Psoriasis

Psoriasis is a medical condition that occurs when skin cells grow too quickly. Faulty signals in the immune system cause new skin cells to form in days rather than weeks. The body does not shed these excess skin cells, so they pile up on the surface of the skin and form lesions.

Signs and Symptoms

Lesions vary in appearance with the type of psoriasis. There are five types of psoriasis: Plaque, guttate, pustular, inverse, and erythrodermic. About 80% of people living with psoriasis have plaque psoriasis, also called “psoriasis vulgaris.” Plaque psoriasis causes patches of thick, scaly skin that may be white, silvery, or red. These patches called plaques can develop anywhere on the skin. The most common areas to find plaques are the elbows, knees, lower back, and scalp.

Psoriasis also can affect the nails. About 50% of people who develop psoriasis see changes in their fingernails and/or toenails. If the nails begin to pull away from the nail bed or develop pitting, ridges, or a yellowish-orange color, this could be a sign of psoriatic (sore-EE-at-ic) arthritis. Without treatment, psoriatic arthritis can progress and become debilitating. It is important to see a dermatologist if nail changes begin or joint pain develops. Early treatment can prevent joint deterioration.

For some people, psoriasis is a nuisance. Others find that psoriasis affects every aspect of their daily life. The unpredictable nature of psoriasis may be the reason. Psoriasis is a chronic (lifelong) medical condition. Some people have frequent flare-ups that occur weekly or monthly. Others have occasional flare-ups.

When psoriasis flares, it can cause severe itching and pain. Sometimes the skin cracks and bleeds. When trying to sleep, cracking and bleeding skin can wake a person and cause sleep deprivation, thus affecting focus at school or work. Some flare-ups require dermatologist treatments which takes time away from commitments.

Cycles of flare-ups and remissions often lead to feelings of embarrassment, sadness, despair, guilt and anger as well as low self-esteem. Depression is higher in people who have psoriasis than in the general population.

What Causes Psoriasis?

Psoriasis is not contagious. You cannot get psoriasis from touching someone who has psoriasis, swimming in the same pool, or even intimate contact. Psoriasis is much more complex. So complex, in fact, scientists are still studying what happens during development. We know that the person’s immune system and genes play key roles. In studying the immune system, scientists discovered that when a person has psoriasis, the T cells (a type of white blood cell that fights unwanted invaders such as bacteria and viruses) mistakenly trigger a reaction in the skin cells. This is why you may hear psoriasis referred to as a “T cell-mediated disease.”

This reaction activates a series of events, causing new skin cells to form in days rather than weeks. The reason T cells trigger this reaction seems to lie in our DNA. People who develop psoriasis inherit genes that cause psoriasis. Unlike some autoimmune conditions, it appears that many genes are involved in psoriasis.

Scientists have also learned that not everyone who inherits genes for psoriasis gets psoriasis. For psoriasis to appear, it seems that a person must inherit the “right” mix of genes and be exposed to a trigger. Some common triggers are a stressful life event, skin injury, and having strep throat. Many people say that their psoriasis first appeared after experiencing one of these. Triggers are not universal. What triggers psoriasis in one person may not cause it to develop in another.

Who Gets Psoriasis?

In the United States, nearly 7.5 million people have psoriasis and about 150,000 new cases are diagnosed each year. Studies indicate that psoriasis develops about equally in males and females. Research also shows that Caucasians develop psoriasis more frequently than other races. A study conducted in the United States found the prevalence was 2.5% in Caucasians and 1.3% in African Americans.

A family history of psoriasis seems to increase the risk of developing psoriasis. It is important to know that a family history of psoriasis does not guarantee that someone will develop it.

Psoriasis can begin at any age, from infancy through the golden years. There are, however, times when psoriasis is most likely to develop. Most people first see psoriasis between 15 and 30 years of age. About 75% develop psoriasis before they turn 40. Another common time for psoriasis to begin is between 50 and 60 years of age.

Psoriasis Treatments

Currently, there is no cure for psoriasis. However, there are many treatment options that can clear psoriasis for a period of time. Each treatment has advantages and disadvantages, and what works for one patient may not be effective for another. Board-certified dermatologists have the medical training and experience needed to determine the most appropriate treatments for each patient.

Each psoriasis form has unique characteristics that allow dermatologists to visually identify psoriasis to determine what type, or types, are present. Sometimes skin biopsies will be performed to confirm the diagnosis.

To choose the most appropriate treatment method, dermatologists consider several factors:

  • Type of psoriasis

  • Severity (the amount of skin affected)

  • Where psoriasis is located

  • Patient’s age and medical history

  • Effects psoriasis has on patient’s overall physical and emotional well-being

  • Previous treatments

Psoriasis treatments fall into 3 categories:

  • Topical (applied to the skin) – Mild to moderate psoriasis

  • Phototherapy (light, usually ultraviolet, applied to the skin) – Moderate to severe psoriasis

  • Systemic (taken orally or by injection or infusion) – Moderate, severe or disabling psoriasis

While each of these therapies is effective, there are also drawbacks. Some topicals are messy and may stain clothing and skin and infect pierced skin. Phototherapy can require 2 to 5 weekly visits to a dermatologist’s office for several weeks. Many of the systemic medications have serious side effects and must be combined or rotated with other therapies to maximize effectiveness and minimize side effects. Research is being conducted to find therapies that provide safe, effective, easy-to-use treatment options for long-term relief

As psoriasis is a life-long condition, it is important to take an active role in managing it. Learn more about psoriasis by seeing a dermatologist to discuss treatment options.