What Is Psoriasis?
What Is Psoriasis?
Everybody's skin gets dry and a little flaky once in a while, and usually, it's easy to clear up—all it takes is applying lotion more frequently, switching soaps or laundry detergents, or avoiding common skin allergens like nickel and certain preservatives. But what if you've developed itchy, painful, rough patches of skin that just won't go away? You might have psoriasis. Learn more about what causes psoriasis, what it looks and feels like, how it's diagnosed, and your treatment options.
What is psoriasis?
Psoriasis is a chronic autoimmune disease that causes a buildup of skin cells. This buildup causes rough patches that are often scaly, red, and inflamed. Psoriasis can affect any part of the body, but it most commonly develops behind the elbows and knees, as well as the scalp, back, face, palms, and feet.
Psoriasis affects roughly 7.5 million people in the United States, according to the American Academy of Dermatology. It can strike at any time in your life, but tends to first develop between the ages of 15 and 30 or between the ages of 50 and 60. Most people have mild-to-moderate psoriasis, but 20 percent of people have moderate-to-severe psoriasis, meaning it covers more than 5 percent of the body's surface.
Psoriasis can occur in men and women and in people of all races. There are several types of psoriasis, but the most common type—which affects 80 to 90 percent of psoriasis patients—is called plaque psoriasis.
Let's bust one common myth right now: Psoriasis is not contagious. So if your rash accidentally rubs on someone else or another person touches it, you don't have to worry about spreading it. But the rash can be unpleasant to look at and can be embarrassing if it's on a body part that's regularly exposed to the public.
hat causes psoriasis?
To be frank, we just don't know yet what, exactly, causes psoriasis. Here's what we do know: White blood cells in your body called T cells, which you can think of as part of your body's department of defense, mistakenly think that your body is under attack. So they start to produce proteins that promote inflammation.
"Because of this pro-inflammatory cascade, the skin cells (keratinocytes) then respond by reproducing. But the old skin can't shed fast enough. So it gets heaped up and forms plaques," says Bobby Buka, MD, a dermatologist at Bobby Buka MD Dermatology in New York City. "Normally, in someone without psoriasis, the epidermis (the outer layer of skin) will turn over every 28 days. In a psoriatic patient, that turnover happens every seven days."
Psoriasis triggers to avoid
There are other factors that experts believe may increase your risk for flare-ups. While they're not precisely causes of psoriasis, many of them are factors that you can try to modify during your treatment to keep your symptoms under control.
- Infections
- Stress
- Certain medications
- Dry skin
- Skin injury or sunburn
- Smoking
- Drinking a lot of alcohol
- Vitamin D deficiency
What are the types of psoriasis?
Plaque Psoriasis
The most common type of psoriasis. Characterized by red or pink skin lesions covered in silvery scales.
Guttate Psoriasis
Causes small, red sores that cover the trunk, arms, and legs. It's the second most-common type of psoriasis.
Pustular Psoriasis
A rare form of psoriasis that causes tiny blisters filled with pus.
Inverse Psoriasis
Usually occurs in skin folds: under the armpits or behind the knees, under the breasts, or in the butt or groin area.
Erythrodermic psoriasis
Very rare, but very serious. It covers more than 75 percent of the body and causes skin to peel off in sheets.
What are the symptoms of psoriasis?
Psoriasis can occur anywhere on the body, but the most common type—plaque psoriasis—often appears on the elbows, knees, and/or scalp. The telltale symptoms include:
Patches of skin that look pink or red and scaly with a silver coloring on top
They may feel itchy or sore, and it almost looks like the skin has been burned or injured. "If you try to uncover one of the plaques, you'll get some pinpoint bleeding due to enlarged blood vessels," says Rhonda Q. Klein, MD, MPH, a dermatologist at Connecticut Dermatology Group. And these patches tend to be symmetrical—in other words, if they show up on one side of the body, you'll often see a mirror image of the patches on the other side of the body.
Misshapen nails
Believe it or not, there can also be signs of psoriasis on the nails. "There can be misshapen nails, nail pitting or ridging, or oil spots under the nail plate that can cause nail discoloration,” says Dr. Buka.
Oral changes
“You can also get what's called a geometric tongue, where it almost looks like fractals on the tongue," says Dr. Buka.
How is psoriasis diagnosed?
Usually, if it's a classic case of plaque psoriasis, a dermatologist will diagnose you by simply looking at your skin and taking a full medical history. Expect your doc to ask you a lot of questions about your symptoms and how long you've been experiencing them, the medications you've been taking, your lifestyle (including whether you smoke, how much sleep you get, and how stressed out you've been), your family history, and more. Sometimes a biopsy (a tissue sample) may need to be analyzed to confirm your psoriasis diagnosis.
Psoriasis severity
Psoriasis is classified as mild, moderate, or severe. It's determined based on how much of the body surface is affected.
What is psoriatic arthritis?
As many as four in 10 people who have psoriasis experience a condition called psoriatic arthritis that can cause joint swelling, stiffness, tenderness, and pain. So a doctor might inspect your hands, ankles, and feet and ask you if you've noticed any joint discomfort or swollen fingers or toes. "Generally, with psoriatic arthritis, it feels the worst in the morning—as opposed to osteoarthritis, which gets worse as the day goes on," says Dr. Klein.
he association between psoriasis and psoriatic arthritis has been known for a while, but the latest news is that research from the past several years has also discovered that, unfortunately, psoriasis patients are at higher risk of developing other serious (and sometimes life-threatening) conditions such as obesity, depression, and cardiovascular disease (heart attack, stroke).
"The thought is: All this inflammation that we're seeing in the dermis is inflammation that's probably happening on a low, basal layer throughout many organs," says Dr. Buka. If you have psoriasis, your doctor may also talk to you about ways to optimize your health in those particular areas mentioned above. This might include eating more nutritious foods and exercising more, seeing a mental health professional, or taking steps to lower your blood pressure or cholesterol.
What are the most common treatments for psoriasis? And what’s the prognosis?
The bad news is that psoriasis is chronic, so if you're diagnosed with it, it's likely a condition that you'll have for life. And there is currently no cure. But there's some very good news to keep in mind, too. Symptoms can come and go over time, and there are a variety of treatment options that are more effective than ever and can help you find significant symptom relief.
Common psoriasis treatments include:
Topical medications
These can include steroid creams, a vitamin D analog, or a combination.
Oral medications
They may include Apremilast, Acitretin, methotrexate, and cyclosporine.
Laser or light therapy
Narrow-band UVB phototherapy feels a lot like going to a tanning salon—you step into a vertical box that's filled with lights.
Biologics
An injection or infusion that can be done weekly, every other week, every six weeks, or every three months, depending on the medication.
Remember: If you think that you might have psoriasis, you don't have to suffer in silence. It's nothing to be ashamed of. Go get an evaluation from a dermatologist so you can get treated right away, get rid of the rash, and live your life with confidence.
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