Psoriasis is a chronic skin condition caused by an overactive immune system. Symptoms include flaking, inflammation, and thick, white, silvery, or red patches of skin. Psoriasis treatments include steroid creams, occlusion, light therapy and oral medications, such as biologics.
Psoriasis – Cause
The exact cause of psoriasis isn’t known.
Doctors believe that the immune system overreacts, causing inflammation and flaking of skin.
Many scientists believe that psoriasis can be inherited. About one-third of people who have psoriasis have one or more family members with the condition.1 But it isn’t clear that genetic factors alone determine whether you get psoriasis.
Psoriasis isn’t contagious—it can’t be spread by touch from person to person.
Psoriasis – Symptoms
There are several types of psoriasis. Symptoms for each type may vary, but the major symptoms are:
- Raised, bright red patches of skin , often covered with loose, silvery scales, usually on the knees, elbows, or low back.
- Tiny areas of bleeding when skin scales are picked or scraped off (Auspitz’s sign).
- Mild scaling to thick, crusted plaques on the scalp.
- Itching, especially during sudden flare-ups or when the psoriasispatches are in body folds, such as under the breasts or buttocks.
- Discolored or pitted nails.
Other symptoms of psoriasis may include:
- Similar plaques in the same area on both sides of the body (for example, both knees or both elbows).
- Flare-ups of many raindrop-shaped patches (guttate psoriasis).
- Joint swelling, tenderness, and pain (psoriatic arthritis).
- Psoriasis patches that appear after an injury, such as a cut, a burn, or too much sun. This is called Koebner’s phenomenon. Because this response is common, it’s important for people with psoriasis to avoid irritating or injuring their skin.
Several other skin conditions have symptoms similar to psoriasis. And some medicine reactions can cause symptoms (such as reddened skin) similar to psoriasis. Talk to your doctor about the medicines you are taking.
Psoriasis – What Happens
Psoriasis is usually a long-term problem. Symptoms tend to come and go in a cycle of flares, when symptoms get worse, and remission, when symptoms improve and go away for awhile. In other cases psoriasismay persist for long periods of time without getting better or worse.
Several things can make symptoms worse, depending on the type ofpsoriasis. These factors, or triggers, include:
- Dry climates.
- Skin injury.
- Certain medicines.
A few cases of psoriasis may go away without treatment. But it’s usually best to treat psoriasis so that it doesn’t get worse. If it becomes severe and widespread, it may be much harder to treat.
Mild, moderate, and severe psoriasis
The severity of psoriasis is indicated by the amount of redness and scaling, the thickness of the large areas of raised skin patches (plaques), and the percentage of your skin that is affected.
- Plaques cover a small portion of the body, such as the elbows or knees.
- Plaques cover several large areas. For example, most of the scalp may be affected.
- Plaques may cover up to 20% of the skin (about equal to having both arms completely covered).
- Any joint pain is mild, but not disabling.
- Plaques tend to be visible to other people.
When severe, psoriasis can be:
- On the face.
- Plaques that may cover large areas (20% to 30%) of the body. When determining the percent of coverage, consider that the palm of your hand equals about 1% of your body surface, and the total surface of both arms equals about 20%.
- Pustular psoriasis with large, fluid-filled plaque and severe scaling.
- Erythrodermic psoriasis with severe inflammation and shedding (sloughing) of the skin.
- Psoriatic arthritis, which includes ongoing joint swelling, tenderness, limitation of range of motion, or joint warmth or redness. Severe cases can result in joint destruction.
Psoriasis – What Increases Your Risk
Many doctors believe that psoriasis may be passed down from parents to their children (inherited). This is because certain genes are found in families who are affected by psoriasis.2 About one-third of people who have psoriasis have one or more family members with the condition.1
Other factors that can contribute to the development of psoriasis include:
- Emotional or physical stress. Stress may cause psoriasis to appear suddenly or make symptoms worse (although this has not been proved in studies).
- Infection. Infections such as strep throat can cause psoriasis to appear suddenly, especially in children.
- Skin injuries. An injury to the skin can cause psoriasis patches to form anywhere on the body, including the site of the injury. This includes injuries to your nails or nearby skin while trimming your nails.
- Smoking. Smoking may make you more likely to get psoriasis and make the symptoms more severe.3
Psoriasis – Treatment Overview
Currently there is no cure for psoriasis. But many types of treatment are available, including products applied to the skin, phototherapy, and oral medicines, which can help control psoriasis. Most cases are mild and can be treated with skin products. In some cases, psoriasis can be hard to treat if it is severe and widespread. Most psoriasis returns, even mild forms.
The purpose of treatment is to slow the rapid growth of skin cells that causes psoriasis and to reduce inflammation. Treatment is based on the type of psoriasis you have, its location, its severity, and your age and overall health.
Treatment can also depend on how much you are affected by the condition, either physically (because of factors such as joint pain) or emotionally (because of embarrassment or frustration from a skin rash that may cover a large or visible area of the body). For example, you may get more aggressive treatment if your psoriasis is severe or if the patches frequently upset you.
Most cases are mild and can be treated with:
- Creams, ointments, and lotions to moisturize the skin.
- Shampoos, oils, and sprays to treat psoriasis of the scalp.
- Some exposure to sunlight.
- Skin products that your doctor prescribes.
- Pills that your doctor prescribes.
- Shots to help your immune system.
- Phototherapy, which involves exposing your skin to special ultraviolet light.
You may need to try different treatments before you find one that works well for you. It’s important to discuss your treatment and progress with your doctor.
Many doctors will recommend that treatments be changed or rotated after a certain period of time to make treatment more effective and to reduce side effects.
People respond differently to psoriasis treatments. A treatment that worked one time may not work again. A treatment that didn’t work the first time may work when tried again later.
It’s also important to avoid anything that can trigger a flare-up of psoriasis or make the condition worse. Stress, skin injury, infection, and use of alcohol can all contribute to symptom flare-ups. Streptococcal infections, which usually affect the upper respiratory tract, are linked to guttate psoriasis.
Treat scalp or nail psoriasis
Scalp and nail psoriasis can be hard to treat. Both conditions are more likely to improve with medicines taken by mouth (oral medicines). Treatment for the scalp often includes tar shampoos, corticosteroid solutions, or zinc and selenium sulfide shampoos.