What is Psoriasis?
Psoriasis is a common skin condition that causes itchy or sore patches of thick, reddened skin covered with silvery scales. Psoriasis occurs when your immune system sends out faulty signals that affects the life cycle of skin cells. Skin cells that should normally take weeks growing to maturity deep beneath the surface of your skin instead rise to the surface and build up into scales and red patches.
More than five million American adults have psoriasis and it usually appears between the ages of 10-45. Although any of your skin can be affected, the most common areas to develop psoriasis are your elbows, knees, other parts of your legs, scalp, lower back, face, palms, and soles of your feet. The patches of affected skin can range in size from very small to quite large.
There are several types of psoriasis. Plaque psoriasis is the most common type and it causes dry, itchy or painful patches. Approximately 90 percent of people have this type of psoriasis. Other types of psoriasis include:
- Nail psoriasis
- Scalp psoriasis
- Guttate psoriasis
- Inverse psoriasis
- Pustular psoriasis
- Erythrodermic psoriasis
- Psoriasis arthritis
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Although symptoms can vary from person to person, the most common symptoms that you may experience include:
- Pink or red patches of skin (called plaques)
- Loose, silvery scales covering the red patches
- Dry, cracked, or flaky skin with a tendency to bleed
- Itching, burning, or sore skin
- Thickened, pitted, or ridged fingernails
Psoriasis is chronic, which means that you will have it for a long time, but you may have mild or severe symptoms. You will likely have times of remission when you do not have any symptoms and other times when the skin symptoms flare up for a few weeks or months.
Psoriasis tends to run in families, so if you have a family member with this skin condition you are more likely to also get it. Although the exact cause of psoriasis is not known, it is thought to develop from a complex interaction between an immune system malfunction, the environment, and genetics. In psoriasis, a type of white blood cell in your immune system, called a T cell, mistakenly attacks healthy skin cells. Overactive T cells then trigger other immune responses that result in inflammation and a rapid turnover of skin cells.
You might get psoriasis for the first time or get a flare up of symptoms after one of these triggers:
- Infection (such as strep throat)
- Skin injury such as a sunburn or cut
- Cold weather
- Heavy alcohol consumption
- Medication use (beta-blockers, lithium, or antimalarial drugs)
Your doctor will probably diagnose psoriasis simply by examining your skin, particularly the areas with red patches. Sometimes a small skin sample called a biopsy will be examined more closely under a microscope for confirmation and to determine which type of psoriasis you have. An X-ray might be taken if psoriatic arthritis is suspected and blood work may help rule out other forms of arthritis.
Psoriasis can sometimes look like other skin diseases, such as ringworm, pityriasis rosea, lichen planus, or seborrheic dermatitis.
Psoriasis appears equally in both men and women. Psoriasis is not contagious. You cannot catch it from someone or give it to anyone else. Since the exact cause remains unknown and includes genetic, environmental, and immune system factors, there is very little you can do to prevent this condition.
However, to reduce the chances of a flare up of psoriasis symptoms you can:
- Keep your skin moist
- Avoid cold, dry climates
- Avoid scratching and picking skin
- Avoid skin injuries (cuts or scrapes)
- Minimize stress and anxiety
- If possible, avoid trigger medicines (beta-blockers, lithium, or antimalarial drugs)
- Limit alcohol to no more than two drinks a day for men or one drink a day for women
- Don’t smoke
Depending on where your psoriasis is on your body and how widespread it is, you could be at risk for additional problems, including:
- Skin infection after scratching
- Fluid and electrolyte imbalance
- Low self-esteem
- Social isolation
- Metabolic syndrome
- Inflammatory bowel disease
- Heart disease
A common treatment plan for psoriasis is called the “1-2-3” approach.
- Your doctor will first try topical creams and ointments applied to the problem areas of your skin. This might be enough if you have a mild to moderate case of psoriasis. The topical medications your doctor might recommend include corticosteroids, vitamin D analogues, anthralin, topical retinoids, calcineurin inhibitors, salicylic acid, coal tar, and/or a moisturizer.
- Your doctor might suggest that you expose your skin to natural or artificial ultraviolet light. This is called light therapy or phototherapy. The light causes the activated T cells in the skin to die, which slows down the cell turnover that is a problem in psoriasis. However, you need to monitor your light exposure carefully since sunburns can make your psoriasis worse.
- If your psoriasis is more severe, your doctor might recommend oral medications or injections of medications. These include medications such as retinoids, methotrexate, cyclosporine, hydroxyurea, immunomodulating drugs, and thioguanine.
It is not uncommon for your skin to become resistant to one treatment, requiring you to periodically switch treatments to continue getting symptom relief. In addition, combining treatments from 1, 2, and 3 can be beneficial.
Taking a daily bath can help remove scales and calm your skin. Try a bath with bath oil, colloidal oatmeal, or Epsom salts added in. However, avoid hot water or harsh soaps. You may find it helpful to keep your skin moisturized with an over-the-counter product. During cold or dry weather you may need to apply moisturizer several times a day. You can also try applying a moisturizer at night and then wrapping the area with plastic wrap overnight.
Although it is difficult when your skin is itchy, try to avoid scratching which can injure the skin and leave you vulnerable to a skin infection. Cortisone creams can reduce the itching of mild psoriasis and are available without a prescription. If possible, avoid cold or dry climates, limit or avoid alcohol, and certainly don’t smoke.