Skin cells in the body have a typical life cycle, but this cycle can be interrupted by a skin condition called psoriasis. A relatively common condition, psoriasis causes cells to build up too quickly on the surface of the skin, leading to scales and patches on the skin that are itchy, dry and sometimes painful.
Psoriasis is considered a chronic disease, and symptoms can fluctuate over time. It can’t be cured, but the right measures can help significantly reduce symptoms and make the condition much easier to
Symptoms and Complications
Psoriasis can come in several different forms:
- Plaque psoriasis: This is the most common type of psoriasis. Plaque psoriasis causes the formation of red skin lesions, known as plaques, that are covered with silvery scales. They can develop anywhere on the body, and are often painful.
- Nail psoriasis: Nail psoriasis can affect both fingernails and toenails, which may become loose, separated or even crumble in severe cases.
- Scalp psoriasis: People with scalp psoriasis may notice flakes of dead skin on the shoulders and their scalp will appear red with itchy, silvery-white scales.
- Guttate psoriasis: This is usually triggered by a bacterial infection like strep throat, and it mostly affects young adults and children. It’s characterized by small sores shaped like water drops on the trunk, arms, legs and scalp. These sores are thinner than normal plaques.
- Inverse psoriasis: Warm, damp areas of the body—the groin, under the breasts, in the armpits and around the genitals—can be affected by inverse psoriasis. Sometimes triggered by fungal infections, this form causes smooth patches of inflamed skin and gets worse with friction or sweating.
- Pustular psoriasis: This type is not common, but it can develop quickly, and in large patches. It shows up in the form of pus-filled blisters.
- Erythrodermic psoriasis: This is the least common type, and can cover the entire body with an intense, peeling rash.
- Psoriatic arthritis: This is a condition that brings painful joints and discolored nails similar to arthritis, in addition to standard psoriasis symptoms.
Symptoms vary between each type of psoriasis and even within individual cases, but some of the most common can include:
- Red skin patches covered with silver scales
- Dry, cracked or bleeding skin
- Itching and burning, or soreness on skin
- Small scaling spots
- Swollen or stiff joints
- Thick, pitted or ridged nails
- Scaly or crusty plaques on the scalp
If you have any of these symptoms, or if they cause extreme discomfort, joint pain or appearance concerns, speak to your doctor. Psoriasis can also increase your risk of numerous other conditions, and can lead to issues with confidence and low self-esteem.
Causes and Risk Factors
The exact cause of psoriasis isn’t known, although doctors believe it’s related to an immune system issue with cells in the body called T cells. These T cells normally fight negative substances like viruses and bacteria, but in cases of psoriasis, the T cells attack healthy skin instead. This can lead to other immune responses and a repeated cycle.
It’s not fully understood what triggers malfunction of T cells, but potential factors can include:
- Smoking or heavy alcohol consumption
- Cuts, scrapes, sunburns or other simple skin injuries
- Cold weather
- Medications: Certain medications like lithium, beta blockers and antimalarial drugs can cause psoriasis in some cases
In addition, there are a few factors that increase your risk of psoriasis:
- History: A family history of the disease increases risk to a certain degree if only one parent has it, and to an even larger degree if both have it.
- Infections: People with HIV have a higher likelihood of psoriasis, and children or young adults with recurring infections could also be at higher risk.
- Smoking: Tobacco smoking can increase both risk of psoriasis and severity of the condition if you do develop it.
- Weight: Obesity can increase your risk of psoriasis, as plaques associated with the disease are more likely to develop in creases or folds of skin.
- Stress: Stress impacts the immune system, and may raise your risk of psoriasis.
Psoriasis Diagnosis and Treatment
Save & Exit Diagnosing psoriasis involves a basic physical exam and questions about your symptoms and medical history. It may also include a skin biopsy in some rare cases—a test where a sample of skin is removed and tested. A few other conditions might look similar to psoriasis, and some of them can even occur at the same time.
The goal of psoriasis treatment is to reduce the speed of cell growth that leads to it and remove the scales, making the skin smooth again. Treatment options include:
Various creams are often the first line of defense for mild psoriasis. They include:
- Topical corticosteroids: These are strong anti-inflammatory drugs meant to slow cell turnover and suppress the immune system. Their strength may depend on the area of the body you need them for. Long-term use can affect resistance and cause thinning of the skin, so these treatments are only usually used on active outbreaks.
- Vitamin D analogues: A synthetic form of vitamin D that helps slow skin cell growth.
- Anthralin: This is a medication that can help normalize DNA activity on the skin, remove scales and smooth the skin.
- Retinoids: Retinoids are also used for acne and sun damage, but they can also help decrease inflammation and normalize DNA activity.
- Salicylic acid: Also used to treat acne, salicylic acid helps remove dead skin cells and reduce scaling.
- Coal tar: One of the oldest treatments for psoriasis, this reduces scaling, itching and inflammation.
- Moisturizers: These won’t heal psoriasis, but they can help with many symptoms, including dryness sometimes caused by other medications.
Exposing the skin to certain kinds of light, both on its own and combined with other medications can help treat psoriasis. There are a few kinds of light therapy:
- Sunlight: UV rays can kill active T cells in the skin, which slows turnover and reduces scaling and inflammation.
- UVB phototherapy: These are controlled UVB light doses that can help mild or moderate cases of psoriasis.
- Narrow-band UVB: A new treatment similar to regular UVB therapy. Narrow-band UVB therapy may be more effective, but it can also increase the severity and longevity of burns.
- Goeckerman therapy: A combination of UVB treatment and coal tar treatment.
- Photochemotherapy: This is a medication that can make your skin more responsive to UVA exposure.
- Psoralen plus ultraviolet A (PUVA): PUVA treatment includes two or three treatments per week using light-sensitizing medications (psoralen) prior to UVA light exposure.
- Excimer laser: A specific form of light therapy only for infected areas, excimer laser therapy uses a controlled beam of UVB light.
Oral or Injected Medications:
In more severe cases of psoriasis, or in cases where other forms of treatment aren’t working, there are other medication forms that might be used:
- Retinoids: Drugs related to vitamin A that can reduce the production of skin cells.
- Methotrexate: An oral medication that suppresses inflammation and decreases skin production.
- Cyclosporine: An immune system suppressor.
- Biologics: Various, naturally sourced drugs that change the immune system. These must be used with caution and doctor supervision.
- Experimental: There are several medications currently being researched for use with psoriasis.
In general, the first psoriasis treatment will be a more mild form, and may progress if initial treatments don’t succeed. Because of the up-and-down cycles with psoriasis, there will be times where it’s tough to treat.
Some people have found success reducing symptoms with a few basic home remedies.
If you have psoriasis or symptoms that are tough to manage, speak to your doctor about your options.
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“Understanding Psoriasis — the Basics.” WebMD. http://www.webmd.com/skin-problems-and-treatments/psoriasis/understanding-psoriasis-basics#1
“Psoriasis.” The Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/psoriasis/basics/definition/con-20030838