Psoriasis is a skin condition that creates red patches of skin with white, thick scales. It most commonly occurs on the elbows, knees and scalp, but can appear anywhere on the body. The first episode usually occurs between the ages of 15 and 35; however, psoriasis can develop at any age. It is a chronic condition that can have flare-ups and remissions throughout the rest of the patient's life. Psoriasis affects as many as 7.5 million people in the United States. About 20,000 children under age 10 have been diagnosed with psoriasis.
In normal skin, skin cells live for about 28 days and then are shed from the outermost layer of the skin. With psoriasis, the immune system sends a faulty signal which speeds up the growth cycle of skin cells. Skin cells mature in a matter of 3 to 6 days. The pace is so rapid that the body is unable to shed the dead cells, and patches of raised, red skin covered by scaly, white flakes form on the skin.
Psoriasis can be a genetic disease (it runs in families), but is not contagious. There is no known cure or method of prevention. Treatment aims to minimize the symptoms and speed healing.
Types of Psoriasis
There are five distinct types of psoriasis:
- Plaque Psoriasis (Psoriasis Vulgaris) — About 80% of all psoriasis sufferers develop this form of the disease. It is typically found on the elbows, knees, scalp and lower back. It classically appears as inflamed, red lesions covered by silvery-white scales.
- Guttate Psoriasis This form of psoriasis appears as small red dot-like spots, usually on the trunk or limbs. It occurs most frequently among children and young adults. Guttate psoriasis comes on suddenly, often in response to some other health problem or environmental trigger, such as strep throat, tonsillitis, stress or injury to the skin.
- Inverse Psoriasis — This type of psoriasis appears as bright red lesions that are smooth and shiny. It is usually found in the armpits, groin, under the breasts and in skin folds around the genitals and buttocks.
- Pustular Psoriasis — Pustular psoriasis looks like white blisters filled with pus surrounded by red skin. It can appear in a limited area of the skin or all over the body. The pus is made up of white blood cells and is not infectious. Triggers for pustular psoriasis include overexposure to ultraviolet radiation, irritating topical treatments, stress, infections and sudden withdrawal from systemic (treating the whole body) medications.
- Erythrodermic Psoriasis — One of the most inflamed forms of psoriasis, erythrodermic psoriasis looks like fiery, red skin covering large areas of the body that sheds in white sheets instead of flakes. This form of psoriasis is usually very itchy and may cause some pain. Triggers for erythrodermic psoriasis include severe sunburn, infection, pneumonia, medications or abrupt withdrawal of systemic psoriasis treatment.
People who have psoriasis are at greater risk for developing other health problems, such as heart disease, inflammatory bowel disease and diabetes. It has also been linked to a higher incidence of cardiovascular disease, hypertension, cancer, depression, obesity and other immune-related conditions. It is very important for psoriasis patients to follow regularly with a primary care physician to evaluate and treat for these conditions and to maintain a healthy lifestyle to reduce the risk of obesity. In addition, smoking has been linked to exacerbation of psoriasis and patients are strongly encouraged to quit smoking.
Psoriasis can also affect the joints, which is termed psoriatic arthritis. About 30% of people with psoriasis develop psoriatic arthritis and experience joint pain, stiffness, and swelling. Psoriatic arthritis most commonly affects the hands and feet, but can affect any joint.
Psoriasis triggers are specific to each person. Some common triggers include stress, injury to the skin, medication allergies, diet and weather.
Psoriasis is classified as mild, moderate or severe depending on the body surface area that is involved and how this involvement affects a patients daily activities and quality of life. The severity of the disease impacts the choice of treatment.
The U.S. Food and Drug Administration has approved two active ingredients for the over the counter treatment of psoriasis: salicylic acid, which works by causing the outer layer to shed, and coal tar, which slows the rapid growth of cells.
Prescription Topical Treatments
Prescription topical medications focus on slowing down the growth of skin cells and reducing inflammation. They include:
- Topical steroids, the most commonly prescribed medication for treating psoriasis. Topical steroids fight inflammation and reduce the swelling and redness of lesions. Varying strengths of topical steroids are used for specific body locations.
- Topical calcineurin inhibitors, which block the inflammatory process and can help relieve itching. These can be used in sensitive areas, such as skin folds and the genital area.
- Calcipotriene and Calcitriol.. Vitamin D derivatives used to help regulate rapid growth of skin cells.
- Tazarotene, a topical retinoid used to slow cell growth.
Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. These include:
- Narrowband UVB: This is the most common type of phototherapy used for psoriasis and involves exposing the skin in a light booth to a particular wavelength of light (311-312 nm) and works well for psoriasis scattered throughout the body. Treatments are generally performed three times a week in a dermatology office and typically patients require 15-25 treatments for a good improvement.
- Excimer lasers: These devices are used to target small localized areas of psoriasis. The laser emits a high-intensity beam of UVB light at a wavelength of 308 nm directly onto the psoriasis plaque. It generally takes between 4 and 10 treatments to see a tangible improvement.
Oral medications. These include methotrexate, Otezla, and Soriatane. Your doctor will recommend the best oral medication based on the location, type and severity of your condition, while also taking into account your overall health. Oral medications can be very effective for psoriasis; however, they do have risks and are generally used for moderate to severe psoriasis and need to be monitored closely by a physician.
Biologics. A newer classification of injectable drugs, biologics are designed to target specific areas of the immune system. While these medications have been found to be very effective for psoriasis, the do have risks, including increased risk of infection and certain cancers, and generally are used for moderate to severe psoriasis, psoriatic arthritis, or psoriasis that is significantly impacting the patient's quality of life.
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