Psoriasis

Psoriasis is recognized by patches that are red and thickened areas with silvery scales, most commonly found on the scalp, elbows, knees, belly button, and lower back. People with mild cases don’t realize that they have psoriasis, whereas severe cases of psoriasis may cover large areas of the body. Psoriasis can occur within members of a family; however, it is not contagious and cannot be passed from one person to another.

Plaques consist of dry, layered, flaky, itchy, and inflamed red skin. It may also crack or bleed. Because of this the lesions can be very painful. Typically, the plaques will appear in the same places on both sides of the body.

There is no exact cause of psoriasis, but researchers believe that the condition may arise due to a genetic dysfunction in the immune system. People with psoriasis may have a dysfunction in their immune system, which causes skin cells to produce faster than normal. When this happens it causes a buildup, which forms a thick plaque. Skin cells shed every 3 to 4 days in a person with psoriasis, whereas in a normal healthy skin, the skin cells shed in typically 30 days. There is associated inflammation as the body tries to get rid of the buildup.

People typically have their first outbreak of psoriasis between the ages of 15 and 35, but it can appear at any age. 1/3 of those diagnosed are under the age of 20 when the first signs of psoriasis begin to appear. Psoriasis occurs equally in both males and females across different races.

Psoriasis can come in many different sizes and forms. Each one differs in duration, location, shape, and pattern of the scales. Scalp, elbows, knees, legs, arms, bellybutton, genitals, nails, palms, and soles are the areas that are most commonly affected by psoriasis.

This is the most common type of psoriasis. It appears as raised plaques of thick, inflamed red skin with silvery flakes or scales. Plaque psoriasis occurs in 90% of patients. Symptoms can range from mild to severe, covering very small or extensive areas of the body.

Scalp psoriasis is a form of plaque psoriasis; it occurs when thick plaque forms on the scalp. Scalp psoriasis tends to be very noticeable around the ears and hairline. The flaking and shedding of dead skin may be mistaken as dandruff.

Guttate psoriasis is the second most common type, often starting during childhood or young adulthood. The guttate psoriasis typically appears within a few weeks and is very extensive. It is characterized by small, scaly, pink raindrop like patches, usually on the trunk, arms and legs, but sometimes can cover the whole body. It usually develops after a respiratory infection or a common bacterial infection, like strep throat, tonsillitis, stress, injury to the skin or the administration of certain drugs. Guttate psoriasis frequently clears up by itself in a few months.

Pustural psoriasis is characterized by pus-filled blisters surrounded by red skin that often occurs on the palms and soles of the hands and feet or spread over large areas of the body. This type of psoriasis can be extremely painful.

Inverse psoriasis occurs in skin folds where there is pressure, friction and moisture. This is typically between buttocks, genitals, under breasts and armpits. It is characterized by bright red lesions that are smooth and shiny. Because it is located on skin folds, it can be irritated by rubbing and sweating and it can bother people who are overweight and with deep skin folds.

Erythrodermic psoriasis is the least common form of psoriasis. It is a rare but serious form of disease with widespread redness and inflammation that resembles a sunburn. It can be resulted from severe sunburns, using certain medications or stopping psoriasis treatments. It can be life-threatening and often requires hospitalization, since the skin loses its ability to perform vital functions, such as controlling body temperatures and protecting against infectious organisms.

There is nothing you can or could have done to get psoriasis but there are some things that may trigger a flare-up.

Skin injury and irritation or any break in the skin can lead to psoriasis. A break in the skin can be characterized as a razor burn, an insect bite, cut, abrasion, sunburn, needle puncture, blister or bruise. Frequent rubbing and/or scratching of the skin can irritate the psoriasis as well.

Weather is another factor that can cause psoriasis to improve or worsen. Moderate sun exposure can be helpful to relieve some psoriasis symptoms, but an overly hot and humid environment can make symptoms worse. The dry cold winter season tends to make the psoriasis worse because it becomes very dry and irritates the skin.

Stress is a factor in a number of health conditions and can be a trigger for psoriasis as well. Stress and tension seem to make psoriasis worse. Living with psoriasis also contributes to stress.

Some medications can make psoriasis worse, such as certain treatments for rheumatoid and osteoarthritis, including some anti-inflammatory medications. Medications such as lithium which is used as an antidepressant can cause a flare-up to appear.

A healthy diet is very important for everyone, especially people with psoriasis. Some foods may cause a flare-up, but it is important to avoid them after the flare-up. For some people, excessive alcohol consumption causes flare-ups.

Psoriasis treatment ranges anywhere from a topical treatment, to a pill, to injections, to light therapy. The dermatologist will give you a treatment plan that is suited best for you, your type of psoriasis, what skin areas are affected, and the disease’s effect on your overall health. The goal of treatment is to reduce the amount of inflammation and to control the amount of skin shedding.

Moisturizing creams loosen scales and help control itching. Special diets have not been successful in treating psoriasis, except in isolated cases; increasing fish in the diet and/or taking fish oil capsules may benefit some patients with psoriasis.

There still isn’t a cure for psoriasis, but there are still options that can help make your skin as clear as possible.

Biologic agents

Biologic agents are typically for people who have failed to respond to other therapies or for people with psoriatic arthritis. Biological therapies use a specific, targeted approach to interrupt the underlying immune-mediated process that drives psoriasis and its symptoms. They are newer therapies and, over time, have shown to be provide superior results with less side effects that other systemic therapies.  They are, however, extremely expensive.

Some biological agents include: Adalimumab (Humira®), Etanercept (Enbrel®), Infliximab (Remicade®), Ustekinumab (Stelara®), Secukinumab (Cosentyx®), and Ixekizumab (Taltz®), Brodalumab (Siliq®), Guselkumab (Tremfya), and Risankizumab (Skyrizi®). They are very effective agents for psoriasis and psoriatic arthritis and are either administered by self-injection subcutaneously (e.g., Humira®, Enbrel®, Stelara®, Cosentyx®, Taltz®) or intravenously (e.g., Remicade) in varying frequencies. Some of these agents are administered once or twice a week, while others are administered every 2-3 months.

Dealing with the symptoms and treatment of psoriasis can be difficult and stressful. It is a cycle: psoriasis makes you stressed, stress makes your psoriasis worse, your psoriasis worsens so you become even more stressed. Psoriasis can take a large toll on your mental health. Psoriasis has an impact on patients that extends beyond the cosmetic or physical aspects. It negatively affects quality of life from the burden of physical pain, discomfort and limitations to exacting a heavy emotional toll. Over 1/3 of respondents (176 of 500) view their skin condition as a significant problem in their daily life. People with psoriasis have an increased risk of depression, anxiety, and suicide.

Psoriatic lesions can be itchy, painful and bleed, making it difficult to sleep, dress or engage in various daily activities. If there is joint involvement, the pain can also make it challenging for the individual to function physically.

If you have psoriasis, you are more likely to develop other diseases. These diseases may include cancer, cardiovascular disease, Crohn’s disease, depression, diabetes, metabolic syndrome, obesity, and liver disease.