Plaque psoriasis is a chronic autoimmune condition. It appears on the skin in patches of thick, red, scaly skin. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, plaque psoriasis is the most common form of psoriasis. It affects about 6.7 million adults in the United States.
Plaque psoriasis can be a very itchy and sometimes painful condition. It also can be embarrassing and doesn't always respond to treatment. It's sometimes misdiagnosed as another skin condition, such as dermatitis and eczema.
Plaque psoriasis typically involves patches of rough, red skin and silvery white scales. This is because the skin cells receive a signal to produce new skin cells too quickly. They build up and shed in scales and patches.
This buildup of skin causes the red and silvery patches, as well as pain and irritation. Scratching can lead to broken skin, bleeding, and infection.
The severity of psoriasis
Psoriasis classification is based on its severity: mild, moderate, or severe. Your doctor will first determine the severity of your psoriasis based on how much of your body is affected:
- mild psoriasis: covers less than 3 percent of the body
- moderate psoriasis: covers between 3 and 10 percent of the body
- severe psoriasis: covers more than 10 percent of the body
The severity is also determined on how the condition is impacting your day-to- day life.
Patches of plaque psoriasis
The most commonly affected parts of the body include the elbows, knees, and scalp. Most people with plaque psoriasis will develop patches in these areas. But some will also have psoriasis patches on other areas of the body.
The location of plaque psoriasis can change as patches heal. New patches may appear in different locations during future attacks. Plaque psoriasis affects everyone differently. No two people will experience the same symptoms.
Plaque psoriasis and the geography of the body
The distribution of psoriasis patches on the body can appear randomly. Some patches may cover large portions of the body, while others may be no larger than a dime. Once a person has developed psoriasis, it may appear in a number of different forms in many different places. Unlike inverse psoriasis, plaque psoriasis doesn't usually affect the genitals and armpits.
Plaque psoriasis and its reach: the scalp and beyond
According to the American Academy of Dermatology, at least 50 percent of people with plaque psoriasis will experience a bout of scalp psoriasis. Plaque psoriasis on the scalp may require different treatment than plaque psoriasis on other parts of the body. Medicated ointments, shampoos, and careful removal of scales can help treat scalp psoriasis. Sometimes, systemic medications must be used to clear plaque psoriasis on the scalp.
Pervasive plaque psoriasis covering the body
In some cases, plaque psoriasis can be very severe. It may cover the majority of the body. Plaque psoriasis of this severity can be uncomfortable, and even dangerous, if it becomes infected or progresses to other forms of psoriasis.
Moderate to severe plaque psoriasis can be treated effectively with different types of therapy, including biologics. Severe cases will often require a specialized treatment plan developed with a dermatologist. Prescription systemic medications may also be necessary.
Diagnosing plaque psoriasis by looking at the skin
Most doctors and nurses can tell if a scaly or rough patch of skin is psoriasis. Sometimes a biopsy or a visit with a dermatologist is needed. During your visit, make sure to point out all of your abnormal patches of skin.
Tell your doctor about your symptoms and what seems to aggravate your skin. Possible triggers of psoriasis include:
- skin trauma
- medication use
- dry skin
- excessive sun exposure
- certain lotions or skin creams
Don't attempt to treat or diagnose psoriasis without consulting with a doctor.
The least pleasant view of plaque psoriasis
Excessive scratching can cause the skin to break. Open psoriasis patches can allow infection to enter the skin or the bloodstream. Infections can be a serious complication of plaque psoriasis.
Signs of infection include:
- leakage of pus
- swelling and redness in the area
- sore skin
- foul smell coming from the broken skin
- fever or fatigue
Seek medical care for a suspected psoriasis-related infection.
Treating your plaque psoriasis
The treatment of plaque psoriasis is different for everyone. Most dermatologists will start with the simplest and least invasive treatment. Initial treatments include:
- topical corticosteroids
- vitamin D preparations
- salicylic acid ointments
Topical skin treatments require diligent application and the careful avoidance of skin irritants. If these are ineffective, several other treatments may be recommended, including:
- oral systemic medications
- intravenous medication
- skin injections
- natural therapy
- light therapy
Oral systemic medications
Your doctor may recommend treating your psoriasis systemically with a prescription drug or medication. A class of oral medications called disease- modifying antirheumatic drugs (DMARDs) can slow down or stop certain conditions that are caused by an overactive immune system. These include:
- apremilast (Otezla)
- acitretin (Soriatane)
Injectable or intravenous medication for plaque psoriasis
Currently, there are several drugs on the market that are classified as biologics. Biologics target specific parts of the immune system. They block the action of a specific type of immune cell called a T cell, or block proteins in the immune system, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A, or interleukins 12 and 23.
Below are some examples:
- Humira (adalimumab): an injectable drug used to reduce inflammation caused by arthritis
- Stelara (ustekinumab): an injectable drug used for plaque psoriasis and psoriatic arthritis
- Cimzia (certolizumab pegol)
- Enbrel (etanercept)
- Remicade (infliximab)
- Simponi (golimumab)
Natural skin treatments for plaque psoriasis
Because it's a chronic condition, many people with plaque psoriasis will try alternative and natural treatment methods. One method that has gained significant attention in the psoriasis community is the mud and salt of the Dead Sea. Thousands of people a year invest in expensive Dead Sea skin treatments or vacations to attempt to heal their psoriasis. Although the scientific evidence is limited regarding the effectiveness of these treatments, many believe it can help treat plaque psoriasis.
Light treatment for plaque psoriasis
Light therapy is a common treatment for plaque psoriasis. Because light therapy is nonpharmaceutical, it's a popular choice prior to systemic medications. Some people are able to achieve healing through regular limited sessions of sun exposure, while others fare better using a special light machine. Check with your dermatologist before treating your psoriasis through exposure to sunlight. Too much sun exposure can burn your skin and make plaque psoriasis worse.
Healing and remission for plaque psoriasis
Most people with psoriasis experience some healing with standardized, guided treatment. Although your skin may never permanently be psoriasis-free, long periods of remission are possible. Healing from psoriasis will begin to return your skin to normal thickness. Flakiness and shedding will slow and the redness will fade. Even if the treatment appears to have worked, don't discontinue use. Always talk to your doctor before stopping or switching your psoriasis treatment. Anyone can develop psoriasis, but it's not contagious. Awareness and visibility are important for bringing psoriasis into the public eye.