What is psoriasis?This non-contagious, chronic inflammatory skin condition affects over seven million Americans. It is the result of an immune system malfunction, which signals rapid development of new skin cells. Because these cells grow faster than they are shed, they accumulate on the surface of the skin, creating dry, itchy, red patches. Psoriasis can develop anywhere on the body, but it is most common on the trunk, knees, and elbows.
Causes of psoriasisThis condition is considered an autoimmune disease, arising from an overactive reaction to compounds that are normally present in a healthy body. When the skin is injured, T cells (white blood cells) attack infective agents and promote healing. When psoriasis is active, these cells act on healthy skin as if it were injured.
In healthy skin regeneration, new cells gradually rise to the surface layer of skin as old cells are shed. However, psoriatic cells develop too quickly, and are unable to follow this pattern. Instead, they build up, forming a thick crust.
In most cases, the onset of psoriasis occurs between 15 and 35 years of age, but it can occur in younger children. Currently, there are approximately 20,000 cases of psoriasis in children under the age of ten. Genetics play a role in the development of psoriasis, though it does not manifest in everyone who has the problematic gene.
Symptoms of psoriasisThere are several types of psoriasis, and it manifests differently in each individual. Therefore, symptoms will vary, but some of the most common include:
- Soreness, itching, or burning.
- Extremely dry skin.
- Cracked, bleeding skin.
- Raised, red areas of skin covered with a silver, scale layer.
- Thick, rough, pitted fingernails.
- Swollen, stiff, painful joints.
Psoriasis triggersPsoriasis is a chronic condition, which often cycles through active flare-ups and periods of remission. In most patients, there are certain conditions that trigger initial symptoms or subsequent flare-ups. Some of the most common triggers include:
- Weather conditions
- Strep throat or other infections
- Excess alcohol consumption
- Skin injury
- Some medications
Types of psoriasisThis condition can manifest in various forms. It is typically divided into these six classifications:
Plaque PsoriasisAlso called Psoriasis Vulgaris, this is the most common type, affecting about 80 percent of all psoriasis patients. It is characterized by silvery scales over red patches of skin, usually on the lower trunk, knees, or elbows.
Guttate PsoriasisThis form of psoriasis is characterized by small sores that are shaped like water drops. It is most common in individuals under the age of 30, usually brought on by a skin injury or illness.
Inverse PsoriasisThis is most common in overweight individuals, and it usually appears near the groin, in the armpits, in the genital area, or under the breasts. Rather than raised patches, it causes shiny, smooth, bright red lesions.
Pustular PsoriasisPus filled blisters, which are usually white in color and surrounded by red skin, characterize this form of psoriasis. It may develop in a small, localized area or spread over the entire body. Like other forms of psoriasis, it is not contagious. UV radiation, irritants, infections, and stress are among the most common triggers.
Erythrodermic PsoriasisThe least common form of psoriasis, this type manifests as a bright red rash with severe itching or burning. It may be triggered by sunburn, medications such as corticosteroids, or a flare-up of another form of psoriasis.
Psoriatic ArthritisWith effects that go beyond the skin, psoriatic arthritis causes pain and swelling in the joints, as well as discoloration and pits in the fingernails. It is less crippling than rheumatoid arthritis, but causes similar joint stiffness and progressive damage.
Customizing a treatment planThis is a chronic skin condition, and there is currently no cure. However, science has made amazing progress in psoriasis research, with the goal of one day developing a permanent cure. The many new discoveries have already led to dramatic improvements in treatment options, making psoriasis controllable.
The goal of treatment is to improve your comfort and help your skin heal. The best treatment, or combination of treatments, will depend on several factors, including the severity of the condition. Severe psoriasis covers more than ten percent of your body.
Treatment options for mild to moderate psoriasisIf the rash covers three to ten percent of your body, it is classified as mild to moderate. Usually a combination of techniques is recommended. This may include some or all of the following.
Phototherapy (light therapy)UV light rays can reduce the symptoms of psoriasis, although sun exposure should be monitored carefully to minimize the risk. Other forms of light therapy include pulse dye lasers, which reduce the vessels associated with psoriasis, and excimer lasers, which are targeted to specific areas.
OTC (over the counter) medicinesThe FDA has approved two active ingredients for OTC psoriasis medication. The first is coal tar, which works by slowing the rapid production of skin cells. The other is salicylic acid, which works by promoting the shedding of skin cells. Other OTC treatments that you may find helpful include:
- Scale lifting formulas loosen scales to eliminate them gently.
- Bathing in solutions such as oilated oatmeal, Epsom salts, or Dead Sea salts, can help remove scales as well as easing the itch.
- Occlusion (covering the area after applying topicals) increases effectiveness by improving absorption.
- Hydrocortisone cream, calamine lotion, or other anti-itch products can make you more comfortable.
- Regular use of moisturizer helps the affected skin stay hydrated, reducing symptoms and encouraging healing.
Prescription topical medicationSeveral prescription-strength formulas are available, which are designed to reduce cell overgrowth and decrease inflammation, including:
- Anthralin – improves plaque by reducing skin cell growth.
- Calcipotriene – slows cell growth, removes scales, and flattens lesions. It is frequently used to treat psoriasis of the nails or scalp.
- Calcipotriene with Betamethasone Dipropionate – lessens inflammation and reduces itch, in addition to the other benefits of Calcipotriene.
- Calcitriol – a form of vitamin D3 that helps to reduce excessive production of skin cells.
- Tazarotene – a retinoid treatment that slows the growth of cells.
- Topical steroids – the most common psoriasis medication, these formulas reduce redness, swelling, and inflammation.
Treatment options for severe psoriasisOne or more of the following may be recommended.
Prescription MedicationsOral medications, such as methotrexate cyclosporine and acitretin, can improve symptoms in some cases, depending on the severity and location of the rash.
BiologicsThis new type of injectable medication is typically reserved for severe psoriasis. Biologics work by suppressing the patient’s immune system, which is effective because psoriasis is an autoimmune disease. However, these treatments tend to be pricey and come with side effects.
Phototherapy (light therapy)Sun exposure may be helpful, as UVA and UVB rays can reduce the symptoms of psoriasis. However, this must be done in short, carefully controlled sessions.
UVA light treatment may be combined with psoralens, which is a photosensitizing medication, in a treatment known as PUVA. Typically, regular sessions are needed for two or three weeks before noticeable improvement occurs.