PSORIASIS: symptoms, diagnosis, and treatments

What is psoriasis?

Psoriasis is a chronic (long-lasting) disease in which the immune system becomes overactive, causing skin cells to multiply too quickly. Patches of skin become scaly and inflamed, most often on the scalp, elbows, knees, palms, feet, face or nails but other parts of the body can be affected as well. Psoriasis is not a contagious condition. (https://www.niams.nih.gov/health-topics/psoriasis#:~:text=Psoriasis%20is%20a%20chronic%20(long,can%20be%20affected%20as%20well.) 

What are the types of psoriasis?

• Plaque psoriasis: Plaque psoriasis is the most common type of psoriasis. About 80% to 90% of people with psoriasis have plaque psoriasis.
• Guttate psoriasis: Guttate psoriasis may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots and often affects children and young adults.
• Pustular psoriasis: Pustular psoriasis has small, pus-filled bumps on top of plaques.
• Erythrodermic psoriasis: This is a severe type of psoriasis that affects a large area (more than 90%) of your skin. It causes widespread skin discoloration and skin shedding.
• Sebo psoriasis: This type typically appears on your face and scalp as bumps and plaques with a greasy, yellow scale. This is a cross between psoriasis and seborrheic dermatitis. 
• Nail psoriasis: Nail psoriasis causes skin discoloration, pitting and changes to your fingernails and toenails. (https://my.clevelandclinic.org/health/diseases/6866-psoriasis) 

Inverse psoriasis: This type appears in your skin folds. It causes thin plaques without scales.

What are the symptoms of psoriasis?

Symptoms of psoriasis vary from person to person, but some common ones are:

• Patches of thick, red skin with silvery-white scales that itch or burn, typically on the elbows, knees, scalp, trunk, palms, and soles of the feet.
• Dry, cracked skin that itches or bleeds.
• Thick, ridged, pitted nails.
• Poor sleep quality. (https://www.niams.nih.gov/health-topics/psoriasis#:~:text=Psoriasis%20is%20a%20chronic%20(long,can%20be%20affected%20as%20well.) 

What are the causes of psoriasis?

The cause of psoriasis isn't fully understood. It's thought to be an immune system problem where infection-fighting cells attack healthy skin cells by mistake. Researchers believe that both genetics and environmental factors play a role.

Many people who are predisposed to psoriasis may be free of symptoms for years until the disease is triggered by some environmental factor. Common psoriasis triggers include:

• Infections, such as strep throat or skin infections
• Weather, especially cold, dry conditions
• Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn
• Smoking and exposure to second-hand smoke
• Heavy alcohol consumption
• Certain medications — including lithium, high blood pressure drugs and antimalarial drugs
• Rapid withdrawal of oral or injected corticosteroids 
• People who smoke and have a family history of psoriasis are at higher risk of getting the condition. (https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840) 

What is psoriatic arthritis? 

Psoriatic arthritis is a type of arthritis that causes joint pain and swelling. Similar to psoriasis, psoriatic arthritis is an autoimmune condition that causes your immune system to function abnormally and cause symptoms. About 1 in 3 people diagnosed with psoriasis will also develop arthritis due to inflammation. Early treatment of psoriatic arthritis can reduce damage to your joints.  

How common is psoriasis?

People of any age, gender or race can get psoriasis. Psoriasis affects millions of people. More than 3% of the U.S. population has psoriasis. (https://my.clevelandclinic.org/health/diseases/6866-psoriasis) 

How is psoriasis diagnosed? 

The appearance of a skin plaque leads to a psoriasis diagnosis, but symptoms can relate to other similar skin conditions. Skin biopsy helps determine the type of psoriasis and rule out other disorders. 

How is psoriasis treated? 

Choice of treatment depends on severity of psoriasis and how responsive it has been to previous treatment and self-care measures. You might need to try different drugs or a combination of treatments before you find an approach that works. Even with successful treatment, usually the disease returns.

TOPICAL THERAPY 

• Corticosteroids: are the most commonly prescribed creams to treat mild to moderate psoriasis. They are available as oils, ointments, creams, lotions, gels, foams, sprays and shampoos. Topical corticosteroids might be applied once a day during flares, and on alternate days or weekends during remission. A stronger corticosteroid cream or ointment triamcinolone (Trianex) or clobetasol (Cormax, Temovate, others) may be prescribed for more severe symptoms. 
• Vitamin D analogues: slow skin cell growth. This type of drug may be used alone or with topical corticosteroids. Calcitriol may cause less irritation in sensitive areas.
• Retinoids in the form of gels or cream can be applied once or twice daily. The most common side effects are skin irritation and increased sensitivity to light.
• Calcineurin inhibitors: calm the rash and reduce scaly buildup. They can be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are irritating or harmful.
• Salicylic acid: shampoos and scalp solutions reduce the scaling of scalp psoriasis. They are available in nonprescription or prescription strengths.
• Coal tar: reduces scaling, itching and inflammation.
• Anthralin: is a tar cream that slows skin cell growth. It can also remove scales and make skin smoother. It's not intended for use on the face or genitals. Anthralin can irritate skin, and it stains almost anything it touches. It's usually applied for a short time and then washed off.

LIGHT THERAPY

• Light therapy (also known as phototherapy) can be combined with medications for moderate to severe psoriasis. Daily exposures to sunlight (heliotherapy) might improve psoriasis.
• Calculated doses of broadband or narrow band ultraviolet B (UVB) can be administered to psoriatic patches. UVB narrowband light therapy might be more effective than UVB broadband treatment. In many places it has replaced broadband therapy. It's usually administered two or three times a week until the skin improves and then less frequently for maintenance therapy.
• Psoralen plus ultraviolet A (PUVA): This treatment involves taking a light-sensitizing medication (psoralen) before exposing the affected skin to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.

ORAL OR INJECTED MEDICATION

• For a few small, persistent psoriasis patches, your health care provider might suggest an injection of triamcinolone (steroid).
• Acitretin and other retinoids are pills used to reduce the production of skin cells.
• Certain drugs that alter the immune system include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), Ustekinumab (Stelara), risankizumab-rzaa (Skyrizi). These must be used with caution because they carry the risk of suppressing the immune system in ways that increase the risk of serious infections. People taking these treatments must be screened for tuberculosis.
• Methotrexate (Trexall), administered once/week, decreases the production of skin cells and suppresses inflammation. 
• Cyclosporin suppresses immune system and is given orally for severe psoriasis. Like other immunosuppressant drugs, cyclosporine increases the risk of infection and other health problems, including cancer. (https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845) 

If you are pregnant or have side effects to the treatment, discuss it with your healthcare provider to explore alternative remedies.