Psoriasis is an autoimmune disease that causes raised, red, scaly patches to appear on the skin. Psoriasis is a chronic disease. Psoriasis is not contagious. Psoriasis can also be associated with arthritis, and less commonly with an increased risk of cardiovascular disease.
There are five types of psoriasis. The type of psoriasis will determine the most appropriate treatment. The types are:
- Plaque psoriasis— the most common form of the disease, it appears as raised, red patches covered with silvery scale, which usually appear on the scalp, knees, elbows and lower back.
- Guttate psoriasis— appears as small, dot-like lesions, often starting in childhood or young adulthood. This type of psoriasis can be triggered by a strep infection. Guttate is the second-most common type of psoriasis and affects about 10 percent of psoriasis sufferers.
- Inverse psoriasis— appears as very red lesions in body folds, typically behind the knees, under the arms or in the groin, and it may appear smooth and shiny. It often accompanies another type of psoriasis.
- Pustular psoriasis— appears as white pustules or blisters surrounded by red skin. The pustules contain white blood cells, but it is not an infection, nor is it contagious. It most commonly occurs on the hands or feet.
- Erythrodermic psoriasis—a severe form of psoriasis, it leads to redness over most of the body. It can cause severe itching and pain. This type of psoriasis can cause skin to peel off in sheets and patients can become very sick. It is rare, occurring only in 3 percent of psoriasis sufferers. It generally affects people who have unstable plaque psoriasis.
Psoriasis is believed to be hereditary with at least 10 percent of the general population inheriting one or more of the genes that create a predisposition to psoriasis. However, only 2-3 percent of the population develop the disease. It is thought that both the predisposition to psoriasis plus exposure to specific external factors, known as “triggers", causes the disease to appear.
Psoriasis triggers are not universal. What may cause one person's psoriasis to become active, may not affect another. Known psoriasis triggers include:
- Skin injury
- Certain medications, such as lithium, antimalarials, Inderal, Quinidine, Indomethacin, beta-blockers
Because of its hereditary component, people with a family history are at higher risk of developing psoriasis. In the United States, about 7.5 million people have psoriasis. Most people, about 80 percent, have plaque psoriasis.
Psoriasis can begin at any age, but most patients develop it between 15 and 30 years of age, or between 50 and 60 years of age. Caucasians are more commonly affected by psoriasis.
Physical examination of the skin, including the scalp, and fingernails can reveal classic findings of psoriasis. Additionally, information regarding family history of psoriasis and personal history of recent infections or medication changes will be helpful in the diagnosis. In rarer forms of psoriasis, like inverse psoriasis, a biopsy of the affected skin may need to be taken for evaluation by a pathologist.
Treating psoriasis can improve a patient’s quality of life by decreasing the appearance of plaques and the associated scaling and itch. There are many different ways to treat psoriasis. The extent of the skin involvement and the presence of arthritis will determine a patient’s appropriate therapy. It is important to keep in mind that individual patients can respond differently to certain therapies.
Treatment options for psoriasis include:
- Biologic Medications— medications that target specific components of the immune system. They are used for moderate to severe psoriasis in patients that have not responded to or cannot take other systemic treatments, or if there is joint involvement. They are given by subcutaneous (just below the surface of the skin) injection or intravenous (IV) infusion. There are risks and side effects associated with the use of biologics which will need to be discussed with your dermatologist.
- Systemic Medications— like biologic medications, systemic medications work by targeting the immune system. They are either oral or injectable prescription drugs that work throughout the body. They are usually used for individuals with moderate to severe psoriasis and psoriatic arthritis. Systemic medications are also used when a patient has failed or cannot use topical medications or UV light therapy.
- Ultraviolet B (UVB) Phototherapy— also referred to as light therapy. This treatment involves consistent exposure of the skin to ultraviolet light under medical supervision. Treatments are done in a doctor's office or at home with a phototherapy unit.
- Excimer Laser Therapy — was recently approved by the Food and Drug Administration (FDA) for treating chronic, localized plaque psoriasis. It emits a high-intensity beam of ultraviolet light B (UVB). The excimer laser can target select areas of the skin affected by mild to moderate psoriasis, and research indicates it is a particularly effective treatment for scalp psoriasis.
- Pulsed dye laser— is approved for treating chronic, localized plaque psoriasis. Using a dye and different wavelength of light than the excimer laser or other UVB-based treatments, pulsed dye lasers destroy the tiny blood vessels that contribute to the formation of psoriasis lesions.
- Topicals— come in many forms: creams, ointments, shampoos, etc. Topical medications are applied to the affected skin and are usually first-line treatment. They can be used in addition to systemic medications. Topicals can be purchased over the counter or by prescription and include substances such as corticosteroids, salicylic acid, coal tar, zinc pyrithione and capsaicin.
- Complementary and Alternative Treatments —Always talk to your doctor or consult with a licensed health care professional before adding any complementary and alternative treatments to your treatment plan for psoriasis and psoriatic arthritis.
Living with psoriasis has unique challenges, but health care providers are becoming more aware of the impact psoriasis can have on a person's quality of life. The best way to prevent flares is to avoid and treat known triggers, such as infections and specific medications.
What Is Psoriasis?
Psoriasis is a skin disease that causes scaling and inflammation (pain, swelling, heat, and redness). Skin cells grow deep in the skin and slowly rise to the surface, a process called cell turnover, which normally takes a month can occur in just a few days because the cells rise too fast and pile up on the surface.
Most psoriasis causes patches of thick, red skin with silvery scales. These patches can itch or feel sore. They are often found on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet. Signs of psoriasis can be seen in the nails and genitals.
Who Gets Psoriasis?
Anyone can get psoriasis, but it occurs more often in adults. In many cases, there is a family history of psoriasis. Certain genes have been linked to the disease. Men and women get psoriasis at about the same rate.
What Causes Psoriasis?
Psoriasis begins in the immune system, mainly with a type of white blood cell called a T cell. T cells help protect the body against infection and disease. With psoriasis, T cells are put into action by mistake. They become so active that they set off other immune responses. This leads to swelling and fast turnover of skin cells. Things that can cause the psoriasis to get worse include:
- Changes in weather that dry the skin
- Certain medicines
How Is Psoriasis Diagnosed?
Psoriasis can be hard to diagnose because it can look like other skin diseases. The doctor might need to take a biopsy, or sample, of the skin to confirm the diagnosis.
How Is Psoriasis Treated?
Treatment depends on:
- How severe the disease is, determined by the size of the psoriasis patches and the site of the skin involvement.
- The type of psoriasis.
- How the patient reacts to certain treatments.
All treatments don't work the same for everyone. Doctors may switch treatments if one doesn't work, if there is a bad reaction, or if the treatment stops working.
Topical Treatment: Treatments applied right on the skin (creams, ointments) may help. These treatments can:
- Help reduce inflammation and skin cell turnover.
- Suppress the immune system.
- Help the skin peel and unclog pores.
- Soothe the skin.
Light Therapy: Natural ultraviolet light from the sun and artificial ultraviolet light are used to treat psoriasis. One treatment, called PUVA, uses a combination of a drug that makes skin more sensitive to light and ultraviolet A light.
Systemic Treatment: If the psoriasis is severe, doctors might prescribe medication by mouth or in the form of an injection. This is called systemic treatment. Antibiotics are not used to treat psoriasis unless bacteria make the psoriasis worse.
Combination Therapy: When you combine topical (medication put on the skin), light, and systemic treatments, you can often use lower doses of each. Combination therapy can also lead to better results.
What Are Some Promising Areas of Psoriasis Research?
Doctors are learning more about psoriasis by studying:
- New treatments that help calm the immune system’s response in the skin
- The association of psoriasis with other conditions such as obesity, high blood pressure, and diabetes
Psoriasis - A guide for patientsLearn more: https://www.aad.org/public/diseases/scaly-skin/psoriasis
A guide for patients: Treatments for psoriasisA guide for patients: Treatments for psoriasis. Learn more: https://www.aad.org/public/diseases/scaly-skin/psoriasis
Psoriasis skin care guideWatch dermatologists' skin care tips for people with psoriasis. Learn more: https://www.aad.org/public/diseases/scaly-skin/psoriasis