There are several different forms of psoriasis. The most common form is psoriasis vulgaris which appears as an elevated, red plaque that is covered by a silvery dry scale. The scale is composed of thin, layers of dead abnormal skin cells.
The initial lesions are usually red and dot-like in appearance and may be as small as 2 millimetres in diameter. These initial eruptions gradually enlarge and produce a silvery white surface scale. Surface scales come off easily and are shed constantly, but those below the surface are quite adherent. When forcibly removed, they may leave tiny bleeding points known as the Auspitz’s sign. As the initial dot-like lesions grow, they form plaques which may cover areas of many inches respectively. These plaques may also unite, merging into each other. These plaques may take on one of several different shapes and appearances.
Often, the lesions are symmetrical. In other words, the lesions appear in the same place on the right and left halves of the body.
Lesions vary in size and in configuration from patient to patient. This difference in the pattern of development is assumed to indicate some basic feature of the disease process not yet understood.
Principally by characteristics of the red, scaly plaque and Auspitz sign. There are no blood tests diagnostic for psoriasis; the diagnosis is made by the physician’s observation of the skin lesions and occasionally microscopic study of the skin biopsy specimen removed from the plaques.
Small pits on the fingernails sometimes aid in a diagnosis of psoriasis. It is unusual to have nail psoriasis without psoriasis elsewhere on the skin.
Yes. Psoriasis often causes the skin to itch, sometimes intensely. It has been estimated that about 50% of those with psoriasis experience itching. The origin of the word psoriasis was from the term derived from the Greek word “psora” meaning itch.
Various anti histamines and baths are often recommended to reduce the itching. Though the only guaranteed way to eliminate itching is to eliminate its cause – the psoriasis itself – there are things that can be tried which can relieve itching.
Why does my Psoriasis itch and how can I control it?
Itching that is associated with psoriasis arises when certain chemicals stimulate nerve fibres just below the outer layer of the skin. Itch messages travel to the brain along the same pathways in the nervous system that carry pain messages. Itch messages trigger the urge to scratch.
One of the simplest ways for people with psoriasis to control itch is by keeping the skin moisturized. Dry skin can induce and aggravate itch. Many people also rely on simple, inexpensive measures, such as pressing a wet towel against the itchy spot. Others find cold showers and cold packs offer relief. Other treatments for itch include antihistamines, steroids, capsaicin, topical anaesthetics, topical immunomodulators, antidepressants and aspirin.
To date, no specific dietary regimen has been identified through scientific investigation that will clear or improve psoriasis. However, there have been foods that are speculated, on the basis of very preliminary analysis, to have some affect on psoriasis. Red meat is suspected of possibly containing a chemical that can potentially worsen psoriasis. On the other side, it has been speculated by investigators that a diet rich in vegetable seed oils and fish oil might help improve psoriasis skin.
When the psoriasis plaques begin to clear, the scaling decreases. The psoriasis plaque then begins to flatten. Once the psoriasis clears, often there are white spots left on the skin which will gradually disappear. They should not be picked as this could leave small scars.
There is no evidence that allergies can directly cause psoriasis to flare or worsen. On the other hand, if one has an allergy to, for example, poison ivy or some other material, psoriasis lesions may appear in the areas which were affected by the allergy. In general, psoriasis patients tend to get lesions in areas of skin injury. Therefore, if the skin is injured because of an allergy to fragrance or to a plant, this injured skin may become subject to psoriasis lesions.
Psoriasis sometimes goes into remission during pregnancy; others experience a flare during pregnancy. In one study, it was found that 32 percent reported improvement during pregnancy; 18 percent said their psoriasis worsened; and 50 percent were not certain. Also, each patient did not seem to behave in the same way during all pregnancies.
Also, one should discuss with the physician the safety of anti-psoriasis therapies while nursing. There has been stated concern in medical journals that steroids can be excreted in milk and can adversely affect the nursing infant. Therefore, the use of topical steroids in this circumstance must be carefully supervised and discussed beforehand between physician and patient. Your dermatologist or physician can give you specific information relevant to this aspect.
The nipple is one tissue of the body where absorption of topical steroids is much greater. As a result, local side effects from topical steroids can occur more often, such as thinning of the skin and the appearance of numerous blood vessels
No. Psoriasis is not contagious. It is not something you can “catch” or “pass on”. The psoriatic lesions may not look good, but they are not infections or open wounds. People with psoriasis pose no threat to the health or safety of others.
The lesions are generally affected by the seasons. Generally, the psoriasis worsens during the winter months and improves in summer, presumably as a result of exposure to sunlight. Sunlight obtained in regular doses can clear psoriasis. Exposure can be difficult, refractory cases, a slow and gradual tan is often recommended. Multiple, short exposure, avoiding sunburn, is usually the recommended method.
Note of caution:Prolonged exposure to sunlight in sensitive individuals can lead to skin cancer. Premature skin ageing can also result. Thus, if a person plans to spend long hours in the sun, it is recommended that a sun screen be used on the unaffected areas. Also, avoid burning as that can cause the psoriasis to worsen.
Psoriasis will often appear following physical and/or emotional trauma. For example, a skin injury will often lead to a worsening of psoriasis. This is known as the Koebner phenomenon. Some examples of skin injuries would be surgery, cuts, rubbing, chemical burns, etc. Drug reactions and infections can also lead to an appearance of psoriasis or worsening of the disorder.
Several reports have been published indicating the Inderal (also called Propranolol) as well as other propranolol analogs (collectively known as beta blockers) will induce psoriasis in about 25 percent of those patients taking these drugs. The psoriasis improves once the administration of the drug is stopped. Sometimes, however, the psoriasis can be cleared even if the beta blocker is aggravating the psoriasis. Generally, however, if one is experiencing a flare from a beta blocker, a substitute class of medication, if possible, should be used.
Lithium, a drug used to treat manic depression, can also worsen psoriasis. About 50 percent of lithium-treated patients experience psoriasis flares. It is difficult to completely clear a lithium patient who is experiencing a psoriasis aggravation as a result of the medication.
There is no evidence that stress is a direct cause of psoriasis, but studies have shown that psoriasis can be aggravated by emotional stress. It has been observed that a change in environment will sometimes by followed by a spontaneous clearance of psoriasis.
It is thought that the stress can contribute to the development of psoriasis. One investigation has found that in approximately one-third of 200 psoriatic patients, a high correlation existed between psychological stress during a year and the severity of psoriasis during that year. Thus, as suggested by the authors of this study, psoriatic patients may be divided into “stress reactors” and “non-stress reactors” and other differences in the disease might be found in the two groups, just as guttate seems to be more closely related to immunological factors than other types of psoriasis.
For the most part people with psoriasis can function normally. Sometimes people experience low self-esteem because psoriasis is unsightly. Psoriasis is often misunderstood by the public, which can make social interactions awkward. This may lead to emotional problems such as anxiety, anger, embarrassment and depression. Psoriasis can affect the type of work people do if it is visible.
Doctors are learning more about psoriasis by studying:
Significant progress has been made in understanding the inheritance of psoriasis. A number of genes involved in psoriasis are already known or suspected. In a multifactor disease (involving genes, environment, and other factors), variations in one or more genes may produce a greater likelihood of getting the disease. Researchers are continuing to study the genetic aspects of psoriasis. Since discovering that inflammation in psoriasis is triggered by T cells, researchers have been studying new treatments that quiet immune system reactions in the skin. Among these are treatments that block the activity of T cells or block cytokines (proteins that promote inflammation). Several of these drugs are awaiting approval by the U.S. Food and Drug Administration (FDA).
Advances in laser technology are making it possible for doctors to experiment with laser light treatment of localized plaques. A UVB laser was recently tested in a study that was conducted at several medical centres. Although improvements in the skin were noted, this treatment is not without possible side effects. In some patients, the skin became inflamed, blistered, or discoloured following treatment.
All types of psoriasis, ranging from mild to severe, can affect a person’s quality of life. Living with this lifelong condition can be physically and emotionally challenging.
Itching, soreness, and cracked and bleeding skin are common. Nail psoriasis can be painful. Even the simple act of squeezing a tube of toothpaste can hurt. One woman described her psoriasis as feeling like “a bad sunburn that won’t go away.”
Several studies have shown that people often feel frustrated. In some cases, psoriasis limits activities and makes it difficult to perform job responsibilities. The National Psoriasis Foundation reports that 56 million work hours are lost each year by those who have psoriasis. Additionally, a survey conducted by the National Psoriasis Foundation in 2002 indicates that 26% of people living with moderate to severe psoriasis have been forced to change or discontinue their normal daily activities.
Studies also have shown that stress, anxiety, loneliness, and low self-esteem are part of daily life for people living with psoriasis. One study found that thoughts of suicide are three times higher for psoriatics than the general population.
Embarrassment is another common feeling. Imagine getting your hair cut and noticing that the stylist or barber is visibly uncomfortable. What if you extended your hand to someone and the person recoiled? How would you feel if you spent most of your life trying to hide your skin?
There is no cure, but many different treatments, both topical (on the skin) and systemic (throughout the body), can clear psoriasis for periods of time. People often need to try out different treatments before they find one that works for them.
The tendency to develop psoriasis is inherited through a person’s genes. We hope to be able to safely modify these genes in the future, but the technology is not yet developed. We do foresee a time, when we will have more specific and more effective therapies for the various forms of psoriasis. Also, while psoriasis cannot be cured, it can often be completely cleared for periods of months or even years. Occasionally, it never returns at all. In most patients, however, it is a chronic, life-long condition with alternating periods of flaring and clearing.
Is there hope for a cure for Psoriasis?
Yes. Researchers are studying psoriasis more than ever before. They understand much more about its genetic causes and how it involves the immune system. The National Psoriasis Foundation and the USA federal government are promoting and funding research to find the cause and cure for psoriasis.
Psoriasis most commonly appears on the scalp, knees, elbows and torso. But psoriasis can develop anywhere, including the nails, palms, soles, genitals and face (which is rare). Often the lesions appear symmetrically, which means in the same place on the right and left sides of the body.
Psoriasis often appears between the ages of 15 and 35, but it can develop at any age. Approximately 10 percent to 15 percent of those with psoriasis get it before age 10. Some infants have psoriasis, although this is considered rare.
Psoriasis occurs nearly equally in men and women across all socioeconomic groups. It is also present in all racial groups, but in varying rates.
The skin, the largest organ in the body, plays an important role. It controls body temperature and serves as a barrier to infection. Large areas of psoriasis can lead to infection, fluid loss and poor blood flow (circulation).
Psoriatic arthritis is a specific type of arthritis that has been diagnosed in approximately 23 percent of people who have psoriasis, according to the Psoriasis Foundation’s 2001 Benchmark Survey. Psoriatic arthritis is similar to rheumatoid arthritis but generally milder. In psoriatic arthritis, the joints and the soft tissue around them become inflamed and stiff. Psoriatic arthritis can affect the fingers and toes and may involve the, neck, lower back, knees and ankles. In severe cases, psoriatic arthritis can be disabling and cause irreversible damage to joints.
Psoriasis can be mild, moderate or severe. Three percent to 10 percent of the body affected by psoriasis is considered to be a moderate case. More than 10 percent is considered severe. The palm of the hand equals 1 percent of the skin. However, the severity of psoriasis is also measured by how psoriasis affects a person’s quality of life. Psoriasis can have a serious impact even if it involves a small area, such as the palms of the hands or soles of the feet.
Triggers can include emotional stress, injury to the skin, some types of infection and reactions to certain drugs. Stress can cause psoriasis to flare for the first time or aggravate existing psoriasis. Psoriasis can also be triggered in areas of the skin that have been injured or traumatized. This is known as the “Koebner phenomenon.” Vaccinations, sunburns and scratches can all trigger a Koebner response. The Koebner response can be treated if it is caught early enough. Certain medications, like antimalarial drugs, lithium and certain beta-blockers, are also known to cause people’s psoriasis to flare. Other triggers may include weather, diet and allergies. Triggers will vary from person to person and what may cause one person’s psoriasis to flare may produce no reaction in another individual.
For the most part, people with psoriasis function normally. Sometimes people experience low self-esteem because of the psoriasis. Psoriasis is often misunderstood by the public, which can make social interactions difficult. This may lead to emotional reactions such as anxiety, anger, embarrassment and depression. Psoriasis can affect the type of work people do if it is visible.
Psoriasis is a chronic (life-long) illness. Most people need ongoing treatments and visits to the doctor. In severe cases, people may need to be hospitalized. In the USA, about 56 million hours of work are lost each year by people who suffer from psoriasis and between $1.6 billion and $3.2 billion is spent per year to treat psoriasis.
Although there is little scientific research into the effects of moisturisers on psoriasis, our own experience shows that: moisturisers make the skin much more comfortable they decrease the dryness, scaling, cracking and soreness, and itching; moisturisers allow the other active treatments you use (e.g. tar, vitamin D) to work more effectively.
Which moisturiser is the best to use?
There are so many to choose from that sometimes it is difficult to know. There are, however, two golden rules: Moisturising is absolutely vital for anyone with psoriasis. Although it does not get rid of the psoriasis, it makes it less scaly and much more comfortable. The best moisturiser is the one that you feel happiest with and that you feel you can use easily on a regular basis. Discuss this with your GP and ask her or him to prescribe one that you like and will use.
It is estimated that over seven million Americans (2.6%) have psoriasis, with more than 150,000 new cases reported each year. According to the National Psoriasis Foundation, 20,000 children under 10 years of age are diagnosed with psoriasis annually.
Anyone can get psoriasis, but it occurs more often in adults. Sometimes there is a family history of psoriasis. Certain genes have been linked to the disease. Men and women get psoriasis at about the same rate.
More than 4.5 million adults in the United States have been diagnosed with psoriasis, and approximately 150,000 new cases are diagnosed each year. An estimated 20% have moderate to severe psoriasis.
Psoriasis occurs about equally in males and females. Recent studies show that there may be an ethnic link. It seems that psoriasis is most common in Caucasians and slightly less common in African Americans. Worldwide, psoriasis is most common in Scandinavia and other parts of northern Europe. It appears to be far less common among Asians and is rare in Native Americans.
There also is a genetic component associated with psoriasis. Approximately one-third of people who develop psoriasis have at least one family member with the condition.
Research shows that the signs and symptoms of psoriasis usually appear between 15 and 35 years of age. About 75% develop psoriasis before age 40. However, it is possible to develop psoriasis at any age. After age 40, a peak onset period occurs between 50 and 60 years of age.
About 1 in 10 people develop psoriasis during childhood, and psoriasis can begin in infancy. The earlier the psoriasis appears, the more likely it is to be widespread and recurrent.
Psoriatic arthritis develops in roughly one million people across the United States, and 5% to 10% experience some disability. Psoriatic arthritis usually first appears between 30 and 50 years of age — often months to years after skin lesions first occur. However, not everyone who develops psoriatic arthritis has psoriasis.
About 30% of people who get psoriatic arthritis never develop the skin condition.
Psoriasis is a non-contagious, chronic skin disorder that is seen as scaly plaques on the skin. It affects one to two percent of the population. Skin cells grow deep in the skin and slowly rise to the surface.
This process is called cell turnover, and it takes about a month. With psoriasis, it can happen in just a few days because the cells rise too fast and pile up on the surface. Most psoriasis causes patches of thick, red skin with silvery scales. These patches can itch or feel sore. They are often found on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet. But they can show up other places such as fingernails, toenails, genitals, and inside the mouth.
Psoriasis is an inflammatory skin condition. There are five types, each with unique signs and symptoms. Between 10% and 30% of people who develop psoriasis get a related form of arthritis called â€œpsoriatic arthritis,â€ which causes inflammation of the joints.
Plaque psoriasis is the most common type of psoriasis. About 80% of people who develop psoriasis have plaque psoriasis, which appears as patches of raised, reddish skin covered by silvery-white scale. These patches, or plaques, frequently form on the elbows, knees, lower back, and scalp. However, the plaques can occur anywhere on the body.
The other types are guttate psoriasis (small, red spots on the skin), pustular psoriasis (white pustules surrounded by red skin), inverse psoriasis (smooth, red lesions form in skin folds), and erythrodermic psoriasis (widespread redness, severe itching, and pain).
Regardless of type, psoriasis usually causes discomfort. The skin often itches, and it may crack and bleed. In severe cases, the itching and discomfort may keep a person awake at night, and the pain can make everyday tasks difficult.
Psoriasis is a chronic, meaning lifelong, condition because there is currently no cure. People often experience flares and remissions throughout their life. Controlling the signs and symptoms typically requires lifelong therapy.
Treatment depends on the severity and type of psoriasis. Some psoriasis is so mild that the person is unaware of the condition. A few develop such severe psoriasis that lesions cover most of the body and hospitalization is required. These represent the extremes. Most cases of psoriasis fall somewhere in between.
Psoriasis begins in the immune system, mainly with a type of white blood cell called a T cell. T cells help protect the body against infection and disease. With psoriasis, T cells are put into action by mistake. They become so active that they set off other immune responses. This leads to swelling and fast turnover of skin cells. People with psoriasis may notice that sometimes the skin gets better and sometimes it gets worse. Things that can cause the skin to get worse include:
Psoriasis may be one of the oldest recorded skin conditions. It was probably first described around 35 AD. Some evidence indicates an even earlier date. Yet, until recently, little was known about psoriasis.
While scientists still do not fully know what causes psoriasis, research has significantly advanced our understanding. One important breakthrough began with the discovery that kidney-transplant recipients who had psoriasis experienced clearing when taking cyclosporine. Since cyclosporine is a potent immunosuppressive medication, this indicates that the immune system is involved.
Immune Mediated: Researchers now believe that psoriasis is an immune-mediated condition. This means the condition is caused by faulty signals in the body’s immune system. It is believed that psoriasis develops when the immune system tells the body to over-react and accelerate the growth of skin cells. Normally, skin cells mature and are shed from the skin’s surface every 28 to 30 days. When psoriasis develops, the skin cells mature in 3 to 6 days and move to the skin surface. Instead of being shed, the skin cells pile up, causing the visible lesions.
Genes: Researchers have identified genes that cause psoriasis. These genes determine how a person’s immune system reacts. These genes can cause psoriasis or another immune-mediated condition, such as rheumatoid arthritis or type 1 diabetes. The risk of developing psoriasis or another immune-mediated condition, especially diabetes or Crohn’s disease, increases when a close blood relative has psoriasis.
Family History: Some people who have a family history of psoriasis never develop this condition. Research indicates that a “trigger” is needed. Stress, skin injuries, a strep infection, certain medications, and sunburn are some of the known potential triggers. Medications that can trigger psoriasis are anti-malarial drugs, beta-blockers (medication used to treat high blood pressure and heart conditions), and lithium. Dermatologists have seen psoriasis suddenly appear after a person takes one of these medications, gets a strep infection, or experiences another trigger.
Psoriasis research continues to accelerate at a rapid pace and will continue to advance our knowledge of what causes psoriasis.