Psoriasis

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Introduction

What is psoriasis?

Psoriasis is a chronic skin disorder marked by raised areas of thickened skin and lesions made up of dead skin cells. Psoriasis results from an abnormal process in which new skin cells are made faster than old skin cells are cast off. Psoriasis is linked to an abnormal response of the immune system that causes inflammation. Psoriasis is not contagious.

Symptoms of psoriasis occur in outbreaks and include itchy, red or pink patches of thickened skin that are covered with whitish scales. Psoriasis most often affects the knees, elbows, lower back, and scalp.

There currently is no cure for psoriasis, but the condition can be controlled to minimize outbreaks with an individualized treatment plan that includes lifestyle changes and medications.

Complications of psoriasis can be serious. Complications include psoriatic arthritis and a secondary bacterial infection or fungal infection of the psoriasis rash. Psoriasis is also associated with atherosclerosis, diabetes, and inflammatory bowel disease. Seek prompt medical care if you have symptoms of psoriasis. Early diagnosis and treatment can help reduce the risk for complications of psoriasis and associated conditions. 

Symptoms

What are the symptoms of psoriasis?

Symptoms of psoriasis can differ in severity, frequency and duration among individuals. Symptoms can occur at any age. If you have psoriasis, your symptoms may be minimal and include infrequent outbreaks, or you may experience more frequent breakouts on larger areas of skin.

Outbreaks of psoriasis include patches of raised areas of itchy, red or pink thickened skin and lesions that are covered with whitish scales. Scratching the area affected by psoriasis generally does not relieve the itching and can lead to increased inflammation, more intense itching, and harder scratching.

Symptoms of psoriasis most often affect the:

  • Elbows

  • Knees

  • Lower back

  • Scalp

  • Soles of the feet

Psoriasis can also affect the:

  • Area round the genitalia

  • Areas under the breasts

  • Armpits

  • Behind the ears

  • Eyebrows

  • Feet

  • Hands

    Psoriasis can also affect the nails and can result in:

    • Nail separation from the skin

    • Pitting of the nails

    • Thickening of the nails

    Symptoms that might indicate a serious condition

    In some cases, scratching of the psoriasis lesions can lead to potentially serious complications, such as a secondary bacterial or fungal infection and cellulitis. Other complications include psoriatic arthritis. Seek prompt medical care if you have any of these symptoms:

    • High fever (higher than 101 degrees Fahrenheit)

    • Joint pain, stiffness, warmth, or swelling

    • Open sores or lesions

    • Redness, swelling and warmth of the skin surrounding the psoriasis rash

    Causes

    What causes psoriasis?

    The exact cause of psoriasis is not known, but it is linked to an abnormal response of the immune system that causes inflammation. There also appears to be a genetic link to the disease. Psoriasis is not contagious, but it may be triggered by certain conditions. Conditions that may trigger psoriasis in some people include:

    • Climate changes

    • Excessive alcohol consumption

    • Infections, such as upper respiratory infections (colds, tonsillitis, sinusitis, or strep throat)

    • Skin disorders

    • Skin injury

    • Smoking

    • Stress or anxiety

    • Sunburn

    • Taking certain medications, such as beta-blockers and lithium

    • Weakened immune system

    What are the risk factors for psoriasis?

    A number of factors increase the risk of developing or triggering an outbreak of psoriasis. Not all people who are at risk for psoriasis will develop the condition. Risk factors include:

    • Alcoholism

    • Climate changes

    • Excessive alcohol consumption

    • Family history of psoriasis

    • Folate and vitamin B12 deficiency

    • Having a weakened immune system due to such conditions as HIV/AIDs or taking steroid medications

    • Infections, such as upper respiratory infections (colds, tonsillitis, sinusitis, or strep throat)

    • Living in a cold, dry climate

    • Skin disorders

    • Skin injury

    • Smoking

    • Stress or anxiety

    • Sunburn

    • Taking certain medications, such as beta-blockers and lithium

      Reducing your risk of psoriasis outbreaks

      If you have psoriasis, you can possibly prevent or at least minimize psoriasis outbreaks by:

      • Avoiding exposing skin to cold, dry conditions

      • Avoiding skin injury

      • Avoiding excessive sun exposure and sunburn and using sunscreen

      • Getting sufficient rest and eating a healthy diet to help prevent colds and other types of upper respiratory infections

      • Not drinking alcohol or limiting alcohol intake to two drinks per day for men or one drink per day for women

      • Not smoking

      • Notifying your health care provider if you experience symptoms of psoriasis after taking a medication

      • Taking steps to reduce stress

      Treatments

      How is psoriasis treated?

      Psoriasis is a chronic condition that is not curable. However, with a well-integrated, medically monitored plan of care, symptoms can be effectively controlled, and people with psoriasis can lead active, comfortable lives. A good treatment plan is individualized to your medical history, the severity of psoriasis, your specific triggers, and other factors.

      A combination of treatments that include lifestyle changes, medications and other treatments as appropriate is the most effective way to best control psoriasis and prevent or minimize the severity of flare-ups.

      Lifestyle changes and general treatments for psoriasis

      Lifestyle changes and considerations for treating psoriasis include:

      • Avoiding exposing skin to cold, dry conditions
      • Avoiding skin injury
      • Avoiding alcohol
      • Avoiding excessive sun exposure and sunburn and using sunscreen
      • Getting sufficient rest and eating a healthy diet to help prevent colds and other types of upper respiratory infections
      • Not smoking
      • Phototherapy, a type of light therapy
      • Taking steps to reduce stress

      Medications used to treat psoriasis

      Medications that may be prescribed for psoriasis include:

      • Antibiotics or antifungal drugs that treat secondary bacterial or fungal infections
      • Antihistamines, which reduce itching
      • Corticosteroid medications, which reduce inflammation
      • Calcineurin inhibitors
      • Vitamin D cream
      • Biologic agents that interrupt key pathways in the development and progression of psoriasis
      • Topical retinoids

      These medications can all have side effects, so they should only be taken under the direction of a licensed health care clinician.

      What are the possible complications of psoriasis?

      When left untreated, psoriasis can develop into an escalating cycle of itching, scratching, and inflammation. In some cases, the excessive scratching can introduce bacteria or fungus into the layers of the skin, resulting in infections that can be serious in some people. Complications include:

      • Adverse effects of psoriasis treatment
      • Bacterial or fungal infection of the skin
      • Cellulitis (an infection of the skin and surrounding tissues caused by a growing bacterial or fungal infection)
      • Open sores and lesions
      • Psoriatic arthritis (a condition that is similar to rheumatoid arthritis and that causes painful, stiff joints)

      In addition, recent studies have found that psoriasis is associated with serious conditions, such as:

      • Atherosclerosis
      • Diseases of the coronary arteries and other arteries
      • Diabetes
      • Inflammatory bowel disease
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      Medical Reviewer: William C. Lloyd III, MD, FACS
      Last Review Date: 2018 Nov 18
      1. About Psoriasis. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis
      2. About psoriasis. The Psoriasis Association. https://www.psoriasis-association.org.uk/psoriasis-and-treatments/default.aspx
      3. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013
      4. Ferri FF (Ed.) Ferri’s Fast Facts in Dermatology. Philadelphia: Saunders Elsevier, 2011
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