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Psoriasis is a chronic, noncontagious skin condition characterized by scaling and inflammation. The inflamed skin forms red, thickened areas with silvery scales. The condition is most commonly found on the scalp, elbows, forearms, knees, shins, ankles, and lower back. The inflammation may also affect the fingernails, toenails, soft tissues of the mouth, genitalia, and joints. The inflamed skin is usually asymptomatic, but may cause pain and discomfort by cracking. Psoriasis is rarely itchy.
Possible Regions of Psoriasis |
The exact cause of psoriasis has not been determined, but current theories suggest that it may be a disorder of the immune system. It appears that T-cells, a type of white blood cell that normally protects the body against infection and disease, trigger inflammation and excessive skin cell reproduction, which causes skin to shed too rapidly. Psoriasis is also believed to be associated with other cellular, biochemical, and metabolic defects.
Psoriasis flare-ups may be triggered by a variety of factors, including environment, certain medications, and stress.
There are five primary types of psoriasis:
Plaque psoriasis:This is the most common form. It is characterized by raised lesions which have a reddened base covered by silvery-white scales. The scales shed frequently and are very dry.
Guttate psoriasis:This type is most often triggered by bacterial infections (most commonly strep throat) and is most common in young adults and children. It is characterized by small, drop-like lesions on the trunk, limbs, and scalp. It may clear up by itself after a few weeks or months.
Pustular psoriasis:Blisters of non-infectious pus appear on the skin and may affect large or small areas of the body, most commonly fingers, palms and soles. This type of psoriasis is usually triggered by medications, infections, emotional stress, or certain chemicals. It may be triggered by abrupt withdrawal of systemic steroids.
Inverse psoriasis (also called flexural psoriasis):This is usually found in skin fold areas, such as the armpits, under the breasts, or folds of skin near the genitals or buttocks. It is more likely to be found in people who are overweight and may be exacerbated by friction or sweating in skin fold areas. The plaques are red, smooth, dry and large.
Erythrodermic psoriasis:This is the least common form of psoriasis and is characterized by widespread reddening and scaling of the skin as well as severe itching and skin discomfort. This form occur after a severe sunburn or use of certain medications.
Some people with psoriasis develop a condition called psoriatic arthritis. This occurs when the inflamed areas of the skin are accompanied by joint inflammation, most often in the hip, spine, knee, or elbow joints but also in the small joints of the hands and feet.
In some cases, psoriasis severely compromises quality of life. In addition to physical discomfort, people with psoriasis may develop emotional problems, such as depression or anxiety, and may experience social difficulties due to visible plaques. If you or a family member is suffering from psoriasis, seek out counseling, support groups, and services.
What are the risk factors for psoriasis?
[What are the symptoms of psoriasis?
[What are the treatments for psoriasis?][5]
Are there screening tests for psoriasis?
[How can I reduce my risk of psoriasis?
[What questions should I ask my doctor?
What is it like to live with psoriasis?
References:
American Academy of Dermatology website. Available at: http://www.skincarephysicians.com/psoriasisnet/index.html .
National Psoriasis Foundation website. Available at: http://www.psoriasis.org/home/ .
References:
American Academy of Dermatology website. Available at: http://www.aad.org/default.htm/ .
National Psoriasis Foundation website. Available at: http://www.psoriasis.org/home/ .
The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
Screening Tests or Guidelines
At this time, there are no screening guidelines or tests for psoriasis.
References:
American Academy of Dermatology website. Available at: http://www.aad.org/default.htm/ .
National Psoriasis Foundation website. Available at: http://www.psoriasis.org/home/ .
In general, outbreaks of psoriasis are difficult to prevent. However, avoiding or minimizing well-known triggers can help reduce the risk of an outbreak. These triggers include:
Stress:Maintaining emotional balance and avoiding stress are strongly recommended, as stress may be a trigger of psoriasis outbreaks. If you need support or assistance in reducing stress, you may want to try some of the following techniques:
- Counseling
- Psoriasis support groups
- Stress management classes
- Relaxation techniques
- Yoga
Weather exposure:If you have had psoriasis, try to protect your skin at all times from cold, dry weather conditions, and minimize outdoor exposure during cold weather. Conversely, although, in mild to moderate doses UV light improves psoriasis, do not overexpose your skin to sunlight or develop a sunburn. Wear clothing that covers and protects your skin as much as possible, and hydrate the skin with baths and moisturizers after exposure. In addition to avoiding cold weather exposure, you can improve (or prevent) psoriasis symptoms by spending time in climates that are warm, humid, and sunny.
Skin injuries or trauma:Psoriasis outbreaks often occur in areas of the body that were previously injured. Prevention of cuts, burns, and other skin irritations may also help to prevent psoriasis flare-ups.
Infections:Although respiratory infections are often hard to avoid, doing so may help minimize your risk of a psoriasis flare-up. Your ability to fight off potential infection depends on maintaining of good immune system function, which you can enhance by getting plenty of rest and eating a healthful diet.
Medications:Certain medications like beta-blocker antihypertensives, antimalarials, lithium, and non-steroidal anti-inflammatory drugs (NSAIDs) may trigger a psoriasis flare-up. Be sure to tell your doctor that you have psoriasis when receiving a new medication.
American Academy of Dermatology
Address:
P.O. Box 4014
Schaumburg, IL 60168-4014
Phone:
1-202-842-3555
Internet address:
http://www.aad.org
http://www.skincarephysicians.com/psoriasisnet/index.html
Description of services provided:
On this website, you can find patient education information on psoriasis, as well as a related website (Psoriasisnet).
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Address:
NIH
1 AMS Circle
Bethesda, Maryland 20892-3675
Phone:
1-301-495-4484
1-877-22-NIAMS
Internet address:
http://www.niams.nih.gov
Description of services provided:
The National Institutes of Health site provides in-depth information on psoriasis, treatment, research, and more.
National Psoriasis Foundation
Address:
6600 SW 92nd Ave., Suite 300
Portland, OR 97223-7195
Phone:
1-503-244-7404
1-800-723-9166
Internet address:
http://www.psoriasis.org
Description of services provided:
This website provides online information on psoriasis, treatments, research, and news. It also offers free (print) educational materials, as well as answers to questions from patient educators.
Psoriasis Society of Canada
Address:
PO Box 25015
Halifax NS B3M 4H4
Phone:
1-800-656-4494
902-443-8680
Internet address:
http://www.psoriasissociety.org/
Description of services provided:
To assist our affiliated chapters, and to represent their members' needs on a national level: assist those who have psoriasis by providing up-to-date information on treatment, programs and services; form support groups across Canada; increase awareness of psoriasis among health care professionals and the public; consult with government to assist with programs and services; encourage research programs to find the cause and cure for psoriasis.
You have a unique medical history. Therefore, it is essential to talk with your doctor or doctor about your personal risk factors and/or experience with psoriasis. By talking openly and regularly with your doctor, you can take an active role in your care.
General Tips for Gathering Information
Here are some tips that will make it easier for you to talk to your doctor:
- Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
- Write out your questions ahead of time, so you don't forget them.
- Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
- Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
Specific Questions to Ask Your Doctor
About Your Risk of Developing Psoriasis
- Based on my medical history and family background, am I at risk for psoriasis?
- Do any of the medications I currently use put me at risk for developing or worsening psoriasis?
About Treatment Options
- What is the best treatment for my type of psoriasis?
- What medications are available to help me?
- What are the benefits/side effects of these medications?
- Will these medications interact with other medications, over-the-counter products, or dietary or herbal supplements that I am already taking for other conditions?
- Are there any long-term health risks associated with my psoriasis medications?
- Are there any alternative or complementary therapies that will help me?
About Lifestyle Changes
- According to the type of psoriasis I have and the medications I use, should I limit or increase my exposure to sunlight?
- Do certain foods affect psoriasis?
- How can I decrease my susceptibility to outbreaks of psoriasis?
About Your Outlook
- Will my psoriasis recur? If so, how often?
- Are there any new developments in psoriasis research that are relevant to my condition?
References:
American Academy of Dermatology website. Available at: http://www.skincarephysicians.com/psoriasisnet/index.html .
Gudjonsson JE, Elder JT. Psoriasis: epidemiology. Clin Dermatol. 2007;25(6):535-546.
National Psoriasis Foundation website. Available at: http://www.psoriasis.org/home/ .
References:
American Academy of Dermatology website. Available at: http://www.skincarephysicians.com/psoriasisnet/index.html .
National Psoriasis Foundation website. Available at: http://www.psoriasis.org/home/ .
References:
American Academy of Dermatology website. Available at: http://www.skincarephysicians.com/psoriasisnet/index.html .
National Psoriasis Foundation website. Available at: http://www.psoriasis.org/home/ .
Psoriasis is a chronic, noncontagious skin condition characterized by scaling and inflammation. The inflamed skin forms red, thickened areas with silvery scales. The condition is most commonly found on the scalp, elbows, forearms, knees, shins, ankles, and lower back. The inflammation may also affect the fingernails, toenails, soft tissues of the mouth, genitalia, and joints. The inflamed skin is usually asymptomatic, but may cause pain and discomfort by cracking. Psoriasis is rarely itchy.
Possible Regions of Psoriasis |
The exact cause of psoriasis has not been determined, but current theories suggest that it may be a disorder of the immune system. It appears that T-cells, a type of white blood cell that normally protects the body against infection and disease, trigger inflammation and excessive skin cell reproduction, which causes skin to shed too rapidly. Psoriasis is also believed to be associated with other cellular, biochemical, and metabolic defects.
Psoriasis flare-ups may be triggered by a variety of factors, including environment, certain medications, and stress.
There are five primary types of psoriasis:
Plaque psoriasis:This is the most common form. It is characterized by raised lesions which have a reddened base covered by silvery-white scales. The scales shed frequently and are very dry.
Guttate psoriasis:This type is most often triggered by bacterial infections (most commonly strep throat) and is most common in young adults and children. It is characterized by small, drop-like lesions on the trunk, limbs, and scalp. It may clear up by itself after a few weeks or months.
Pustular psoriasis:Blisters of non-infectious pus appear on the skin and may affect large or small areas of the body, most commonly fingers, palms and soles. This type of psoriasis is usually triggered by medications, infections, emotional stress, or certain chemicals. It may be triggered by abrupt withdrawal of systemic steroids.
Inverse psoriasis (also called flexural psoriasis):This is usually found in skin fold areas, such as the armpits, under the breasts, or folds of skin near the genitals or buttocks. It is more likely to be found in people who are overweight and may be exacerbated by friction or sweating in skin fold areas. The plaques are red, smooth, dry and large.
Erythrodermic psoriasis:This is the least common form of psoriasis and is characterized by widespread reddening and scaling of the skin as well as severe itching and skin discomfort. This form occur after a severe sunburn or use of certain medications.
Some people with psoriasis develop a condition called psoriatic arthritis. This occurs when the inflamed areas of the skin are accompanied by joint inflammation, most often in the hip, spine, knee, or elbow joints but also in the small joints of the hands and feet.
In some cases, psoriasis severely compromises quality of life. In addition to physical discomfort, people with psoriasis may develop emotional problems, such as depression or anxiety, and may experience social difficulties due to visible plaques. If you or a family member is suffering from psoriasis, seek out counseling, support groups, and services.
What are the risk factors for psoriasis?
What are the symptoms of psoriasis?
What are the treatments for psoriasis?
Are there screening tests for psoriasis?
How can I reduce my risk of psoriasis?
What questions should I ask my doctor?
What is it like to live with psoriasis?
References:
Azfar RS, Gelfand JM. Psoriasis and metabolic disease: epidemiology and pathophysiology. Curr Opin Rheumatol. 2008 Jul;20(4):416-22.
Behnam SM, Behnam SE, Koo JY. Alcohol as a risk factor for plaque-type psoriasis. Cutis. 2005 Sep;76(3):181-5.
Kirby B, Richards HL, Mason DL, Fortune DG, Main CJ, Griffiths CE. Alcohol consumption and psychological distress in patients with psoriasis. Br J Dermatol. 2008 Jan;158(1):138-40.
National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/ .
National Psoriasis Foundation website. Available at: http://www.psoriasis.org/home/ .
Although most cases of psoriasis can be reliably diagnosed by simple physical examination, some cases can be difficult to diagnose, because the appearance can be similar to other skin conditions. Currently, there is no blood test that can conclusively diagnose psoriasis. A skin biopsy is the most specific test in the diagnosis of psoriasis.
Your doctor may do the following tests to determine whether or not you have psoriasis:
Physical examination—Your doctor will begin by carefully examining your skin, scalp, fingernails, and toenails for reddening or scaling skin that is characteristic of psoriasis. Small pits on the fingernails are also signs of psoriasis. Your doctor will also examine your joints for signs of psoriatic arthritis.
Skin biopsy—To confirm the diagnosis, your doctor may also take a small sample of skin (a biopsy) to test for psoriasis.
Severity of Psoriasis
Psoriasis affects people with varying degrees of severity. Seventy-five percent to 80% of people with psoriasis have what is considered mild psoriasis, while the remaining 20% to 25% have moderate to severe psoriasis. Treatment depends on the severity of the condition.
If you do have psoriasis, your doctor will assess the severity and grade it according to the following guidelines:
Mild psoriasis—If the psoriasis covers less than 2% of your body, it is considered mild. Usually, people with mild cases develop isolated patches of psoriasis on the knees, elbows, scalp, hands, and feet.
Moderate psoriasis—If the psoriasis covers 2% to 10% of your body, it is considered a moderate case. Psoriasis may appear on the arms, legs, torso, scalp, and other areas.
Severe psoriasis—When psoriasis covers more than 10% of your body, it is considered severe. Large areas of skin may be covered with psoriasis plaques or pustules, or widespread erythrodermic psoriasis can cause severe peeling of the skin. People with severe psoriasis are more likely to develop psoriatic arthritis.
A risk factor is something that increases your likelihood of getting a disease or condition.
It is possible to develop psoriasis with or without the risk factors listed below. In fact, most cases of psoriasis are not associated with any of the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing psoriasis. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.
Risk factors include:
Genetic Factors
There is a strong genetic component to psoriasis. In about one third of all cases, there is a family history of psoriasis.
Certain Medical Conditions
Medical conditions that are most likely to trigger psoriasis include:
Stress/emotional disorders:Stress, suppressed anger, anxiety, depression, or other emotional disorders often trigger psoriasis outbreaks.
Infection:Psoriasis frequently flares up after upper respiratory infections, such as tonsillitis, sinusitis, or strep throat.
Skin injuries:Psoriasis may develop at the site of a previous skin injury or mild abrasion, such as a cut, burn, or injection. This delayed development of psoriasis at these injured skin sites is known as the Köbner Phenomenon.
HIV/AIDS:Psoriasis may become particularly severe in people infected with HIV/AIDS.
Obesity:There is some evidence that obesity may exacerbate psoriasis.
Alcoholism:It is not entirely clear whether alcoholism is a risk factor for developing psoriasis or vice versa (due to the emotional burden of psoriasis). In any case, consuming excessive amounts of alcohol should be discouraged, especially during periods of psoriasis exacerbation.
Certain Medications
Certain medications have been associated with triggering or exacerbating outbreaks of psoriasis. These include:
- Beta-blocker and angiotensin-converting enzyme (ACE) inhibitors:Used to treat high blood pressure
- Lithium:Used to treat severe depression or bipolar disorder
- Hydroxychloroquine and Chloroquine:Used to prevent malaria
- Non-steroidal anti-inflammatory drugs (NSAIDs):Certain types of NSAIDs, such as indomethacin, may cause or worsen psoriasis; however, other types of NSAIDs may actually improve psoriatic symptoms.
Age
Plaque psoriasis first appears during 2 peak age ranges. The first peak occurs in persons aged 16-22 years, and the second occurs in persons aged 57-60 years. It is considered quite rare in infants, but may occur in children before the age of 10.
Racial/Ethnic Background
Psoriasis is more prevalent in fair-skinned people, particularly those who have a blood relative with psoriasis. It is less common in people with darker skin.
Environment
Psoriasis is often triggered by weather and climatic conditions. In general, people living in cold, dry climates are at much greater risk of developing psoriasis than people living in temperate or warm climates. In fact, warm, humid weather helps to heal psoriasis symptoms.
There are several types of psoriasis. Each type of psoriasis has unique “signs.” Doctors look for signs during a physical exam so they can distinguish one type of psoriasis from another. Examples of signs include descriptions of the location and shape and pattern of the lesions. Symptoms are words that patients use to describe how their disease feels. Psoriasis is typically asymptomatic, but the affected skin may elicit discomfort due to shedding or fissuring. Most types of psoriasis are classically not itchy.
Psoriasis |
The following is a brief outline of each type of psoriasis and a description of the accompanying signs and symptoms.
Plaque Psoriasis
Plaque psoriasis is the most common form. It is named for the “plaques,” or lesions, that are characteristic of this type of psoriasis. Plaques tend to be stable and slow growing, and they may remain unchanged for long periods of time.
Signs and symptoms include:
- Red, raised skin patches (plaques) topped by silvery-white scales
- Frequent shedding of silvery scales
- Outbreaks most frequent on the elbows, knees, scalp, buttocks, and lower back
- Patches often occur in the same area on both sides of the body
- Patches may join together to form large affected areas on the back and chest
- Occasional discomfort and cracking in the affected areas, especially palms, fingers and soles
Guttate Psoriasis
Guttate psoriasis is most often triggered by bacterial infections, such as streptococcus ( strep throat ), and is most common in childhood or young adulthood.
Signs and symptoms include:
- Small, drop-like lesions on the trunk, limbs, and scalp
Inverse Psoriasis
Most commonly found in skin fold areas of the body, such as the armpits, groin, under the breasts, and genital areas. This type of psoriasis is also known as flexural psoriasis.
Signs and symptoms include:
- Smooth, pink or red, mostly dry patches without a scaly surface
- Sensitivity to friction and sweating
Erythrodermic Psoriasis
This is the least common form of the disease. It can be triggered by severe sunburn, use of certain drugs, or abrupt withdrawal of oral steroids.
Signs and symptoms include:
- Widespread, fiery redness of the skin
- Severe itching and discomfort in the affected areas
- Possible swelling of the affected areas
Pustular Psoriasis
This form of psoriasis may be triggered by medication, emotional stress, infections, abrupt withdrawal of systemic steroids, or exposure to certain chemicals. It is a more rare form of psoriasis.
Signs and symptoms include:
- Blisters containing noninfectious pus in large (generalized) or small (localized) areas of the body
- Localized:Blisters confined to local areas, usually the palms, fingers, and soles. Pustules appear in a studded, pattern, turn brown, and then peel.
- Generalized:Blisters spread over large portions of the body, dry, and then recur again in repeated cycles lasting several days.
