From toledoblade.com
By Alexa Scherzinger
Though psoriasis and eczema may seem similar on the surface, the risk of comorbidities that comes with psoriasis makes it a more serious condition, requiring heftier treatments and quicker action.
“Psoriasis comes with a lot of things that eczema doesn’t come with, like the potential for joint disease and inflammatory arthritis,” said Jeremy Rowe, a physician’s assistant with Mercy Health Dermatology in Sylvania.
Psoriasis is a chronic immune-mediated disease with an unclear cause, characterized by inflammation due to immune system dysfunction. The inflammation manifests physically on the skin as raised plaques or scales, which may itch, burn, or sting.
Both psoriasis and eczema cause scaly patches of skin on the body, but the location of those patches, as well as other symptoms, can be a clear indicator of which disease is present.
The patches caused by psoriasis are often well-defined, thick, and red, and occur in the elbows, knees, face, and scalp most commonly. Eczema, however, appears mainly in the crooks of the knees and elbows, with more intense itching than psoriasis.
“Eczema is a little bit scaly and very, very itchy,” Mr. Rowe said. “Psoriasis tends to be very scaly and a little bit itchy most of the time.”
Psoriasis is also commonly found in the genital region, on hands, feet, and nails, and in skin folds. There are five types of psoriasis, the most common of which affects about 80 percent of psoriasis patients.
That type is plaque psoriasis — the most common target of television ads for pharmaceuticals. Though the commercials may boast of a so-called “cure” for the disease, doctors say there’s no such thing.
“The problem becomes patient expectation, and understanding that this isn’t a shot that you’re going to get once or twice or for a year and be able to come off of this,” Mr. Rowe said. “This is ongoing treatment, kind of like how you manage blood pressure.”
Plaque psoriasis causes raised patches of inflamed, itchy, painful skin with scales. The next most common type, inverse psoriasis, affects about a quarter of patients, causing deep red patches of smooth skin that are worsened by sweat or chafing.
The three other types of psoriasis are much less common, affecting as little as one percent of patients. Guttate psoriasis causes small, round, red spots; pustular psoriasis causes white, pus-filled bumps; and erythrodermic psoriasis causes the skin to shed in large sheets. While erythrodermic psoriasis is the rarest condition, it is also the most dangerous.
More than 8 million Americans suffer from psoriasis, according to data from the National Psoriasis Foundation.
Psoriasis isn’t just a cosmetic problem, the foundation argued, stating that nearly two-thirds of patients reported the disease to be a “large problem” in their everyday life. Patients with moderate to severe psoriasis experienced a greater impact on their quality of life, particularly in younger patients and women.
As far as severity goes, mild psoriasis is defined as affecting less than three percent of the body. Moderate psoriasis affects between three and 10 percent, and more than 10 percent is considered severe. Severity is also often measured by the disease’s effect on the patient’s quality of life.
Fortunately, psoriasis isn’t contagious — nor is eczema. The two are mostly affected by genetics. If one parent has psoriasis, their child has about a 10 percent chance of developing the disease. However, if both parents suffer from psoriasis, the child has a 50 percent chance of developing it.
Though eczema often begins to manifest in children, psoriasis has two main peaks of onset: between 20-30 years old and between 50-60 years old. Still, nearly one percent of children have psoriasis, often misdiagnosed as eczema, according to the American Academy of Dermatology.
Skin plaques from psoriasis are caused by overactivity in the immune system which speeds up skin cell growth. Normal skin cells grow and shed over the course of a month, but with psoriasis, the process speeds up to just three or four days, causing cells to pile up on the surface.
Certain environmental factors can trigger more severe episodes of psoriasis, including stress, skin injuries, medications, weather changes, and obesity. A number of infections can also cause flare-ups.
“As with any disease, everybody has their triggers,” said Dr. Matthew Rennels of ProMedica Physicians Wildwood Family Practice. “In younger populations, that can be something like a strep infection. People with HIV can get triggers.”
Quitting smoking can also help tone down the severity of psoriasis cases, as can a slight increase in sun exposure, as UV radiation accelerates skin cell regrowth. Mr. Rowe said that psoriasis symptoms often lessen in the summer months.
A psoriasis diagnosis can also mean a higher chance of multiple comorbidities, including cardiovascular disease, heart attack, stroke, metabolic syndrome, depression, and psoriatic arthritis.
“Psoriasis often has co-existing conditions, and the common one can be psoriatic arthritis,” Dr. Rennels said. Still, of all the types of arthritis he sees, psoriatic is one of the least common. Non-inflammatory types like osteoarthritis are far more typical — Dr. Rennels said he sees that on a daily basis.
If a patient’s concerns about potential psoriasis are strictly skin-related and haven’t spread to joints, many primary care physicians can prescribe topical medications to help, as well as evaluating family history and genetic predisposition to psoriasis among other conditions.
