Psoriasis photo

What Is Psoriasis?

Psoriasis is a common, chronic, immune-related skin condition characterized by red, scaly, flaky plaques. Psoriasis occurs equally in males and females and may occur at any time, although onset in adulthood is common. The severity of psoriasis varies and in severe cases may diminish confidence and self-esteem.

What Causes Psoriasis?

Psoriasis is caused by a complex immune-mediated disease resulting from an increase in cytokines. Psoriasis is worsened by environmental and emotional factors, as well as smoking and excessive alcohol consumption. Patients with psoriasis have a shortened cell turnover rate resulting in thickened scales on the skin. Genetic predisposition plays a large role in psoriasis and risk is increased if there is a family history.

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psoriasis

What Are the Symptoms of Psoriasis?

Psoriasis commonly appears as scaly plaques on the extensor surfaces such as the elbows and knees but may appear on the scalp, back, chest, arms, and legs. The plaques in psoriasis are red, scaly, and well-defined. These plaques may be associated with mild itching, burning, or discomfort. Psoriasis appearance can vary based on the type of psoriasis.

Psoriasis Types

There are many subtypes of psoriasis including plaque, guttate, pustular, erythrodermic, and inverse psoriasis.

Plaque psoriasis is the most common type. These red, scaly, well-circumscribed patches often appear on the flexural skin such as elbows, knees, and scalp, and are often symmetrical. The lesions are covered in a thick white scale. Nail changes are common in psoriasis and include nail pitting, yellowing of the nail, or abnormal separation of the nail plate.

Guttate psoriasis appears as small droplet-like well-circumscribed plaques. Guttate psoriasis appears more rapidly than plaque psoriasis and is often triggered by a streptococcal infection. In some cases, psoriasis may be triggered by medications or trauma. The “koebner phenomenon” describes psoriasis plaques forming in areas of trauma or following surgical incision.

Pustular psoriasis appears as multiple, tiny pustules that may be filled with pus. Pustular psoriasis often appears on the palms and soles and is more acute in onset than plaque psoriasis. These pustules are often very itchy.

Erythrodermic psoriasis is described as a widespread redness covering a large surface area of the body. This rash appears quickly and can be very painful. This is a form of exfoliative dermatitis.

Inverse psoriasis is a common form of psoriasis located in the flexural areas of the body such as the armpits, groin, inframammary folds, and gluteal cleft. Due to the location, these rashes often appear as red plaques without extensive overlying scale. Inverse psoriasis is often misdiagnosed as a fungal rash.

Psoriasis Comorbidity Explained

There are many comorbidities associated with psoriasis such as psoriatic arthritis, cardiovascular disease, or inflammatory bowel disease. Some patients with psoriasis may develop psoriatic arthritis. This is characterized by joint stiffness or pain especially in the morning or after periods of inactivity.

What Is the Best Treatment for Psoriasis?

Psoriasis is a chronic skin disease with no definitive cure. However, there are many medications to reduce exacerbations, decrease itch, thin and remove plaques, and can greatly improve quality of life.

Treatment includes extensive education on the disease and its chronic nature. In addition, topical creams, prescription solutions/shampoos, phototherapy, injections, and systemic medications may be prescribed. Typically, treatment will include a combination of these therapies. Treatment depends on location, severity, patient preference, and patient comorbidities.

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