What is Psoriasis?

Psoriasis is a relatively common, long-term (chronic) autoimmune condition that causes reddish, scaly plaques, most commonly on the knees, elbows, trunk and scalp. This occurs because the overactive immune system makes the growth rate of the skin cells rapid. Normal skin cells completely grow and shed (fall off) in a month’s duration. In a person with psoriasis, the skin cells proliferate in only three or four days. Instead of shedding off, the skin cells pile up on the surface of the skin which makes the skin build up into bumpy red plaques covered with white scales.

The prevalence of Psoriasis is around 2-3% of people throughout the world. It usually appears in early adulthood and can affect men, women, and children of all skin colours. Usually, it only affects a few areas. However, in severe cases, it can affect large parts of the body.

Inflammation caused by psoriasis can impact other organs and tissues in the body. People may also develop psoriatic arthritis which can lead to swelling, stiffness and pain in the joints and areas surrounding the joints.

The patches can heal and then come back throughout a person’s life. Psoriasis as such has a tendency to go through cycles. There may be a flare lasting from a few weeks to a few months, then subsiding for a while which is known as “remission“. Various modalities of treatments are available to manage the symptoms. And you can implement lifestyle habits and skincare strategies to help you lead a better life.

What are the symptoms?

Psoriasis lesions can vary from dandruff-like scaling to major reddish eruptions that cover large areas. The most commonly affected areas are the elbows, knees, lower back, legs, palms, soles of the feet and scalp.

The signs and symptoms can vary from person to person. Common ones include:

Red, raised plaques of skin covered with thick, white scales.
Dry, cracked skin with or without itching and sometimes bleeding.
Burning sensation.
Soreness.
Thick nails, pitting on the nails.
Swollen and stiff joints.

Not every person will experience all of these symptoms. Some people may have a less common type of psoriasis in which case them may have entirely different symptoms.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time. When you have no active signs of the condition, you may be in “remission.” That doesn’t mean that the condition won’t come back, but for now, you’re symptom-free. Sometimes, symptoms disappear completely with only mild seasonal scaling which goes unnoticed.

What are the different types of Psoriasis?

Plaque psoriasis: This is the most common form which causes dry, raised, red skin lesions covered with whitish scales. The plaques might be few or many and may be itchy. They usually appear on the elbows, knees, lower back and scalp. The American Academy of Dermatology (AAD) estimates that about 80% of people with the condition have plaque psoriasis.
Pustular psoriasis: There is red and scaly skin with tiny pustules, usually on the palms of the hands and soles of the feet but can be generalised in more severe forms.
Guttate psoriasis: This type primarily affects children and it is usually triggered by a bacterial infection such as Streptococcal throat infection. It’s marked by small, drop-shaped, reddish scaly lesions on the trunk, arms or legs.
Inverse psoriasis: It is commonly confused with fungal infections and there are bright red, shiny lesions that appear in skin folds, such as the armpits, groin, and under the breasts.
Erythrodermic psoriasis: In this type, there is redness and scaling over the whole body and it can be life-threatening, so individuals should see a doctor immediately.
Nail psoriasis: Psoriasis can affect the fingernails and toenails, causing pitting, abnormal nail growth and discolouration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
Psoriatic arthritis: There may be swollen, stiff and/or painful joints. Sometimes the joint symptoms are the first or only sign or symptom of psoriasis. Psoriatic arthritis can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent joint damage so it should be treated in the early stages.

What Causes Psoriasis?

Although the exact cause is not know, but scientists have found out that there are a combination of things wrong with the immune system that causes inflammation, triggering new skin cells to form rapidly. Usually, skin cells are replaced every 30 days and the old cells shed off soon after. In psoriasis, new cells grow every 3 to 4 days. The buildup of old cells being replaced by new ones creates those “silvery-white” scales.

Are there any risk factors?

Although anyone can develop psoriasis, every person with this condition has their own triggers. But remember that things which cause your psoriasis to become active may not affect another person. Finding out what causes your skin to flare up, will make you better able to control your symptoms.

Family history. Psoriasis usually 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. However, some people may have no one else in the family with psoriasis and still develop it. Even though it’s less common, it is possible.
Stress. Because stress can impact your immune system, high stress levels can increase your risk of developing the condition. So one should keep calm and try to stay relaxed. Outbreaks are more likely to occur if/when you are anxious.
Smoking. Smoking tobacco not only increases your risk but also may increase the severity of the disease. It may also play a role in the initial development of the disease. Using tobacco or being around passive smoking also raises your risk.
Cold, dry weather. Psoriasis is known to flare up during the winter season. Try to spend some time in warm sunny weather and high humidity.
Some medicines. Blood pressure medications (like beta-blockers), Hydroxychloroquine, antimalarial medications, lithium, a treatment for bipolar disorder are some of the common medicines which can trigger it or cause flare-ups.
Infections. Certain infections including strep throat and tonsillitis can trigger a special kind of psoriasis outbreak known as Guttate Psoriasis (see above). HIV infection can also make it worse.
Skin Injury. In some people, the tiniest cuts, bruises, and burns can cause an outbreak. Even tattoos and bug bites might trigger a new lesion. You can wear gloves or put on an extra layer of clothes to avoid a break in your skin. Severe sunburns are also known to cause flare-ups so use sun protection measures.
Alcohol. Drinking, especially heavy drinking in young men, may trigger or worsen symptoms and interfere with treatments. Combining certain psoriasis medications with alcohol can have dangerous side effects, especially for women in their child-bearing years.
Steroids: Rapid withdrawal of oral or systemic corticosteroids

Is it contagious?

Psoriasis is not contagious. You cannot pass the skin condition from one person to another by touching a psoriatic lesion so don’t worry.

Is there a cure?

Generally, the treatments are used to greatly reduce the symptoms, even in serious cases and improve the quality of life. However, although periods of sustained remission are possible (period of many years without recurrence), the lesions of psoriasis can occur in the future and there is no permanent cure.

What can I do about it?

Although there is no cure, there are more effective treatments today than ever before. Recent studies have suggested that when you better control the inflammation of psoriasis, your risk of heart disease, stroke, metabolic syndrome, depression and other diseases associated with inflammation go down.

See lifestyle modifications and diet recommendations.

Are there any other diseases associated with it?

According to one study, around 7.4 million Americans have psoriasis. It’s commonly associated with several other conditions, including:

When to see a doctor?

If you suspect that you may have the condition, see your skin specialist. Also, consult with a dermatologist if your psoriasis:

Becomes severe or involves large areas.
Causes any discomfort and/or pain.
Makes you conscious or concerned about the appearance of your skin.
Leads to joint pain, swelling or inability to perform daily tasks.
Doesn’t improve with treatment.

Diagnosing The Condition

Physical examination

Most skin specialists are able to make a diagnosis with a simple physical exam. Psoriasis is typically evident and easy to distinguish from other conditions that may cause similar symptoms. During this exam, be sure to show your skin doctor all the areas involved. In addition, let your doctor know if any family members have the condition.

Biopsy

If the symptoms are unclear or if your doctor wants to confirm their suspected diagnosis, they may take a small sample of skin. This is known as a biopsy. The skin is usually sent to a lab, where it is examined under a microscope. The examination can diagnose the type of psoriasis and it can also rule out other possible disorders or infections.

Most biopsies are done in your dermatologist’s clinic on the day of your appointment itself. The doctor will inject a local numbing medication to make the biopsy less painful and then send the biopsy to a lab for analysis. When the results return, your skin specialist may request an appointment to discuss the findings and treatment options with you.