Medical Myths: All About Psoriasis
Psoriasis is a relatively common immune-mediated skin condition. It causes crusty, flaky patches to appear on the skin, commonly on the knees, scalp, elbows, and back. These patches present as red on light skin and may appear violet or purple on dark skin.
Globally, the exact prevalence of psoriasis is difficult to ascertain. However, a 2020 study found that the prevalence varies from 0.14% of the population in East Asia to 1.99% in Australasia.
Other studies have identified much higher rates, with one study measuring a prevalence rate of 11.4% in Norway.
Aside from the physical aspects of psoriasis, the condition can affect peopleâ€™s well-being and quality of life.
â€œStigmatizing views of persons with psoriasis are prevalent among people in the United States. Educational campaigns for the public and medical trainees may reduce stigma toward persons with psoriasis.â€
With this in mind, we will address some persistent myths that surround psoriasis. We have enlisted the help of two experts to assist.
The first is David Chandler, chief executive of the Psoriasis and Psoriatic Arthritis Alliance in the United Kingdom. The second is Dominic Urmston, patient advocacy and communications manager at the Psoriasis Association, also in the U.K.
1. Psoriasis is contagious
Although this myth is pervasive, it is still a myth. As Chandler explained: â€œYou cannot catch psoriasis. It is an autoimmune condition where the immune system responds inappropriately and produces too many skin cells.â€
To stress the point further, Urmston told ishonest:
â€œIt cannot be caught by person-to-person contact or by sharing of bodily fluids â€” for instance, by kissing or sharing food or drinks. It also cannot be caught by others in close contact public areas, such as in swimming pools or in saunas.â€
2. Psoriasis is just dry skin
â€œNo, itâ€™s much more than that,â€ Chandler told us. â€œThe skin structure turns over much quicker â€” the usual skin turnover is around every 28 days, [but] in psoriasis, it can be as short as 4â€“5 days.
Due to this short turnaround, the skin cells have not yet matured, which causes them to build up into thick scales, which the body cannot shed as usual.
In addition, Chandler explained, â€œblood vessels also change and move closer to the surface, which causes the areas, if scratched, to bleed, becoming very red and sore.â€
â€œIn more severe cases, psoriasis can cause the skin to crack and bleed, which can be debilitating,â€ Urmston said. â€œPsoriasis on the hands or feet can make everyday activities difficult, and psoriasis on areas such as the groin or buttocks can make even sitting down or going to the toilet painful.â€
3. There is only one type of psoriasis
There is a common misconception that psoriasis is psoriasis and there is no variation. However, this is not the case. â€œThe most common type,â€ explained Chandler, â€œis large plaque psoriasis with typical thick silvery scales.â€ Other types include:
- Guttate psoriasis: People sometimes describe this widespread rash as â€œraindrop psoriasisâ€ because the scaly patches are tear-shaped.
- Inverse psoriasis: This type only forms in regions that make contact with other parts of the body, such as the armpits, groin, or area under the breasts.
- Erythrodermic psoriasis: This uncommon type of psoriasis involves a peeling rash that appears red on white skin and covers much of the body.
- Pustular psoriasis: In this type, pus-filled bumps develop, most commonly on the hands and feet.
4. Psoriasis results from poor hygiene
â€œThe presence of psoriasis does not mean that a personâ€™s hygiene is poor,â€ confirmed Urmston.
â€œNo, definitely not,â€ Chandler concurred. â€œIn fact, people with psoriasis tend to have to be scrupulous about self-care, as the skin is so sore and flaky that it needs constant care.â€
He also explained that people with psoriasis often have to use their treatments twice each day, meaning that â€œpeople will spend a great deal of time managing it, particularly areas such as the scalp, because if it is left, it will become very difficult to manage very quickly.â€
5. Doctors can cure psoriasis
This is another myth, as currently, there is no cure for psoriasis. However, scientists are continuing to develop their understanding of the condition, and, as Chandler noted, this new understanding â€œmay lead to a cure at some stage in the future.â€
Importantly, as Urmston pointed out, â€œpsoriasis can be successfully treated and managed, and doctors and dermatologists can offer a wide range of treatment options.â€
6. Psoriasis only affects the skin
The conditionâ€™s effect on the skin is the most noticeable, but psoriasis is not just skin-deep. As Urmston told MNT:
â€œPsoriasis can affect more than just the skin.â€ An estimated 6â€“42% of people with psoriasis also develop psoriatic arthritis, which Urmston describes as â€œan inflammatory arthritis that affects the joints. It often affects the knees or the joints in the hands and feet â€” as well as areas where tendons join to bone, such as the heel and lower back.â€
Beyond its physical effects, psoriasis can have a psychological impact, too. â€œPeople with psoriasis are also more likely to experience anxiety, depression, and low confidence and self-esteem,â€ explained Urmston, â€œwhich can all have a significant impact on day-to-day life.â€
7. No treatments can relieve psoriasis
Although there is no cure, it is a myth that there are no treatment options. â€œThere are numerous treatments that can help relieve the symptoms of psoriasis, depending on how badly the individual is affected,â€ Chandler stated.
â€œThese range from topical (applied) creams to ointments, foams, and gels. Light therapy is also used, as are disease-modifying drugs both as tablet and injection â€” all having varying benefits and associated risks.â€
As psoriasis is a chronic condition that lasts a lifetime, a person may need to work with their doctor to modify their treatment plan over time.
â€œMost people with psoriasis start their treatment under the guidance of a doctor who can prescribe topical (applied to the skin) treatments in different formulations (creams, ointments, and gels).â€
â€œIf psoriasis is more severe, or if various types of topical treatments are ineffective, a doctor should provide a referral to a dermatologist, who can offer further treatment options, such as UV light therapy and tablet and injection treatments.â€
â€“ Dominic Urmston
8. Psoriasis only affects adults
â€œAlthough most commonly seen in adults â€” psoriasis often starts in teenage years and lasts a lifetime â€” it can be seen in children and also, rarely, in babies,â€ explained Chandler.
Urmston told MNT that â€œthere seem to be two â€˜peaksâ€™ of onset: from the late teens to early 30s and between the ages of about 50 and 60.â€
9. Psoriasis is the same as eczema
Although the primary symptoms of eczema and psoriasis are both dermatological, the conditions are entirely different.
As Chandler explained, â€œeczema is often based on an allergic reaction, which psoriasis is not.â€ Also, eczema is â€œmore common in young children and can disappear over time.â€ Conversely, psoriasis is less common in children and tends to be a lifelong condition.
â€œThey also tend to affect different areas of the body,â€ wrote Urmston, â€œwith eczema tending to appear inside the elbows and knees (the crook), whereas psoriasis appears more frequently on the outside of the elbows and knees, as well as on the scalp.â€
Overall, the underlying mechanisms that drive eczema and psoriasis are different, too. Psoriasis is an autoimmune condition, whereas eczema can involve genetic, environmental, and other factors. However, there is some evidence to suggest that eczema can be an autoimmune condition, as well.
Importantly, Urmston stated, â€œWith both conditions, a diagnosis from a trained healthcare professional is vital in order to begin the most relevant treatment pathway as early on in the course of the condition as possible.â€
10. Changing your diet can cure psoriasis
â€œThere is no evidence to suggest a particular diet can cure psoriasis,â€ Chandler told MNT. â€œMany people may associate changes in diet with an improvement, but as the nature of psoriasis is to â€˜wax and wane,â€™ this could be a coincidental occurrence.â€
However, he also wrote that â€œfollowing a healthy, well-balanced diet, keeping weight down, and exercising regularly are generally good pieces of advice to follow for overall well-being.â€
In agreement, Urmston told us: â€œAt this time, there is a lack of robust research linking any specific change in diet to an improvement in psoriasis symptoms. We do know that factors such as obesity, alcohol, and smoking can increase the severity of psoriasis symptoms, so a healthy lifestyle, including regular exercise and a healthy, balanced diet, can be beneficial in managing psoriasis.â€
Psoriasis is not curable, but it is treatable. Anyone who believes that they might have psoriasis should speak with a doctor so that they can begin treatment as soon as possible.
As with all medical conditions, researchers continue to investigate ways in which it might be possible to manage the symptoms more effectively. One day, scientists may also develop a cure.
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