Psoriasis: Understanding, Types, Symptoms, Causes, Diagnosis and Treatments

Psoriasis

Psoriasis is an autoimmune condition that leads to the formation of thick, scaly patches on the skin. While there is no cure at the moment, treatments can help reduce the frequency and severity of flare-ups. In psoriasis, the immune system mistakenly increases the production of skin cells in the body. Normally, skin cells grow and shed within about a month. However, in psoriasis this psoriasis speeds up, with new cells growing every 3-4 days. Instead of shedding properly, these excess cells accumulate on the skin’s surface, forming plaques. For more research you can also visit the American Academy of Dermatology.

What is Psoriasis?

Psoriasis is like a hiccup in your skin’s natural routine. Normally, your skin cells refresh every few weeks, but if you have psoriasis symptoms, they do it way too fast. This rush to replace old cells with new ones leads to patches of skin becoming raised, red and covered in white or silver flakes. These patches are known as plaques and can show up on different parts of your body, like your elbow, knees, or even your scalp.

Where Does Psoriasis Usually Start?

Scales usually appear on joints like elbows and knees. But they can show up anywhere on your body including:

  • Hands 
  • Feet
  • Neck
  • Scalp 
  • Face 

Less common types of psoriasis affect the:

  • Nails 
  • Mouth 
  • Area around the genitals 

It’s commonly associated with several other conditions, including:

What are the Types of Psoriasis?

There are different types of it, such as:

 Plaque Psoriasis:

This is the most usual type, and it shows as red patches with flakes. Plaque is the common type, affecting about 80-90% of people with psoriasis. It’s characterized by raised and inflamed lesions, but its appearance can vary based on skin tone:

  • Light Skin Tones: Lesions are pink or red with silver-white scales.
  • Medium Skin Tones: Lesions are coral-colored with silver-white scales.
  • Dark Skin Tones: Lesions are purple or dark brown with gray scales.

These lesions typically appear on the trunk, buttocks, scalp, and extremities, but they can develop anywhere on the body.

 Guttate Psoriasis:

These are tiny spots, often linked to infections. This form of it leads to small, individual spots on the skin. These spots are typically not as thick or crusty as the patches seen in plaque psoriasis. Various factors can trigger guttate psoriasis, including:

  • Upper respiratory infections
  • Streptococcal infections
  • Tonsillitis
  • Stress
  • Skin injury

Guttate psoriasis may clear up on its own without treatment and never return. However, there’s a possibility that the condition may resolve temporarily and then reappear later as patches of plaque psoriasis.

 Inverse Psoriasis:

Inverse psoriasis is a form of psoriasis that emerges in skin folds, often impacting:

  • Armpits
  • Groin
  • Areas beneath the breasts
  • Other skin creases, like around the genitals and buttocks

In inverse psoriasis, lesions usually lack the scales seen in plaque psoriasis. Instead, they may appear smooth and shiny.

 Pustular Psoriasis:

Pustular psoriasis is a type of psoriasis characterized by white blisters filled with pus, surrounded by inflamed skin. It can occur in specific areas of the body like the hands and feet, or it can be more widespread. It’s important to note that pustular psoriasis is not caused by an infection, and it is not contagious.

 Erythrodermic Psoriasis:

It’s severe and turns your skin all red and flaky. This may lead to severe complications that could require medical attention, including:

  • Pneumonia
  • Congestive heart failure
  • Edema

People experiencing symptoms of this condition should promptly contact a doctor. In some cases, they may also require hospitalization.

 Psoriatic Arthritis:

Sometimes, psoriasis affects your joints, causing pain and swelling.

What are the Symptoms of Psoriasis?

The diagnosed psoriasis a dermatologist will examine your skin, nails and scalp for signs of this condition. Your dermatologist will also ask if you have any symptoms:

  • Itchy skin.
  • Nails problems, yellow nails, nail pain .
  • Joint problems such as pain and swelling or stiffness when you wake up.
  • Blood relatives who have psoriasis .
  • Illness and increased stress.
  • Raised inflamed patches of skin that appear red on light skin and brown or purple on dark skin
  • Dry skin that may cracked and bleed
  • Soreness around patches
  • Itching and burning sensations around patches
  • Painful swollen joints

Not everyone will have all these symptoms. Some people might have different symptoms if they have a less common type of psoriasis.  

What are the Causes of Psoriasis?

Doctors are unsure about the exact cause of it. However, after years of research, they have identified two main factors:

  • Genetics
  • Immune system

Immune System:

Psoriasis is an autoimmune condition where the body’s defense system, specifically white blood cells called T cells, mistakenly attack the skin cells. Normally, these white blood cells fight off bacteria and infections, but in psoriasis they cause the skin cells to multiply too quickly. This rapid growth leads to the formation of thick patches known as plaques on the skin’s surfaces, along with redness and inflammation. Psoriasis is an autoimmune disorder that affects the skin, causing rapid multiplication of skin cells and the accumulation of thick, scaly patches called plaques. These plaques most often develop on the:

  • Elbows
  • Knees
  • Scalp
  • Lower back
  • Palms of the hands
  • Soles of the feet

Genetics:

Some individuals inherit genes that increase their risk of developing it. Research published in 2019 suggests that if you have a close family member with the condition, your risk of developing it is higher.

What are the Risk Factors of Psoriasis?

Both external and internal factors may increase a person’s risk of developing psoriasis.

Inflammatory Bowel Disease (IBD):

IBD includes long-lasting conditions like ulcerative colitis and Crohn’s disease. These conditions lead to swelling and sores in the digestive system. Some medicines used for psoriasis, like interleukin-17 inhibitors and tumor necrosis factors alpha blockers, might make IBD symptoms worse or cause them. It’s crucial for someone with psoriasis to let their doctor know if they have IBD. This way, the doctor can make a treatment plan that suits them best.

Genetics:

Genetics might be significant in causing psoriasis. Research shows over 60 genetic markers linked to the activation of Th17 cells, which are crucial in psoriasis-related inflammation. About 40% of individuals with psoriasis or psoriatic arthritis have family members who also have one of these conditions.

Infections:

In younger individuals, it might worsen after getting a common infection like strep throat, bronchitis, or tonsillitis. Almost one-third of individuals with psoriasis develop it during childhood.

Other Risk Factors:

Other factors that increase the risk of developing it include:

What is the Diagnosis of Psoriasis?

Two tests or examinations may be necessary to diagnose it:

Physical Examination:

Most doctors can make a diagnosis with a simple physical exam. Symptoms of psoriasis are typically evident and easy to distinguish from other conditions that may cause similar symptoms. During this exam, make sure to show your doctors all areas of concern. Additionally, inform your doctor if any family members have the condition.

Biopsy:

If your symptoms are unclear, or if your doctor wants to confirm their suspected diagnosis, they may take a small sample of your skin. This procedure is called a biopsy. Biopsies can be performed in your doctor’s office on the day of your appointment. Your doctor will likely inject a local numbing medication to make the biopsy less painful. The skin biopsy will then be sent to a lab for analysis, where it will be examined under a microscope. This examination can diagnose the type of it you have and rule out other possible disorders of infections. Once the results are available, your doctor may request an appointment to discuss the findings and treatment options with you.

What are the Triggers of Psoriasis?

External factors, known as “triggers” can bring on new episodes of psoriasis. These triggers vary from person to person and may also change over time. The most common triggers for psoriasis include:

  • Stress
  • Alcohol 
  • Injury 
  • Medications 
  • Infections 

What is the Treatment of Psoriasis?

It cannot be cured, but treatments aim to:

  • Reduce inflammation and scales
  • Slow down the growth of skin cells
  • Remove plaques

So, it treatments are divided into three categories:

Topical Treatments:

So, creams and ointment that you put directly on your skin can help with mild to moderate it. Some topical treatments for it:

  • Creams with corticosteroids
  • Creams with retinoids
  • Anthralin
  • Vitamin D creams
  • Salicylic acid
  • Moisturizers
  • Creams with JAK inhibitors like tofacitinib

Systemic Medications:

For people with moderate to severe it, or those who haven’t had success with other treatments, oral or injected medications may be necessary. So these medications can have serious side effects, so doctors often prescribe them for short periods. They include:

  • Methotrexate
  • Cyclosporine
  • Biologics
  • Oral retinoids
  • Oral apremilast (Otezla) for moderate psoriasis

Light Therapy:

This treatment for it involves using ultraviolet (UV) or natural light. Sunlight can help by killing the overactive white blood cells that attack healthy skin cells and cause rapid cell growth. Both UVA and UVB can be effective in reducing symptoms of mild to moderate it. For most people with moderate to severe it, a combination of treatment works best. This means using more than one type of treatment to reduce symptoms. Some individuals may stick with the same treatment for their entire lives, while others might need to switch treatments occasionally if their skin stops responding to the current treatment.

Other Medications:

Some remedies available without a prescription may help ease symptoms of mild disease.

  • Coal Tar: It can help soothe itching and lesions caused by plaque psoriasis on the scalp, palms, and soles.
  • Hydrocortisone Creams: It may reduce inflammation and alleviate itching.
  • Salicylic Acid: It can reduce swelling and remove scales, especially for those with scalp psoriasis.
  • Anti-itch Agents: It contains calamine, hydrocortisone, camphor, or menthol may also relieve itching.

What are the Complications of Psoriasis?

It can lead to other health issues that affect the bones, muscles, and metabolic system. Around 1 in 3 people with it develop psoriasis arthritis (PsA) within 5-10 years after being diagnosed with psoriasis. However, arthritis precedes it in 13-17% of cases. PsA is a chronic autoimmune disease that often starts in people aged 30-50. It can result in pain, stiffness, and inflammation in the joints, leading to progressive damage. People with it may also face a higher risk of developing:

  • Depression
  • Anxiety
  • Cardiovascular disease
  • Metabolic syndrome
  • IBD
  • Obesity
  • Dyslipidemia
  • Diabetes
  • Some types of cancer include lung cancer, lymphoma, and non-melanoma skin cancer.

What is the Prevention of Psoriasis?

Some strategies can help a person lower their risk of it flares, including:

  • Identifying and avoiding food triggers
  • Maintaining a healthy weight
  • Regularly moisturizing the skin
  • Spending time in sunny climates during winter
  • Reducing stress through activities like yoga, exercise, and meditation
  • Avoiding smoking and excessive alcohol consumption
  • Using topical home remedies to relieve itching
  • Following an anti-inflammatory diet may also assist in managing symptoms and decreasing the risk of complications.

People with it can improve their condition by following a diverse, nutritious diet, which might include:

  • Limiting alcohol consumption
  • Choosing lean protein sources like chicken breast
  • Including omega-3 fatty acid-rich fish in their diet
  • Reducing gluten intake for those with a gluten allergy
  • Avoiding pro-inflammatory foods, such as those high in simple carbohydrates and saturated fats

Diet Recommendation for People with Psoriasis?

While food isn’t a cure or treatment for psoriasis, having a diet rich in nutrients might help lessen your symptoms. So, here are some lifestyles changes that might help ease psoriasis symptoms and decrease flare-ups:

  • Managing your body weight 
  • Eating heart-healthy diet 
  • Avoiding red meat, refined sugar, highly processed foods, dairy products 
  • Drinking too much alcohol 
  • Taking supplements 

Living with Psoriasis:

Dealing with psoriasis can be tough, but with the right strategies, you can lower-flare ups. Focusing on these three areas can help you manage both in the short and long term:

  • Diet 
  • Stress 
  • Emotional health 

What to Know About Psoriatic Arthritis?

Psoriatic arthritis affects around 30% to 33% of people with it, according to recent clinical guidelines from the AAD and the NPF. This type of arthritis causes swelling, pain, and inflammation in affected joints, often mistaken for rheumatoid arthritis or gout. It’s typically distinguished by the presence of inflamed, red or purple areas of skin with plaques. It is a chronic condition that can come and go in flare-ups and remission or be continuous with constant symptoms. It usually affects joints in the fingers or toes but can also involve the lower back, wrists, knees, or ankles. While most people with psoriatic arthritis also have it, it’s possible to have the joint condition without a psoriasis diagnosis, often seen in individuals with family members who have it. So treatments for psoriatic arthritis aim to ease symptoms, relieve pain, and improve joint mobility. Managing weight, maintaining a nutrient rich diet, and avoiding triggers can also help reduce flare-ups. Early diagnosis and tailored treatment plans can help prevent severe complications, including joint damages. 

FAQs:

IS hot water bad for psoriasis?

The hot water is harmful for it. So instead opt for a cold compress to soothe itchy feelings.

Can Dettol help with psoriasis?

I have noticed that taking a bath with Dettol helps me. It may sound strange but it seems to be  through the skin making it feel less painful, similar to the rough skin on the sole of my foot. So I also have Vaseline which does not necessarily clear it up but provides relief and acts as a barrier to reduce peeling.

Can salt impact psoriasis?

When it comes to swimming, saltwater can be helpful. So it might assist in clearing flaky skin cells and reducing inflammation and irritation. However, it’s crucial for individuals to rinse off any remaining salt after being in saltwater.

Is steam beneficial for psoriasis?

Using a steam room not only helps hydrate your skin and unclog pores but can also be advantages for those dealing with it. It can aid in reducing inflammation and irritation.

Can psoriasis lead to hair loss?

Yes, it’s quite common for people with it to experience hair loss, especially when the scalp is affected. However, the type of hair loss associated with scalp psoriasis is typically non-permanent and hair usually grows back completely once the inflammation subsides.

Should I scrub psoriasis?

It’s best to avoid scratching or scrubbing lesions, as this can irritate and worsen them. Refrain from picking at scales as it may lead to bleeding and increase the risk of infection. Instead, consult with your doctor about using creams and ointment that can gently remove thick scales.

Is milk beneficial or harmful for psoriasis?

Individuals who are lactose intolerant, lacking the digestive enzyme lactase, may experience chronic gastrointestinal irritation that can worsen inflammation. Cutting dairy from the diet has been found to improve symptoms for some people.

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