What
Is Psoriasis? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Psoriasis is an
autoimmune disease that causes plaques, which are itchy or sore patches of
thick, dry, discolored skin.
While any part of your body can be affected,
psoriasis plaques most often develop on the elbows, knees, scalp, back, palms, and feet.
Like other auto inflammatory diseases,
psoriasis occurs when your immune system — which normally attacks infectious
germs — begins to attack healthy cells instead.online medicine
Signs and Symptoms of
Psoriasis
Psoriasis plaques can
range from a few spots of dandruff-like scaling to major eruptions that
cover large areas. The disease’s symptoms and appearance vary according to the
type and severity of psoriasis.
mental health awareness
Some common signs and
symptoms include:
·
Discolored patches —
classically, they’re red on fair skin and purple on dark skin — or raised
plaques of skin that are covered with scales
·
Dry or cracked skin that bleeds
·
Burning, itching, or
soreness near the affected areas
·
Pitted or thickened
fingernails or toenails
·
Swollen joints (1)
·
Causes
and Risk Factors of Psoriasis
·
Psoriasis, in general, is a genetic condition passed down
through families. “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,” says James W. Swan, MD, a dermatologist who
specializes in psoriasis at Loyola Medicine in Maywood, Illinois.
·
·
At least 10 percent of people inherit genes that could lead to
psoriasis, but only 3 percent or less actually develop the disease. (2) For this reason, it is
believed that the disease is caused by a combination of genetics and external
factors or triggers.
·
A psoriasis outbreak may be provoked by:
·
Stress
·
Stress is a major trigger for some people with psoriasis,
either causing psoriasis to flare up for the first time or to make it worse
after you’ve been diagnosed. (3)
·
“Psoriasis is very stress-dependent. It flares very easily when
patients are under stress, and it tends to improve when they’re relaxed,” says
Vesna Petronic-Rosic, MD, a visiting professor at the University of
Illinois Chicago and the director of dermatopathology at John H. Stroger, Jr.
Hospital of Cook County in Chicago. Stress management techniques, such as
exercise, yoga, and meditation, may help manage psoriasis symptoms.
·
Cold Weather
·
A trip to the Caribbean might be a good idea during the winter
months if you have psoriasis and live in a cold climate. That’s because
the sun’s ultraviolet light turns off the skin’s immune system, which is
overactive in people with psoriasis. Check with your dermatologist before
traveling for sun safety skin tips and limit your daily exposure to no more
than 10 minutes of direct sunlight.
·
Dry Skin
·
Anything that injures the skin can cause a psoriasis flare,
including excessively dry skin.
·
The solution: Keep your skin moisturized. If you’re
allergic to the fragrances in moisturizers, use a product that’s fragrance-free
to avoid a rash.
·
Vaccinations
·
As with dry skin, puncturing the skin during a vaccination may
cause a psoriasis flare, but that’s no reason to skip a needed shot. (4)
·
One thing to keep in mind: If you’re on a potent psoriasis
medication that suppresses your immune system (such as a biologic treatment),
you shouldn’t take a live vaccine. Your body may not be able to fight off a
live virus because of the medication you’re taking. In that case, ask your
doctor for a vaccine that contains a deactivated virus.
·
Beta-Blockers and Lithium
·
Beta-blockers to treat high blood pressure and lithium for
a mental disorder can make psoriasis worse. (5,6)
·
If you have high blood pressure, your doctor may be able to
switch your medication to another drug that won’t affect the psoriasis. If
you’re taking lithium, your dermatologist may consider having you try
light therapy or a topical treatment for psoriasis.
·
Upper Respiratory Infections
·
Colds and other infections, especially strep
throat, activate the immune system and can cause psoriasis to flare. (7) If you have psoriasis and develop a sore
throat, get it treated and be sure to have a culture taken to check for strep.
Long-term antibiotics may be an option for someone who has psoriasis
and frequent sore throats.
·
Smoking
·
There’s some evidence that smoking can make psoriasis worse. According
to a study, smokers have almost double the risk of developing psoriasis
compared with people who’ve never smoked. (8) In a smaller study that
looked at twins, heavy smokers were more than twice as likely to have
psoriasis. (9)
·
Diet
·
Studies haven’t shown any beneficial effects of taking
nutritional supplements for psoriasis, but avoiding certain foods may reduce
inflammation and help with psoriasis. Additionally, studies have shown that
many people with psoriasis may also have a gluten sensitivity, and
eating a gluten-free diet can help reduce psoriasis symptoms. (10)
·
It’s also best to eat nightshade vegetables —
including eggplant, tomato, white potato, and peppers — in smaller quantities;
they contain a chemical known to cause inflammation. In general, if you find
that a certain food makes the psoriasis worse, try to avoid it.
·
Alcohol
·
For some people with psoriasis, having more than one or two
drinks a day has been shown to cause psoriasis flares, but the association is
not a strong one. Flares from alcohol use could also be linked to psychological
stress.
·
·
There are five types of psoriasis, yet people most often
have only one type of psoriasis at a time. Each type has its own set of
symptoms.
·
Plaque Psoriasis
·
Also called psoriasis vulgaris, plaque
psoriasis is the most common form of the skin disease. It appears as
raised, discolored plaques covered with a scaly buildup of dead skin
cells, or scales. The itchy, sometimes painful plaques can crack and bleed, and
commonly affect the scalp, knees, elbows, back, hands, and feet.
·
Guttate Psoriasis
·
Often beginning in childhood or young adulthood, guttate psoriasis is
the second most common type of psoriasis. Nearly 10 percent of people who get
psoriasis develop guttate psoriasis. Guttate psoriasis is
the type of psoriasis most closely linked to a recent strep infection. If you
develop guttate psoriasis, you will also likely be tested for strep bacteria.
·
Inverse Psoriasis
·
Also known as intertriginous psoriasis, inverse
psoriasis causes red or otherwise discolored lesions in skin folds of the
body that may look smooth and shiny. Each lesion can occur on the genitals or
in areas near the genitals, like the upper thighs and groin. It’s common for
people with inverse psoriasis to have another type of psoriasis somewhere else
on their body at the same time.
·
Pustular Psoriasis
·
This causes white blisters of pus that surround red or otherwise
discolored skin, often on the hands or feet. The pus consists of white blood
cells. When pus-filled bumps cover the body, you may have bright-red skin and
feel ill or exhausted, and have a fever, chills, severe itching, rapid pulse,
loss of appetite, or muscle weakness.
·
Erythrodermic Psoriasis
·
This is a dangerous and rare form of the skin disease
characterized by a widespread, fiery redness or other discoloration and
exfoliation of the skin that causes severe itching and pain. Erythrodermic
psoriasis occurs once or more in 3 percent of people with psoriasis.
·
How
Is Psoriasis Diagnosed?
·
There aren’t any special tests to help doctors diagnose
psoriasis. Typically, a dermatologist will examine your skin and ask about your
family history.
·
You’ll likely be given a diagnosis based on this physical exam.
·
In some situations, doctors will remove a small sample of the
skin and examine it under a microscope. This might allow them to get a better
look at the affected area and make a more accurate diagnosis. (11)
·
Duration
of Psoriasis
·
Psoriasis is considered a chronic, lifelong condition. There
currently isn’t a cure, and this skin disorder can worsen or improve.
·
For some, psoriasis can clear up for months or even years at a
time. This is known as remission.
·
Others experience psoriasis flares in cyclical patterns. For
instance, the disease may get better in the summer and worsen in the winter. (12) There are treatments
that can keep your skin clear or nearly clear.
Prevention of
Psoriasis
There’s no way to
prevent psoriasis, but there are things you can do to improve your symptoms and
help lessen the number of flare-ups you experience. (13)
Some ways to reduce your risk of a psoriasis
outbreak include:
·
Take daily baths
·
Keep skin moisturized
·
Avoid triggers if you
can
·
Get a small amount of
sunlight each day (1)
Complications of
Psoriasis
Having psoriasis can
increase your risk for developing a number of health conditions, including:
·
High blood pressure
·
Obesity
·
High cholesterol
·
Diabetes
·
Cardiovascular disease
·
Osteoporosis
·
Liver disease
·
Kidney disease
·
Cancer
·
Uveitis (an eye
disease)
·
Crohn’s disease
·
Depression (14)
“Over the past few years, we've seen that
maybe psoriasis plays a more integral part in metabolic syndrome, a collection
of symptoms that can lead to diabetes and heart disease,” says Erin Boh, MD, chairman and a professor of dermatology at the Tulane
University School of Medicine in New Orleans.
It is estimated that up to 30 percent of
people with psoriasis will also develop psoriatic arthritis, an autoimmune disease that affects the
joints. Psoriasis occurs before joint disease in 85 percent of psoriatic
arthritis patients. (15)
The risks for psoriasis-related complications
are greater the younger a patient is when diagnosed and the more severe the
psoriasis. (16) Anyone with psoriasis should be aware that they are at
risk for comorbid conditions and should monitor their overall health
accordingly.
Research and Statistics:
Who Has Psoriasis?
About 7.5 million
people in the United States have psoriasis. Most are white, but the skin
disease also affects Black, Latino, and Asian Americans as well as Native
Americans and Pacific Islanders. (17)
The disease occurs about equally among men and
women. It is more common in adults, and you are at a greater risk if someone in
your family has it. (18) A study concluded that “interactions
between particular genes as well as genetic and environmental factors play an
important role” in the disease’s development. (19)
People with psoriasis generally see their
first symptoms between ages 15 and 30, although developing the disease between
50 and 60 years of age is also common. (20)
“The biggest factor for determining prognosis
is the amount of disease someone has,” says Michael P. Heffernan, MD, a dermatologist at the San Luis Dermatology
& Laser Clinic in San Luis Obispo, California.
Related Conditions
Many conditions are
closely related to, and sometimes mistaken for, psoriasis.
Psoriasis and eczema may be tricky to tell
apart.
If psoriasis affects your scalp, it might be
hard to determine if it’s dandruff or psoriasis.
Other skin conditions like ringworm and pityriasis rosea are occasionally confused with
psoriasis.
Is It Psoriasis or Eczema?
Like psoriasis, eczema
is a very itchy skin condition. In fact, eczema usually results in a more
intense itch than psoriasis. Scratching causes inflammation of the skin,
leading to a worsening of the eczema. Scratching can also cause a secondary
bacterial infection.
Eczema is not a specific disease, but rather a
term referring to a group of rash-like conditions. The most common type of eczema is caused by a reaction to irritants,
like detergents, soaps, or household cleansers.
Eczema often shows up on the back of the knees
or the inside of the elbows.
Eczema can affect anyone and affects
children more than psoriasis does. (21)
Is It Scalp Psoriasis or Dandruff?
More than half of all
psoriasis patients have scalp psoriasis. (22) Itchy plaques can
extend beyond the hairline onto the forehead, neck, and around the ears.
“Most people with scalp psoriasis have it on
other parts of their body as well,” says Dina D. Strachan, MD, a dermatologist and assistant clinical professor of
dermatology at NYU Langone Health in New York City.
Scalp psoriasis is sometimes confused with seborrheic dermatitis, or dandruff. According to Dr. Strachan,
dandruff — which causes a flaky, itchy scalp without signs of inflammation —
tends to itch more than scalp psoriasis. “It has a greasy-appearing yellow
scale,” Strachan says. “In contrast, psoriasis — whether it's on your scalp or
any other body part — tends to have a thick, silvery scale."
BIPOC and Psoriasis
Psoriasis is less
common in BIPOC (Black, Indigenous, and People of Color) populations compared
with white ones, but it may be more severe and more challenging to diagnose.
According to research, psoriasis affects about 3.6 percent of Caucasians, as well 1.9
percent of African Americans and 1.6 percent of Hispanic Americans.
The appearance of psoriasis can differ
depending on race and ethnicity. Psoriasis tends to be red or pink with
silvery-white scale in white patients, while a Hispanic person is more likely
to have salmon-colored psoriasis and silvery-white scale. In Black Americans,
psoriasis often looks violet and the scale gray, or can be a deep brown and
hard to see on people with very dark skin.
Psoriasis can be more severe for people of
color than white people. A study found that
Asians with psoriasis had the highest percentage of body surface area affected
(41 percent), while Caucasians had the lowest (28 percent).
People of color who have psoriasis are less
likely to get appropriate and timely treatment than their white counterparts.
A study found that
Black, Asian, and Native Americans are 40 percent less likely to see a
dermatologist for their psoriasis than non-Hispanic white Americans, regardless
of their health insurance or socioeconomic status.
One reason more people of color with psoriasis
are not receiving high-quality treatment may be systemic racism in the medical
field and the health disparities it causes. An analysis of dermatology textbooks showed that the number of images of skin
of color ranged from 4 to 18 percent, with many textbooks showing zero images
of skin of color with psoriasis.
