Unpredictable and irritating, psoriasis is one of the most baffling and persistent of skin disorders. It's characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin's surface and die, their sheer volume causes raised, red plaques covered with white scales.Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and soles of the feet.
Some people have such mild, limited psoriasis that they may not even suspect that they have the disease. Others have very severe psoriasis that affects their entire body surface.
Psoriasis is considered an incurable, long-term (chronic) skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.
Psoriasis affects all races and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. The quality of life of patients with psoriasis is often diminished because of the appearance of their skin. Recently, it has become clear that people with psoriasis are more likely to have diabetes, high blood lipids, and cardiovascular disease. This may reflect an inability to control inflammation.
The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis -- the most common variety of the condition -- include:
- Plaques of red skin, often covered with loose, silver-colored scales; these lesions may be itchy and painful, and they sometimes crack and bleed. In severe cases, the plaques of irritated skin will grow and merge into one another, covering large areas.
- Disorders of the fingernails and toenails, including discoloration and pitting of the nails; the nails may also begin to crumble or detach from the nail bed.
- Plaques of scales or crust on the scalp
Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints.
Other forms of psoriasis include:
Pustular psoriasis , characterized by red and scaly skin on the palms of the hands and/or feet with tiny pustules
Guttate psoriasis, which often starts in childhood or young adulthood, is characterized by small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and use of anti-malarial and beta-blocker medications.
Inverse psoriasis, characterized by bright red, shiny lesions that appear in skin folds, such as the armpits, groin area, and under the breasts
Erythrodermic psoriasis, characterized by periodic, fiery redness of the skin and shedding of scales in sheets; this form of psoriasis, triggered by withdrawal from a systemic psoriasis treatment, severe sunburn, infection, and certain medications, requires immediate medical treatment, because it can lead to severe illness.
People who suffer from psoriasis know that this uncomfortable and at times disfiguring skin disease can be difficult and frustrating to treat. The condition comes and goes in cycles of remissions and flare-ups over a lifetime. While there are medications and other therapies that can help to clear up the patches of red, scaly, thickened skin that are the hallmark of psoriasis, there is no cure.
Can psoriasis affect only my nails?
Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications for the treatment of psoriasis.
Eczema vs. psoriasis
Occasionally, it can be difficult to distinguish eczematous dermatitis from psoriasis. This is when a biopsy can be quite valuable to distinguish between the two conditions. Of note, both eczematous dermatitis and psoriasis often respond to similar treatments. Certain types of eczematous dermatitis (eczema) can be cured where this is not the case for psoriasis.
A variety of factors -- ranging from emotional stress and trauma to streptococcal infection -- can cause an episode of psoriasis. Recent research indicates that some abnormality in the immune system is the key cause of psoriasis. As many as 80% of people having flare-ups report a recent emotional trauma, such as a new job or the death of a loved one. Most doctors believe such external stressors serve as triggers for an inherited defect in immune function.
Psoriasis tends to run in families, but it may be skip generations; a grandfather and his grandson may be affected, but the child's mother never develops the disease. Although psoriasis may be stressful and embarrassing, most outbreaks are relatively harmless. With appropriate treatment, symptoms generally subside within a few months.
Is psoriasis contagious?
No. A person cannot catch it from someone else, and one cannot pass it to anyone else by skin-to-skin contact. Directly touching someone with psoriasis every day will never transmit the condition.
Is there a psoriasis diet?
Most patients with psoriasis seem to be overweight. Since there is a predisposition for those patients to develop cardiovascular disease and diabetes, it is suggested strongly that they try to maintain a normal body weight. Although evidence is sparse, it has been suggested that slender patients are more likely to respond to treatment.
Although dietary studies are notoriously difficult to perform and interpret, it seems likely that a diet whose fat content is composed of polyunsaturated oils like olive oil and fish oil is beneficial for psoriasis. The so-called Mediterranean diet is an example.
Tests to Diagnose Psoriasis
In most cases, your primary care doctor or dermatologist will be able to diagnose psoriasis by examining your skin. However, since psoriasis can look like eczema and other skin diseases, diagnosing it can sometimes be difficult.
If your doctor isn't sure whether you have psoriasis, he or she may order a biopsy. Your doctor will remove a small sample of your skin and have it looked at under a microscope.
Choosing a Treatment for Psoriasis
There isn't a cure for psoriasis, and there isn't a perfect treatment either. Treatment for psoriasis can be demanding and cause side effects.
Before treatment, you should make sure that your doctor is comfortable prescribing systemic and biologic medications when they're necessary. Some doctors are reluctant to use these powerful drugs because of their side effects. Caution is important, but experts point out that certain cases demand systemic and biologic medicines. Working with a doctor who understands all of the possible treatments will give you the widest array of options.