It May Be Risky to Ignore Signs of Psoriasis, Psoriasis is a skin disease that causes red, itchy scaly patches, most commonly on the knees, elbows, trunk and scalp.
Psoriasis is a common, long-term (chronic) disease with no cure. It tends to go through cycles, flaring for a few weeks or months, then subsiding for a while or going into remission. Treatments are available to help you manage symptoms. And you can incorporate lifestyle habits and coping strategies to help you live better with psoriasis.
What Is Psoriasis?
Psoriasis is a genetically programmed inflammatory disease that primarily affects the skin in about 3% of people in the United States. Psoriasis is characterized by skin cells that multiply up to 10 times faster than normal. When these cells reach the surface and die, raised, red plaques form that are covered with white scales. Psoriasis begins as a small scaling papule. When multiple papules coalesce, they form scaling plaques. These plaques tend to occur in the scalp, elbows, and knees.
Although psoriatic plaques can be limited to only a few small areas, the condition can involve widespread areas of skin anywhere on the body. Psoriasis symptoms vary depending on the type of psoriasis you have. Common psoriasis symptoms can include the following:
- Red patches of skin covered with silvery scales
- Small scaling spots
- Dry, cracked skin
- Itching, burning, or soreness
- Itchy plaques
- Small bleeding points when the scale is peeled away
Types of Psoriasis
Plaque psoriasis is the most common type of psoriasis and it gets its name from the plaques that build up on the skin. There tend to be well-defined patches of red raised skin that can appear on any area of the skin, but the knees, elbows, scalp, trunk, and nails are the most common locations. There is also a flaky, white buildup on top of the plaques called scales. Possible plaque psoriasis symptoms include skin pain, itching, and cracking.
There are plenty of over-the-counter products that are effective in the treatment of plaque psoriasis. 1% hydrocortisone cream is a topical steroid that can suppress mild disease and preparations containing tar are effective in treating plaque psoriasis.
Scalp psoriasis is a common skin disorder that makes raised, reddish, often scaly patches. Scalp psoriasis can affect your whole scalp, or just pop up as one patch. This type of psoriasis can even spread to the forehead, the back of the neck, or behind the ears. Scalp psoriasis symptoms may include only slight, fine scaling. Moderate to severe scalp psoriasis symptoms may include dandruff-like flaking, dry scalp, and hair loss. Scalp psoriasis does not directly cause hair loss, but stress and excess scratching or picking of the scalp may result in hair loss.
Scalp psoriasis can be treated with medicated shampoos, creams, gels, oils, ointments, and soaps. Salicylic acid and coal tar are two medications in over-the-counter products that help treat scalp psoriasis. Steroid injections and phototherapy may help treat mild scalp psoriasis. Biologics are the latest class of medications that can also help treat severe scalp psoriasis.
Guttate psoriasis looks like small, pink dots or drops on the skin. The word guttate is from the Latin word “gutta,” meaning drop. There tend to be fine scales with guttate psoriasis that are finer than the scales in plaque psoriasis. Guttate psoriasis is typically triggered by streptococcal infection (strep throat) and the outbreak will usually occur two to three weeks after having strep throat.
Guttate psoriasis tends to go away after a few weeks without treatment. Moisturizers can be used to soften the skin. If there is a history of psoriasis, a doctor may take a throat culture to determine if strep throat is present. If the throat culture shows that Streptococcus is present, a doctor may prescribe antibiotics.
Many patients with psoriasis have abnormal nails. Psoriatic nails often have a horizontal white or yellow margin at the tip of the nail called distal onycholysis because the nail is lifted away from the skin. There can often be small pits in the nail plate, and the nail is often yellow and crumbly.
The same treatment for skin psoriasis is beneficial for nail psoriasis. However, since nails grow slowly, it may take a while for improvements to be seen. Nail psoriasis can be treated with phototherapy, systemic therapy (medications that spread throughout the body), and steroids (cream or injection). If medications do not improve the condition of nail psoriasis, a doctor may surgically remove the nail.
Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a disease that causes red patches of skin topped with silvery scales. Most people develop psoriasis years before being diagnosed with psoriatic arthritis. But for some, the joint problems begin before skin patches appear or at the same time.
Joint pain, stiffness and swelling are the main signs and symptoms of psoriatic arthritis. They can affect any part of the body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares can alternate with periods of remission.
What is Psoriatic Arthritis?
Psoriatic arthritis is a chronic disease characterized by a form of inflammation of the skin and joints. About 15%-25% of patients with psoriasis also develop an inflammation of their joints. Psoriatic arthritis is a systemic rheumatic disease that can not only cause inflammation of the skin, but in the eyes, heart, kidneys, and lungs as well. Currently, the cause of psoriatic arthritis is unknown, but a combination of genetic, immune, and environmental factors is likely involved.
Psoriatic Arthritis Symptoms
Typically, a patient will have psoriasis months or years before they develop psoriatic arthritis. Psoriatic arthritis usually involves the knees, ankles, and joints in the feet. There may also be a loss of range of motion of the involved joints as well as joint stiffness. Psoriatic arthritis can also cause inflammation of the spine and the sacrum, which causes pain and stiffness in the low back, buttocks, neck, and upper back.
Psoriatic Arthritis Treatment
Treatment for psoriatic arthritis generally involves anti-inflammatory medications and exercise. It is important to stretch or take a hot shower before exercise in order to relax the muscles. Ice application after exercise can help minimize soreness and inflammation. Nonsteroidal anti-inflammatory drugs may also reduce joint inflammation, pain, and stiffness.
What Causes Psoriasis?
It is now clear that there is a genetic basis for psoriasis. This hereditary predisposition is necessary before the disease can be triggered by environmental factors. White blood cells called T-cells mediate the development of the psoriatic plaques that are present in the skin. When someone has psoriasis, their body is unable to offer protection from invaders. Instead, inflammation is promoted, and skin cells are on overdrive. When cell growth is increased, old skin cells pile up instead of flaking off, causing psoriasis to occur. Currently, most experts conclude that environmental, genetic and immunologic factors interact to cause this disease.
Living with Psoriasis
Learn to Cope
The physical effects of psoriasis are frustrating, but the emotional effects can be much worse. Psoriasis may cause your relationships to change and people may treat you differently. Unfortunately, this may lead to stress, which then leads to worsening psoriasis. A doctor may prescribe antidepressant medications if psoriasis is diminishing your quality of life. Support groups can also help you cope with psoriasis by talking to other people who are suffering from the same disease.
Tips to Prevent Psoriasis Flare-Ups
- Use moisturizing lotions
- Take care of your skin and scalp: never pick at patched or scales
- Avoid dry, cold weather
- Use a humidifier
- Avoid medications that cause flare-ups (lithium, propranolol, and quinidine)
- Avoid scrapes, cuts, bumps, and infections
- Get some sun, but not too much: use sunscreen and soak up the sun in 20-minute increments
- Reduce stress: join a yoga class or get a massage
- Reduce alcohol consumption
- Exercise and maintain a healthy weight
Psoriasis During Fall and Winter
Fall and winter may bring shorter days, colder temperatures, and dry air. These can all lead to worsening psoriasis symptoms. The sun’s ultraviolet light hinders the rapid growth of skin cells that is characteristic of psoriasis. Therefore, spending less time in the sun may cause psoriasis symptoms to flare. The dry weather may remove moisture in your skin so it is important to use moisturizer and/or a humidifier at home.
Alternative Medicine for Psoriasis Symptoms
There are many different remedies that may ease psoriasis symptoms. The following is a partial list of alternative medicine to help treat psoriasis:
- Aloe Vera gel
- Apple cider vinegar to relieve itch from scalp psoriasis
- Turmeric concentrated in pill or supplement form
- Acupuncture for stress reduction
- Reiki for stress reduction
Always consult your doctor before trying new medications, including alternative or naturopathic medicines.
Managing Psoriasis Stigma
There is plenty of evidence that extensive psoriasis can have a significant, negative effect on a patient’s self-image and emotions. This is especially true in social situations, although all aspects of life can be disturbed. Inverse psoriasis (which affects the genital skin) and scalp psoriasis can be particularly troubling. Psoriasis affecting the hands may make it difficult to interact normally with others. It is important to remember that there are ways to manage and treat psoriasis flares. It may seem as if one’s quality of life has diminished, but there are many organizations that offer support to psoriasis patients. The National Psoriasis Foundation is an excellent source of accurate information as well as emotional support for afflicted patients.
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