What is Psoriasis? Symptoms, Causes, Diagnosis, Treatment, and Prevention
While any part of your body can be affected, psoriasis plaques most often develop on the elbows, knees, scalp, back, face, palms, and feet.
Like other autoinflammatory diseases, psoriasis occurs when your immune system â€” which normally attacks infectious germs â€” begins to attack healthy cells instead.
Signs and Symptoms of Psoriasis
Psoriasis plaques can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. The diseaseâ€™s symptoms and appearance vary according to the type and severity of psoriasis.
Some common signs and symptoms include:
- Discolored patches or raised plaques of skin that are covered with scales
- Dry or cracked skin that bleeds
- Burning, itching, or soreness near the affected areas
- Pitted or thickened fingernails or toenails
- Swollen joints (1)
Causes and Risk Factors of Psoriasis
Psoriasis, in general, is a genetic condition passed down through families. "It's likely that multiple genes need to be affected to allow psoriasis to occur and that it's frequently triggered by an external event, such as an infection," says James W. Swan, MD, professor of dermatology at the Loyola University Stritch School of Medicine in Maywood, Illinois.
Certain risk factors, such as a family history or being obese, may increase your odds of developing psoriasis.
According to the National Psoriasis Foundation (NPF), at least 10 percent of people inherit genes that could lead to psoriasis, but only 3 percent or less actually develop the disease. (2) For this reason, it is believed that the disease is caused by a combination of genetics and external factors or triggers.
A psoriasis outbreak may be provoked by:
Stress is a major trigger for some people with psoriasis, either causing psoriasis to flare up for the first time or to make it worse after youâ€™ve been diagnosed. (3)
"Psoriasis is very stress-dependent. It flares very easily when patients are under stress, and it tends to improve when they're relaxed," says Vesna Petronic-Rosic, MD, a dermatologist and associate professor of medicine at the University of Chicago Medicine in Illinois. Stress management techniques, such as exercise, yoga, and meditation, may help manage psoriasis symptoms.
A trip to the Caribbean might be a good idea during the winter months if you have psoriasis and live in a cold climate. Thatâ€™s because the sunâ€™s ultraviolet light turns off the skinâ€™s immune system, which is overactive in people with psoriasis. Check with your dermatologist before traveling for sun safety skin tips and limit your daily exposure to no more than 10 minutes of direct sunlight.
Anything that injures the skin can cause a psoriasis flare, including excessively dry skin.
The solution: Keep your skin moisturized. If youâ€™re allergic to the fragrances in moisturizers, use a product thatâ€™s fragrance-free to avoid a rash.
As with dry skin, puncturing the skin during a vaccination may cause a psoriasis flare, but thatâ€™s no reason to skip a needed shot. (4)
One thing to keep in mind: If youâ€™re on a potent psoriasis medication that suppresses your immune system (such as a biologic treatment), you shouldnâ€™t take a live vaccine. Your body may not be able to fight off a live virus because of the medication youâ€™re taking. In that case, ask your doctor for a vaccine that contains a deactivated virus.
Beta-Blockers and Lithium
Beta-blockers to treat high blood pressure and lithium for a mental disorder can make psoriasis worse. (5, 6)
If you have high blood pressure, your doctor may be able to switch your medication to another drug that wonâ€™t affect the psoriasis. If youâ€™re taking lithium, your dermatologist may consider having you try light therapy or a topical treatment for psoriasis.
Upper Respiratory Infections
Colds and other infections, especially strep throat, activate the immune system and can cause psoriasis to flare. (7) If you have psoriasis and develop a sore throat, get it treated and be sure to have a culture taken to check for strep. Long-term antibiotics may be an option for someone who has psoriasis and frequent sore throats.
Studies havenâ€™t shown any beneficial effects of taking nutritional supplements for psoriasis, but avoiding certain foods may reduce inflammation and help with psoriasis. Additionally, studies have shown that many people with psoriasis may also have a gluten sensitivity, and eating a gluten-free diet can help reduce psoriasis symptoms. (10) In general, if you find that a certain food makes the psoriasis worse, try to avoid it.
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Types of Psoriasis
There are five types of psoriasis, yet people most often have only one type of psoriasis at a time. Each type has its own set of symptoms.
Also called psoriasis vulgaris, plaque psoriasis is the most common form of the skin disease. It appears as raised, discolored plaques covered with a scaly buildup of dead skin cells, or scales. The itchy, sometimes painful plaques can crack and bleed, and commonly affect the scalp, knees, elbows, back, hands, and feet.
Often beginning in childhood or young adulthood, guttate psoriasis is the second most common type of psoriasis. Nearly 10 percent of people who get psoriasis develop guttate psoriasis, according to the NPF. Guttate psoriasis is the type of psoriasis most closely linked to a recent strep infection. If you develop guttate psoriasis, you will also likely be tested for strep bacteria.
Also known as intertriginous psoriasis, inverse psoriasis causes red or otherwise discolored lesions in skin folds of the body that may look smooth and shiny. Each lesion can occur on the genitals or in areas near the genitals, like the upper thighs and groin. It's common for people with inverse psoriasis to have another type of psoriasis somewhere else on their body at the same time.
This causes white blisters of pus that surround red or otherwise discolored skin, often on the hands or feet. The pus consists of white blood cells. When pus-filled bumps cover the body, you may have bright-red skin and feel ill or exhausted, and have a fever, chills, severe itching, rapid pulse, loss of appetite, or muscle weakness.
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How Is Psoriasis Diagnosed?
There arenâ€™t any special tests to help doctors diagnose psoriasis. Typically, a dermatologist will examine your skin and ask about your family history.
Youâ€™ll likely be given a diagnosis based on this physical exam.
In some situations, doctors will remove a small sample of the skin and examine it under a microscope. This might allow them to get a better look at the affected area and make a more accurate diagnosis. (11)
Duration of Psoriasis
Psoriasis is considered a chronic, lifelong condition. There currently isnâ€™t a cure, but this skin disorder can worsen or improve.
For some, psoriasis can clear up for months or even years at a time. This is known as remission.
Others experience psoriasis flares in cyclical patterns. For instance, the disease may get better in the summer and worsen in the winter. (12)
Treatment and Medication Options for Psoriasis
While psoriasis cannot be cured, there are effective options for treating it. Talk to your doctor about the benefits, risks, and side effects of any therapies you use.
Some medication to treat psoriasis includes:
- Topicals Prescription treatments, such as topical steroids, and over-the- counter (OTC) treatments that are applied directly to the skin can minimize symptoms of psoriasis. Each topical medication contains different active ingredients, such as salicylic acid, and can come as a lotion, cream, shampoo, gel, spray, or ointment. Topical corticosteroids are often prescribed for mild psoriasis or moderate psoriasis, according to the Mayo Clinic.
- Biologics Biologic drugs are a type of systemic medication, which impact the entire body and alter the immune system. They are usually given as an injection. They include Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Stelara (ustekinumab), Simponi (golimumab), Cosentyx (secukinumab), Taltz (ixekizumab), brodalumab, tildrakizumab, and Skyrizi (risankizumab).
- Otezla (apremilast) This medicine comes as a pill and works by suppressing an enzyme thatâ€™s involved in inflammation.
- Oral Retinoids This type of systemic therapy is usually given if you have severe psoriasis that doesnâ€™t respond to other treatments.
- Rheumatrex (methotrexate) This drug helps control inflammation.
- Cyclosporine (Gengraf, Neoral) This systemic treatment suppresses the immune system but can be taken for only short periods of time. (1)
Prevention of Psoriasis
Thereâ€™s no way to prevent psoriasis, but there are things you can to do to improve your symptoms and help lessen the number of flare-ups you experience. (13)
Some ways to reduce your risk of a psoriasis outbreak include:
- Take daily baths
- Keep skin moisturized
- Avoid triggers if you can
- Get a small amount of sunlight each day (1)
Complications of Psoriasis
Having psoriasis can increase your risk for developing a number of health conditions, including:
- High blood pressure
- High cholesterol
- Cardiovascular disease
- Liver disease
- Kidney disease
- Uveitis (an eye disease)
- Crohnâ€™s disease
- Depression (14)
"Over the last few years, we've seen that maybe psoriasis plays a more integral part in metabolic syndrome, a collection of symptoms that can lead to diabetes and heart disease," says Erin Boh, MD, chairman and a professor of dermatology at Tulane University in New Orleans and a member of the National Psoriasis Foundation board.
It is estimated that up to 30 percent of people with psoriasis will also develop psoriatic arthritis, an autoimmune disease that affects the joints. According to the National Psoriasis Foundation, psoriasis occurs before joint disease in 85 percent of psoriatic arthritis patients. (15)
The risks for psoriasis-related complications are greater the younger a patient is when diagnosed and the more severe the psoriasis. (16) Anyone with psoriasis should be aware that they are at risk for comorbid conditions and should monitor their overall health accordingly.
Research and Statistics: Who Has Psoriasis?
According to the National Psoriasis Foundation, about 7.5 million people in the United States have psoriasis. Most are white, but the skin disease also affects Black, Latino, and Asian Americans as well as Native Americans and Pacific Islanders. (17)
People with psoriasis generally see their first symptoms between ages 15 and 30, although developing the disease between 50 and 60 years of age is also common. (20)
â€œThe biggest factor for determining prognosis is the amount of disease someone has,â€ says Michael P. Heffernan, MD, a dermatologist at the San Luis Dermatology and Laser Clinic in San Luis Obispo, California.