From forbes.com
By Suzie Glassman
An estimated 7.5 million people in the U.S. live with psoriasis, making it one of the most common immune-mediated disorders in the country. Immune-mediated conditions occur when overactive immune cells attack normal cells within the body, causing inflammation. In the case of psoriasis, this manifests as a rash, which most often appears as raised red or silvery scales, or plaques, on the skin—but the rash can also present as small white pustules or shiny smooth lesions in more rare forms of the disease.
“Despite the chronic nature of psoriasis, there’s no reason for anyone to suffer,” says Lawrence Green, M.D., clinical professor of dermatology at George Washington University School of Medicine. “There are many effective treatments, and delaying care can lead to other serious conditions like cardiovascular disease, diabetes and depression.”
Below, learn everything you need to know about psoriasis, from types and causes to diagnosis and available treatments.
What is Psoriasis?
Psoriasis is a chronic skin condition resulting from an overactive immune system and is often characterized by thick, red skin and silvery plaques. Despite its rash-like appearance, psoriasis is not contagious. Normal skin cells grow and shed over a month. In the case of psoriasis, however, skin cells grow faster, piling up on the skin instead of shedding and causing plaques that can be irritating, painful and itchy.
Different Types of Psoriasis
According to the National Psoriasis Foundation (NFP), there are five types of psoriasis. These include:
- Guttate psoriasis: Affecting up to 8% of people with psoriasis, this appears as small, raised, round spots that are sometimes scaly and often appear on the arms, legs and trunk.
- Pustular psoriasis: This type is characterized by small, white pustules on the skin that often develop quickly and in tandem with fever, chills, itching, fatigue and muscle weakness. It’s essential to see a doctor as soon as these signs appear.
- Plaque psoriasis: The most common type of psoriasis, affecting up to 80% of those with the condition, plaque psoriasis causes raised, scaly patches of skin and can show up anywhere on the body. Patches may vary in colour depending on a person’s skin tone. For example, on dark skin, plaques can appear purple, dark brown or grey. On lighter skin, plaques typically appear more reddish.
- Inverse psoriasis: Around 25% of people with psoriasis experience shiny, smooth lesions (rather than scaly) ranging from bright red to purple or brown, depending on skin tone. Lesions appear in skin folds like armpits, under the breasts, or in the groin.
People may experience inverse psoriasis simultaneously with one of the other types, and friction or sweat can exacerbate symptoms. - Erythrodermic psoriasis: This rare form of psoriasis causes intense swelling, redness, and, sometimes, skin shedding in sheets. This is a severe and potentially life-threatening condition that can lead to increased heart rate, body temperature changes and severe itching and pain, so it’s imperative to see a doctor immediately if symptoms appear.
Psoriatic Arthritis
Psoriatic arthritis is also associated with psoriasis. This condition causes inflammation and pain in the joints, tendons and ligaments that connect to bones. About 30% of people with psoriasis develop psoriatic arthritis, according to the NFP, and many develop the condition about ten years after a psoriasis diagnosis. However, it’s possible to develop psoriatic arthritis without ever developing psoriasis.
“Psoriatic arthritis can cause irreversible joint damage,” says Mary Stevenson, M.D., associate professor of dermatology at New York University Langone Health. “This is why seeing a board-certified dermatologist if you have psoriasis is essential. There is no cure, but there are medications that can lessen the severity and slow the progression.”
Common Signs and Symptoms of Psoriasis
While psoriasis can appear on any part of the body, the most common places are in skin folds, the scalp, genitals, face, hands, feet and nails. Psoriasis can begin at any age but is most common in adults ages 50 to 69.
Symptoms on the skin range from red, scaly, itchy patches to pus-filled bumps, depending on the type. A study published in Reumatologia found that around 50% of people with plaque psoriasis experience nail symptoms like deformation, pitting, discoloration, and splitting from the nail bed.
Symptoms in the hands and feet, such as thickened skin and deep cracking, may also appear and can be painful, according to the study.
What Causes Psoriasis?
The exact cause of psoriasis is unknown, but genetics, stress and lifestyle choices may play a role, according to a global psoriasis report by the World Health Organization (WHO). “It can run in families, so the more family members who have it, specifically your parents, the more likely you are to have it,” says Dr. Stevenson. “Smoking can also increase your risk.”
What Triggers Psoriasis?
There are a few known triggers that can worsen existing symptoms of psoriasis or cause new ones to appear:
- Stress is a major trigger for psoriasis and can make itching worse, according to the NFP. Also, the appearance of psoriasis can be stressful for those embarrassed by the condition. “I’ve had patients tell me they’ve been kicked out of swimming pools by lifeguards who think they have a contagious rash,” says Dr. Green.
- Injury, like a scrape to the body in people with the genetic tendency to develop psoriasis, can also cause the immune system to develop an overactive response, adds Dr. Green.Sunburns, vaccinations, and bug bites can also have a similar effect due to the Koebner phenomenon, in which new psoriatic skin lesions appear after an injury to otherwise healthy skin, according to Dr. Stevenson. While uncommon, some studies have linked psoriasis flares after vaccination for influenza, pneumococcal pneumonia, and yellow fever. The Covid-19 vaccine has also triggered reactions in a small number of documented anecdotal cases, according to a series of case studies in Cureus, but more research is needed into this potential link.
- Viruses and illness are other triggers because they affect the immune system. The NPF says psoriasis can flare due to an ear infection, bronchitis, tonsillitis or a respiratory infection, and strep throat can trigger the onset of guttate psoriasis in children.
- Certain medications may cause psoriasis flares, including common blood pressure medications called beta-blockers and lithium, so patients on these medications should be aware, says Dr. Stevenson.
- Dietary factors, such as diets high in refined sugars, sodium, meat and alcohol have been implicated in increasing inflammation and psoriasis symptoms, according to a 2020 study in the International Journal of Molecular Science.
- The weather can also be a trigger. Cold weather brings less sunlight and humidity, as well as potentially more stress and illness. “There may also be some other environmental triggers we aren’t aware of, but the underlying [disposition] to get psoriasis has to be there, or it won’t develop,” says Dr. Green.
The NPF recommends patients keep track of their psoriasis triggers to anticipate flares and know when to seek treatment.
Psoriasis Risk Factors
According to a 2019 review in the International Journal of Molecular Sciences, extrinsic risks of psoriasis come from the external environment and include air pollutants, certain medications, lifestyle factors, illness or skin injury. Intrinsic risks come from certain medical conditions, such as suffering from obesity, diabetes mellitus, high blood pressure, mental stress and dyslipidemia, a condition where lipid levels are too high or too low.
Smoking and alcohol consumption are associated with psoriasis, according to research. A 2012 study in the American Journal of Dermatology reports smoking to be a risk factor for developing psoriasis.
Untreated psoriasis causes inflammation throughout the body, which, according to Dr. Green, can also contribute to heart damage and high blood pressure.
Complications of Psoriasis
As mentioned above, psoriasis can progress into the chronic skin and nail disease, psoriatic arthritis.
In addition to that risk, the American Journal of Medical Care (AJMC) notes that some individuals may be at an elevated risk for certain cancers, such as squamous cell carcinoma, lymphoma and basal cell carcinoma. A higher chance of being impacted by more severe disease may also be associated with psoriasis, including cardiovascular disease, endothelial dysfunction, metabolic syndrome, hypertension, hyperlipidemia, obesity and diabetes.
Research into the condition of psoriasis continues, as scientists still aren’t fully clear on the connection between psoriasis and other more serious conditions. To learn more about what potential psoriasis complications might look like for you or a loved one, consult your doctor or a dermatologist.
How is Psoriasis Diagnosed?
Psoriasis is typically diagnosed and treated by a dermatologist. “Psoriasis is usually diagnosed clinically by a skin exam, including [an examination of] your scalp and nails,” says Dr. Stevenson. “Your clinician will also ask you questions about your [health] history, including joint pain, as psoriasis is associated with psoriatic arthritis. [Psoriasis] can also be diagnosed by biopsy, where a sample of tissue is sent to the lab.”
What Does Psoriasis Look Like and Where is it Found on the Body?
Plaque psoriasis, typically the most prevalent type of psoriasis, often appears as thick, scaled patches on the skin in a silvery colour, popping up on the scalp, elbows, knees, lower back and potentially other areas of the body, according to the American Academy of Dermatology Association (AAD).
Scalp psoriasis can be thick or thin, with thicker patches creating a greater risk for hair loss. This type of psoriasis can be found on the scalp, forehead, neck or ears. Other types, such as nail psoriasis, include yellow-brown colouring on the fingernails or toenails, and are associated with crumbling or pitted nails. Another, guttate psoriasis, most common in children and often brought on by strep throat, can appear as small, scaly spots.
Additional types of psoriasis can have other visual characteristics and appear in different spots on the body, however many will have the scaly appearance mentioned above.
Psoriasis vs. Eczema: What's the Difference?
While often confused with eczema, psoriasis is believed to be an autoimmune condition, while eczema is commonly associated with allergic conditions, such as asthma or food sensitivities.
Eczema is often itchier than psoriasis and presents itself most commonly in folds of the body, such as the inside of the elbows or back of the knees. Psoriasis may also show up on the knees or elbows, as well as the scalp, buttocks and face. (It’s important to note that both conditions can show up in the same areas in some cases.) Psoriasis lesions are also typically more well-defined with sharper borders and thicker scaling.
Expert-Recommended Treatments for Psoriasis
Treatments for psoriasis fall into four categories: topicals, phototherapy, systemics and complementary or integrative medicine, according to the NPF. The choice of therapy depends on the severity of the disease, says Dr. Green.
Topical treatments are creams applied directly to the affected area, slowing the rapid production of skin cells and reducing inflammation. The most common topical medications are topical steroids, which contain an anti-inflammatory ingredient to heal swelling and redness and usually require a prescription from your doctor. However, topical steroids can’t be used in some areas because they may cause side effects like bruising, pigmentation and redness.
In 2022, the U.S. Food and Drug Administration (FDA) approved a new, nonsteroidal topical cream for adults for the first time in 25 years called tapinarof. “Patients can use this treatment from head to toe without any limitations, which is great for those who have mild to moderate psoriasis,” says Dr. Green.
The FDA has also approved several over-the-counter (OTC) topical treatments for psoriasis, such as lotions, shampoos, tars and bath foams that often contain coal tar and salicylic acid.
Phototherapy is a type of light therapy that a dermatologist may prescribe if topical treatments are ineffective. This therapy involves regularly exposing the skin to ultraviolet (UV) light—, particularly UVB light. UVB rays are found in natural sunlight and slow the growth of skin cells.
There are several types of phototherapy, and it’s most effective when patients receive therapy at least two to five times a week for several weeks, according to the AAD. Phototherapy is not prescribed for patients with skin cancer or in the case of any condition or medication that makes them more sensitive to UV light.
Systemic treatments are prescription drugs taken orally or through an injection or infusion and are usually prescribed when topicals and phototherapy are unsuccessful. These drugs, known as biologics or biosimilars, work throughout the body to target specific molecules inside immune cells and correct the overactive immune response causing psoriasis flares.
Biologics and biosimilars include medicines that come from live organisms, including animal cells and microorganisms like yeast and bacteria. Both treatments are highly regulated by the FDA and deemed by the organization to be safe and effective.
Can You Prevent Psoriasis Flares?
“The best way to prevent psoriasis flares is to follow your dermatologist’s treatment recommendations, moisturize well and avoid trauma to the skin. Lowering stress can also help,” says Dr. Stevenson.
The AAD suggests practicing stress-relieving activities, such as yoga, meditation and attending support groups. Lifestyle changes like reducing alcohol consumption, quitting smoking, avoiding skin exposure to dry, cold weather, treating infections and avoiding cutting yourself while shaving can also help prevent flares. Dietary considerations, such as increasing fruits and vegetables and avoiding foods that are high in fat, sugars, sodium and meat as well as limiting processed foods, may play an important role in minimizing psoriasis symptoms, according to an article in Immunity.
What is the Best Medication for Psoriasis?
The best medication for psoriasis will depend on your unique experience, such as the type and severity of symptoms. As mentioned above, topicals, phototherapy and systemic treatments are used, with a combination of these treatments typically providing the most promising results.
For the best possible outcome, it’s important to regularly visit with your general practitioner or a dermatologist to manage symptoms.
Are Home Remedies Effective for Psoriasis?
In addition to prescription treatments, the AAD notes that OTC products, shampoos, creams, ointments and bath solutions for psoriasis containing the active ingredient coal tar may reduce symptoms of psoriasis and slow the growth of skin cells. Mild corticosteroids or hydrocortisone can also assist in decreasing itch and inflammation. However, either should first be tested on a small area of the skin before using regularly, as skin irritation is possible.
Other OTC solutions, like scale softeners with salicylic acid, can remove and soften scales, as well as reduce swelling. Anti-itch products containing ingredients like calamine or menthol may also assist with treatment.
Dermatologists also recommend using cold compresses and moisturizing the skin every day to help alleviate itching, in addition to taking medication and applying ointments and creams as directed.
When to See a Doctor About Psoriasis
Dr. Green recommends seeing a doctor as soon as signs of psoriasis appear on the skin, even if it’s just one flare.
Seeing a dermatologist as soon as possible is critical, as even people with mild psoriasis (covering less than 3% of their body) may have significant internal inflammation, according to the NPF.
While most types of psoriasis aren’t life-threatening, seek immediate medical care if you notice an increased heart rate, fatigue and skin shedding in sheets, as those are signs of erythrodermic psoriasis and can be fatal.
Frequently Asked Questions (FAQs)
How common is psoriasis?
Psoriasis is common. According to the AAD, about 2% of people in the U.S. have psoriasis, while the National Psoriasis Foundation attributes the condition to over 8 million Americans and between 2% and 3% of people, or 125 million, worldwide.
Is there a permanent cure for psoriasis?
While there may not be a permanent cure just yet, treatment can keep psoriasis at bay, allowing some with the condition to go into “remission” (meaning they have clear skin and no symptoms) for up to months and even years.
Treatment can help keep psoriasis stable, clear and control flare-ups. While psoriasis can be unpredictable and may return, knowing your personal triggers can help you to best avoid it.
Is psoriasis contagious?
No, psoriasis is not contagious. A large part of the possibility of developing psoriasis often comes down to genetics.
How do you know if it's dandruff or scalp psoriasis?
With dandruff, you may find white flakes and experience a tight or dry feeling in the scalp. Psoriasis is typically characterized by red, scaly plaques that are well-defined. In lighter skin, psoriasis can sometimes have a silver-white appearance, while those with darker skin tones may find plaques appear a bit darker in colour, such as purple or grey.
Treatments for dandruff and scalp psoriasis can overlap. If you’re unsure, you can visit your primary care doctor or a dermatologist to determine a diagnosis.
What should you avoid putting on psoriasis?
You should avoid harsh skincare products that may irritate the skin, such as lotions containing alcohol. Products with alcohol can dry out the skin and worsen psoriasis. Opt for mild soaps instead of those that are scented or contain other harsh ingredients.
