How to Tell the Difference Between Psoriasis and Skin Cancer

From healthcentral.com

The conditions are quite different, but in some cases, they may look similar. Here’s how to distinguish between them 

Key Takeaways

• Psoriasis and some skin cancers can both look red and scaly, so appearances can be misleading.
• Psoriasis plaques are usually broad and may cover large areas, while skin cancers are more often isolated bumps.
• Psoriasis can spread quickly over months, while many skin cancers stay small and grow slowly.
• Dermatologists often diagnose by exam, and a biopsy can clearly distinguish psoriasis from skin cancer.
• Early evaluation and treatment matter, because untreated psoriasis can cause infection and distress, and skin cancer can spread.

Discovering a new rash or growth on your skin can be nerve-wracking. The spectrum of possible answers to the question “What is it?” ranges from absolutely nothing to an inflammatory condition like psoriasis, to skin cancer. And after Googling it, you might think it’s all three. So, how can you figure it out? When it comes to psoriasis and skin cancer, while the two diseases are very different, to the untrained eye, appearances may look similar. Here’s what you need to know about the similarities and differences between psoriasis and skin cancer.

Types of Psoriasis and Skin Cancer

Psoriasis and skin cancer both have multiple variants that present differently, which can complicate their diagnosis.

Types of Psoriasis

• Plaque Psoriasis

• Guttate Psoriasis

• Pustular Psoriasis

• Inverse Psoriasis

• Erythrodermic Psoriasis

Types of Skin Cancer

• Basal Cell Carcinoma (BCC)

• Squamous Cell Carcinoma (SCC)

• Melanoma

• Dermatofibrosarcoma protuberans (DFSP)

• Merkel cell carcinoma

• Sebaceous carcinoma

Comparing the Appearance of Psoriasis and Skin Cancer

In most cases, psoriasis and skin cancer look distinct, says Lisa Rhodes, M.D., a dermatologist at Westlake Dermatology in Austin, TX. For example, melanoma appears as an abnormal mole; strikingly different from any type of psoriasis. However, in some instances, psoriasis and skin cancer can have similar symptoms. “Psoriasis is a red, scaly plaque of skin,” explains Dr. Rhodes. “Basal cell carcinoma and squamous cell carcinoma can also be red and scaly.” This raised, red, and scaly characteristic is the most correlated symptom between the two conditions. Plaque psoriasis and squamous cell carcinoma are most likely to present in this way.

According to the AAD, precancerous skin growths called actinic keratoses (AKs) look like dry, scaly patches or spots on the skin. They’re caused by sun exposure and can develop into SCC over time, per the AAD.

When trying to discern skin cancer from psoriasis, a few key traits can tip you off:

• Shape: “Typically plaque psoriasis is broader than it is raised,” Dr. Hwang notes. “Skin cancers generally look more like bumps, or little hills.”

• Surface Area: While psoriasis can be limited to one or two areas on the body, it generally spans large areas, whereas skin cancer is limited to one isolated area or lesion, Dr. Hwang notes. “The broad nature and coverage of psoriasis would very rarely happen in cancer.”

• Speed of Growth: “Skin cancers tend to be small and grow slowly,” Dr. Hwang adds. “Psoriasis can develop quickly over a few months and cover a whole region.”

How Psoriasis and Skin Cancer Are Diagnosed

Both conditions are typically diagnosed with a physical exam—a dermatologist will look at your skin with a dermatoscope, a tool that uses magnification and light—and a medical history. Your clinician will ask about your symptoms, overall health, family history, and recent life events and stressors that may play a role in either psoriasis or skin cancer, explains Samuel Hwang, M.D., Ph.D., professor and chair of dermatology at UC Davis Health in Sacramento, CA.

More often than not, a licensed dermatologist can tell just by examining your skin whether you’re dealing with psoriasis or skin cancer, Dr. Hwang says. They are trained to spot different types of skin cancer and use the ABCDEs of melanoma to diagnose a skin spot—asymmetry, border, colour, diameter, evolving.

If the cause of your skin growth or rash isn’t apparent, your doctor will take a sample of the skin and send it to a lab for testing, called a biopsy. “Psoriasis and skin cancer look different on a biopsy,” Dr. Hwang explains. This will allow your doctor to make an accurate diagnosis and ensure that you get the proper care.

Side by side comparison of psoriasis (left) and skin cancer (right). GettyImages/RUTH JENKINSON (left), GettyImages/Irena Sowinska (right)

How Psoriasis and Skin Cancer Are Treated

The importance of a correct diagnosis can’t be overstated, in large part because the treatments for psoriasis or skin cancer are drastically different. Whatever you’re dealing with, you’ll want to receive treatment sooner rather than later to improve symptoms and avoid complications.

Psoriasis Treatment

If you do have psoriasis, the treatment option your doctor chooses will depend on the severity, type, how your body responds to certain medications, as well as your lifestyle. Psoriasis is a chronic condition, so while treatment can keep symptoms at bay for long periods of time, it’s normal to still experience flare-ups from time to time, especially when you encounter triggers like stress.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), psoriasis treatments include:

• Topical medications including corticosteroids, vitamin D-based therapies, retinoids, and coal tar

• Oral retinoids

• Phototherapy

• Oral immunosuppressants including methotrexate and phosphodiesterase 4 (PDE4) inhibitors

• Injectable immunomodulating medications called biologics

Skin Cancer Treatment

Skin cancer treatment is also tailored to the type of cancer you have and the stage at diagnosis—in other words, whether it’s in an early stage and confined to the top layer of the skin, or at a later stage and already spread to other areas. In general, skin cancer treatment may consist of the following, per the National Cancer Institute:

• Surgery, of which there are many different types depending on depth and size

• Radiation therapy

• Chemotherapy

• Photodynamic therapy, which uses a drug that concentrates in cancer cells and is activated by a laser light

• Immunotherapy, including drugs called PD-1 inhibitors (which reprogram the body’s immune system to fight the cancer), topical imiquimod therapy, and injected interferon

• Targeted therapies that identify and attack specific cancer cells

Risk Factors

Both skin conditions have their own set of risk factors. Fortunately, Dr. Hwang notes that there is no evidence that having psoriasis or skin cancer increases one's risk of developing the other.

Psoriasis Risk Factors

What sparks the immune system to overreact and cause psoriasis is still a bit of a mystery. Experts believe that a combination of genetics and environmental factors come together to create the perfect storm, resulting in psoriasis, according to NIAMS. However, a few traits seem to increase a person’s risk of developing the condition:

• A family history of psoriasis

• The presence of specific genes linked to psoriasis

• Smoking cigarettes

• Obesity

• Certain medications

• Infections, including strep and HIV

Skin Cancer Risk Factors

No one is immune to skin cancer—anyone can get it. Exposure to UV rays from the sun (or artificial sources, like tanning beds) can contribute to skin cancer development, even if you don’t have any other risk factors, according to the CDC. By using sun protection and avoiding sunburn, you can mitigate your risk of developing melanoma or any other type of skin cancer. Per the CDC, other factors that increase your risk include:

• Light skin colour

• Skin that burns, freckles, reddens easily, or hurts in the sun

• Blue or green eyes

• Light natural hair colour (blonde or red)

• A large number of moles

• A family history of skin cancer

• A personal history of skin cancer

• Older age

• Certain genes or conditions linked to melanoma risk

What Happens if Psoriasis and Skin Cancer Are Left Untreated?

Getting treatment is essential for both of these skin diseases, as the consequences of leaving them untreated can range from unpleasant to fatal. And because treatment for both psoriasis and skin cancer is most effective in early stages, don’t delay in seeing your doctor for an accurate diagnosis and treatment plan.

Untreated Psoriasis

The biggest issue with leaving psoriasis untreated is that you have to deal with the uncomfortable symptoms, which can disrupt your day-to-day life. “More than 60% of people with psoriasis have very significant itching, so it’s uncomfortable,” Dr. Hwang says. Itchy lesions can also predispose a person to infection, Dr. Rhodes adds. On top of that, the chronic inflammation caused by psoriasis can cause other symptoms, like fatigue, so you may also feel unwell overall. The treatments we have for psoriasis “are very good at removing pain and inflammation,” says Dr. Hwang. “They can help people feel much better.”

Obvious patches of psoriasis on your skin or a flaking scalp can also impact one’s self-esteem. “The visual symptoms are alarming to people and generally considered not cosmetically appealing, so it does have an impact on one's self-image and willingness to go out,” Dr. Hwang notes. “There’s a higher incidence of depression in people with psoriasis, too.”

Untreated Skin Cancer

If you don’t treat skin cancer, it will likely continue to grow. “Skin cancer can be locally destructive and even metastasize if left untreated,” Dr. Rhodes says. Metastasis is a significant concern with melanoma and some rarer forms of skin cancer, but not so much with BCC and SCC, Dr. Hwang notes. “The most common types of skin cancers tend to just grow and get bigger and require more extensive surgeries to remove, some of which can be disfiguring if you don't find it when it's small,” he explains. “If very large areas of skin are involved, surgery can be complex and quite invasive—some people even need skull and bone removed.”

Outlook

Psoriasis and skin cancer are both skin conditions that require a proper diagnosis and treatment to keep you healthy long-term. While psoriasis cannot be cured, it can be managed with the right medications. “We have excellent treatments for psoriasis with new ones approved every year,” Dr. Rhodes notes. “And skin cancer, if caught early enough, is easily treated,” she adds. That’s why it’s imperative to keep tabs on your skin and call your doctor if you notice any new growths or lesions, or think that something old has changed in shape, colour, or size. A clinician can investigate anything that seems suspicious and help you get to the bottom of it.

https://www.healthcentral.com/condition/psoriasis/psoriasis-or-skin-cancer?ap=nl2060&rhid=67ec2b8321f52bf01b0cca01&mui=&lid=141093361&mkt_tok=NTQxLUdLWi0yNDMAAAGh34SIlmYPyCx2Fh3w3wHUNNn6i-WCABs_rxUD-F1fK0aWwSuinFhNEJ50QZe9bJmO0TngpkCqPJkG1PRtxEkapEG8ZRjc_USlTdpcx2e9qBOTxZE

4 Sneaky Signs You Might Have Psoriasis

From eatingwell.com 

Psoriasis may have some common symptoms, but not all skin looks the same

KEY POINTS

• Psoriasis symptoms vary and can include plaques, nail changes and discomfort like itching or pain.
• Stress management, a healthy diet and proper skin care can help reduce psoriasis flares.
• Early diagnosis and treatment by a dermatologist can improve quality of life for people with psoriasis.

Psoriasis is a chronic skin disease that affects more than 8 million people in the U.S. Caused by an overactive immune system, skin cells grow more quickly than they are shed, leading to flares of scaly skin that builds up in patches around the body.

While a health care provider like a dermatologist can diagnose you with psoriasis based on a skin exam and medical history, research indicates that there is often a delay in diagnosis—sometimes over the span of years, leading to late treatment and lower quality of life. We asked experts about things we might notice if we have psoriasis; here’s what they said.

                                                                                                  Credit:  Getty Images. EatingWell Design

1. You Have Patches in Hidden or Sensitive Areas

Common psoriasis symptoms include raised, red patches of skin with silvery-white scales, often appearing on areas like the elbows and knees. “In those cases, both patients and clinicians may quickly suspect psoriasis,” says dermatologist Sejal Shah, M.D. But symptoms can be subtle or misdiagnosed as eczema, a fungal infection, dandruff or contact dermatitis, she explains. 

However, patches can also be present in oft-missed areas, such as the scalp (which can look like dandruff), behind the ears, nails, genitals, hands, feet and skin folds like armpits, under the breasts and the groin, says Shah.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Psoriasis.

 “Because these areas may not have the classic scaling or may be sensitive or private, patients and even clinicians sometimes miss them,” she explains. 

Given dermatologists are accustomed to seeing skin on every part of the body, don’t be shy (or ashamed) about pointing out areas of concern on your body. 

2. Your Nails Have Changed

Psoriasis can affect the nails in up to half of people with the skin disease. “Psoriatic nails typically present with small indentations we call ‘nail pitting,’ along with ‘oil spots,’ which are clear yellowish discolorations that look like a drop of oil sitting under the nail,” says dermatologist Joel Spitz, M.D. He also notes that the nail plate can thicken. Interestingly enough, nail psoriasis and nail fungus can look similar. For some folks, nail psoriasis occurs without the tell-tale skin symptoms, making diagnosis even trickier.

3. You Have Plaques, But They’re Not Red

Redness is a common feature of psoriasis skin plaques—if you have lighter skin tones. “As with many dermatologic conditions, psoriasis can look quite different depending on a patient’s skin tone,” says Spitz. For example, if you have a darker complexion, “plaques tend to appear as darker, pigmented raised lesions with overlaying scale, often without the obvious redness seen in lighter skin,” he says. This can add to the challenge of diagnosis.

4. You Have Skin Pain & Discomfort

Psoriasis isn’t just something you see—you can feel it, too. “Psoriasis is often thought of as a cosmetic skin condition, but many patients experience burning, stinging, pain, severe itching, cracking or bleeding skin,” says Shah. This can be a detriment to your health and overall well-being in a variety of ways, including by affecting your sleep, mood and daily functioning, she says.

Unfortunately, research suggests that pain associated with psoriasis is often underrecognized and inadequately managed. “Many treatment plans still focus more on visible skin clearance than on symptom burden like pain or sleep disruption,” adds Shah.  

Tips for Managing Psoriasis

Psoriasis is treated in a variety of ways, and often a well-rounded treatment plan has both medical and lifestyle components:

• Follow your dermatologist’s recommendations on topicals. There are a variety of topical medications that your derm might suggest based on your symptoms and their severity. Options that may be considered include corticosteroids, synthetic vitamin D or a calcineurin inhibitor.
• Consider systemic medications. Some people with psoriasis benefit from powerful systemic medications (meaning one that travels throughout the bloodstream to treat the whole body) called biologics. “[These] have allowed many patients to achieve and maintain completely clear skin as long as they stay on therapy,” says Spitz. 
• Focus on stress. “Stress management is important because emotional stress is one of the biggest triggers and can worsen inflammation and immune responses, leading to flare-ups,” says Shah. This, in turn, can worsen emotional stress from the condition.
• Practice good skin care. Avoid harsh soaps and over-scrubbing, and make sure to moisturize skin regularly and well with a thick emollient, says Shah.
• Maintain a healthy diet. What you eat matters for your skin and overall health, and some people may notice that their skin flares are associated with foods like ultra-processed foods, excess sugar, red meat, dairy or gluten, says Shah. “Anti-inflammatory diets rich in fruits, vegetables and omega-3s may be helpful,” she says. This eating pattern can also help you maintain a healthy weight for your body and reduce inflammation.

Our Expert Take

Psoriasis signs and symptoms can take many forms, including plaques that appear in less obvious or sensitive areas of the body, changes to the nails and other varied characteristics depending on your skin tone. In addition, psoriasis symptoms can also involve itch, pain and sleep disruption. For diagnosis and to develop a treatment plan, see a board-certified dermatologist. Lifestyle management, including a healthy diet and stress reduction, can help reduce flares and improve quality of life.

https://www.eatingwell.com/sneaky-signs-you-might-have-psoriasis-11970790

Plant-Based Diets May Lower Psoriasis Risk and Severity

From medcentral.com

New research highlights nutrition’s expanding role in the inflammatory skin condition 

Dietary interventions may help reduce psoriasis severity and, in some cases, the development of the inflammatory skin condition. Nutrition may be the key.

Emerging evidence supports the role of nutrition in psoriasis management, including the potential benefits of plant-based and Mediterranean-style dietary patterns, the role of weight loss and adiposity in psoriasis pathogenesis, and the relationship between diet quality and long-term psoriasis risk. As patient interest in nutrition counselling continues to increase, the latest research outlined below may help you identify opportunities for practical, evidence-informed discussions around psoriasis diet and care.

Healthy Plant-Based Eating May Reduce Psoriasis Incidence

Goals

This prospective cohort study evaluated whether adherence to different dietary quality patterns was associated with incident psoriasis risk and whether genetic susceptibility modified these associations. Investigators used UK Biobank data to assess plant-based dietary patterns, Mediterranean diet adherence, inflammatory dietary indices, and other diet quality measures in relation to future psoriasis development.

Study Details

• Investigators analysed 121,299 UK Biobank participants without psoriasis at baseline who completed at least two Oxford WebQ 24-hour dietary recalls. Median follow-up was 11.4 years; 822 incident psoriasis cases were identified through self-report, hospital, and primary care records.

• Ten dietary quality indices were evaluated using multivariable Cox proportional hazards regression models adjusted for demographic, lifestyle, clinical, environmental, and body mass index (BMI) covariates, including the Plant-Based Diet Index (PDI), Mediterranean Diet Score, Dietary Approaches to Stop Hypertension (DASH), Healthy Diet Index, and Dietary Inflammatory Index.

• Strengths included the large prospective design, repeated dietary assessments, and integration of polygenic risk scores. Limitations included reliance on self-reported dietary intake, limited ethnic diversity, potential residual confounding, observational design preventing causal inference, and lack of psoriasis-specific immunologic biomarkers.

Key Findings

• Participants with the highest adherence to a plant-based dietary pattern (PDI scores 56 to 77) had a 19% lower risk of incident psoriasis compared with those with the lowest adherence (hazard ratio [HR], 0.806; 95% CI, 0.651 to 0.997), although no statistically significant interaction (P for trend = 0.028) between diet and genetic susceptibility was identified.

• Greater intake of less healthy plant-based foods, including refined grains (HR, 1.097; 95% CI, 1.032 to 1.165) and sweets/desserts (HR, 1.086; 95% CI, 1.030 to 1.144), was associated with increased psoriasis risk, while healthier plant-based dietary patterns appeared protective across multiple sensitivity analyses.

• Mediation analyses suggested that reductions in adiposity and serum urate partially explained the relationship between plant-based diets and psoriasis risk, with BMI mediating approximately 14% of the observed protective association.

https://www.medcentral.com/dermatology/psoriasis/plant-based-diets-may-lower-psoriasis-risk-and-severity

5 Psoriatic Arthritis Myths and Facts

From everydayhealth.com

Psoriatic arthritis (PsA) is often misunderstood, and those misconceptions can make it harder for people to recognize symptoms, seek care, or understand what living with the condition is really like. It can also be challenging to explain the effects of the condition to friends, family, and co-workers.

“Psoriatic arthritis can also be difficult to diagnose, which can add to the confusion,” says Christopher Richard Morris, MD, a board-certified rheumatologist in Kingsport, Tennessee.

From its demographics to its progression, misconceptions about this autoimmune disease can be surprisingly persistent. Here are five common myths — and the facts to help set the record straight.

                                                                                                                         Everyday Health

1. Myth: Everyone With Psoriatic Arthritis Has Psoriasis

Not everyone with one condition will automatically have the other. While there is a strong link between psoriasis and psoriatic arthritis, up to 17 percent of people with a PsA diagnosis don’t have any visible skin symptoms at the time of their joint diagnosis.

“Though most adult patients develop psoriasis concurrently or before the symptoms of arthritis, there is a small subset of patients where arthritis develops before the skin manifestations,” says Nayaab Bakshi, DO, a fellow at Stony Brook Medicine’s division of rheumatology in Stony Brook, New York.

That said, Dr. Morris points out that there are PsA patients who may not be aware they also have psoriasis, which manifests in different ways. There can be patches of thick, scaly skin that can appear on the scalp, elbows, knees, or lower back; yellow-brown spots on the nails; or pustules can develop on the hands or feet.

“Psoriasis is not recognized easily, and you may not know what to be looking for,” Morris says. If you do notice a skin eruption, he adds, make an appointment with a dermatologist for a thorough examination.

2. Myth: PsA Is Caused by ‘Wear and Tear,’ Like Osteoarthritis

While both conditions are defined by joint pain, they are driven by different biological processes. Osteoarthritis is a degenerative disease in which the cartilage in the joints breaks down over time due to age, injury, or repetitive use.

PsA is inflammatory, which means joint damage is caused by an overactive immune response.

“Inflammation in psoriatic arthritis triggers a cascade of immune responses that cause joint pain, swelling, and destruction through multiple mechanisms: synovial tissue invasion, cartilage breakdown, and bone erosion,” says Dr. Bakshi. The synovium is the lining in the joints that can become inflamed, causing pain, swelling, and stiffness.

In psoriatic arthritis, your immune system also mistakenly tells your body to strip away bone in some spots while simultaneously building extra bone in others. This uneven process can reshape the joint, whereas osteoarthritis involves the gradual breakdown of protective cartilage.

3. Myth: If Your Skin Is Clear, Your Joints Are Fine

While there is some correlation between the severity of skin symptoms and the severity of the joint pain, the two don’t always move in tandem. The skin and the joints are independent targets of the same overactive immune system.

“We have an immune system that can be directed in many different ways,” says Aly Cohen, MD, a rheumatologist and an integrative health specialist in Princeton, New Jersey, and the medical director of the online education platform the Smart Human. “Because of that variability, you can’t always predict what’s going to become inflamed.”

One study found that some immune cells can migrate from the skin into the joints, where they may continue to trigger inflammation. This could help explain why your joints are affected while your skin looks perfectly healthy.

But it is true that if your skin isn’t clear, your joints may also be affected. Bakshi says the severity of skin symptoms can mirror the severity of joint pain. On the other hand, patients can also have severe psoriasis with mild joint disease, or minimal skin issues with significant joint pain and damage.

4. Myth: Psoriatic Arthritis Primarily Affects Elderly People

Since PsA isn’t an aging-joint issue like osteoarthritis, it doesn’t take decades of living for it to emerge. PsA is triggered by a malfunctioning immune system, and that can activate at any age, including in childhood. Studies suggest that the disease is most common in people 40 to 59 years old.

“There is no great way to understand the demographics,” says Dr. Cohen. “It used to be considered male dominant, but I’ve seen it equalize over the years.” It was also long considered a Caucasian disease, but research now suggests Hispanic and non-white PsA patients may experience more pain and limitations in their daily activities.

More than 1.5 million people in the United States have PsA, and about one-third of people who have the skin condition will develop it. Most people develop psoriasis about 10 to 20 years before being diagnosed with PsA.

5. Myth: The Symptoms Are Limited to Joint Pain and Skin Rash

PsA is often thought of as a condition that is limited to two specific areas, but that view is incomplete. “Psoriatic arthritis (PsA) is a multisystem inflammatory disease that extends beyond joint and skin involvement,” says Bakshi.

In addition to achy joints and skin rashes, other symptoms of PsA include:

• Fatigue or a lack of energy
• Tenderness in the areas where tendons or ligaments attach to bones, such as the back of the heel or sole of the foot
• Painful, sausage-like swelling of a whole finger or toe
• Nail changes, such as pitting (tiny dents), crumbling, or separation from the nail bed.
• Eye inflammation, especially uveitis, which can cause eye pain, redness, and blurry vision, and must be treated promptly to avoid vision loss.
• Inflammatory bowel disease
• An increased risk of heart disease

The Takeaway

• Misconceptions about psoriatic arthritis (PsA) are common, largely because it can be difficult to recognize and diagnose; it can have both a joint and a skin component, and doesn’t always present in obvious or predictable ways.
• PsA is an inflammatory disease, not the result of cartilage deterioration. It’s caused by an overactive immune system that damages joints in complex ways, and skin symptoms don’t always reliably reflect what’s happening in the joints.
• PsA can affect the whole body, can develop at almost any age, and can impact more than joints and skin. It can also affect your eye, digestive, and cardiovascular health.
• Understanding the condition and the effects it may have can help you manage it better.

 https://www.everydayhealth.com/psoriatic-arthritis/myths-and-facts/