psoriasis

Psoriasis

Psoriasis is an autoimmune skin condition that causes inflamed skin patches. There is no cure, but symptoms can be managed with treatment.

Psoriasis is an autoimmune skin disorder that speeds up the growth of skin cells. As a result, skin cells pile up and develop into patches of thick discolored skin, often accompanied by silver-colored scales.

Psoriasis can look different depending on a person's skin tone. People with darker skin tones may show less skin reddening and patches may appear purple or brown.1 People with lighter skin may have patches that are red or pink.2

These inflamed patches can appear anywhere on the body but are primarily found on the elbows, knees, joints, and scalp. Patches may also show up on hands, feet, genitals, and skin folds such as under your arms or breasts. Typically, psoriasis forms smaller lesions (areas of skin damage) on the body. In severe cases, however, it can cover large areas of the body, such as the back.3

Psoriasis commonly occurs in cycles. You may have periods during which your symptoms are more active, which can cause psoriatic flare-ups. These flare-ups can last weeks or months. Once a flare-up subsides, the condition tends to go into remission for some time. Remission in psoriasis means symptoms disappear temporarily.3

More than 8 million Americans have psoriasis.4 Typically, psoriasis affects people between the ages of 15 and 35. However, children under 10 may also experience psoriatic symptoms, as the condition can develop at any age.

Types

There are five distinct types of psoriasis.5 It is also possible to have more than one type of psoriasis.6

  • Plaque psoriasis: The most common type of psoriasis which causes inflamed patches and silver-colored scales.
  • Guttate psoriasis: A type of psoriasis that anyone can develop, but commonly affects children. This type can cause lesions that are small, red, and round.
  • Inverse psoriasis: This type of psoriasis causes discoloration in skin folds (where skin touches skin) and often appears to be smooth or shiny.
  • Pustular psoriasis: A type of psoriasis that a person of any age can develop, but commonly affects adults. This type can cause pus-filled blisters or sores on the body.
  • Erythrodermic psoriasis: The least common type of psoriasis which affects about 2% of people with the condition. This form of psoriasis triggers inflammation on large parts of the body, can cause the skin to peel, and may be life-threatening.

Symptoms

Each type of psoriasis has its own unique set of symptoms. These symptoms can vary in how they affect you and what treatments may be required.

Plaque Psoriasis

This is the most common type of psoriasis, affecting up to 80% of people with the condition. On lighter skin tones, plaque psoriasis causes dry, raised, and red-colored skin patches covered with silvery scales. These patches are typically over 1 centimeter wide. On darker skin tones, patches may look purple or brown. Plaque psoriasis commonly affects the knees, elbows, scalp, and lower back.5,10

Guttate Psoriasis

This type of psoriasis causes small and round red spots and scaling lesions. Unlike plaque psoriasis, the lesions for the guttate type are smaller (less than 1 centimeter wide) and known as papules. These spots can often appear on the arms, legs, face, and torso.5

The prognosis for guttate psoriasis differs depending on the person. Some people with the condition can have guttate psoriasis for life. Others may have the condition clear up and develop plaque psoriasis later in life. Unfortunately, there is no known way to predict what may happen after the first incidence of guttate psoriasis.7

Inverse Psoriasis

In contrast to other types of psoriasis, inverse psoriasis causes smooth patches, rather than scales. These patches are often inflamed and cause red or purple-colored skin that could look raw or sore. People with inverse psoriasis typically experience patches in skin folds such as underarms, breasts, groin, and buttocks. Patches can worsen with sweating and friction.5

Pustular Psoriasis

This type of psoriasis is less common. People with pustular psoriasis may experience pus-filled lesions and white-colored bumps known as pustules. These pustules tend to be surrounded by inflamed red patches. They can either occur all over the body or be restricted to certain body parts such as the palms of the hands and soles of the feet. Due to the location of the psoriatic patches, people with this condition may experience difficulty with activities that involve the hands or feet, such as walking.5

Erythrodermic Psoriasis

Erythrodermic psoriasis is the most severe type and can be potentially life-threatening. Patches may often cover the entire body with a red, peeling rash that causes intense itching and burning sensations. People with this type of psoriasis may also experience skin shedding and nail changes, such as discoloration or nail bed separation. Additional symptoms may include rapid heartbeat, chills, and fever.

Erythrodermic psoriasis does not develop on its own. Typically, people with the condition will have a less severe form of psoriasis before symptoms worsen or do not respond to treatment.7 It is advised to receive medical attention immediately if you or a loved one shows symptoms of this type of psoriasis.5

Causes

While researchers do not know the exact reason psoriasis develops, they have some ideas about what could be happening. Generally, as psoriasis is an autoimmune disease, an overactive immune system and genetics play a large role in how symptoms develop.

Environmental factors such as stress, illness, and skin infections can trigger changes in your immune system that can influence the onset of symptoms. When this happens, cells that are made to fight infection can attack healthy cells and tissue in the body by mistake.3 For example, young children may often develop guttate psoriasis after an infection, such as a strep throat.7

Genetic factors may also be responsible for passing the disease on through families. If you have one parent with psoriasis, you have a 28% chance of experiencing psoriatic symptoms. If both of your parents have psoriasis, you have a 65% chance of developing the condition.16

Diagnosis

Your healthcare provider or dermatologist can diagnose psoriasis by examining your skin. It can sometimes be hard to confirm psoriasis because it resembles other conditions, including eczema. Eczema is a skin condition that can cause inflammation, dry skin, rashes, and itchiness. Eczema is considered much less severe than psoriasis because it typically does not affect the whole body, patches tend to be thinner, and can often be relieved by topical treatment.15

A physical examination is typically used to diagnose psoriasis. In some cases, your health care provider may use a skin biopsy to reach an accurate diagnosis. A skin biopsy involves removing a small sample of affected skin and looking at it under a microscope. The skin biopsy can also tell your provider what type of psoriasis you have.

At your appointment, you can expect your provider to ask you about your symptoms, recent life changes, family history of psoriasis, and alcohol or tobacco use.

Treatment

Your health care provider will suggest a treatment plan based on the type of psoriasis you have, the severity of your symptoms, the areas of your body that are affected, and if you have other health concerns or conditions. A wide range of treatment options are available for psoriasis.11,12,13

There are three primary categories for psoriasis treatments.

Topicals

The first line of psoriasis treatment is topical treatments that you can apply directly to your skin. These treatments include creams and ointments that contain coal tar, retinoid, salicylic acid, corticosteroids, or immune modulators (which affect your immune response and include a cream called tapinarof).11,17

Phototherapy

Commonly also referred to as light therapy, phototherapy involves regular exposure to ultraviolet light under the supervision of a medical professional. Light therapy penetrates the skin to reduce inflammation and slow the growth of affected skin cells.

Systemic Medications

This form of treatment includes oral and injected medicines that work throughout the body to reduce inflammation and stop inflammatory processes that cause the immune system to speed up and attack healthy tissue. Systemic medications are typically used if other forms of treatment have not worked.

Treatment options for psoriasis are the same regardless of skin tone. However, your healthcare provider may personalize your treatment plan for your skin type and color. For example, people with darker skin might experience harsher side effects, such as hyperpigmentation (dark patches) or hypopigmentation (light spots). To reduce the appearance of effects, your health care provider may prescribe less harsh treatments or additional therapies.12

Other Treatment Recommendations

Symptoms such as redness, itching, and dryness of the skin can feel frustrating to deal with daily. You may find it helpful to use mild soaps and lukewarm water when you shower and hydrate your skin with gentle moisturizers, along with any topical treatments you are prescribed. Loose-fitted clothing and soft fabrics may also help minimize skin irritation.

Most people with psoriasis tend to use a combination of treatments that is best fit for their symptoms, diagnosis, and lifestyle.

Prevention of Psoriatic Flare-Ups

Psoriasis is not a preventable condition. If psoriasis runs in your family, your risk of developing the condition increases. Although, a genetic link does not guarantee that you will develop psoriasis. Environmental triggers may also lead to the onset of psoriasis symptoms.8

While you may not be able to prevent the condition, you can take steps to reduce the frequency and severity of flare-ups if you are diagnosed with psoriasis. This includes following your treatment and avoiding triggers that might worsen psoriasis.

Triggering events can include:3,9

  • Prolonged physical or emotional stress
  • An infection (such as strep throat)
  • Injury to the skin or skin-related infections
  • Use of certain medications
  • Tobacco or alcohol use
  • In some cases, cold and dry weather

Some recommendations for preventing flare-ups include limiting alcohol use and avoiding foods such as red meat or refined sugars. While it may be hard to completely avoid the weather conditions where you live, it can be useful to invest in moisturizers or a humidifier during cold weather.13,14

Stress is often a trigger for psoriatic flare-ups. Similarly, dealing with psoriatic symptoms can also cause stress. While this may seem like a never-ending loop, there are options that can help you manage your stress. Self-care practices such as yoga, daily walks, and getting enough sleep can aid your stress management. Stress may also increase your risk of developing mental health concerns such as anxiety or depression. If you find yourself struggling with stress management, you may consider reaching out to a mental health professional or joining a psoriasis support group for assistance.13,14

Living With Psoriasis

Psoriasis can impact your daily life in a variety of ways. You may feel challenges with your physical health, emotional well-being, social life, and self-esteem. With support from your care team and loved ones, these challenges can be managed.10,14

People with psoriasis may have higher risks of developing other health conditions such as type 2 diabetes, arthritis, heart disease, and depression. Talk to your health care provider to understand your risk for development and steps you can take to prevent other conditions.

Psoriasis may be an individual health condition, but that does not mean you have to deal with it on your own. A common emotional side effect of psoriasis is embarrassment about your condition. Many people may feel self-conscious about the appearance of their patches.

While it may be difficult to speak with your partner, family, or close friends, try your best to talk to your loved ones about your condition. The more your care providers and inner circle know about the impact of psoriasis on your life, the better they may be able to support you as you navigate this disease.

Sources

1. Abrouk M, Lee K, Brodsky M, et al. Ethnicity affects the presenting severity of psoriasis. J Am Acad Dermatol. 2017;77(1):180-182. doi:10.1016/j.jaad.2017.02.042

2. American Academy of Dermatology Association. Can you get psoriasis if you have skin of color?

3. National Psoriasis Foundation. About psoriasis.

4. Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis prevalence in adults in the United States. JAMA Dermatol. Published online June 30, 2021. doi:10.1001/jamadermatol.2021.2007

5. National Psoriasis Foundation. Locations and types.

6. American Academy of Dermatology Association. Types of psoriasis: Can you have more than one?

7. American Academy of Dermatology Association. Psoriasis: Signs and symptoms.

8. Prinz JC. Human leukocyte antigen-class I alleles and the autoreactive T cell response in psoriasis pathogenesis. Front Immunol. 2018;9:954. Published 2018 Apr 30. doi:10.3389/fimmu.2018.00954

9. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Psoriasis.

10. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Psoriasis: Diagnosis, treatment, and steps to take.

11. American Academy of Dermatology Association. Psoriasis: Diagnosis and treatment.

12. National Psoriasis Foundation. Treating skin of color.

13. American Academy of Dermatology Association. Are triggers causing your psoriasis flare-ups?

14. National Psoriasis Foundation. Life with psoriasis.

15. National Psoriasis Foundation. Psoriasis or eczema?

16. National Psoriasis Foundation. Psoriatic disease and the immune system.

17. U.S. Food and Drug Administration. VTAMA (tapinarof) prescribing information.

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