For many sufferers, psoriasis is one of the most confusing and annoying skin disorders out there. Although psoriasis can be associated with other serious health conditions, many people report that the worst part of the condition is the unbearable itching, burning, and stinging of the skin.
An Overview
Psoriasis appears as raised red and scaly patches on the skin that an immune-mediated disease typically causes. Most psoriasis areas are found on the scalp, the elbows, or the knees. However, these patches can appear anywhere that there is skin, including the palms, the soles of the feet, and the torso.
Psoriasis is known for being particularly uncomfortable because of its seemingly incessant irritation. It often disappears only for brief periods of relief before reappearing with a vengeance. These flare-ups can occur repeatedly over a sufferer’s lifetime, sometimes disfiguring the skin. There is hope, though. Prescription medications like Humira, Enbrel, Taltz, Otezla, and Cosentyx can help to curb the occurrence and severity of outbreaks.
The Symptoms
The signs and symptoms of psoriasis vary slightly for each afflicted person. However, the most common symptoms include:
- red skin patches, often with thick, silvery scales;
- small scaling spots (especially in children);
- dry or cracked skin that may or may not bleed;
- itching, stinging, or burning skin;
- thickened, ridged, or pitted nails; and
- swollen or stiff joints.
These symptoms can appear in small patches or in major eruptions that are widespread over large areas of skin. Flare-ups can last for weeks or months before going into periods of remission. Like the flare-ups, the severity of the symptoms can increase and decrease through different episodes.
The Types of Psoriasis
There are several forms of psoriasis, including:
- pustular psoriasis, in which the red scaly skin are covered with tiny pustules;
- guttate psoriasis, which focuses mainly on the torso, limbs, or scalp, and a streptococcal infection can trigger it in late childhood or young adulthood;
- inverse psoriasis, which appears as bright, shiny red lesions in the skin folds, such as in the groin, under the breasts, or in the armpits;
- erythrodermic psoriasis, which is triggered by a severe sunburn, an infection, or certain medications (to name a few) to appear as fiery red skin;
- nail psoriasis, which affects the fingernails and toenails, causing abnormal coloring, pitting, and crumbling; and
- psoriatic arthritis, in which the joints become painful and swollen in addition to the skin becoming inflamed.
In addition to the visible skin changes that accompany most types of psoriasis, some forms can cause additional troublesome symptoms. For example, pustular psoriasis often leads to fever, chills, and even diarrhea in addition to the blisters. Likewise, psoriatic arthritis can vary in its severity, sometimes causing progressive joint damage and permanent deformities.
The Causes
Doctors are still unsure what exactly causes the onset of psoriasis. However, evidence suggests that it is related to an immune system problem with the body’s white blood cells and T cells.
In a normally functioning immune system, T cells travel throughout the body and attack foreign substances, such as bacteria or viruses. In the case of psoriasis, T cells seemingly attack healthy skin cells by mistake. These attacks trigger an increase in the production of T cells and white blood cells. This reaction, in turn, can cause redness and possibly lesions as the new cells rush to the skin’s surface. This all begins a never-ending cycle of cellular attack and creation.
What causes this T-cell malfunction remains unclear, but most researchers and doctors think it likely that both genetics and environmental factors play into it. Men and women seem to be afflicted with psoriasis at equal rates, and the disease affects all racial groups to different extents. Most people have their first flare-ups between the ages of 15 and 35 years, but it can happen at any age, including infancy. However, it is important to remember that psoriasis is not contagious.
The Risk Factors
Although nearly anyone can develop psoriasis, researchers have developed a list of risk factors associated with this condition, including:
- family history of the disease,
- viral and bacterial infections,
- stress,
- obesity or sudden weight gain, and
- smoking tobacco.
The Common Triggers
In addition to the strongest risk factors, there are several triggers that people can avoid to prevent the onset of a psoriasis episode, including:
- infections, especially to the skin or the throat;
- injuries to the skin, such as a severe sunburn or a cut;
- vitamin D deficiency;
- certain medications, such as lithium, beta blockers, and antimalarial drugs;
- stress;
- smoking; and
- heavy alcohol consumption.
The Diagnosis
At this time, there is no blood test or specific tool used to diagnose psoriasis. A dermatologist diagnoses most patients, but other healthcare providers can examine the skin as well. Sometimes a biopsy may be ordered and examined, but this is not always necessary.
The Treatment
Over-the-counter medications are not effective against psoriasis, so sufferers must contact their doctors to find relief. Most treatments involve reducing the inflammation and the appearance of the rash.
The Topical Treatments
Many people can treat mild-to-moderate psoriasis with topical creams. These include:
- topical corticosteroids,
- vitamin D analogues,
- anthralin,
- topical retinoids,
- calcineurin inhibitors,
- salicylic acid,
- coal tar, and
- moisturizers.
The Phototherapy Treatments
Using either natural or artificial ultraviolet light, phototherapy is often used in combination with topical or oral treatments. Common light therapies include:
- sunlight,
- UVB phototherapy,
- narrow band UVB phototherapy,
- Goeckerman therapy,
- psoralen plus ultraviolet A (PUVA), and
- excimer laser.
The Oral or Injected Treatments
The most severe cases of psoriasis, or the ones that remain resistant to other forms of treatment, may need oral or injected medications. These options often have severe side effects, and most are only used for a brief period or in alternation with another form of treatment. Such treatments include:
- retinoids,
- methotrexate,
- cyclosporine,
- biologics that alter the immune system,
- thioguanine, and
- hydroxyurea.
The Conclusion
People who think that they may be suffering the effects of psoriasis should get a professional opinion from a doctor or another licensed medical provider. Because the disease is unlikely to improve without medical intervention, this is the best course of treatment for anyone dealing with the symptoms of psoriasis.
Disclaimers: This article is not to replace professional medical advice nor should it be used to diagnose any condition.
