Psoriasis is a common, chronic, inflammatory disease of the immune system that develops when the body makes skin cells too quickly, causing skin cells to pile up and form silvery, visible patches or rash on the skin. It is a long term, relapsing skin condition. Psoriasis affects nearly 7.5 million people in the United States. It is most commonly found on the knees, elbows, trunk and scalp. It can be painful, interfere with sleep and make it hard to concentrate. The condition tends to go through cycles, flaring for a few weeks or months, then subsiding for a while.
Symptoms
Common signs and symptoms of psoriasis include:
A patchy rash that varies widely in how it looks from person to person, ranging from spots of dandruff-like scaling to major eruptions over much of the body
Rashes that vary in color, tending to be shades of purple with gray scale on brown or Black skin and pink or red with silver scale on white skin
Small scaling spots (commonly seen in children)
Dry, cracked skin that may bleed
Itching, burning or soreness
Cyclic rashes that flare for a few weeks or months and then subside
Types of psoriasis
There are several types of psoriasis, each of which varies in its signs and symptoms:
Plaque psoriasis. The most common type of psoriasis, plaque psoriasis causes dry, itchy, raised skin patches (plaques) covered with scales. There may be few or many. They usually appear on the elbows, knees, lower back and scalp. The patches vary in color, depending on skin color. The affected skin might heal with temporary changes in color (post inflammatory hyperpigmentation), particularly on brown or Black skin.
Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe disease may cause the nail to crumble.
Guttate psoriasis. Guttate psoriasis primarily affects young adults and children. It's usually triggered by a bacterial infection such as strep throat. It's marked by small, drop-shaped, scaling spots on the trunk, arms or legs.
Inverse psoriasis. Inverse psoriasis mainly affects the skin folds of the groin, buttocks and breasts. It causes smooth patches of inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.
Pustular psoriasis. Pustular psoriasis, a rare type, causes clearly defined pus-filled blisters. It can occur in widespread patches or on small areas of the palms or soles.
Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover the entire body with a peeling rash that can itch or burn intensely. It can be short-lived (acute)
Psoriasis triggers
Many people who are predisposed to psoriasis may be free of symptoms for years until the disease is triggered by some environmental factor. Common psoriasis triggers include:
Infections, such as strep throat or skin infections
Weather, especially cold, dry conditions
Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn
Smoking and exposure to secondhand smoke
Heavy alcohol consumption
Certain medications — including lithium, high blood pressure drugs and antimalarial drugs
Rapid withdrawal of oral or injected corticosteroids
Risk factors
Anyone can develop psoriasis. About a third of instances begin in childhood. These factors can increase the risk of developing the disease:
Family history. The condition runs in families. Having one parent with psoriasis increases your risk of getting the disease. And having two parents with psoriasis increases your risk even more.
Smoking. Smoking tobacco not only increases the risk of psoriasis but also may increase the severity of the disease.
Complications
If you have psoriasis, you're at greater risk of developing other conditions, including:
Psoriatic arthritis, which causes pain, stiffness, and swelling in and around the joints
Temporary skin color changes (post-inflammatory hypopigmentation or hyperpigmentation) where plaques have healed
Eye conditions, such as conjunctivitis, blepharitis and uveitis
Obesity
Type 2 diabetes
High blood pressure
Cardiovascular disease
Other autoimmune diseases, such as celiac disease, sclerosis and the inflammatory bowel disease called Crohn's disease
Mental health conditions, such as low self-esteem and depression
When to see a doctor
If you suspect that you may have psoriasis, see your dermatologist. Also seek medical care if your condition:
Becomes severe or widespread
Causes you discomfort and pain
Causes you concern about the appearance of your skin
Doesn't improve with treatment
Treatment options:
Psoriasis treatment has advanced significantly over the past decade, allowing many patients to achieve clearer skin and long-term disease control than ever before. Treatment is individualized based on the severity of the disease, the areas of the body affected, your age, overall health, and whether you have associated psoriatic arthritis.
Topical Medications: Prescription creams, ointments, foams, lotions, and shampoos are often effective for mild to moderate psoriasis and may also be used in combination with other therapies for more extensive disease.
Phototherapy: Controlled ultraviolet (UV) light therapy is a safe and effective treatment option for many patients with moderate psoriasis and may be used alone or in combination with topical or systemic medications.
Systemic Medications: For moderate to severe psoriasis, oral or injectable medications that work throughout the body can effectively reduce inflammation and improve skin symptoms.
Advanced Biologic Therapies: Biologic medications have transformed the treatment of moderate to severe psoriasis. These targeted therapies work by blocking specific immune pathways that drive psoriasis rather than suppressing the entire immune system. Today's biologics offer excellent safety profiles, convenient dosing schedules, and can provide long-lasting skin clearance for many patients.
Several highly effective biologic medications are now available, allowing treatment to be tailored to each patient's needs. One of the newest advances is Tremfya® (guselkumab), which is FDA-approved for adults and for children 6 years of age and older with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. This expanded pediatric approval provides an important treatment option for younger patients with more extensive disease. Many biologic therapies also improve or prevent the progression of psoriatic arthritis, helping protect joint health while treating the skin.
At Bruce Robinson, MD, we remain current with the latest advances in psoriasis treatment and work with each patient to develop an individualized treatment plan that offers the best opportunity for healthy skin and an improved quality of life.
