no cure* for psoriasis.

Diagnosing Psoriasis

There are two ways to diagnose psoriasis.

1. Medical History and Physical Examination
The doctor can usually diagnose psoriasis by taking the patient’s medical history and examining the affected areas including the skin, scalp and nails. However, there are several skin conditions that appear like psoriasis so it may require an experienced doctor or dermatologist for an accurate diagnosis.

2. Skin Biopsy
If the healthcare professional cannot make a diagnosis due to factors like other skin problems, a biopsy may be necessary. A small sample of skin is taken from the patient and microscopically examined. This helps determine the specific type of psoriasis and rules out other skin disorders. The procedure is relatively simple and can be done in a doctor’s office after applying an anesthetic.

Other Conditions That Look Like Psoriasis

There are other conditions that have similar symptoms to psoriasis. In some cases, these conditions can occur at the same time with psoriasis.

  • Seborrheic Dermatitis – This is a type of dermatitis which is characterized by red, itchy, scaly and oily skin. It usually occurs in the oily parts of the body like the face, shoulders, upper chest and back. It can also occur on the scalp causing stubborn and sometimes itchy dandruff.
  • Lichen Planus – This skin condition is inflammatory and it appears in rows of itchy, bumps with flat tops or lesions. It often develops on the arms and legs.
  • Pityriasis Rosea – This is a common skin condition that typically starts as one large spot on the chest, stomach area or back which eventually spreads to other parts of the body. The rash looks like branches of pine tree starting from the middle part of the body.
  • Ringworm of the Body or Tinea Corporis – This is caused by a fungal infection on the outermost layer of the skin. The infection causes a red, circular rash in certain parts of the body.

Detecting Psoriatic Arthritis

Psoriatic arthritis affects about 10 to 15% of people with psoriasis. Its symptoms are similar to rheumatoid arthritis, reactive arthritis and gout. There is no definitive test to diagnose psoriatic arthritis. Diagnosis is made mostly by a process of elimination. The healthcare provider or dermatologist reviews the patient’s medical history, blood test results, x-rays, MRIs and physical examination is conducted. If you have psoriasis and are experiencing joint pain and aches, consult your doctor for a diagnosis and to determine the treatment. Primary-care physicians and dermatologists can treat* psoriatic arthritis but it in severe cases it may be necessary to consult a rheumatologist.

Speak with Your Dermatologist

Once you are diagnosed with psoriasis, you need to see a dermatologist in order to determine the best treatment and help guide you on how to live a normal life in spite of the condition. You need to be honest with your dermatologist so that he/she will understand the impact of psoriasis on you physically and emotionally. When you see your dermatologist, remember to talk about changes in your symptoms since your last visit. Also, take note of how often it flares up and how effective your treatment is. Also mention any joint pain, medical conditions and medications you are taking.

Home Remedies for Psoriasis

There are some remedies that can help improve* the symptoms of psoriasis including the following.

  • Take a Bath Daily – This helps remove* scales and reduces* inflammation. You can try adding bath oil, Epsom salts, colloidal oatmeal and other soothing bath products. Do not use harsh soaps and hot water which can make the symptoms worse.
  • Moisturize Your skin – Use a mild moisturizer recommended by your dermatologist depending on the severity of your psoriasis. During cold weather, you may need to moisturize your skin several times in a day to reduce* dryness, itching and scaling.
  • Get Enough Sunlight – Small amounts of sunlight can help improve* lesions. However, too much can trigger flare-ups and increase* skin cancer risk. Consult your dermatologist on how to use natural sunlight to help treat* your psoriasis.
  • Discover Your Triggers – You need to avoid psoriasis triggers like smoking, prolonged sun exposure and stress. Triggers for psoriasis differ from one person to another.
  • Avoid Alcohol Intake – According to research, drinking alcohol may decrease* effectiveness of particular psoriasis treatments.

All in All: Psoriasis, a skin disease that has no cure* at this time is affecting 2 to 4% of general population. It can affect people at any age. The disease is prone to cardiovascular disease as patients with psoriasis should be carefully monitored for heart and blood disease.

Is There a Cure* for Psoriasis?

There is no medical evidence of a permanent cure* for psoriasis to make it go away for good. It is usually referred to as a chronic condition by doctors in which, even after the disappearance of symptoms, recurrence is commonplace. Once a person is diagnosed with psoriasis, a person should be dealing with two questions – how they will cope with the condition and how will they manage its symptoms. The only way to go about dealing with psoriasis is to treat* its aggravated symptoms and be proactively careful to avoid all possible external factors that trigger them.

Psoriasis patients should be constantly vigilant of their condition and should never despair – think of psoriasis as a condition similar to common cold, only less common. There is no absolute cure* for common cold either, yet we continue to manage and treat* the condition. Similarly, the psoriasis patient should aim to keep their symptoms in check so that they don’t get out of hand.

Any Prevention Tips?

Not only should you deal with the external symptoms of psoriasis, you should also work to minimize your stress levels since it is considered a major trigger for symptoms of the condition. You should also avoid consuming large quantities of processed foods containing artificial flavors, enhancer or colorings as well as soda drinks. Natural foods such as fresh vegetables and fruits, organic meat and dairy products, etc. should be on top of your shopping list.

Always consult with your physicians specializing in dermatologist as there are different medication and treatments to different types of psoriasis. Remember it is vital to understand what types of psoriasis occur on the body and characteristics of the psoriasis as it is easier to find treatments.

Conclusion

The best way to deal with psoriasis, recommended by those who suffer from it themselves, is to come to terms with the fact that the condition is intrinsically linked to your body. You cannot get rid of it but you can work to take control of it and manage its symptoms so that it doesn’t take over your whole life and dictate your lifestyle.

Psoriasis

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Author

Expert Author : Dr. Ahmed Zayed (Consumer Health Digest)

Dr. Ahmed Zayed Helmy holds a baccalaureate of Medicine and Surgery. He has completed his degree in 2011 at the University of Alexandria, Egypt. Dr. Ahmed believes in providing knowledgeable information to readers. Other than his passion for writing, currently he is working as a Plastic surgeon and is doing his masters at Ain shams University.