What Is Psoriasis?
Psoriasis is a chronic autoimmune condition that speeds up the life cycle of skin cells and results in rapid skin-cell buildup on the surface of the skin. Normal skin cells live about 28 days and then shed from the outer layer of skin. With psoriasis, the growth cycle is sped up and the body isn't able to shed the dead skin cells. As dead skin cells accumulate, patches of raised red skin covered by scaly, white flakes form.
Patients with psoriasis have red patches of skin with white, flaky scales. These scales commonly appear on the elbows, knees, and trunk, but may develop anywhere on the body, including the hands, feet, neck, scalp, and face. A condition marked by intermittent cycles, psoriasis usually develops in patients 15–35 years of age. More than eight million people in the United States are affected by psoriasis.
Types Of Psoriasis
There are five distinct types of psoriasis: plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis. Patients with psoriasis have a higher risk of developing other health issues. The condition has been linked to a higher frequency of immune system-related conditions, such as heart disease, hypertension, type 2 diabetes, inflammatory bowel disease, psoriatic arthritis, anxiety, and depression. If you require treatment for psoriasis or other types of skin condition, contact our dermatologists in Boardman and Warren, OH.
This form of psoriasis accounts for 80 percent of cases — it is the most common type of psoriasis. Plaque psoriasis is typically found on the elbows, knees, lower back, and scalp. It appears as inflamed, red lesions often covered by silvery-white scales, or plaques.
Guttate psoriasis is most common in children and young adults. Small, red dot-like spots form on the limbs or torso, usually in response to an environmental trigger or health issue, such as a bacterial infection. Outbreaks typically develop on the torso, arms, and legs.
This type of psoriasis appears as bright red lesions that are smooth and shiny in appearance. These lesions worsen with friction and sweating. Inverse psoriasis is usually found in areas such as the armpits, groin, in the skin around the genitals and buttocks, and under the breasts.
An uncommon type of psoriasis, pustular psoriasis can occur in smaller areas, such as the hands, feet, or fingertips (generalized pustular psoriasis) or wide-spread patches. Pustular psoriasis develops quickly, with pus-filled blisters appearing before skin becomes inflamed.
The least common type of psoriasis, erythrodermic psoriasis can cover the entire body. Instead of flaking off the body, the skin sheds in white sheets. Severe itching and pain are associated with erythrodermic psoriasis, and these symptoms require medical attention and treatment.
Areas of the body affected by psoriasis outbreaks can be as small as a few scales on the elbow or scalp, or as severe as lesions covering the majority of the body. In the vast majority of patients affected by this condition, psoriasis symptoms differ from person to person and largely depend on the type of psoriasis. The most common symptoms of plaque psoriasis — the most prevalent form of psoriasis — include the following, among other symptoms.
- Dry skin that may crack and bleed
- Red, raised, and inflamed patches of skin
- Silver-white colored scales or plaques on red patches
- Painful, swollen joints
- Sore and tender skin around patches
- Itching and burning sensations around patches
The majority of patients with psoriasis go through cycles of symptoms, during which the condition may cause an outbreak of severe symptoms for a few days or weeks before clearing up and becoming relatively unnoticeable. If exacerbated by certain triggers, the condition may cause the recurrence of a psoriasis flare-up.
Common psoriasis triggers include high stress levels; heavy alcohol use; an accident, such as a cut, injury, or sunburn; certain medications, including lithium and medications for treating malaria and high blood pressure; and infections that target weak immune systems, such as strep throat — a common trigger of psoriasis.
Psoriasis Vs. Eczema
Dry and scaly skin can be due to a number of skin conditions, such as psoriasis and eczema. These two chronic skin conditions can sometimes appear so similar that they are commonly mistaken for one another. While both conditions can cause the skin to become red and itchy, there are a number of differences between eczema and psoriasis that a dermatologist uses to distinguish one skin condition from the other.
The degree to which patients feel itchy can be a significant point of differentiation between eczema and psoriasis — psoriasis typically causes mild itching while eczema causes intense itching. Children tend to experience eczema at a greater rate than adults, while psoriasis typically develops in patients between the ages of 15 and 35. A psoriasis rash may also be mistaken for lichen planus, seborrhea, and ringworm, in addition to eczema.
Is Psoriasis Contagious?
Psoriasis is not contagious. Patients with psoriasis cannot pass the condition to others unaffected by psoriasis. Touching a psoriatic lesion on another individual will not result in the transmission of the skin condition. For more information about psoriasis or other common skin conditions or to schedule a dermatologist appointment, please contact our office.
What Causes Psoriasis?
While the primary psoriasis causes are unclear, research points to two key factors: genetics and the immune system. Psoriasis is a type of autoimmune condition — these conditions result from the body attacking itself. In the case of psoriasis, white blood cells (T cells) mistakenly attack the skin cells as they would to heal a wound, fight an infection, or destroy harmful bacteria. These mistaken attacks put into overdrive the rate of skin cell production, which causes new skin cells to develop too quickly and accumulate on the skin’s surface. It isn’t clear what causes T cells to malfunction in people with psoriasis, but genetics and environmental factors may play a role. Genetic predisposition is another potential cause for psoriasis — patients with immediate family members that have the skin condition have a higher risk of developing psoriasis. There is only a small percentage of people, however, that have both psoriasis and a genetic predisposition for developing the skin condition.
How Is Psoriasis Diagnosed?
In most cases, a dermatologist with our practice will conduct a physical exam, take a medical history, and perform a skin biopsy in order to diagnose psoriasis. During the physical examination, the doctor examines the patient’s skin, scalp, and nails for signs of psoriasis and discusses with the patient their medical history and asks questions about their overall health, lifestyle, and habits. Rarely, the doctor may take a small sample of skin (biopsy) and proceed to examine the sample under a microscope to determine the exact type of psoriasis and to rule out other skin conditions and disorders.
Treatment of psoriasis reduces inflammation and clears the skin. Psoriasis treatments can be divided by type into three categories: topical treatments, light therapy, and systemic psoriasis medication. Treatments are typically selected based upon the severity of the condition, which ranges from mild to severe. Mild-to-moderate psoriasis covers 3-10 percent of the body, while moderate-to-severe psoriasis covers more than 10 percent of the body.
Certain creams and ointments, when used alone, can effectively treat mild-to-moderate psoriasis symptoms. When the disease is more severe, however, creams are combined with oral medications or light therapy. Prescription topical treatments focus on slowing the growth of skin cells and reducing inflammation. Topical psoriasis treatments include the following.
- Topical corticosteroids. Most commonly prescribed medication for psoriasis, topical steroids fight inflammation and reduce lesion swelling and redness. Long-term use or overuse of highly potent corticosteroids can cause thinning of the skin and may stop working over time. These are best for short-term treatment during flare ups.
- Vitamin D analogues. Synthetic forms of vitamin D that slow skin cell growth. Calcipotriene (Dovonex) is a prescription topical cream or solution containing a vitamin D analogue that treats mild-to-moderate psoriasis in conjunction with other treatments.
- Anthralin. Helps slow skin cell growth. Anthralin (Dritho-Scalp) can likewise be used to remove scales from the skin and smooth the skin, but it can irritate the skin and stain anything it comes in contact with. It’s best for short-term use.
- Topical retinoids. Vitamin A derivatives that can decrease inflammation. The most common side effect is skin irritation and hypersensitivity of the skin to sunlight. As such, patients must generously apply sunscreen before going outdoors.
- Salicylic acid. Available both in over-the-counter forms and by prescription. Salicylic acid promotes the sloughing of dead skin cells and reduces the appearance of scaling. It may be combined with other medications to increase its effectiveness.
- Coal tar. Coal tar (derived from coal) reduces inflammation, scaling, and itching. It is available by non-prescription as well as a prescription. However, coal may irritate the skin, it can easily stain absorbent surfaces, and it has a strong odor.
- Moisturizers. Moisturizers can reduce itching, scaling, and dryness, but they won’t heal psoriasis alone. When used in an ointment base, moisturizers are typically more effective than lighter creams and lotions. Apply after a bath or shower, while the skin is still wet, in order to effectively lock-in moisture to the skin.
Light Therapy (Phototherapy)
Some forms of psoriasis can be successfully treated by using controlled skin exposure to ultraviolet (UV) light. Light therapy, also called phototherapy, uses natural or artificial light. The simplest forms of phototherapy involve exposing the skin to controlled amounts of natural sunlight, while other forms of light therapy use artificial UVA or UVB lights, either alone or in conjunction with prescribed and over-the-counter medications.
- Sunshine (UVA and UVB). Sunshine can help ease the symptoms of psoriasis. But, sunlight exposure requires careful monitoring to make sure no other skin damage occurs. It's recommended sunshine be used in controlled, short bursts.
- Excimer lasers. These devices target specific areas of psoriasis. The laser emits a high-intensity beam of UVB directly onto the psoriasis plaque. Between four treatments and 10 treatments are needed to see an improvement.
- Pulse dye lasers. This treatment uses a wavelength of UVB light to treat smaller areas of psoriasis. Pulse dye lasers destroy the blood vessels that contribute to lesion formation. Generally, four sessions to six sessions are necessary to clear up a small area.
Oral Or Injected Medications
Oral or injected medications — commonly referred to as systemic treatment — may be prescribed to patients with severe psoriasis or psoriasis resistant to other types of treatment. Due to severe side effects, these medications are used for only brief periods and may be alternated with other types of treatments. Certain medications, such as thioguanine and hydroxyurea, may be used when other drugs cannot be given.
- Retinoids. Closely related to vitamin A, this group of drugs may prove effective in patients with severe psoriasis that does not respond to other medications. Side effects, however, may include lip inflammation and hair loss.
- Methotrexate. When taken orally, methotrexate helps heal psoriasis by reducing skin inflammation and decreasing the production of skin cells. It is generally well-tolerated in low doses but may cause an upset stomach, appetite loss, and fatigue. Methotrexate should not be used for long periods of time due to the risk of severe side effects.
- Cyclosporine. It suppresses the immune system, but can only be taken for a short period. As with other immunosuppressive medications, cyclosporine increases the risk of infection and may lead to other health problems, such as cancer, high blood pressure, and kidney problems. The risk also increases with higher dosages and long-term use.