Home > Psoriasis

Table of Contents

• What is psoriasis?
• Causes
• Types and Symptoms
• Pictures
• Diagnosis
• Treatment
• Free Brochures

" Psoriasis (psoriasis vulgaris) is a chronic skin condition characterized by dry, red plaques of thick skin that affects 1.5% to 2% of the population. Dry flakes and scales are commonly found on the scalp, face, back, elbows, palms, knees, and feet. In some people, Psoriasis may occur as a mild condition that is not noticeable, while in other people, it may be a severe condition that affects the entire body It is classified into 5 categories with Plaque Psoriasis seen in up to 90% of cases.

The condition can be treated, but not cured. It is thought to be triggered by environmental factors, stress, skin rubbing and scratching, medications and alcohol use. Most children with the condition start at age 8 while adults start to see signs at age 22. In addition to skin lesions, most patients experience skin itch (pruritis). 

This is a non-contagious but long-term skin condition where there is no cure. It follows a variable course, which can periodically improve or worsen. In some people, the condition spontaneously clears for years and stays in remission."

What is Psoriasis?

Psoriasis is an inflammatory immune-mediated disease that is primarily seen in joints and the skin. It is characterized by red skin patches, plaques and papules that are often itchy.

Psoriasis vulgaris is a common disease worldwide, affecting 2% of the population. It is seen in both sexes and all races. Although it occurs in people of any age, the usual onset for most patients is early on in their adult years between age 20 and 30 and 50 and 60 (higher incidences during both 10 year age spans.) 

In 30% of cases it is also seen in a first-degree relative such as a parent.

Psoriasis skin outbreaks will increase and decrease across the patients life.

What Causes Psoriasis?

The cause is unknown but factors associated with Psoriasis include:

• genetic predisposition
• immune system dysfunction
• environmental influence

The condition runs in families and it may be triggered by environmental factors such as intake of certain medications and cold weather. Other factors include stress, dry skin, infections, and skin injury.

The specific cause of any symptoms are skin cells that rapidly divide resulting in scaling and thickening skin.

Many people experience worsening of symptoms during the winter months. Severe psoriasis can lead to social embarrassment, emotional distress, job stress, and other personal issues.

Eczema vs. Psoriasis

The difference between eczema and psoriasis is that psoriasis is an autoimmune disease whereas eczema is a hypersensitivity reaction to something that comes in contact with your skin. 

Types and Symptoms

Psoriasis types are classified in five categories. Actual cases can overlap in more than one classification category.

Psoriasis Pictures

The condition can appear on any part of the body as shown in the following psoriasis pictures.

Abdomen

Buttocks

Trunk, legs and Abdomen

Arm

Feet and Legs

Scalp Psoriasis Pictures

Scalp psoriasis symptoms are characterized by thick skin scales accompanied by flaky dead skin cells and itch. The condition does not cause hair loss.

Diagnosis

A doctor can diagnose the condition based on medical history and physical examination. A skin biopsy may help confirm the diagnosis. Other laboratory tests can help exclude other conditions or determine the severity of the disease.

Psoriasis and Heart Disease

People with moderate-severe psoriasis have more cardiovascular risk factors. This is why patients with disease are encourage to follow a heart healthy diet and exercise plan that includes maintaining a normal weight. Studies show that people with higher body mass (BMI) are prone to more severe frequency and severity of psoriasis.⁽¹⁾

Psoriasis Joint Pain

About 1/3 of people with psoriasis have what is called psoriatic arthritis. This autoimmune psoriasis arthritis disorder can degrade the body's joints, leading to joint pain.

Quality of Life

Psoriasis can affect the patients quality of life, even when not entirely visible. Emotional issues among psoriasis patients include:

• Feeling stigmatized
• Higher stress
• Physical limitations
• Alcoholism
• Depression
• Problems with employment

Treatment

Psoriasis treatment will depend on the cause and accompanying symptoms which need immediate or long-term relief. Many psoriasis skin bumps are harmless and may go away on their own, while others may need medical treatment involving topical medications, oral medications, phototherapy or even surgery.

If you have just one area of the body with Plaque Psoriasis then it is fine to see your regular Doctor who will prescribe a topical ointment or cream. If multiple skin areas or other types of the disease are involved then see a Dermatologist.

Treatment may be directed at curing an infection, relieving itchiness or inflammation, treating a systemic disease (like a viral infection) or improving one’s appearance (cosmetic reasons).

One may need to call a doctor if skin bumps are accompanied by symptoms that indicate severe inflammation or widespread infection, such as fever, severe pain, and weakness. Immediate medical help is needed in cases of anaphylactic or severe allergic reactions causing difficulty in breathing and swallowing, swelling of the tongue, hoarseness, dizziness, and loss of consciousness.

For plaque psoriasis or psoriasis that covers less than 5% of the body a Doctor will typically prescribe one of the following topical treatments:

• Topical steroids (for every type of psoriasis)
• Calcipotriene (Vitamin D Cream, used with other creams)
• Topical Retinoid (Tazarotene)
• Coal Tar (for Plaque Psoriasis)
• Calcineurin Inhibitors (for face and areas where skin rubs together)

Treatment with oral medications (methotrexate, acitretin, cyclosporin, apremilast), biologic agents (inflximab, etanercept, adalumimab, infliximab, ustekinumab, secukinumab) or UV light therapy (UVA or UVB) may also be helpful (called phototherapy, requires 20 to 25 treatments 2x to 3x/week). Phototherapy is used ot reduce skin inflammation.  Natural sunlight exposure may also help.

Other topical treatments include immunomodulators creams like pimecrolimus and tacrolimus, bath salts, coal tar (an ingredient in bath solutions, shampoos, and creams), anthralin cream or ointment, and Calcitriol, a vitamin D analogue cream.

Scalp Treatment

Mild scalp conditions calls for the use of Tar or ketoconazole shampoos followed by a topical lotion (betamethasone valerate 1%). For more chronic scalppsoriasis, the skin plaque is removed with a topical that contains 10% salicylic acid suspended in a mineral oil solution. After scales are shed, a cream or lotion that contains fluocinolone is left on the scalp overnight (covered by a plastic shower cap). Once under control, other lotions (clobetasol propionate) or calcipotriene lotion is used.

Palm (hands) and Sole (foot) Treatment

Topical glucocorticoids are used to treat the skin as well as phototherapy (PUVA).

Inverse Psoriasis

Topical glucocorticoids are applied for limited periods in some patients depending on skin condition. Others receive a vitamin D based topical such as atacrolimus. Tar baths or Castellani paint can be of help.

Nail Treatment

Topicals are used to treatpsoriasis in nails. The condition may go away on its own with no treatment. Phototherapy can be effective using high-intensity UVA light. Topical retinoids are effective as well. If the nail cannot be cured, then removal and regrowth is used.

Guttate Treatment

Any infection is treated with antibiotics. For localized conditions (in one area), phototherapy and UVB irradiation therapy can be effective. 

Risk Factors

Both smoking and alcohol consumption are considered risk factors for psoriasis and may increase the severity of outbreaks.

Brochures and Articles

References

(1) AAD

Cole, G. MedicineNet.

National Psoriasis Foundation

Abdelaziz A, Burge S. What should undergraduate medical students know about psoriasis? Involving patients in curriculum development: modified Delphi technique. BMJ 2005;330:633-6. 

Berger T, Hong J, Saeed S, Colaco S, Tsang M, Kasper R. The Web-Based Illustrated Clinical Dermatology Glossary. MedEdPORTAL; 2007. Available from: . 

Kimball AB, et al. National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. National Psoriasis Foundation. J American Academy of Dermatology. 2008 Jun;58(6):1031-42. 

Jobling R. A Patient’s Journey. Psoriasis. BMJ 2007;334:953-4. 

Kimball AB et al. The Psychosocial Burden of Psoriasis. American Journal of Clinical Dermatology 2005;6:383-392. 

Menter A et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J American Academy of Dermatology 2009;60:643-659.