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Advances in Psoriasis Treatment

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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. Instead of normal skin cell turnover taking weeks, new skin cells grow in days.

Psoriasis is linked to an abnormal response of the immune system that causes inflammation. Psoriasis symptoms are not due to infection, and 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. In its most common form, plaque psoriasis, skin lesions mainly form on the elbows, knees, scalp, low back and belly, the cleft between the buttocks and thigh, and the genitalia. Psoriasis can also affect the nails.

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. An autoimmune form of arthritis—psoriatic arthritis—develops in about 30% of psoriasis patients.

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.

What are the different types of psoriasis?

Psoriasis is characterized by how it looks and its severity. The five types of psoriasis include:

  • Erythrodermic psoriasis appears as very inflamed red skin over most of the body. Approximately 3% of people with psoriasis develop an erythrodermic psoriasis flare-up one or more times. It is a dangerous condition that requires immediate medical supervision.
  • Guttate psoriasis, the second-most common type of psoriasis appears as small but raised, dot-like red lesions.
  • Inverse psoriasis appears as large red areas in body folds, including underarms, behind the knee, and groin. Typically, the lesions are not raised or scaly because the environment is moist and sweaty. It can occur with other types of psoriasis.
  • Plaque psoriasis, or psoriasis vulgaris, is the most common type of psoriasis. It appears as raised red patches with silver-white layers of dead skin cells on top.
  • Pustular psoriasis appears as blister-like lesions filled with white blood cells. The surrounding skin is red.

What are the symptoms of psoriasis?

Symptoms of psoriasis can differ in severity, frequency and duration among individuals and by type. 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 resulting 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 the psoriasis lesions can lead to potentially serious complications, such as a secondary bacterial or fungal infection and cellulitis. Other complications of psoriasis 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

What does psoriasis look like?

These photos show how different types of psoriasis appear around the body.

Plaque psoriasis, the most common type of psoriasis, causes thick red patches with silvery scales.

The next most common type of psoriasis, guttate psoriasis, appears as small, dot-like lesions that are red and raised.

guttate psoriasis on man's hand and wrist

Erythrodermic psoriasis is marked by very inflamed red skin over a large area of the body.

erythrodermic psoriasis on palm of hand
Diomedia / ISM

Image Credit: Diomedia / ISM

Inverse psoriasis can occur with other types and most often appears in skin folds, such as in the underarms, behind the knee, or around the groin.

photo of inverse psoriasis
Diomedia / ISM

Image Credit: Diomedia / ISM

Pustular psoriasis causes blister-like lesions filled with pus, surrounded by red skin.

pustular psoriasis on sole of man's foot
Diomedia / Hercules Robinson

Image Credit: DIOMEDIA / Hercules Robinson

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. Scientists who study psoriasis have learned that certain variations, or alleles, of immune system genes prime the abnormal immune reaction and skin cell overproduction seen in psoriasis patients. Research has identified at least 60 different genes involved in psoriasis.

Psoriasis is not contagious, but certain conditions may trigger it. 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?

In the United States, about 7 million people (adults and children) have psoriasis, which is just over 2% of the population.

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
  • Metabolic syndrome
  • Obesity
  • 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
  • Maintaining a healthy weight
  • 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 healthcare provider if you experience symptoms of psoriasis after taking a medication
  • Taking steps to reduce stress

Psoriasis is a multifactorial disease, meaning both genetic and environmental factors can contribute to its cause. This makes it difficult to know who will or won’t develop it. However, experts who study psoriasis report these facts:

  • Individuals with an affected biological parent have a 10% chance of developing psoriasis. The risk jumps to 50% if both parents have the condition.
  • Most people are between 15 to 35 years of age at the time of diagnosis. Another common age range for diagnosis is 50 to 60 years.
  • About 10 to 15% of individuals with psoriasis are younger than 10 years of age when diagnosed; psoriasis rarely affects infants.
  • Psoriasis is more prevalent in non-Hispanic white Americans, as compared to other races and ethnic groups.

What are some conditions related to psoriasis?

Psoriasis is an inflammatory disease caused by an abnormal immune response. Other autoimmune or inflammatory conditions related to psoriasis include:

  • Psoriatic arthritis—a type of inflammatory arthritis that develops in about 30% of psoriasis patients. It can also develop before skin symptoms appear.
  • Rheumatoid arthritis—an autoimmune disorder that causes painful joint inflammation.
  • Scleroderma—an autoimmune disorder that causes inflammation in the skin and other connective tissues.

How do doctors diagnose psoriasis?

In most cases, a dermatologist diagnoses psoriasis with a physical exam of the skin. However, a skin biopsy may be necessary to rule out or confirm other diagnoses. These include atopic dermatitis (eczema), skin reactions, and allergies.

There is no blood test for psoriasis, but doctors may order a complete blood count prior to beginning treatment. The doctor will also look for signs of joint involvement.

What are the treatments for psoriasis?

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.

Home remedies for psoriasis symptoms

Along with your treatment plan, there are at-home remedies you can try to reduce, relieve or prevent symptom flares, including:

  • Aloe vera creams containing 0.5% aloe, to reduce redness and scaling
  • Apple cider vinegar, which can help relieve scalp itch
  • Capsaicin ointment, which may help reduce pain, inflammation and redness
  • Epsom or Dead Sea salts added to your bath, to help remove scales and relieve itching
  • Moderate exposure to natural sunlight, which can improve the appearance of skin affected by psoriasis
  • Oat bath or oat paste, reported to help reduce itching
  • Omega-3 fatty acids, which have anti-inflammatory benefits that could ease psoriasis symptoms
  • Oregon grape (Mahonia aquifolium) cream, an herbal remedy that can relieve mild to moderate psoriasis
  • Tea tree oil, which may help relieve symptoms of scalp psoriasis
  • Turmeric, an antioxidant that can reduce inflammation and minimize psoriasis flares

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

Categories of drugs for psoriasis include:

  • Biologic drugs, also known as biologic response modifiers or immunomodulators. These drugs target the abnormal immune response in psoriasis patients. They also work for other autoimmune conditions.
  • Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate and cyclosporine.
  • Phototherapy, including ultraviolet B (UVB) and UVA light treatments, in moderate to severe cases. Doctors may combine light therapy with topical and systemic drugs—those that work throughout the body.
  • Topical drugs, in mild cases—where the disease affects less than 5% of body surface area and does not involve the hands, feet or genitalia.

Other 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
  • Vitamin D cream

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

Many treatments are available to quiet psoriasis symptoms and drive the disease into remission. There is no cure for psoriasis, but consistent and continuous psoriasis treatment calms the immune system, improves skin symptoms, and helps patients enjoy more normal lives.

What are the potential 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.

Psoriasis 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 type of inflammatory arthritis that develops in about 30% of psoriasis patients. It can also develop before skin symptoms appear.)

How does psoriasis affect quality of life?

Lifelong diseases, especially those that are visible to others, can be overwhelming physically, emotionally and financially.

In one large U.S. study, 38% of patients reported an impact on physical functioning. The physical burden of psoriasis itself is aggravated by these other serious conditions:

  • Another autoimmune disease—people who have psoriasis are nearly twice as likely as the general population to have another autoimmune disease, such as rheumatoid arthritis, lupus, Sjogren’s syndrome, celiac disease, or inflammatory bowel disease.
  • Cardiovascular problems—the rate of heart attack in psoriasis patients may be up to twice that of the general population.
  • Obesity—the rate of obesity is higher in people who have psoriasis and it is also a risk factor for psoriasis. Metabolic syndrome is also more common in people with psoriasis.
  • Psoriatic arthritis—patients with both psoriasis and arthritis report a greater impact on quality of life than those with either condition alone.
  • Sleep disorder—more than 50% of psoriasis patients complain of sleep disturbances.

In the same U.S. study, 98% of psoriasis patients reported an emotional impact, and 94%, an impact on relationships and activities. The social-emotional burdens of psoriasis include:

  • Anxiety and stress—not only do people with psoriasis have greater rates of anxiety and stress, but the physiological effect of these conditions can make psoriasis worse.
  • Depression—this mood disorder is 1.5 times more prevalent in people with psoriasis, as compared to the general population. Suicidality is also a major concern.
  • Sexual difficulty—an effect on intimate relationships was reported by 17% of respondents in the study.

As for the financial burden, a typical psoriasis patient pays approximately $2,528 in out-of-pocket medication costs annually. The cost of treatment and potential for side effects can also interfere with some psoriasis patients seeking medical care.

Does psoriasis shorten life expectancy?

As the skin is supposed to act as a natural barrier and protectant, the compromising effects of psoriasis can be life threatening. In particular, complications of pustular and erythrodermic psoriasis, such as dehydration and infection, can be fatal.

Larger research studies are necessary to determine the specific causes of death in psoriasis patients; however, mortality is linked to both disease severity and cardiovascular disease.

Doctors recommend regular checkups for psoriasis patients, especially those with more severe cases, to screen for heart disease and other comorbid conditions. Experts also recommend leading a heart-healthy lifestyle to help reduce the risk of heart disease and improve life expectancy.

Additional psoriasis facts

August is National Psoriasis Month. Learn more about psoriasis and related conditions at the National Psoriasis Foundation.

The social stigma of psoriasis will likely ease with increased awareness, such as highlighting celebrities with psoriasis. But improving the lives of people with psoriasis is most important.

In 2016, the National Psoriasis Foundation medical board established a goal of limiting plaque psoriasis lesions to 1% or less of body surface area within three months of starting treatment. Indeed, patients and doctors working together on a common “treat to target” goal will help improve quality of life for the millions of Americans with psoriasis.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Feb 8
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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