Psoriasis is a skin condition that can greatly impact your quality of life. An estimated 8 million Americans and 125 million people worldwide struggle with a psoriasis diagnosis, according to statistics from the National Psoriasis Foundation. Luckily, with early detection and treatment, you can optimize control of your psoriasis and possibly prevent the worsening of your disease.
Here is a guide for everything you need to know about psoriasis.
Psoriasis is an autoimmune disease. It occurs when the body’s skin cells go haywire and begin producing new skin cells at a much faster rate than normal. The growth cycle of skin cells affected by psoriasis is mere days, whereas the typical growth cycle of skin cells is about a month.
The hyperactivity of skin cells seen in psoriasis leads to a buildup of excess skin and the formation of patch-like plaques. These plaques can be very irritating and painful, and they can also be visibly distressing because they affect the cosmetic appearance of the skin.
Where Does Psoriasis Appear?
Psoriasis affects everyone a bit differently. The location of psoriasis on the body is typically determined by the type of psoriasis:
- In “plaque psoriasis,” which is the most common type of psoriasis, skin lesions develop most commonly in places like the elbows, forearms, knees, or lower back. This type of psoriasis can also impact the scalp and the nails.
- A certain form of psoriasis that is more common in children, known as “guttate psoriasis,” causes small pink dots that generally appear on the body’s trunk, and also on the arms and legs.
- In cases of “inverse psoriasis,” skin plaques are smoother and flatter, occurring in places where the skin folds in on itself, like the armpits or genital area.
- A rarer form of the condition, known as “pustular psoriasis” can cause pustules (fluid-filled blisters), that are most commonly located on the hands or feet.
- The rarest form of psoriasis, known as “erythrodermic psoriasis,” causes extreme redness of the skin, generally in large patches of skin.
When Should a Person Suspect That They Have Psoriasis?
If you are suffering from thickened, rough, or scaly patches of skin, you may have psoriasis. These patches are more likely to be from psoriasis than from another type of skin condition if they have a slight silver color and if they are itchy. Itchiness is one of the most difficult symptoms of psoriasis, but there are ways that you can help reduce itching.
You may have a rarer version of psoriasis if you are struggling with skin bumps that appear suddenly and are sore or painful. You may also suspect psoriasis if you have smooth, red patches that are sore, skin that looks burnt by the sun, or pustules that look infected. Psoriasis should also be suspected if you have nail changes such as crumbling or brittle nails, color changes, or little divots in your nails.
Who is Most Likely to Get Psoriasis?
Psoriasis is more common in families (it can be "genetic”), so your suspicion should be raised if you have a family member who also has psoriasis. The most common time to develop psoriasis is around the third decade of life, though it is also common to develop psoriasis later in life, in the fifth or sixth decade. Psoriasis seems to affect men and women similarly.
Other risk factors for the development of psoriasis include:
- Cigarette smoking
- Alcohol use
- Use of certain medications, such as beta-blockers, lithium, or antimalarial medications
Psoriasis is not contagious; you cannot get psoriasis from having contact with someone else who has the skin condition.
How Do Healthcare Providers Diagnose Psoriasis?
A healthcare provider can typically diagnose psoriasis by looking at your skin; there are no specific tests that can detect psoriasis. If your healthcare provider suspects another skin condition, he or she may do a skin biopsy to rule out other possibilities.
When making a diagnosis, healthcare providers will evaluate the overall percentage of your skin that is involved in psoriasis, and assign a “grade,” ranging from mild to severe. If more than 10 percent of the surface of your body is covered with psoriasis lesions, your psoriasis will be classified as severe.
What Conditions Are Associated With Psoriasis?
Psoriasis can impact body systems outside of the skin, most commonly the joints. If you have joint involvement with your psoriasis, it is known as “psoriatic arthritis.” Psoriatic arthritis typically appears several years after a person is diagnosed with psoriasis, but sometimes people can have psoriatic arthritis without any skin involvement at all. The U.S. Centers for Disease Control and Prevention (CDC) estimates that 10 to 20 percent of people with psoriasis will develop psoriatic arthritis.
People who suffer from psoriatic arthritis can experience the following symptoms:
- Joint stiffness early in the morning
- Joint stiffness after sitting or being inactive for long periods of time
- Pain at the points where their soft tissues insert into the bone (for example, where the Achilles tendon inserts at the heel)
- Swelling and inflammation of the fingers or toes
- Nail changes, such as breaking, discoloration, or nail denting
In addition to psoriatic arthritis, people who have psoriasis are more likely to have other medical conditions related to inflammation, particularly cardiovascular diseases, such as high cholesterol, high blood pressure, or coronary artery disease.
Other conditions associated with psoriasis include the following:
- Kidney disease
- Inflammatory bowel disease
- Metabolic syndrome
- Mental health issues
If you are being evaluated or treated for psoriasis, your medical provider will likely screen you for the development of other health conditions that are associated with psoriasis.
What Conditions Mimic Psoriasis?
There are other skin conditions that are similar to psoriasis that your healthcare provider may consider if you are having symptoms of painful skin changes or itching.
These conditions include:
- Eczema (also known as atopic dermatitis)
- Contact dermatitis
- Seborrheic dermatitis
- Skin infections, such as cellulitis
- Herpetic whitlow
- Fungal infections
- Insect bites
What Can I Do to Treat My Psoriasis?
When it comes to treating psoriasis, the earlier treatment can help decrease the likelihood of the condition becoming more severe. The following categories of medications and therapies can be helpful in treating psoriasis. Your healthcare provider will take into account your medical history, possible other medical conditions, and the severity of your psoriasis before prescribing a treatment.
Treatment For Mild to Moderate Psoriasis
Topical medications (medications that can be applied to the skin directly) are the most common types of medicine that are used to treat mild to moderate psoriasis. These can be easily placed directly on the affected skin areas, and include the following:
- Emollients, such as petroleum jelly, to improve skin hydration
- Topical steroids of various strengths and formulas
- Vitamin D-derivative medications (calcipotriene or calcitriol)
- Retinoid medications (tazarotene)
- Combination medications (retinoids and steroids)
- Tacrolimus or pimecrolimus
- Salicylic acid
- Coal tar
Another mode of treatment for mild to moderate psoriasis is called “phototherapy.” This type of treatment uses UV light (generally a narrow UVB spectrum) to help improve skin lesions. During a phototherapy treatment phase, you will generally go for a light treatment session three times a week. This therapy is usually used in combination with other forms of treatment. Exposure to natural sunlight can also help improve a psoriasis flare.
Treatment for Moderate to Severe Psoriasis
When a greater percentage of the skin is involved in psoriasis, it becomes difficult to apply a topical medication to all the affected areas, and you can have side effects from absorbing too much medication through your skin. For these reasons, healthcare providers will usually recommend an oral (or “systemic”) medicine to improve your psoriasis from the inside out. The most commonly used oral medications for psoriasis include:
- Biologic agents such as Infliximab, Adalimumab, Etanercept, Ustekinumab, Ixekizumab, Secukinumab, Brodalumab, or Certolizumab
Many of the oral medications that are used to manage psoriasis can have side effects. Your healthcare provider may recommend blood work or other forms of monitoring before you begin taking one of these medications, and he or she may also routinely monitor your status as you continue taking the medication. Many of these medications work by suppressing your immune system, so it is important to make sure that you are up to date on vaccinations before you begin taking them.
What is the Outlook For My Psoriasis?
A diagnosis of psoriasis can be discouraging, because, in addition to causing physical and emotional discomfort, psoriasis is usually a lifelong disease. Although there is no specific “cure” for psoriasis, the above therapies can help you control flare-ups, manage your symptoms, and improve your quality of life.
Make sure to talk with your healthcare provider about measures you can take to personally improve your condition, such as possible diet modifications. The American Academy of Dermatology has published a number of insider tips for dealing with psoriasis as well, such as applying cold compresses to the areas that are most inflamed and avoiding common triggers, like stress or certain weather conditions.
Though psoriasis is a chronic inflammatory illness, research is informing new developments and treatments every day.
How to Get Screened For Psoriasis
If you suspect that you or a loved one may have psoriasis, Lompoc Valley Medical Center has many resources available to you. The best starting place is scheduling an appointment with a primary care provider. You can even consider one of our handy TeleVisits, which will afford you the opportunity to be assessed from the comfort of your own home.
If you have a new skin rash that has appeared with other symptoms such as a fever, feeling very ill, or your skin sloughing off, this could represent an emergent medical condition. Make sure to call 911 or seek emergency services immediately.