What You Need to Know About Plaque Psoriasis

Plaque psoriasis is the most common type of psoriasis, an autoimmune disease that causes skin to become red, inflamed, and scaly. About four out of every five people with psoriasis have plaque psoriasis, also known as psoriasis vulgaris.

Plaque psoriasis causes thick, red-violet lesions topped with silvery scales to form on different parts of the body. These plaques are often accompanied by itching or pain.

Psoriasis is believed to be a genetic disorder triggered by a wide range of factors, including infection, stress, injury, dry skin, lack of sunlight, and certain medications. The disease causes the immune system to prompt new skin cells to grow too quickly, causing dead skin cells to build up on the skin's surface.

"Psoriasis has a strong genetic component and can be from either the mother or father's side," says James W. Swan, MD, a professor of dermatology at the Loyola University Medical Center in La Grange Park, Illinois. "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."

Plaque Psoriasis Symptoms

The symptom most often associated with psoriasis vulgaris is having psoriasis plaques. The lesions typically develop on the elbows, knees, scalp, and trunk of the body, but can occur anywhere. About 70 percent of people with this type of psoriasis complain of skin pain or burning, particularly if a psoriasis plaque has formed on the scalp.

Other symptoms related to plaque psoriasis include severe dandruff on the scalp and, for men, lesions on the genitals. In addition, 36 percent of psoriasis patients contend with achy, painful, inflamed joints due to psoriatic arthritis, a lifelong condition that must be treated to preserve mobility.

Plaque Psoriasis Diagnosis and Treatment

Plaque psoriasis can often be diagnosed through a simple medical examination. Your dermatologist might order a skin biopsy to rule out any other possible diseases, or X-rays if you have extreme joint pain.

Because there is no cure for psoriasis, treatment focuses on controlling symptoms and preventing skin infections. There are various treatment options to try based on the severity of your symptoms; often, treatments are used in combination for the best results.

Approaches to easing psoriasis symptoms include:

Topical treatments These are creams and lotions applied directly to the lesions:

  • Corticosteroids, or steroidal ointments or creams, can help suppress the immune response and thereby reduce inflammation and decrease skin cell growth. These are available in different strengths depending on your symptoms.
  • Retinoids, or topical preparations of synthetic vitamin A, work more slowly than corticosteroids but do not cause some of their side effects.
  • Calcipotriene, a synthetic form of vitamin D3, can be spread in ointment form over the lesions. It can slow skin cell turnover but can also be irritating to the skin, so it's not recommended for use on the genitals or face.
  • Coal tar can be applied to the skin as a gel or ointment, added to a bath in liquid form, or used as a shampoo for the scalp.

Light therapy This involves exposing lesions to ultraviolet light — either natural sunlight or by spending time under a sun lamp. You may be prescribed a medication to accompany the light therapy and enhance the body's response; psoralen, coal tar, and anthralin are such medications.

"Psoralen is used as a topical soak or orally in combination with UVA as PUVA [photochemotherapy]," Dr. Swan says. "However, due to increased awareness of skin cancer development following long term oral and whole body PUVA treatments, this is seldom used. Narrow band ultraviolet B is generally as effective as PUVA and has largely replaced this therapy for psoriasis, but PUVA soaks are still useful and safe for hand and foot psoriasis."

Systemic treatment The highest level of psoriasis treatment, these are medications taken by pill or injection, including:

  • Trexall (methotrexate)
  • Oral retinoids
  • Cyclosporine, an immunosuppressive drug
  • Biologics like Enbrel (etanercept), Remicade (infliximab), and Stelara (ustekinumab), which target and quell specific immune responses in the body

Combination therapy often allows patients to take lower doses of medication while increasing the effectiveness of the treatment. Working with a doctor who specializes in psoriasis will help you stay on top of managing the condition.

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