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Psoriasis – What is Psoriasis? Basic Symptoms and Types

Articles OnWhat Is Psoriasis? What Is Psoriasis? What Is Psoriasis? What Is Psoriasis?

Unpredictable and irritating, psoriasis is one of the most baffling and persistent of skin disorders. It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plaques covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and soles of the feet.

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis — the most common variety of the condition — include:

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Other forms of psoriasis include:

Pustular psoriasis , characterized by red and scaly skin on the palms of the hands and/or feet with tiny pustules

Guttate psoriasis, which often starts in childhood or young adulthood, is characterized by small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and use of anti-malarial and beta-blocker medications.

Inverse psoriasis, characterized by bright red, shiny lesions that appear in skin folds, such as the armpits, groin area, and under the breasts

Erythrodermic psoriasis, characterized by periodic, fiery redness of the skin and shedding of scales in sheets; this form of psoriasis, triggered by withdrawal from a systemic psoriasis treatment, severe sunburn, infection, and certain medications, requires immediate medical treatment, because it can lead to severe illness.

People who suffer from psoriasis know that this uncomfortable and at times disfiguring skin disease can be difficult and frustrating to treat. The condition comes and goes in cycles of remissions and flare-ups over a lifetime. While there are medications and other therapies that can help to clear up the patches of red, scaly, thickened skin that are the hallmark of psoriasis, there is no cure.

A variety of factors — ranging from emotional stress and trauma to streptococcal infection — can cause an episode of psoriasis. Recent research indicates that some abnormality in the immune system is the key cause of psoriasis. As many as 80% of people having flare-ups report a recent emotional trauma, such as a new job or the death of a loved one. Most doctors believe such external stressors serve as triggers for an inherited defect in immune function.

Injured skin and certain drugs can aggravate psoriasis, including certain types of blood pressure medications (like beta-blockers), the anti-malarial medication hydroxychloroquine, and ibuprofen (Advil, Motrin, etc.).

Psoriasis tends to run in families, but it may be skip generations; a grandfather and his grandson may be affected, but the child’s mother never develops the disease. Although psoriasis may be stressful and embarrassing, most outbreaks are relatively harmless. With appropriate treatment, symptoms generally subside within a few months.

SOURCES:National Institute of Arthritis and Musculoskeletal and Skin Disease.National Psoriasis Foundation.The Psoriasis Foundation.American Academy of Dermatology.

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Psoriasis – What is Psoriasis? Basic Symptoms and Types

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis facts

What is psoriasis?

Psoriasis is a noncontagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-lymphocytes. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface.

Psoriasis is considered an incurable, long-term (chronic) inflammatory skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.

Psoriasis affects all races and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. The quality of life of patients with psoriasis is often diminished because of the appearance of their skin. Recently, it has become clear that people with psoriasis are more likely to have diabetes, high blood lipids, cardiovascular disease, and a variety of other inflammatory diseases. This may reflect an inability to control inflammation. Caring for psoriasis takes medical teamwork.

No. Psoriasis is not contagious. Psoriasis is not transmitted sexually or by physical contact. Psoriasis is not caused by lifestyle, diet, or bad hygiene.

While the exact cause of psoriasis is unknown, researchers consider environmental, genetic, and immune system factors as playing roles in the establishment of the disease.

What are psoriasis causes and risk factors?

The exact cause remains unknown. A combination of elements, including genetic predisposition and environmental factors, are involved. It is common for psoriasis to be found in members of the same family. Defects in immune regulation and the control of inflammation are thought to play major roles. Certain medications like beta-blockers have been linked to psoriasis. Despite research over the past 30 years, the “master switch” that turns on psoriasis is still a mystery.

What are the different types of psoriasis?

There are several different forms of psoriasis, including plaque psoriasis or psoriasis vulgaris (common plaque type), guttate psoriasis (small, drop-like spots), inverse psoriasis (in the folds like of the underarms, navel, groin, and buttocks), and pustular psoriasis (small pus-filled yellowish blisters). When the palms and the soles are involved, this is known as palmoplantar psoriasis. In erythrodermic psoriasis, the entire skin surface is involved with the disease. Patients with this form of psoriasis often feel cold and may develop congestive heart failure if they have a preexisting heart problem. Nail psoriasis produces yellow pitted nails that can be confused with nail fungus. Scalp psoriasis can be severe enough to produce localized hair loss, plenty of dandruff, and severe itching.

Can psoriasis affect my joints?

Yes, psoriasis is associated with inflamed joints in about one-third of those affected. In fact, sometimes joint pains may be the only sign of the disorder, with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and needs to be treated with medications in order to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. Usually, the skin symptoms and signs precede the onset of the arthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

What are psoriasis symptoms and signs? What does psoriasis look like?

Plaque psoriasis signs and symptoms appear as red or pink small scaly bumps that merge into plaques of raised skin. Plaque psoriasis classically affects skin over the elbows, knees, and scalp and is often itchy. Although any area may be involved, plaque psoriasis tends to be more common at sites of friction, scratching, or abrasion. Sometimes pulling off one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is a special diagnostic sign in psoriasis called the Auspitz sign.

Fingernails and toenails often exhibit small pits (pinpoint depressions) and/or larger yellowish-brown separations of the nail from the nail bed at the fingertip called distal onycholysis. Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.

Guttate psoriasis symptoms and signs include bumps or small plaques ( inch or less) of red itchy, scaling skin that may appear explosively, affecting large parts of the skin surface simultaneously, after a sore throat.

In inverse psoriasis, genital lesions, especially in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or the area between the buttocks (intergluteal folds) may look like flat red plaques without much scaling. This may be confused with other skin conditions like fungal infections, yeast infections, allergic rashes, or bacterial infections.

Symptoms and signs of pustular psoriasis include at rapid onset of groups of small bumps filled with pus on the torso. Patients are often systemically ill and may have a fever.

Erythrodermic psoriasis appears as extensive areas of red skin often involving the entire skin surface. Patients may often feel chilled.

Scalp psoriasis may look like severe dandruff with dry flakes and red areas of skin. It can be difficult to differentiate between scalp psoriasis and seborrheic dermatitis when only the scalp is involved. However, the treatment is often very similar for both conditions.

How do health care professionals diagnose psoriasis?

The diagnosis of psoriasis is typically made by obtaining information from the physical examination of the skin, medical history, and relevant family health history.

Sometimes lab tests, including a microscopic examination of tissue obtained from a skin biopsy, may be necessary.

Eczema vs. psoriasis

Occasionally, it can be difficult to differentiate eczematous dermatitis from psoriasis. This is when a biopsy can be quite valuable to distinguish between the two conditions. Of note, both eczematous dermatitis and psoriasis often respond to similar treatments. Certain types of eczematous dermatitis can be cured where this is not the case for psoriasis.

How many people have psoriasis?

Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S. population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.

Is psoriasis contagious?

No. A person cannot catch it from someone else, and one cannot pass it to anyone else by skin-to-skin contact. Directly touching someone with psoriasis every day will never transmit the condition.

Is there a cure for psoriasis?

No, psoriasis is not currently curable. However, it can go into remission, producing an entirely normal skin surface. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis hereditary?

Although psoriasis is not contagious from person to person, there is a known hereditary tendency. Therefore, family history is very helpful in making the diagnosis.

What health care specialists treat psoriasis?

Dermatologists are doctors who specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the treatment of joint disorders and psoriatic arthritis. Many kinds of doctors may treat psoriasis, including dermatologists, family physicians, internal medicine physicians, rheumatologists, and other medical doctors. Some patients have also seen other allied health professionals such as acupuncturists, holistic practitioners, chiropractors, and nutritionists.

The American Academy of Dermatology and the National Psoriasis Foundation are excellent sources to help find doctors who specialize in this disease. Not all dermatologists and rheumatologists treat psoriasis. The National Psoriasis Foundation has one of the most up-to-date databases of current psoriasis specialists.

It is now apparent that patients with psoriasis are prone to a variety of other disease conditions, so-called comorbidities. Cardiovascular disease, diabetes, hypertension, inflammatory bowel disease, hyperlipidemia, liver problems, and arthritis are more common in patients with psoriasis. It is very important for all patients with psoriasis to be carefully monitored by their primary care providers for these associated illnesses. The joint inflammation of psoriatic arthritis and its complications are frequently managed by rheumatologists.

What are psoriasis treatment options?

There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.

For mild disease that involves only small areas of the body (less than 10% of the total skin surface), topical treatments (skin applied), such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (>10% or more of the total skin surface), topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

It is important to keep in mind that as with any medical condition, all medicines carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may become incapacitated and require treatment internally.

A proposal to minimize the toxicity of some of these medicines has been commonly called “rotational” therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an option. An exception to this proposal is the use of the newer biologic medications as described below. An individual who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy.

What creams, lotions, and home remedies are available for psoriasis?

Topical (skin applied) treatments include topical corticosteroids, vitamin D analogue creams like calcipotriene (Calcitrene, Dovonex, Sorilux), topical retinoids (tazarotene [Tazorac]), moisturizers, topical immunomodulators (tacrolimus and pimecrolimus), coal tar, anthralin, and others.

Are psoriasis shampoos available?

Coal tar shampoos are very useful in controlling psoriasis of the scalp. Using the shampoo daily can be very beneficial adjunctive therapy. There are a variety of shampoos available without a prescription. There is no evidence that one shampoo is superior to another. Generally, the selection of a tar shampoo is simply a matter of personal preference.

What oral medications are available for psoriasis?

Oral medications include methotrexate (Trexall), acitretin (Soriatane), cyclosporine (Neoral), apremilast (Otezla), and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare-up if administered.

What injections or infusions are available for psoriasis?

Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:

Drug choice can be complicated, and your physician will help in selecting the best option. In some patients. it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.

Newer drugs are in development and no doubt will be available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored. Biologics are all comparatively expensive especially in view of the fact they none of them are curative. Recently, the FDA has attempted to address this problem by permitting the use of “biosimilar” drugs. These drugs are structurally identical to a specific biologic drug and are presumed to produce identical therapeutic responses in human beings to the original, but are produced using different methodology. Biosimilars ought to be available at some fraction of the cost of the original. If this will be an effective approach remains to be seen. The only biosimilar available currently is infliximab (Inflectra). Two other biosimilar drugs have been accepted by the FDA, an etanercept equivalent (Erelzi) and an adalimumab equivalent (Amjevita) — but currently, neither are available.

Some biologics are to be administered by self-injections for home use while others are given by intravenous infusions in the doctor’s office. Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy. As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs. Precautions include patients with known or suspected hepatitis B infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy. In particular, there may be an increased association of lymphoma in patients taking a biologic.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologic manufacturers have patient-assistance programs to help with financial issues. Therefore, choice of the right medication for your condition depends on many factors, not all of them medical. Additionally, convenience of receiving the medication and lifestyle affect the choice of the right biologic medication.

Is there an anti-psoriasis diet?

Most patients with psoriasis seem to be overweight. Since there is a predisposition for those patients to develop cardiovascular disease and diabetes, it is suggested strongly that they try to maintain a normal body weight. Although evidence is sparse, it has been suggested that slender patients are more likely to respond to treatment.

Although dietary studies are notoriously difficult to perform and interpret, it seems likely that a diet whose fat content is composed of polyunsaturated oils like olive oil and fish oil is beneficial for psoriasis. The so-called Mediterranean diet is an example.

What about light therapy for psoriasis?

Light therapy is also called phototherapy. There are several types of medical light therapies that include PUVA (an acronym for psoralen + UVA), UVB, and narrow-band UVB. These artificial light sources have been used for decades and generally are available in only certain physician’s offices. There are a few companies who may sell light boxes or light bulbs for prescribed home light therapy.

Natural sunlight is also used to treat psoriasis. Daily short, controlled exposures to natural sunlight may help or clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may need to be protected during sun exposure.

There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating medication and a special light source) that have been used to treat psoriasis.

PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure composed of wavelengths of ultraviolet light in the UVA spectrum. The photosensitizing drug in PUVA is called psoralen. Both the psoralen and the UVA light must be administered within one hour of each other for a response to occur. These treatments are usually given in a physician’s office two to three times per week. Several weeks of PUVA is usually required before seeing significant results. The light exposure time is gradually increased during each subsequent treatment. Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun sensitive and must avoid sun exposure for a period of time after PUVA. Common side effects with PUVA include burning, aging of the skin, increased brown spots called lentigines, and an increased risk of skin cancer, including melanoma. The relative increase in skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a physician and discontinued when a maximum number of treatments have been reached.

Narrow-band UVB phototherapy is an artificial light treatment using very limited wavelengths of light. It is frequently given daily or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and exposure is gradually increased as tolerated. Potential side effects with UVB include skin burning, premature aging, and possible increased risk of skin cancer. The relative increase in skin cancer risk with UVB treatment needs further study but is probably less than PUVA or traditional UVB.

Sometimes UVB is combined with other treatments such as tar application. Goeckerman is a special psoriasis therapy using this combination. Some centers have used this therapy in a “day care” type of setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.

Recently, a laser (excimer laser XTRAC) has been developed that generates ultraviolet light in the same range as narrow-band ultraviolet light. This light can be beneficial for psoriasis localized to small areas of skin like the palms, soles, and scalp. It is impractical to use in in extensive disease.

What is the long-term prognosis with psoriasis? What are complications of psoriasis?

Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable. As described above, recent studies show an association of psoriasis and other medical conditions, including obesity, diabetes, and heart disease.

Is it possible to prevent psoriasis?

Since psoriasis is inherited, it is impossible at this time to suggest anything that is likely to prevent its development aside from indulging in a healthy lifestyle.

What does the future hold for psoriasis?

Psoriasis research is heavily funded and holds great promise for the future. Just the last five to 10 years have produced great improvements in treatment of the disease with medications aimed at controlling precise sites of the process of inflammation. Ongoing research is needed to decipher the ultimate underlying cause of this disease.

Is there a national psoriasis support group?

Yes, the National Psoriasis Foundation (NPF) is an organization dedicated to helping patients with psoriasis and furthering research in this field. They hold national and local chapter meetings. The NPF web site (http://www.psoriasis.org/home/) shares up-to-date reliable medical information and statistics on the condition.

Where can people get more information on psoriasis?

A dermatologist, the American Academy of Dermatology at http://www.AAD.org, and the National Psoriasis Foundation at http://www.psoriasis.org/home/ may be excellent sources of more information.

There are many ongoing clinical trials for psoriasis all over the United States and in the world. Many of these clinical trials are ongoing at academic or university medical centers and are frequently open to patients without cost.

Clinical trials frequently have specific requirements for types and severity of psoriasis that may be enrolled into a specific trial. Patients need to contact these centers and inquire regarding the specific study requirements. Some studies have restrictions on what recent medications have been used for psoriasis, current medication, and overall health.

Some of the many medical centers in the U.S. offering clinical trials for psoriasis include the University of California, San Francisco Department of Dermatology, the University of California, Irvine Department of Dermatology, and the St. Louis University Medical School.

Medically Reviewed on 2/1/2018

References

Alwan, W., and F.O. Nestle. “Pathogenesis and Treatment of Psoriasis: Exploiting Pathophysiological Pathways for Precision Medicine.” Clin Exp Rheumatol 33 (Suppl. 93): S2-S6.

Arndt, Kenneth A., eds., et al. “Topical Therapies for Psoriasis.” Seminars in Cutaneous Medicine and Surgery 35.2S Mar. 2016: S35-S46.

Conrad, Curdin, Michel Gilliet. “Psoriasis: From Pathogenesis to Targeted Therapies.” Clinical Reviews in Allergy & Immunology Jan. 18, 2015.

Dowlatshahi, E.A., E.A.M van der Voort, L.R. Arends, and T. Nijsten. “Markers of Systemic Inflammation in Psoriasis: A Systematic Review and Meta-Analysis.” British Journal of Dermatology 169.2 Aug. 2013: 266282.

Greb, Jacqueline E., et al. “Psoriasis.” Nature Reviews Disease Primers 2 (2016): 1-17.

National Psoriasis Foundation. “Systemic Treatments: Biologics and Oral Treatments.” 1-25.

Ogawa, Eisaku, Yuki Sato, Akane Minagawa, and Ryuhei Okuyama. “Pathogenesis of Psoriasis and Development of Treatment.” The Journal of Dermatology 2017: 1-9.

Villaseor-Park, Jennifer, David Wheeler, and Lisa Grandinetti. “Psoriasis: Evolving Treatment for a Complex Disease.” Cleveland Clinic Journal of Medicine 79.6 June 2012: 413-423.

Woo, Yu Ri, Dae Ho Cho, and Hyun Jeong Park. “Molecular Mechanisms and Management of a Cutaneous Inflammatory Disorder: Psoriasis.” International Journal of Molecular Sciences 18 Dec. 11, 2017: 1-26.

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Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis – Symptoms and causes – Mayo Clinic

Overview

Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.

Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly.

There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help.

Psoriasis care at Mayo Clinic

Psoriasis signs and symptoms are different for everyone. Common signs and symptoms include:

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

There are several types of psoriasis. These include:

Guttate psoriasis. This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.

The lesions are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.

Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips.

It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.

If you suspect that you may have psoriasis, see your doctor for an examination. Also, talk to your doctor if your psoriasis:

Seek medical advice if your signs and symptoms worsen or don’t improve with treatment. You may need a different medication or a combination of treatments to manage the psoriasis.

The cause of psoriasis isn’t fully understood, but it’s thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body.

T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.

But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.

Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.

The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.

Just what causes T cells to malfunction in people with psoriasis isn’t entirely clear. Researchers believe both genetics and environmental factors play a role.

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:

Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:

If you have psoriasis, you’re at greater risk of developing certain diseases. These include:

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Psoriasis – Symptoms and causes – Mayo Clinic

Psoriasis | Psoriatic Arthritis | MedlinePlus

Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales. You usually get the patches on your elbows, knees, scalp, back, face, palms and feet, but they can show up on other parts of your body. Some people who have psoriasis also get a form of arthritis called psoriatic arthritis.

A problem with your immune system causes psoriasis. In a process called cell turnover, skin cells that grow deep in your skin rise to the surface. Normally, this takes a month. In psoriasis, it happens in just days because your cells rise too fast.

Psoriasis can be hard to diagnose because it can look like other skin diseases. Your doctor might need to look at a small skin sample under a microscope.

Psoriasis can last a long time, even a lifetime. Symptoms come and go. Things that make them worse include

Psoriasis usually occurs in adults. It sometimes runs in families. Treatments include creams, medicines, and light therapy.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

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Psoriasis | Psoriatic Arthritis | MedlinePlus

Psoriasis – Symptoms and causes – Mayo Clinic

Overview

Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.

Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly.

There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help.

Psoriasis care at Mayo Clinic

Psoriasis signs and symptoms are different for everyone. Common signs and symptoms include:

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

There are several types of psoriasis. These include:

Guttate psoriasis. This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.

The lesions are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.

Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips.

It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.

If you suspect that you may have psoriasis, see your doctor for an examination. Also, talk to your doctor if your psoriasis:

Seek medical advice if your signs and symptoms worsen or don’t improve with treatment. You may need a different medication or a combination of treatments to manage the psoriasis.

The cause of psoriasis isn’t fully understood, but it’s thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body.

T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.

But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.

Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.

The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.

Just what causes T cells to malfunction in people with psoriasis isn’t entirely clear. Researchers believe both genetics and environmental factors play a role.

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:

Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:

If you have psoriasis, you’re at greater risk of developing certain diseases. These include:

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Psoriasis – Symptoms and causes – Mayo Clinic

Turmeric’s Amazing Effect on Psoriasis

See that teaspoon? Thats what you need for your flakes.

Today I want to talk about the benefits of eating turmeric for psoriasis, and especially, of taking a supplement known as curcumin.

Many of you curry-eating flakers out there might know that its used by the bucket-load in Indian cuisine. It has a warm yellow colour, an earthy, peppery taste, and it stains absolutely everything a nice ten-day old urine colour. So dont get any on your pants.

Turmerics use in Asia goes back at least 2,500 years and its not just contained to the cooking pot. In fact, this amazing spice was highly valued in traditional healing practices, especially when it came to skin conditions. Which is where psoriasis comes in.

It looks pleasant enough right?

So why is turmeric so good for our flaky skin?

Science has no proven that it contains certain compounds that are fantastic for fighting chronic inflammation, such as psoriasis.

The most important compound of them all for us flakers is curcumin. It reduces histamine levels (which are responsible for inflammation), blocks a molecule called NF-kB, which turns on the inflammation response in cells, and a does a whole range of other good things.

Curcumin has even been found to treat Alzheimers, prevent cancer, destroy bacteria, boost brain function and protect the liver from toxin damage which also helps to reduce psoriasis as the liver is essential for cleaning the blood and getting rid of impurities.

There are several studies out there supporting the claim that curcumin is great for psoriasis:

In thisstudy, patients with at least 6% psoriasis coverage were given three 500 mg pills of curcumin three times a day.At the end of four months, two patients saw excellent improvements of over 80%. The researchers did note that theres a problem with it not being readily absorbed by the body. Ill show you how to get around that later!

In another clinical trial, this time conducted by the University of California, curcuminwas put up againstcalcipotriol, which many of you might know as the branded cream Dovonex. Patients in this study either used an alcoholic gel with 1% curcumin, or the Dovonex. The ones who used curcumin did far better: five had morethan a 90% improvementafter 26 weeks of treatment, and the remainingfivepatients showed a 5085% improvementafter 38 weeks.

Before you run off to your local shop to get some, there are two little catches.

Firstly, only 3% of turmeric powder, by weight, is curcumin. So for you to get the full benefits Ive mentioned above, you would have to gobble hundreds of grams of turmeric powder every day. Youd youd have to add it to your Weetabix and froth it up in your latte, and thats before lunch!

There is a workaround for this, which Ill mention later.

Secondly, curcumin is not absorbed very well by the body. This is why you have to ingest it with black pepper, as itcontains a compound called piperine which increased the bodys absorption of curcumin by a whopping 2000%!

There are several ways of using turmeric for psoriasis. Ill go over the rather unpleasant ones first.

I made and drank this for your benefit, reader!

First of all, you can consume it. Its simple, just mix it in a glass and drink it, trying not to gag. Its super inexpensive and should set you back only $1 or $2 dollars for a nice bag.

All you have to do ismix one teaspoon of turmeric powder with a bit of juice and a teaspoon of black pepper. The last part is essential as otherwise it will be broken down before having any noticeable effect.

I wont lie; its not like a nice cold cup of OJ in the morning. The pepper gets stuck between your teeth and it feels like youve just washed down a cup of curry.

But it does the job. I took it this way for ages as it was the cheapest method available, and I was extremely happy with the results.

Remember, you can also add a pinch to your favourite marinade or saut it with onions to increase your daily intake. Get creative.

Id like to see you laugh when you try to scrub it off!

Secondly, you can rub it onto your psoriasis patches.

This is also simple, but highly, highly dangerous to your wardrobe. Or anything that stains for that matter. Just mix the powder with a bit of water, or Vaseline, and whack it on.

At this point I have to emphasise that turmeric is a pain in the ass to remove! Its like having the Midas touch, but only in colour. Your skin, your shirt, your iPhone, your dishes, your dog, your girlfriend everything you touch will turn yellow. The first time I tried it, it took three days for it to come off. My hands were so yellow it looked like I had jaundice.

To get around this, buy powder with any extra dyes removed, such as Starwest Botanicals Organic Turmeric.Starwest turmeric is still yellow but they do not add additional dyes to make it look even yellower, like some other brands.

However, the effect was simply amazing, particularly after a few runs. It really soothes psoriasis when its inflamed!

The most convenient solution that Ive found, is taking turmeric pill capsules. Just the amount of time they save me from splashing around in the kitchen with turmeric makes them worthwhile.

If youre like me and are not in love with the taste of turmeric, then this route may be for you too. The brand Ive started ordering regularly is called Dr. Danielles Organic Curcumin.

Its comes in a bottleof 120 capsules, each one containing 500 mg. At two a day it lasts me for two months, which is pretty affordable when its only $24. 95

As a bonus, its already pre-mixed with a compound called bioperine, which is basically a branded form ofpiperine, so you dont have to swallow any black pepper when you take it!

For me, turmeric, and curcumin by extension, is a staple in the psoriasis-fighting cupboard. Ive been using it regularly for over two years now and cannot recommend it highly enough!

I partly bought this brand because it had great reviews from other flakers on Amazon. For example:

Julie Casbar says: I used this product because I have psoriasis and nothing pharmaceutical was working or was too expensive. I found that this tumeric worked excellently for inflamation! My skin cleared within 6 weeks between diet and using the tumeric.

Chad Phillippi says: I suffer from extreme psoriasis and psoriatic arthritis, along with some IBS, just because God has a sense of humor, I suppose. Ive been using this product for a few weeks now and have really noticed a change in my body for the better! My joints, fingers, ankles, and toes dont seem to ache as often as they did prior to the product. Also, my stomach issues have gotten a lot better!

Let me know if you end up trying it!

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Tags: psoriasis, supplement, turmeric

redblob I’m just an average 28 year old living with psoriasis. Over the last decade, I’ve tried everything, from real snake poison to rubbing banana peels over my body. I’ve finally found an approach that’s working for me, and I’m sharing it with all the flakers out there. But Psoriasis Blob is not about one man, it’s a growing community of great, red people.

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Turmeric’s Amazing Effect on Psoriasis

Apple Cider Vinegar Melts Away Psoriasis Flakes

Its made from squashed apples and it makes your flakes cry. Every man or woman with psoriasis needs a bottle of it. I have two.

There are two types of people in this world. Those who use apple cider vinegar (known as ACV) for salad dressings, and those who drink it and rub it onto their skin. Guess which category flakers fall into? The weird kind. To find out why apple cider vinegar and psoriasis isnt as crazy as it sounds, read on!

I currently have two bottles in my cupboard: Bragg, the big daddy brand of ACV that all hippies swear by, and a random Italian brand that I picked up from my local shopkeeper Vimal for cooking with that cost just $2.

You might think that Im bonkers, but there are tonnes of people out there with psoriasis that swear by ACV.Over the centuries, its been used time and again to treat skin conditions cultures as diverse as the ancient Egyptians, to the Romans, and even American used it, the latter in the 19th century, when it was used as a wound disinfectant. Ive even read that the Victorians lathered it on as a perfume called Vinegar de Toilette!

Tonight, were drinking from the bottle! (Just kidding. Please dont try this unless you have dentures handy.)

The first time I came across using apple cider vinegar for psoriasis was when I was researching the effects of bad diet.One popular, albeit alternative theory, is that it is caused by a leaky gut and candida overgrowth, which allows toxins to infiltrate the body.

This, in turn, can be down to a highly-acidic modern diet, full of processed foods and empty carbs.What ACV does for us flakers is that it reverses this by making pH levels in the body more alkaline, thus helping the digestive tract to function better, and by killing toxins as it is anti-fungal and anti-viral.

You might be thinking, Wait a minute, isnt it acidic!? and thats true, but the end products it creates while being digested turn out to be alkaline. It also includes a boat load of essential nutrients (such as Vitamins C, A, B1, B6, potassium & iron for starters), and alpha hydroxy acids, which exfoliate the top layers of the skin and are now used in a lot of dermatological creams.

To me knowledge there are no clinical studies out there supporting the use of ACV for psoriasis probably because theres no way a company could slap a label on it, patent it and sell it for a million dollars but the anecdotal stories of it working are plenty. There are also Amazon reviews for Braggs apple cider vinegar from people who have psoriasis.

Heres what Nigel, from the UK, says on a website called Curezone:

About 2 weeks ago I was surfing this forum when I saw several posts about ACV. Not knowing what it was, I proceeded to read the posts and finally I figured out it was apple cider vinegar. I set out to my local grocery store and started on the treatment of 2 teaspoons mixed with honey. 2 weeks later here I am, VERY HAPPY and giddy! The ACV treatment is working. The patches are diminishing. They are no longer rough and flaky. Instead, smooth, REGULAR, HEALTHY skin is now there (only thing that remains is a mark where the patch once was!)

This comment was left by Sreenivas, from India, on a site called EarthClinic:

I read your comments and bought the organic ACV and the result was amazing. I drank 1 tea spoon of ACV with 250 ml of water for about 2 weeks and I see 90% improvement. I got psoriasis in 2007 on my hands and my feet. Cracks, blisters and discharges was something I have lived with while trying all kinds of creams, tablets. It worked like magic for me.

I also found this testimonial from a mid-50s flaker in the US:

Drank 2 teaspoons of natural ACV with 16 oz. of water each day and the red, painful, scaly condition just disappeared! This is the cloudy version of ACV with all the active nutrients. Not the clearer, grocery-store ACV. My skin was freaking me out and scary painful when acting up. And no, I would not have believed something so simple would have worked.I thought this psoriasis was going to flat out eat me alive!

This is one of the original posts that made me want to experiment with ACV, left by a guy in London!

ACV definitely works.I was on prescription topical steroids and it just made it worse. Every time I came off the steroids the psoriasis would bounce back worse.I apply ACV at least twice daily with a sponge and bowl to affected areas and here are my observations.Day 1-3)Massive reduction in skin production & much cleaner appearance.Day 3-7)Small amount of outer shrinkage of spots of psoriasis.Week 3)Hollowing out of spots of psoriosis to form a ring of psoriosis with healthy skin on the insideWeek 6)Ring breaks up into smaller spots which turn into scabs that reveal deep itchy lesions if picked at.Week 12)Lesions slowly heal and close up.

ACV is quite versatile

Most people recommend drinking apple cider vinegar for psoriasis, and thats how I normally take it.What I do is mix two to three tablespoons of ACV in a tall glass of water, normally once a day in the evenings, just before dinner in order to get those gastric juices flowing, baby.

The best kind to get is organic ACV, without preservatives or any other additives. The cream of the crop is organic ACV with what is known as the Mother,a little tangled clot of enzymes, bacteria and living nutrients. It is created during the fermentation process and is the most nutritious thing in the whole bottle!

Ive been drinking it for around a year, off and on, and I really like the effects. It takes around 2 weeks to see the main improvements, but I find that when Im using it my skin doesnt feel like a pile of wood shavings, and its a nice light-pinkish in colour.

Apart from slurping it up, you can also use ACV topically. I normally do this with cotton pads or a sponge, but you can also apply it straight to the scalp or soak your hands and feet in a bowl. Ive even heard of people with penile psoriasis dipping their bits in it, but remember, only try this if you have nuts of steel as the stinging and pain will be pretty, pretty high!

Mmm, vinegary elbow

Research shows that when used externally, it promotes blood circulation in the small capillaries of the skin, has antiseptic qualities which prevent bacteria, and regulates pH levels on the skin.

Most people Ive spoken to apply it on their body for 20 to 30 minutes before rinsing it off, but you can also leave it on overnight. You can even pour some into a bath if your psoriasis coverage is extensive.

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Tags: ACV, apple cider vinegar, psoriasis

redblob I’m just an average 28 year old living with psoriasis. Over the last decade, I’ve tried everything, from real snake poison to rubbing banana peels over my body. I’ve finally found an approach that’s working for me, and I’m sharing it with all the flakers out there. But Psoriasis Blob is not about one man, it’s a growing community of great, red people.

Visit link:

Apple Cider Vinegar Melts Away Psoriasis Flakes

Psoriasis – What is Psoriasis? Basic Symptoms and Types

Articles OnWhat Is Psoriasis? What Is Psoriasis? What Is Psoriasis? What Is Psoriasis?

Unpredictable and irritating, psoriasis is one of the most baffling and persistent of skin disorders. It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plaques covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and soles of the feet.

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis — the most common variety of the condition — include:

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Other forms of psoriasis include:

Pustular psoriasis , characterized by red and scaly skin on the palms of the hands and/or feet with tiny pustules

Guttate psoriasis, which often starts in childhood or young adulthood, is characterized by small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and use of anti-malarial and beta-blocker medications.

Inverse psoriasis, characterized by bright red, shiny lesions that appear in skin folds, such as the armpits, groin area, and under the breasts

Erythrodermic psoriasis, characterized by periodic, fiery redness of the skin and shedding of scales in sheets; this form of psoriasis, triggered by withdrawal from a systemic psoriasis treatment, severe sunburn, infection, and certain medications, requires immediate medical treatment, because it can lead to severe illness.

People who suffer from psoriasis know that this uncomfortable and at times disfiguring skin disease can be difficult and frustrating to treat. The condition comes and goes in cycles of remissions and flare-ups over a lifetime. While there are medications and other therapies that can help to clear up the patches of red, scaly, thickened skin that are the hallmark of psoriasis, there is no cure.

A variety of factors — ranging from emotional stress and trauma to streptococcal infection — can cause an episode of psoriasis. Recent research indicates that some abnormality in the immune system is the key cause of psoriasis. As many as 80% of people having flare-ups report a recent emotional trauma, such as a new job or the death of a loved one. Most doctors believe such external stressors serve as triggers for an inherited defect in immune function.

Injured skin and certain drugs can aggravate psoriasis, including certain types of blood pressure medications (like beta-blockers), the anti-malarial medication hydroxychloroquine, and ibuprofen (Advil, Motrin, etc.).

Psoriasis tends to run in families, but it may be skip generations; a grandfather and his grandson may be affected, but the child’s mother never develops the disease. Although psoriasis may be stressful and embarrassing, most outbreaks are relatively harmless. With appropriate treatment, symptoms generally subside within a few months.

SOURCES:National Institute of Arthritis and Musculoskeletal and Skin Disease.National Psoriasis Foundation.The Psoriasis Foundation.American Academy of Dermatology.

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Psoriasis – What is Psoriasis? Basic Symptoms and Types

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis facts

What is psoriasis?

Psoriasis is a noncontagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-lymphocytes. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface.

Psoriasis is considered an incurable, long-term (chronic) inflammatory skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.

Psoriasis affects all races and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. The quality of life of patients with psoriasis is often diminished because of the appearance of their skin. Recently, it has become clear that people with psoriasis are more likely to have diabetes, high blood lipids, cardiovascular disease, and a variety of other inflammatory diseases. This may reflect an inability to control inflammation. Caring for psoriasis takes medical teamwork.

No. Psoriasis is not contagious. Psoriasis is not transmitted sexually or by physical contact. Psoriasis is not caused by lifestyle, diet, or bad hygiene.

While the exact cause of psoriasis is unknown, researchers consider environmental, genetic, and immune system factors as playing roles in the establishment of the disease.

What are psoriasis causes and risk factors?

The exact cause remains unknown. A combination of elements, including genetic predisposition and environmental factors, are involved. It is common for psoriasis to be found in members of the same family. Defects in immune regulation and the control of inflammation are thought to play major roles. Certain medications like beta-blockers have been linked to psoriasis. Despite research over the past 30 years, the “master switch” that turns on psoriasis is still a mystery.

What are the different types of psoriasis?

There are several different forms of psoriasis, including plaque psoriasis or psoriasis vulgaris (common plaque type), guttate psoriasis (small, drop-like spots), inverse psoriasis (in the folds like of the underarms, navel, groin, and buttocks), and pustular psoriasis (small pus-filled yellowish blisters). When the palms and the soles are involved, this is known as palmoplantar psoriasis. In erythrodermic psoriasis, the entire skin surface is involved with the disease. Patients with this form of psoriasis often feel cold and may develop congestive heart failure if they have a preexisting heart problem. Nail psoriasis produces yellow pitted nails that can be confused with nail fungus. Scalp psoriasis can be severe enough to produce localized hair loss, plenty of dandruff, and severe itching.

Can psoriasis affect my joints?

Yes, psoriasis is associated with inflamed joints in about one-third of those affected. In fact, sometimes joint pains may be the only sign of the disorder, with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and needs to be treated with medications in order to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. Usually, the skin symptoms and signs precede the onset of the arthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

What are psoriasis symptoms and signs? What does psoriasis look like?

Plaque psoriasis signs and symptoms appear as red or pink small scaly bumps that merge into plaques of raised skin. Plaque psoriasis classically affects skin over the elbows, knees, and scalp and is often itchy. Although any area may be involved, plaque psoriasis tends to be more common at sites of friction, scratching, or abrasion. Sometimes pulling off one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is a special diagnostic sign in psoriasis called the Auspitz sign.

Fingernails and toenails often exhibit small pits (pinpoint depressions) and/or larger yellowish-brown separations of the nail from the nail bed at the fingertip called distal onycholysis. Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.

Guttate psoriasis symptoms and signs include bumps or small plaques ( inch or less) of red itchy, scaling skin that may appear explosively, affecting large parts of the skin surface simultaneously, after a sore throat.

In inverse psoriasis, genital lesions, especially in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or the area between the buttocks (intergluteal folds) may look like flat red plaques without much scaling. This may be confused with other skin conditions like fungal infections, yeast infections, allergic rashes, or bacterial infections.

Symptoms and signs of pustular psoriasis include at rapid onset of groups of small bumps filled with pus on the torso. Patients are often systemically ill and may have a fever.

Erythrodermic psoriasis appears as extensive areas of red skin often involving the entire skin surface. Patients may often feel chilled.

Scalp psoriasis may look like severe dandruff with dry flakes and red areas of skin. It can be difficult to differentiate between scalp psoriasis and seborrheic dermatitis when only the scalp is involved. However, the treatment is often very similar for both conditions.

How do health care professionals diagnose psoriasis?

The diagnosis of psoriasis is typically made by obtaining information from the physical examination of the skin, medical history, and relevant family health history.

Sometimes lab tests, including a microscopic examination of tissue obtained from a skin biopsy, may be necessary.

Eczema vs. psoriasis

Occasionally, it can be difficult to differentiate eczematous dermatitis from psoriasis. This is when a biopsy can be quite valuable to distinguish between the two conditions. Of note, both eczematous dermatitis and psoriasis often respond to similar treatments. Certain types of eczematous dermatitis can be cured where this is not the case for psoriasis.

How many people have psoriasis?

Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S. population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.

Is psoriasis contagious?

No. A person cannot catch it from someone else, and one cannot pass it to anyone else by skin-to-skin contact. Directly touching someone with psoriasis every day will never transmit the condition.

Is there a cure for psoriasis?

No, psoriasis is not currently curable. However, it can go into remission, producing an entirely normal skin surface. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis hereditary?

Although psoriasis is not contagious from person to person, there is a known hereditary tendency. Therefore, family history is very helpful in making the diagnosis.

What health care specialists treat psoriasis?

Dermatologists are doctors who specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the treatment of joint disorders and psoriatic arthritis. Many kinds of doctors may treat psoriasis, including dermatologists, family physicians, internal medicine physicians, rheumatologists, and other medical doctors. Some patients have also seen other allied health professionals such as acupuncturists, holistic practitioners, chiropractors, and nutritionists.

The American Academy of Dermatology and the National Psoriasis Foundation are excellent sources to help find doctors who specialize in this disease. Not all dermatologists and rheumatologists treat psoriasis. The National Psoriasis Foundation has one of the most up-to-date databases of current psoriasis specialists.

It is now apparent that patients with psoriasis are prone to a variety of other disease conditions, so-called comorbidities. Cardiovascular disease, diabetes, hypertension, inflammatory bowel disease, hyperlipidemia, liver problems, and arthritis are more common in patients with psoriasis. It is very important for all patients with psoriasis to be carefully monitored by their primary care providers for these associated illnesses. The joint inflammation of psoriatic arthritis and its complications are frequently managed by rheumatologists.

What are psoriasis treatment options?

There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.

For mild disease that involves only small areas of the body (less than 10% of the total skin surface), topical treatments (skin applied), such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (>10% or more of the total skin surface), topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

It is important to keep in mind that as with any medical condition, all medicines carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may become incapacitated and require treatment internally.

A proposal to minimize the toxicity of some of these medicines has been commonly called “rotational” therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an option. An exception to this proposal is the use of the newer biologic medications as described below. An individual who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy.

What creams, lotions, and home remedies are available for psoriasis?

Topical (skin applied) treatments include topical corticosteroids, vitamin D analogue creams like calcipotriene (Calcitrene, Dovonex, Sorilux), topical retinoids (tazarotene [Tazorac]), moisturizers, topical immunomodulators (tacrolimus and pimecrolimus), coal tar, anthralin, and others.

Are psoriasis shampoos available?

Coal tar shampoos are very useful in controlling psoriasis of the scalp. Using the shampoo daily can be very beneficial adjunctive therapy. There are a variety of shampoos available without a prescription. There is no evidence that one shampoo is superior to another. Generally, the selection of a tar shampoo is simply a matter of personal preference.

What oral medications are available for psoriasis?

Oral medications include methotrexate (Trexall), acitretin (Soriatane), cyclosporine (Neoral), apremilast (Otezla), and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare-up if administered.

What injections or infusions are available for psoriasis?

Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:

Drug choice can be complicated, and your physician will help in selecting the best option. In some patients. it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.

Newer drugs are in development and no doubt will be available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored. Biologics are all comparatively expensive especially in view of the fact they none of them are curative. Recently, the FDA has attempted to address this problem by permitting the use of “biosimilar” drugs. These drugs are structurally identical to a specific biologic drug and are presumed to produce identical therapeutic responses in human beings to the original, but are produced using different methodology. Biosimilars ought to be available at some fraction of the cost of the original. If this will be an effective approach remains to be seen. The only biosimilar available currently is infliximab (Inflectra). Two other biosimilar drugs have been accepted by the FDA, an etanercept equivalent (Erelzi) and an adalimumab equivalent (Amjevita) — but currently, neither are available.

Some biologics are to be administered by self-injections for home use while others are given by intravenous infusions in the doctor’s office. Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy. As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs. Precautions include patients with known or suspected hepatitis B infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy. In particular, there may be an increased association of lymphoma in patients taking a biologic.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologic manufacturers have patient-assistance programs to help with financial issues. Therefore, choice of the right medication for your condition depends on many factors, not all of them medical. Additionally, convenience of receiving the medication and lifestyle affect the choice of the right biologic medication.

Is there an anti-psoriasis diet?

Most patients with psoriasis seem to be overweight. Since there is a predisposition for those patients to develop cardiovascular disease and diabetes, it is suggested strongly that they try to maintain a normal body weight. Although evidence is sparse, it has been suggested that slender patients are more likely to respond to treatment.

Although dietary studies are notoriously difficult to perform and interpret, it seems likely that a diet whose fat content is composed of polyunsaturated oils like olive oil and fish oil is beneficial for psoriasis. The so-called Mediterranean diet is an example.

What about light therapy for psoriasis?

Light therapy is also called phototherapy. There are several types of medical light therapies that include PUVA (an acronym for psoralen + UVA), UVB, and narrow-band UVB. These artificial light sources have been used for decades and generally are available in only certain physician’s offices. There are a few companies who may sell light boxes or light bulbs for prescribed home light therapy.

Natural sunlight is also used to treat psoriasis. Daily short, controlled exposures to natural sunlight may help or clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may need to be protected during sun exposure.

There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating medication and a special light source) that have been used to treat psoriasis.

PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure composed of wavelengths of ultraviolet light in the UVA spectrum. The photosensitizing drug in PUVA is called psoralen. Both the psoralen and the UVA light must be administered within one hour of each other for a response to occur. These treatments are usually given in a physician’s office two to three times per week. Several weeks of PUVA is usually required before seeing significant results. The light exposure time is gradually increased during each subsequent treatment. Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun sensitive and must avoid sun exposure for a period of time after PUVA. Common side effects with PUVA include burning, aging of the skin, increased brown spots called lentigines, and an increased risk of skin cancer, including melanoma. The relative increase in skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a physician and discontinued when a maximum number of treatments have been reached.

Narrow-band UVB phototherapy is an artificial light treatment using very limited wavelengths of light. It is frequently given daily or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and exposure is gradually increased as tolerated. Potential side effects with UVB include skin burning, premature aging, and possible increased risk of skin cancer. The relative increase in skin cancer risk with UVB treatment needs further study but is probably less than PUVA or traditional UVB.

Sometimes UVB is combined with other treatments such as tar application. Goeckerman is a special psoriasis therapy using this combination. Some centers have used this therapy in a “day care” type of setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.

Recently, a laser (excimer laser XTRAC) has been developed that generates ultraviolet light in the same range as narrow-band ultraviolet light. This light can be beneficial for psoriasis localized to small areas of skin like the palms, soles, and scalp. It is impractical to use in in extensive disease.

What is the long-term prognosis with psoriasis? What are complications of psoriasis?

Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable. As described above, recent studies show an association of psoriasis and other medical conditions, including obesity, diabetes, and heart disease.

Is it possible to prevent psoriasis?

Since psoriasis is inherited, it is impossible at this time to suggest anything that is likely to prevent its development aside from indulging in a healthy lifestyle.

What does the future hold for psoriasis?

Psoriasis research is heavily funded and holds great promise for the future. Just the last five to 10 years have produced great improvements in treatment of the disease with medications aimed at controlling precise sites of the process of inflammation. Ongoing research is needed to decipher the ultimate underlying cause of this disease.

Is there a national psoriasis support group?

Yes, the National Psoriasis Foundation (NPF) is an organization dedicated to helping patients with psoriasis and furthering research in this field. They hold national and local chapter meetings. The NPF web site (http://www.psoriasis.org/home/) shares up-to-date reliable medical information and statistics on the condition.

Where can people get more information on psoriasis?

A dermatologist, the American Academy of Dermatology at http://www.AAD.org, and the National Psoriasis Foundation at http://www.psoriasis.org/home/ may be excellent sources of more information.

There are many ongoing clinical trials for psoriasis all over the United States and in the world. Many of these clinical trials are ongoing at academic or university medical centers and are frequently open to patients without cost.

Clinical trials frequently have specific requirements for types and severity of psoriasis that may be enrolled into a specific trial. Patients need to contact these centers and inquire regarding the specific study requirements. Some studies have restrictions on what recent medications have been used for psoriasis, current medication, and overall health.

Some of the many medical centers in the U.S. offering clinical trials for psoriasis include the University of California, San Francisco Department of Dermatology, the University of California, Irvine Department of Dermatology, and the St. Louis University Medical School.

Medically Reviewed on 2/1/2018

References

Alwan, W., and F.O. Nestle. “Pathogenesis and Treatment of Psoriasis: Exploiting Pathophysiological Pathways for Precision Medicine.” Clin Exp Rheumatol 33 (Suppl. 93): S2-S6.

Arndt, Kenneth A., eds., et al. “Topical Therapies for Psoriasis.” Seminars in Cutaneous Medicine and Surgery 35.2S Mar. 2016: S35-S46.

Conrad, Curdin, Michel Gilliet. “Psoriasis: From Pathogenesis to Targeted Therapies.” Clinical Reviews in Allergy & Immunology Jan. 18, 2015.

Dowlatshahi, E.A., E.A.M van der Voort, L.R. Arends, and T. Nijsten. “Markers of Systemic Inflammation in Psoriasis: A Systematic Review and Meta-Analysis.” British Journal of Dermatology 169.2 Aug. 2013: 266282.

Greb, Jacqueline E., et al. “Psoriasis.” Nature Reviews Disease Primers 2 (2016): 1-17.

National Psoriasis Foundation. “Systemic Treatments: Biologics and Oral Treatments.” 1-25.

Ogawa, Eisaku, Yuki Sato, Akane Minagawa, and Ryuhei Okuyama. “Pathogenesis of Psoriasis and Development of Treatment.” The Journal of Dermatology 2017: 1-9.

Villaseor-Park, Jennifer, David Wheeler, and Lisa Grandinetti. “Psoriasis: Evolving Treatment for a Complex Disease.” Cleveland Clinic Journal of Medicine 79.6 June 2012: 413-423.

Woo, Yu Ri, Dae Ho Cho, and Hyun Jeong Park. “Molecular Mechanisms and Management of a Cutaneous Inflammatory Disorder: Psoriasis.” International Journal of Molecular Sciences 18 Dec. 11, 2017: 1-26.

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Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis – Symptoms and causes – Mayo Clinic

Overview

Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.

Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly.

There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help.

Psoriasis care at Mayo Clinic

Psoriasis signs and symptoms are different for everyone. Common signs and symptoms include:

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

There are several types of psoriasis. These include:

Guttate psoriasis. This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.

The lesions are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.

Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips.

It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.

If you suspect that you may have psoriasis, see your doctor for an examination. Also, talk to your doctor if your psoriasis:

Seek medical advice if your signs and symptoms worsen or don’t improve with treatment. You may need a different medication or a combination of treatments to manage the psoriasis.

The cause of psoriasis isn’t fully understood, but it’s thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body.

T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.

But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.

Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.

The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.

Just what causes T cells to malfunction in people with psoriasis isn’t entirely clear. Researchers believe both genetics and environmental factors play a role.

Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:

Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:

If you have psoriasis, you’re at greater risk of developing certain diseases. These include:

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Psoriasis – Symptoms and causes – Mayo Clinic

Psoriasis | NIAMS

Psoriasis is an autoimmune disease, which means that your bodys immune system which protects you from diseases starts overacting and causing problems. If you have psoriasis, a type of white blood cells called the T cells become so active that they trigger other immune system responses, including swelling and fast turnover of skin cells.

Your skin cells grow deep in the skin and rise slowly to the surface. This is called cell turnover, and it usually takes about a month. If you have psoriasis, though, cell turnover can take only a few days. Your skin cells rise too fast and pile up on the surface, causing your skin to look red and scaly.

Some things may cause a flare, meaning your psoriasis becomes worse for a while, including:

Certain genes have been linked to psoriasis, meaning it runs in families.

Original post:

Psoriasis | NIAMS

Psoriasis – What is Psoriasis? Basic Symptoms and Types

Articles OnWhat Is Psoriasis? What Is Psoriasis? What Is Psoriasis? What Is Psoriasis?

Unpredictable and irritating, psoriasis is one of the most baffling and persistent of skin disorders. It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plaques covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and soles of the feet.

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis — the most common variety of the condition — include:

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Other forms of psoriasis include:

Pustular psoriasis , characterized by red and scaly skin on the palms of the hands and/or feet with tiny pustules

Guttate psoriasis, which often starts in childhood or young adulthood, is characterized by small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and use of anti-malarial and beta-blocker medications.

Inverse psoriasis, characterized by bright red, shiny lesions that appear in skin folds, such as the armpits, groin area, and under the breasts

Erythrodermic psoriasis, characterized by periodic, fiery redness of the skin and shedding of scales in sheets; this form of psoriasis, triggered by withdrawal from a systemic psoriasis treatment, severe sunburn, infection, and certain medications, requires immediate medical treatment, because it can lead to severe illness.

People who suffer from psoriasis know that this uncomfortable and at times disfiguring skin disease can be difficult and frustrating to treat. The condition comes and goes in cycles of remissions and flare-ups over a lifetime. While there are medications and other therapies that can help to clear up the patches of red, scaly, thickened skin that are the hallmark of psoriasis, there is no cure.

A variety of factors — ranging from emotional stress and trauma to streptococcal infection — can cause an episode of psoriasis. Recent research indicates that some abnormality in the immune system is the key cause of psoriasis. As many as 80% of people having flare-ups report a recent emotional trauma, such as a new job or the death of a loved one. Most doctors believe such external stressors serve as triggers for an inherited defect in immune function.

Injured skin and certain drugs can aggravate psoriasis, including certain types of blood pressure medications (like beta-blockers), the anti-malarial medication hydroxychloroquine, and ibuprofen (Advil, Motrin, etc.).

Psoriasis tends to run in families, but it may be skip generations; a grandfather and his grandson may be affected, but the child’s mother never develops the disease. Although psoriasis may be stressful and embarrassing, most outbreaks are relatively harmless. With appropriate treatment, symptoms generally subside within a few months.

SOURCES:National Institute of Arthritis and Musculoskeletal and Skin Disease.National Psoriasis Foundation.The Psoriasis Foundation.American Academy of Dermatology.

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Psoriasis – What is Psoriasis? Basic Symptoms and Types

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis facts

What is psoriasis?

Psoriasis is a noncontagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-lymphocytes. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface.

Psoriasis is considered an incurable, long-term (chronic) inflammatory skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.

Psoriasis affects all races and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. The quality of life of patients with psoriasis is often diminished because of the appearance of their skin. Recently, it has become clear that people with psoriasis are more likely to have diabetes, high blood lipids, cardiovascular disease, and a variety of other inflammatory diseases. This may reflect an inability to control inflammation. Caring for psoriasis takes medical teamwork.

No. Psoriasis is not contagious. Psoriasis is not transmitted sexually or by physical contact. Psoriasis is not caused by lifestyle, diet, or bad hygiene.

While the exact cause of psoriasis is unknown, researchers consider environmental, genetic, and immune system factors as playing roles in the establishment of the disease.

What are psoriasis causes and risk factors?

The exact cause remains unknown. A combination of elements, including genetic predisposition and environmental factors, are involved. It is common for psoriasis to be found in members of the same family. Defects in immune regulation and the control of inflammation are thought to play major roles. Certain medications like beta-blockers have been linked to psoriasis. Despite research over the past 30 years, the “master switch” that turns on psoriasis is still a mystery.

What are the different types of psoriasis?

There are several different forms of psoriasis, including plaque psoriasis or psoriasis vulgaris (common plaque type), guttate psoriasis (small, drop-like spots), inverse psoriasis (in the folds like of the underarms, navel, groin, and buttocks), and pustular psoriasis (small pus-filled yellowish blisters). When the palms and the soles are involved, this is known as palmoplantar psoriasis. In erythrodermic psoriasis, the entire skin surface is involved with the disease. Patients with this form of psoriasis often feel cold and may develop congestive heart failure if they have a preexisting heart problem. Nail psoriasis produces yellow pitted nails that can be confused with nail fungus. Scalp psoriasis can be severe enough to produce localized hair loss, plenty of dandruff, and severe itching.

Can psoriasis affect my joints?

Yes, psoriasis is associated with inflamed joints in about one-third of those affected. In fact, sometimes joint pains may be the only sign of the disorder, with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and needs to be treated with medications in order to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. Usually, the skin symptoms and signs precede the onset of the arthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

What are psoriasis symptoms and signs? What does psoriasis look like?

Plaque psoriasis signs and symptoms appear as red or pink small scaly bumps that merge into plaques of raised skin. Plaque psoriasis classically affects skin over the elbows, knees, and scalp and is often itchy. Although any area may be involved, plaque psoriasis tends to be more common at sites of friction, scratching, or abrasion. Sometimes pulling off one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is a special diagnostic sign in psoriasis called the Auspitz sign.

Fingernails and toenails often exhibit small pits (pinpoint depressions) and/or larger yellowish-brown separations of the nail from the nail bed at the fingertip called distal onycholysis. Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.

Guttate psoriasis symptoms and signs include bumps or small plaques ( inch or less) of red itchy, scaling skin that may appear explosively, affecting large parts of the skin surface simultaneously, after a sore throat.

In inverse psoriasis, genital lesions, especially in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or the area between the buttocks (intergluteal folds) may look like flat red plaques without much scaling. This may be confused with other skin conditions like fungal infections, yeast infections, allergic rashes, or bacterial infections.

Symptoms and signs of pustular psoriasis include at rapid onset of groups of small bumps filled with pus on the torso. Patients are often systemically ill and may have a fever.

Erythrodermic psoriasis appears as extensive areas of red skin often involving the entire skin surface. Patients may often feel chilled.

Scalp psoriasis may look like severe dandruff with dry flakes and red areas of skin. It can be difficult to differentiate between scalp psoriasis and seborrheic dermatitis when only the scalp is involved. However, the treatment is often very similar for both conditions.

How do health care professionals diagnose psoriasis?

The diagnosis of psoriasis is typically made by obtaining information from the physical examination of the skin, medical history, and relevant family health history.

Sometimes lab tests, including a microscopic examination of tissue obtained from a skin biopsy, may be necessary.

Eczema vs. psoriasis

Occasionally, it can be difficult to differentiate eczematous dermatitis from psoriasis. This is when a biopsy can be quite valuable to distinguish between the two conditions. Of note, both eczematous dermatitis and psoriasis often respond to similar treatments. Certain types of eczematous dermatitis can be cured where this is not the case for psoriasis.

How many people have psoriasis?

Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S. population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.

Is psoriasis contagious?

No. A person cannot catch it from someone else, and one cannot pass it to anyone else by skin-to-skin contact. Directly touching someone with psoriasis every day will never transmit the condition.

Is there a cure for psoriasis?

No, psoriasis is not currently curable. However, it can go into remission, producing an entirely normal skin surface. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis hereditary?

Although psoriasis is not contagious from person to person, there is a known hereditary tendency. Therefore, family history is very helpful in making the diagnosis.

What health care specialists treat psoriasis?

Dermatologists are doctors who specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the treatment of joint disorders and psoriatic arthritis. Many kinds of doctors may treat psoriasis, including dermatologists, family physicians, internal medicine physicians, rheumatologists, and other medical doctors. Some patients have also seen other allied health professionals such as acupuncturists, holistic practitioners, chiropractors, and nutritionists.

The American Academy of Dermatology and the National Psoriasis Foundation are excellent sources to help find doctors who specialize in this disease. Not all dermatologists and rheumatologists treat psoriasis. The National Psoriasis Foundation has one of the most up-to-date databases of current psoriasis specialists.

It is now apparent that patients with psoriasis are prone to a variety of other disease conditions, so-called comorbidities. Cardiovascular disease, diabetes, hypertension, inflammatory bowel disease, hyperlipidemia, liver problems, and arthritis are more common in patients with psoriasis. It is very important for all patients with psoriasis to be carefully monitored by their primary care providers for these associated illnesses. The joint inflammation of psoriatic arthritis and its complications are frequently managed by rheumatologists.

What are psoriasis treatment options?

There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.

For mild disease that involves only small areas of the body (less than 10% of the total skin surface), topical treatments (skin applied), such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (>10% or more of the total skin surface), topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

It is important to keep in mind that as with any medical condition, all medicines carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may become incapacitated and require treatment internally.

A proposal to minimize the toxicity of some of these medicines has been commonly called “rotational” therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an option. An exception to this proposal is the use of the newer biologic medications as described below. An individual who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy.

What creams, lotions, and home remedies are available for psoriasis?

Topical (skin applied) treatments include topical corticosteroids, vitamin D analogue creams like calcipotriene (Calcitrene, Dovonex, Sorilux), topical retinoids (tazarotene [Tazorac]), moisturizers, topical immunomodulators (tacrolimus and pimecrolimus), coal tar, anthralin, and others.

Are psoriasis shampoos available?

Coal tar shampoos are very useful in controlling psoriasis of the scalp. Using the shampoo daily can be very beneficial adjunctive therapy. There are a variety of shampoos available without a prescription. There is no evidence that one shampoo is superior to another. Generally, the selection of a tar shampoo is simply a matter of personal preference.

What oral medications are available for psoriasis?

Oral medications include methotrexate (Trexall), acitretin (Soriatane), cyclosporine (Neoral), apremilast (Otezla), and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare-up if administered.

What injections or infusions are available for psoriasis?

Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:

Drug choice can be complicated, and your physician will help in selecting the best option. In some patients. it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.

Newer drugs are in development and no doubt will be available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored. Biologics are all comparatively expensive especially in view of the fact they none of them are curative. Recently, the FDA has attempted to address this problem by permitting the use of “biosimilar” drugs. These drugs are structurally identical to a specific biologic drug and are presumed to produce identical therapeutic responses in human beings to the original, but are produced using different methodology. Biosimilars ought to be available at some fraction of the cost of the original. If this will be an effective approach remains to be seen. The only biosimilar available currently is infliximab (Inflectra). Two other biosimilar drugs have been accepted by the FDA, an etanercept equivalent (Erelzi) and an adalimumab equivalent (Amjevita) — but currently, neither are available.

Some biologics are to be administered by self-injections for home use while others are given by intravenous infusions in the doctor’s office. Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy. As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs. Precautions include patients with known or suspected hepatitis B infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy. In particular, there may be an increased association of lymphoma in patients taking a biologic.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologic manufacturers have patient-assistance programs to help with financial issues. Therefore, choice of the right medication for your condition depends on many factors, not all of them medical. Additionally, convenience of receiving the medication and lifestyle affect the choice of the right biologic medication.

Is there an anti-psoriasis diet?

Most patients with psoriasis seem to be overweight. Since there is a predisposition for those patients to develop cardiovascular disease and diabetes, it is suggested strongly that they try to maintain a normal body weight. Although evidence is sparse, it has been suggested that slender patients are more likely to respond to treatment.

Although dietary studies are notoriously difficult to perform and interpret, it seems likely that a diet whose fat content is composed of polyunsaturated oils like olive oil and fish oil is beneficial for psoriasis. The so-called Mediterranean diet is an example.

What about light therapy for psoriasis?

Light therapy is also called phototherapy. There are several types of medical light therapies that include PUVA (an acronym for psoralen + UVA), UVB, and narrow-band UVB. These artificial light sources have been used for decades and generally are available in only certain physician’s offices. There are a few companies who may sell light boxes or light bulbs for prescribed home light therapy.

Natural sunlight is also used to treat psoriasis. Daily short, controlled exposures to natural sunlight may help or clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may need to be protected during sun exposure.

There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating medication and a special light source) that have been used to treat psoriasis.

PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure composed of wavelengths of ultraviolet light in the UVA spectrum. The photosensitizing drug in PUVA is called psoralen. Both the psoralen and the UVA light must be administered within one hour of each other for a response to occur. These treatments are usually given in a physician’s office two to three times per week. Several weeks of PUVA is usually required before seeing significant results. The light exposure time is gradually increased during each subsequent treatment. Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun sensitive and must avoid sun exposure for a period of time after PUVA. Common side effects with PUVA include burning, aging of the skin, increased brown spots called lentigines, and an increased risk of skin cancer, including melanoma. The relative increase in skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a physician and discontinued when a maximum number of treatments have been reached.

Narrow-band UVB phototherapy is an artificial light treatment using very limited wavelengths of light. It is frequently given daily or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and exposure is gradually increased as tolerated. Potential side effects with UVB include skin burning, premature aging, and possible increased risk of skin cancer. The relative increase in skin cancer risk with UVB treatment needs further study but is probably less than PUVA or traditional UVB.

Sometimes UVB is combined with other treatments such as tar application. Goeckerman is a special psoriasis therapy using this combination. Some centers have used this therapy in a “day care” type of setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.

Recently, a laser (excimer laser XTRAC) has been developed that generates ultraviolet light in the same range as narrow-band ultraviolet light. This light can be beneficial for psoriasis localized to small areas of skin like the palms, soles, and scalp. It is impractical to use in in extensive disease.

What is the long-term prognosis with psoriasis? What are complications of psoriasis?

Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable. As described above, recent studies show an association of psoriasis and other medical conditions, including obesity, diabetes, and heart disease.

Is it possible to prevent psoriasis?

Since psoriasis is inherited, it is impossible at this time to suggest anything that is likely to prevent its development aside from indulging in a healthy lifestyle.

What does the future hold for psoriasis?

Psoriasis research is heavily funded and holds great promise for the future. Just the last five to 10 years have produced great improvements in treatment of the disease with medications aimed at controlling precise sites of the process of inflammation. Ongoing research is needed to decipher the ultimate underlying cause of this disease.

Is there a national psoriasis support group?

Yes, the National Psoriasis Foundation (NPF) is an organization dedicated to helping patients with psoriasis and furthering research in this field. They hold national and local chapter meetings. The NPF web site (http://www.psoriasis.org/home/) shares up-to-date reliable medical information and statistics on the condition.

Where can people get more information on psoriasis?

A dermatologist, the American Academy of Dermatology at http://www.AAD.org, and the National Psoriasis Foundation at http://www.psoriasis.org/home/ may be excellent sources of more information.

There are many ongoing clinical trials for psoriasis all over the United States and in the world. Many of these clinical trials are ongoing at academic or university medical centers and are frequently open to patients without cost.

Clinical trials frequently have specific requirements for types and severity of psoriasis that may be enrolled into a specific trial. Patients need to contact these centers and inquire regarding the specific study requirements. Some studies have restrictions on what recent medications have been used for psoriasis, current medication, and overall health.

Some of the many medical centers in the U.S. offering clinical trials for psoriasis include the University of California, San Francisco Department of Dermatology, the University of California, Irvine Department of Dermatology, and the St. Louis University Medical School.

Medically Reviewed on 2/1/2018

References

Alwan, W., and F.O. Nestle. “Pathogenesis and Treatment of Psoriasis: Exploiting Pathophysiological Pathways for Precision Medicine.” Clin Exp Rheumatol 33 (Suppl. 93): S2-S6.

Arndt, Kenneth A., eds., et al. “Topical Therapies for Psoriasis.” Seminars in Cutaneous Medicine and Surgery 35.2S Mar. 2016: S35-S46.

Conrad, Curdin, Michel Gilliet. “Psoriasis: From Pathogenesis to Targeted Therapies.” Clinical Reviews in Allergy & Immunology Jan. 18, 2015.

Dowlatshahi, E.A., E.A.M van der Voort, L.R. Arends, and T. Nijsten. “Markers of Systemic Inflammation in Psoriasis: A Systematic Review and Meta-Analysis.” British Journal of Dermatology 169.2 Aug. 2013: 266282.

Greb, Jacqueline E., et al. “Psoriasis.” Nature Reviews Disease Primers 2 (2016): 1-17.

National Psoriasis Foundation. “Systemic Treatments: Biologics and Oral Treatments.” 1-25.

Ogawa, Eisaku, Yuki Sato, Akane Minagawa, and Ryuhei Okuyama. “Pathogenesis of Psoriasis and Development of Treatment.” The Journal of Dermatology 2017: 1-9.

Villaseor-Park, Jennifer, David Wheeler, and Lisa Grandinetti. “Psoriasis: Evolving Treatment for a Complex Disease.” Cleveland Clinic Journal of Medicine 79.6 June 2012: 413-423.

Woo, Yu Ri, Dae Ho Cho, and Hyun Jeong Park. “Molecular Mechanisms and Management of a Cutaneous Inflammatory Disorder: Psoriasis.” International Journal of Molecular Sciences 18 Dec. 11, 2017: 1-26.

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Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis | Psoriatic Arthritis | MedlinePlus

Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales. You usually get the patches on your elbows, knees, scalp, back, face, palms and feet, but they can show up on other parts of your body. Some people who have psoriasis also get a form of arthritis called psoriatic arthritis.

A problem with your immune system causes psoriasis. In a process called cell turnover, skin cells that grow deep in your skin rise to the surface. Normally, this takes a month. In psoriasis, it happens in just days because your cells rise too fast.

Psoriasis can be hard to diagnose because it can look like other skin diseases. Your doctor might need to look at a small skin sample under a microscope.

Psoriasis can last a long time, even a lifetime. Symptoms come and go. Things that make them worse include

Psoriasis usually occurs in adults. It sometimes runs in families. Treatments include creams, medicines, and light therapy.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

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Psoriasis | Psoriatic Arthritis | MedlinePlus

Psoriasis | NIAMS

Psoriasis is an autoimmune disease, which means that your bodys immune system which protects you from diseases starts overacting and causing problems. If you have psoriasis, a type of white blood cells called the T cells become so active that they trigger other immune system responses, including swelling and fast turnover of skin cells.

Your skin cells grow deep in the skin and rise slowly to the surface. This is called cell turnover, and it usually takes about a month. If you have psoriasis, though, cell turnover can take only a few days. Your skin cells rise too fast and pile up on the surface, causing your skin to look red and scaly.

Some things may cause a flare, meaning your psoriasis becomes worse for a while, including:

Certain genes have been linked to psoriasis, meaning it runs in families.

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Psoriasis | NIAMS

Psoriasis – What is Psoriasis? Basic Symptoms and Types

Articles OnWhat Is Psoriasis? What Is Psoriasis? What Is Psoriasis? What Is Psoriasis?

Unpredictable and irritating, psoriasis is one of the most baffling and persistent of skin disorders. It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plaques covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and soles of the feet.

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis — the most common variety of the condition — include:

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Other forms of psoriasis include:

Pustular psoriasis , characterized by red and scaly skin on the palms of the hands and/or feet with tiny pustules

Guttate psoriasis, which often starts in childhood or young adulthood, is characterized by small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and use of anti-malarial and beta-blocker medications.

Inverse psoriasis, characterized by bright red, shiny lesions that appear in skin folds, such as the armpits, groin area, and under the breasts

Erythrodermic psoriasis, characterized by periodic, fiery redness of the skin and shedding of scales in sheets; this form of psoriasis, triggered by withdrawal from a systemic psoriasis treatment, severe sunburn, infection, and certain medications, requires immediate medical treatment, because it can lead to severe illness.

People who suffer from psoriasis know that this uncomfortable and at times disfiguring skin disease can be difficult and frustrating to treat. The condition comes and goes in cycles of remissions and flare-ups over a lifetime. While there are medications and other therapies that can help to clear up the patches of red, scaly, thickened skin that are the hallmark of psoriasis, there is no cure.

A variety of factors — ranging from emotional stress and trauma to streptococcal infection — can cause an episode of psoriasis. Recent research indicates that some abnormality in the immune system is the key cause of psoriasis. As many as 80% of people having flare-ups report a recent emotional trauma, such as a new job or the death of a loved one. Most doctors believe such external stressors serve as triggers for an inherited defect in immune function.

Injured skin and certain drugs can aggravate psoriasis, including certain types of blood pressure medications (like beta-blockers), the anti-malarial medication hydroxychloroquine, and ibuprofen (Advil, Motrin, etc.).

Psoriasis tends to run in families, but it may be skip generations; a grandfather and his grandson may be affected, but the child’s mother never develops the disease. Although psoriasis may be stressful and embarrassing, most outbreaks are relatively harmless. With appropriate treatment, symptoms generally subside within a few months.

SOURCES:National Institute of Arthritis and Musculoskeletal and Skin Disease.National Psoriasis Foundation.The Psoriasis Foundation.American Academy of Dermatology.

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Psoriasis – What is Psoriasis? Basic Symptoms and Types

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis facts

What is psoriasis?

Psoriasis is a noncontagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-lymphocytes. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface.

Psoriasis is considered an incurable, long-term (chronic) inflammatory skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.

Psoriasis affects all races and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. The quality of life of patients with psoriasis is often diminished because of the appearance of their skin. Recently, it has become clear that people with psoriasis are more likely to have diabetes, high blood lipids, cardiovascular disease, and a variety of other inflammatory diseases. This may reflect an inability to control inflammation. Caring for psoriasis takes medical teamwork.

No. Psoriasis is not contagious. Psoriasis is not transmitted sexually or by physical contact. Psoriasis is not caused by lifestyle, diet, or bad hygiene.

While the exact cause of psoriasis is unknown, researchers consider environmental, genetic, and immune system factors as playing roles in the establishment of the disease.

What are psoriasis causes and risk factors?

The exact cause remains unknown. A combination of elements, including genetic predisposition and environmental factors, are involved. It is common for psoriasis to be found in members of the same family. Defects in immune regulation and the control of inflammation are thought to play major roles. Certain medications like beta-blockers have been linked to psoriasis. Despite research over the past 30 years, the “master switch” that turns on psoriasis is still a mystery.

What are the different types of psoriasis?

There are several different forms of psoriasis, including plaque psoriasis or psoriasis vulgaris (common plaque type), guttate psoriasis (small, drop-like spots), inverse psoriasis (in the folds like of the underarms, navel, groin, and buttocks), and pustular psoriasis (small pus-filled yellowish blisters). When the palms and the soles are involved, this is known as palmoplantar psoriasis. In erythrodermic psoriasis, the entire skin surface is involved with the disease. Patients with this form of psoriasis often feel cold and may develop congestive heart failure if they have a preexisting heart problem. Nail psoriasis produces yellow pitted nails that can be confused with nail fungus. Scalp psoriasis can be severe enough to produce localized hair loss, plenty of dandruff, and severe itching.

Can psoriasis affect my joints?

Yes, psoriasis is associated with inflamed joints in about one-third of those affected. In fact, sometimes joint pains may be the only sign of the disorder, with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and needs to be treated with medications in order to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. Usually, the skin symptoms and signs precede the onset of the arthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

What are psoriasis symptoms and signs? What does psoriasis look like?

Plaque psoriasis signs and symptoms appear as red or pink small scaly bumps that merge into plaques of raised skin. Plaque psoriasis classically affects skin over the elbows, knees, and scalp and is often itchy. Although any area may be involved, plaque psoriasis tends to be more common at sites of friction, scratching, or abrasion. Sometimes pulling off one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is a special diagnostic sign in psoriasis called the Auspitz sign.

Fingernails and toenails often exhibit small pits (pinpoint depressions) and/or larger yellowish-brown separations of the nail from the nail bed at the fingertip called distal onycholysis. Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.

Guttate psoriasis symptoms and signs include bumps or small plaques ( inch or less) of red itchy, scaling skin that may appear explosively, affecting large parts of the skin surface simultaneously, after a sore throat.

In inverse psoriasis, genital lesions, especially in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or the area between the buttocks (intergluteal folds) may look like flat red plaques without much scaling. This may be confused with other skin conditions like fungal infections, yeast infections, allergic rashes, or bacterial infections.

Symptoms and signs of pustular psoriasis include at rapid onset of groups of small bumps filled with pus on the torso. Patients are often systemically ill and may have a fever.

Erythrodermic psoriasis appears as extensive areas of red skin often involving the entire skin surface. Patients may often feel chilled.

Scalp psoriasis may look like severe dandruff with dry flakes and red areas of skin. It can be difficult to differentiate between scalp psoriasis and seborrheic dermatitis when only the scalp is involved. However, the treatment is often very similar for both conditions.

How do health care professionals diagnose psoriasis?

The diagnosis of psoriasis is typically made by obtaining information from the physical examination of the skin, medical history, and relevant family health history.

Sometimes lab tests, including a microscopic examination of tissue obtained from a skin biopsy, may be necessary.

Eczema vs. psoriasis

Occasionally, it can be difficult to differentiate eczematous dermatitis from psoriasis. This is when a biopsy can be quite valuable to distinguish between the two conditions. Of note, both eczematous dermatitis and psoriasis often respond to similar treatments. Certain types of eczematous dermatitis can be cured where this is not the case for psoriasis.

How many people have psoriasis?

Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S. population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.

Is psoriasis contagious?

No. A person cannot catch it from someone else, and one cannot pass it to anyone else by skin-to-skin contact. Directly touching someone with psoriasis every day will never transmit the condition.

Is there a cure for psoriasis?

No, psoriasis is not currently curable. However, it can go into remission, producing an entirely normal skin surface. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis hereditary?

Although psoriasis is not contagious from person to person, there is a known hereditary tendency. Therefore, family history is very helpful in making the diagnosis.

What health care specialists treat psoriasis?

Dermatologists are doctors who specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the treatment of joint disorders and psoriatic arthritis. Many kinds of doctors may treat psoriasis, including dermatologists, family physicians, internal medicine physicians, rheumatologists, and other medical doctors. Some patients have also seen other allied health professionals such as acupuncturists, holistic practitioners, chiropractors, and nutritionists.

The American Academy of Dermatology and the National Psoriasis Foundation are excellent sources to help find doctors who specialize in this disease. Not all dermatologists and rheumatologists treat psoriasis. The National Psoriasis Foundation has one of the most up-to-date databases of current psoriasis specialists.

It is now apparent that patients with psoriasis are prone to a variety of other disease conditions, so-called comorbidities. Cardiovascular disease, diabetes, hypertension, inflammatory bowel disease, hyperlipidemia, liver problems, and arthritis are more common in patients with psoriasis. It is very important for all patients with psoriasis to be carefully monitored by their primary care providers for these associated illnesses. The joint inflammation of psoriatic arthritis and its complications are frequently managed by rheumatologists.

What are psoriasis treatment options?

There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.

For mild disease that involves only small areas of the body (less than 10% of the total skin surface), topical treatments (skin applied), such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (>10% or more of the total skin surface), topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

It is important to keep in mind that as with any medical condition, all medicines carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may become incapacitated and require treatment internally.

A proposal to minimize the toxicity of some of these medicines has been commonly called “rotational” therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an option. An exception to this proposal is the use of the newer biologic medications as described below. An individual who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy.

What creams, lotions, and home remedies are available for psoriasis?

Topical (skin applied) treatments include topical corticosteroids, vitamin D analogue creams like calcipotriene (Calcitrene, Dovonex, Sorilux), topical retinoids (tazarotene [Tazorac]), moisturizers, topical immunomodulators (tacrolimus and pimecrolimus), coal tar, anthralin, and others.

Are psoriasis shampoos available?

Coal tar shampoos are very useful in controlling psoriasis of the scalp. Using the shampoo daily can be very beneficial adjunctive therapy. There are a variety of shampoos available without a prescription. There is no evidence that one shampoo is superior to another. Generally, the selection of a tar shampoo is simply a matter of personal preference.

What oral medications are available for psoriasis?

Oral medications include methotrexate (Trexall), acitretin (Soriatane), cyclosporine (Neoral), apremilast (Otezla), and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare-up if administered.

What injections or infusions are available for psoriasis?

Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:

Drug choice can be complicated, and your physician will help in selecting the best option. In some patients. it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.

Newer drugs are in development and no doubt will be available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored. Biologics are all comparatively expensive especially in view of the fact they none of them are curative. Recently, the FDA has attempted to address this problem by permitting the use of “biosimilar” drugs. These drugs are structurally identical to a specific biologic drug and are presumed to produce identical therapeutic responses in human beings to the original, but are produced using different methodology. Biosimilars ought to be available at some fraction of the cost of the original. If this will be an effective approach remains to be seen. The only biosimilar available currently is infliximab (Inflectra). Two other biosimilar drugs have been accepted by the FDA, an etanercept equivalent (Erelzi) and an adalimumab equivalent (Amjevita) — but currently, neither are available.

Some biologics are to be administered by self-injections for home use while others are given by intravenous infusions in the doctor’s office. Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy. As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs. Precautions include patients with known or suspected hepatitis B infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy. In particular, there may be an increased association of lymphoma in patients taking a biologic.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologic manufacturers have patient-assistance programs to help with financial issues. Therefore, choice of the right medication for your condition depends on many factors, not all of them medical. Additionally, convenience of receiving the medication and lifestyle affect the choice of the right biologic medication.

Is there an anti-psoriasis diet?

Most patients with psoriasis seem to be overweight. Since there is a predisposition for those patients to develop cardiovascular disease and diabetes, it is suggested strongly that they try to maintain a normal body weight. Although evidence is sparse, it has been suggested that slender patients are more likely to respond to treatment.

Although dietary studies are notoriously difficult to perform and interpret, it seems likely that a diet whose fat content is composed of polyunsaturated oils like olive oil and fish oil is beneficial for psoriasis. The so-called Mediterranean diet is an example.

What about light therapy for psoriasis?

Light therapy is also called phototherapy. There are several types of medical light therapies that include PUVA (an acronym for psoralen + UVA), UVB, and narrow-band UVB. These artificial light sources have been used for decades and generally are available in only certain physician’s offices. There are a few companies who may sell light boxes or light bulbs for prescribed home light therapy.

Natural sunlight is also used to treat psoriasis. Daily short, controlled exposures to natural sunlight may help or clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may need to be protected during sun exposure.

There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating medication and a special light source) that have been used to treat psoriasis.

PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure composed of wavelengths of ultraviolet light in the UVA spectrum. The photosensitizing drug in PUVA is called psoralen. Both the psoralen and the UVA light must be administered within one hour of each other for a response to occur. These treatments are usually given in a physician’s office two to three times per week. Several weeks of PUVA is usually required before seeing significant results. The light exposure time is gradually increased during each subsequent treatment. Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun sensitive and must avoid sun exposure for a period of time after PUVA. Common side effects with PUVA include burning, aging of the skin, increased brown spots called lentigines, and an increased risk of skin cancer, including melanoma. The relative increase in skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a physician and discontinued when a maximum number of treatments have been reached.

Narrow-band UVB phototherapy is an artificial light treatment using very limited wavelengths of light. It is frequently given daily or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and exposure is gradually increased as tolerated. Potential side effects with UVB include skin burning, premature aging, and possible increased risk of skin cancer. The relative increase in skin cancer risk with UVB treatment needs further study but is probably less than PUVA or traditional UVB.

Sometimes UVB is combined with other treatments such as tar application. Goeckerman is a special psoriasis therapy using this combination. Some centers have used this therapy in a “day care” type of setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.

Recently, a laser (excimer laser XTRAC) has been developed that generates ultraviolet light in the same range as narrow-band ultraviolet light. This light can be beneficial for psoriasis localized to small areas of skin like the palms, soles, and scalp. It is impractical to use in in extensive disease.

What is the long-term prognosis with psoriasis? What are complications of psoriasis?

Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable. As described above, recent studies show an association of psoriasis and other medical conditions, including obesity, diabetes, and heart disease.

Is it possible to prevent psoriasis?

Since psoriasis is inherited, it is impossible at this time to suggest anything that is likely to prevent its development aside from indulging in a healthy lifestyle.

What does the future hold for psoriasis?

Psoriasis research is heavily funded and holds great promise for the future. Just the last five to 10 years have produced great improvements in treatment of the disease with medications aimed at controlling precise sites of the process of inflammation. Ongoing research is needed to decipher the ultimate underlying cause of this disease.

Is there a national psoriasis support group?

Yes, the National Psoriasis Foundation (NPF) is an organization dedicated to helping patients with psoriasis and furthering research in this field. They hold national and local chapter meetings. The NPF web site (http://www.psoriasis.org/home/) shares up-to-date reliable medical information and statistics on the condition.

Where can people get more information on psoriasis?

A dermatologist, the American Academy of Dermatology at http://www.AAD.org, and the National Psoriasis Foundation at http://www.psoriasis.org/home/ may be excellent sources of more information.

There are many ongoing clinical trials for psoriasis all over the United States and in the world. Many of these clinical trials are ongoing at academic or university medical centers and are frequently open to patients without cost.

Clinical trials frequently have specific requirements for types and severity of psoriasis that may be enrolled into a specific trial. Patients need to contact these centers and inquire regarding the specific study requirements. Some studies have restrictions on what recent medications have been used for psoriasis, current medication, and overall health.

Some of the many medical centers in the U.S. offering clinical trials for psoriasis include the University of California, San Francisco Department of Dermatology, the University of California, Irvine Department of Dermatology, and the St. Louis University Medical School.

Medically Reviewed on 2/1/2018

References

Alwan, W., and F.O. Nestle. “Pathogenesis and Treatment of Psoriasis: Exploiting Pathophysiological Pathways for Precision Medicine.” Clin Exp Rheumatol 33 (Suppl. 93): S2-S6.

Arndt, Kenneth A., eds., et al. “Topical Therapies for Psoriasis.” Seminars in Cutaneous Medicine and Surgery 35.2S Mar. 2016: S35-S46.

Conrad, Curdin, Michel Gilliet. “Psoriasis: From Pathogenesis to Targeted Therapies.” Clinical Reviews in Allergy & Immunology Jan. 18, 2015.

Dowlatshahi, E.A., E.A.M van der Voort, L.R. Arends, and T. Nijsten. “Markers of Systemic Inflammation in Psoriasis: A Systematic Review and Meta-Analysis.” British Journal of Dermatology 169.2 Aug. 2013: 266282.

Greb, Jacqueline E., et al. “Psoriasis.” Nature Reviews Disease Primers 2 (2016): 1-17.

National Psoriasis Foundation. “Systemic Treatments: Biologics and Oral Treatments.” 1-25.

Ogawa, Eisaku, Yuki Sato, Akane Minagawa, and Ryuhei Okuyama. “Pathogenesis of Psoriasis and Development of Treatment.” The Journal of Dermatology 2017: 1-9.

Villaseor-Park, Jennifer, David Wheeler, and Lisa Grandinetti. “Psoriasis: Evolving Treatment for a Complex Disease.” Cleveland Clinic Journal of Medicine 79.6 June 2012: 413-423.

Woo, Yu Ri, Dae Ho Cho, and Hyun Jeong Park. “Molecular Mechanisms and Management of a Cutaneous Inflammatory Disorder: Psoriasis.” International Journal of Molecular Sciences 18 Dec. 11, 2017: 1-26.

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Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis facts

What is psoriasis?

Psoriasis is a noncontagious, chronic skin condition that produces plaques of thickened, scaling skin. The dry flakes of skin scales result from the excessively rapid proliferation of skin cells. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-lymphocytes. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface.

Psoriasis is considered an incurable, long-term (chronic) inflammatory skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months.

Psoriasis affects all races and both sexes. Although psoriasis can be seen in people of any age, from babies to seniors, most commonly patients are first diagnosed in their early adult years. The quality of life of patients with psoriasis is often diminished because of the appearance of their skin. Recently, it has become clear that people with psoriasis are more likely to have diabetes, high blood lipids, cardiovascular disease, and a variety of other inflammatory diseases. This may reflect an inability to control inflammation. Caring for psoriasis takes medical teamwork.

No. Psoriasis is not contagious. Psoriasis is not transmitted sexually or by physical contact. Psoriasis is not caused by lifestyle, diet, or bad hygiene.

While the exact cause of psoriasis is unknown, researchers consider environmental, genetic, and immune system factors as playing roles in the establishment of the disease.

What are psoriasis causes and risk factors?

The exact cause remains unknown. A combination of elements, including genetic predisposition and environmental factors, are involved. It is common for psoriasis to be found in members of the same family. Defects in immune regulation and the control of inflammation are thought to play major roles. Certain medications like beta-blockers have been linked to psoriasis. Despite research over the past 30 years, the “master switch” that turns on psoriasis is still a mystery.

What are the different types of psoriasis?

There are several different forms of psoriasis, including plaque psoriasis or psoriasis vulgaris (common plaque type), guttate psoriasis (small, drop-like spots), inverse psoriasis (in the folds like of the underarms, navel, groin, and buttocks), and pustular psoriasis (small pus-filled yellowish blisters). When the palms and the soles are involved, this is known as palmoplantar psoriasis. In erythrodermic psoriasis, the entire skin surface is involved with the disease. Patients with this form of psoriasis often feel cold and may develop congestive heart failure if they have a preexisting heart problem. Nail psoriasis produces yellow pitted nails that can be confused with nail fungus. Scalp psoriasis can be severe enough to produce localized hair loss, plenty of dandruff, and severe itching.

Can psoriasis affect my joints?

Yes, psoriasis is associated with inflamed joints in about one-third of those affected. In fact, sometimes joint pains may be the only sign of the disorder, with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and needs to be treated with medications in order to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. Usually, the skin symptoms and signs precede the onset of the arthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

What are psoriasis symptoms and signs? What does psoriasis look like?

Plaque psoriasis signs and symptoms appear as red or pink small scaly bumps that merge into plaques of raised skin. Plaque psoriasis classically affects skin over the elbows, knees, and scalp and is often itchy. Although any area may be involved, plaque psoriasis tends to be more common at sites of friction, scratching, or abrasion. Sometimes pulling off one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is a special diagnostic sign in psoriasis called the Auspitz sign.

Fingernails and toenails often exhibit small pits (pinpoint depressions) and/or larger yellowish-brown separations of the nail from the nail bed at the fingertip called distal onycholysis. Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.

Guttate psoriasis symptoms and signs include bumps or small plaques ( inch or less) of red itchy, scaling skin that may appear explosively, affecting large parts of the skin surface simultaneously, after a sore throat.

In inverse psoriasis, genital lesions, especially in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or the area between the buttocks (intergluteal folds) may look like flat red plaques without much scaling. This may be confused with other skin conditions like fungal infections, yeast infections, allergic rashes, or bacterial infections.

Symptoms and signs of pustular psoriasis include at rapid onset of groups of small bumps filled with pus on the torso. Patients are often systemically ill and may have a fever.

Erythrodermic psoriasis appears as extensive areas of red skin often involving the entire skin surface. Patients may often feel chilled.

Scalp psoriasis may look like severe dandruff with dry flakes and red areas of skin. It can be difficult to differentiate between scalp psoriasis and seborrheic dermatitis when only the scalp is involved. However, the treatment is often very similar for both conditions.

How do health care professionals diagnose psoriasis?

The diagnosis of psoriasis is typically made by obtaining information from the physical examination of the skin, medical history, and relevant family health history.

Sometimes lab tests, including a microscopic examination of tissue obtained from a skin biopsy, may be necessary.

Eczema vs. psoriasis

Occasionally, it can be difficult to differentiate eczematous dermatitis from psoriasis. This is when a biopsy can be quite valuable to distinguish between the two conditions. Of note, both eczematous dermatitis and psoriasis often respond to similar treatments. Certain types of eczematous dermatitis can be cured where this is not the case for psoriasis.

How many people have psoriasis?

Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S. population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.

Is psoriasis contagious?

No. A person cannot catch it from someone else, and one cannot pass it to anyone else by skin-to-skin contact. Directly touching someone with psoriasis every day will never transmit the condition.

Is there a cure for psoriasis?

No, psoriasis is not currently curable. However, it can go into remission, producing an entirely normal skin surface. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Is psoriasis hereditary?

Although psoriasis is not contagious from person to person, there is a known hereditary tendency. Therefore, family history is very helpful in making the diagnosis.

What health care specialists treat psoriasis?

Dermatologists are doctors who specialize in the diagnosis and treatment of psoriasis, and rheumatologists specialize in the treatment of joint disorders and psoriatic arthritis. Many kinds of doctors may treat psoriasis, including dermatologists, family physicians, internal medicine physicians, rheumatologists, and other medical doctors. Some patients have also seen other allied health professionals such as acupuncturists, holistic practitioners, chiropractors, and nutritionists.

The American Academy of Dermatology and the National Psoriasis Foundation are excellent sources to help find doctors who specialize in this disease. Not all dermatologists and rheumatologists treat psoriasis. The National Psoriasis Foundation has one of the most up-to-date databases of current psoriasis specialists.

It is now apparent that patients with psoriasis are prone to a variety of other disease conditions, so-called comorbidities. Cardiovascular disease, diabetes, hypertension, inflammatory bowel disease, hyperlipidemia, liver problems, and arthritis are more common in patients with psoriasis. It is very important for all patients with psoriasis to be carefully monitored by their primary care providers for these associated illnesses. The joint inflammation of psoriatic arthritis and its complications are frequently managed by rheumatologists.

What are psoriasis treatment options?

There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.

For mild disease that involves only small areas of the body (less than 10% of the total skin surface), topical treatments (skin applied), such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.

For moderate to severe disease that involves much larger areas of the body (>10% or more of the total skin surface), topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic (total body treatments such as pills or injections) medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

It is important to keep in mind that as with any medical condition, all medicines carry possible side effects. No medication is 100% effective for everyone, and no medication is 100% safe. The decision to use any medication requires thorough consideration and discussion with your health care provider. The risks and potential benefit of medications have to be considered for each type of psoriasis and the individual. Of two patients with precisely the same amount of disease, one may tolerate it with very little treatment, while the other may become incapacitated and require treatment internally.

A proposal to minimize the toxicity of some of these medicines has been commonly called “rotational” therapy. The idea is to change the anti-psoriasis drugs every six to 24 months in order to minimize the toxicity of one medication. Depending on the medications selected, this proposal can be an option. An exception to this proposal is the use of the newer biologic medications as described below. An individual who has been using strong topical steroids over large areas of their body for prolonged periods may benefit from stopping the steroids for a while and rotating onto a different therapy.

What creams, lotions, and home remedies are available for psoriasis?

Topical (skin applied) treatments include topical corticosteroids, vitamin D analogue creams like calcipotriene (Calcitrene, Dovonex, Sorilux), topical retinoids (tazarotene [Tazorac]), moisturizers, topical immunomodulators (tacrolimus and pimecrolimus), coal tar, anthralin, and others.

Are psoriasis shampoos available?

Coal tar shampoos are very useful in controlling psoriasis of the scalp. Using the shampoo daily can be very beneficial adjunctive therapy. There are a variety of shampoos available without a prescription. There is no evidence that one shampoo is superior to another. Generally, the selection of a tar shampoo is simply a matter of personal preference.

What oral medications are available for psoriasis?

Oral medications include methotrexate (Trexall), acitretin (Soriatane), cyclosporine (Neoral), apremilast (Otezla), and others. Oral prednisone (corticosteroid) is generally not used in psoriasis and may cause a disease flare-up if administered.

What injections or infusions are available for psoriasis?

Recently, a new group of drugs called biologics have become available to treat psoriasis and psoriatic arthritis. They are produced by living cells cultures in an industrial setting. They are all proteins and therefore must be administered through the skin because they would otherwise be degraded during digestion. All biologics work by suppressing certain specific portions of the immune inflammatory response that are overactive in psoriasis. A convenient method of categorizing these drugs is on the basis of their site of action:

Drug choice can be complicated, and your physician will help in selecting the best option. In some patients. it may be possible to predict drug efficacy on the basis of a prospective patient’s genetics. It appears that the presence of the HLA-Cw6 gene is correlated with a beneficial response to ustekinumab.

Newer drugs are in development and no doubt will be available in the near future. As this class of drugs is fairly new, ongoing monitoring and adverse effect reporting continues and long-term safety continues to be monitored. Biologics are all comparatively expensive especially in view of the fact they none of them are curative. Recently, the FDA has attempted to address this problem by permitting the use of “biosimilar” drugs. These drugs are structurally identical to a specific biologic drug and are presumed to produce identical therapeutic responses in human beings to the original, but are produced using different methodology. Biosimilars ought to be available at some fraction of the cost of the original. If this will be an effective approach remains to be seen. The only biosimilar available currently is infliximab (Inflectra). Two other biosimilar drugs have been accepted by the FDA, an etanercept equivalent (Erelzi) and an adalimumab equivalent (Amjevita) — but currently, neither are available.

Some biologics are to be administered by self-injections for home use while others are given by intravenous infusions in the doctor’s office. Biologics have some screening requirements such as a tuberculosis screening test (TB skin test or PPD test) and other labs prior to starting therapy. As with any drug, side effects are possible with all biologic drugs. Common potential side effects include mild local injection-site reactions (redness and tenderness). There is concern of serious infections and potential malignancy with nearly all biologic drugs. Precautions include patients with known or suspected hepatitis B infection, active tuberculosis, and possibly HIV/AIDS. As a general consideration, these drugs may not be an ideal choice for patients with a history of cancer and patients actively undergoing cancer therapy. In particular, there may be an increased association of lymphoma in patients taking a biologic.

Biologics are expensive medications ranging in price from several to tens of thousands of dollars per year per person. Their use may be limited by availability, cost, and insurance approval. Not all insurance drug plans fully cover these drugs for all conditions. Patients need to check with their insurance and may require a prior authorization request for coverage approval. Some of the biologic manufacturers have patient-assistance programs to help with financial issues. Therefore, choice of the right medication for your condition depends on many factors, not all of them medical. Additionally, convenience of receiving the medication and lifestyle affect the choice of the right biologic medication.

Is there an anti-psoriasis diet?

Most patients with psoriasis seem to be overweight. Since there is a predisposition for those patients to develop cardiovascular disease and diabetes, it is suggested strongly that they try to maintain a normal body weight. Although evidence is sparse, it has been suggested that slender patients are more likely to respond to treatment.

Although dietary studies are notoriously difficult to perform and interpret, it seems likely that a diet whose fat content is composed of polyunsaturated oils like olive oil and fish oil is beneficial for psoriasis. The so-called Mediterranean diet is an example.

What about light therapy for psoriasis?

Light therapy is also called phototherapy. There are several types of medical light therapies that include PUVA (an acronym for psoralen + UVA), UVB, and narrow-band UVB. These artificial light sources have been used for decades and generally are available in only certain physician’s offices. There are a few companies who may sell light boxes or light bulbs for prescribed home light therapy.

Natural sunlight is also used to treat psoriasis. Daily short, controlled exposures to natural sunlight may help or clear psoriasis in some patients. Skin unaffected by psoriasis and sensitive areas such as the face and hands may need to be protected during sun exposure.

There are also multiple newer light sources like lasers and photodynamic therapy (use of a light activating medication and a special light source) that have been used to treat psoriasis.

PUVA is a special treatment using a photosensitizing drug and timed artificial-light exposure composed of wavelengths of ultraviolet light in the UVA spectrum. The photosensitizing drug in PUVA is called psoralen. Both the psoralen and the UVA light must be administered within one hour of each other for a response to occur. These treatments are usually given in a physician’s office two to three times per week. Several weeks of PUVA is usually required before seeing significant results. The light exposure time is gradually increased during each subsequent treatment. Psoralens may be given orally as a pill or topically as a bath or lotion. After a short incubation period, the skin is exposed to a special wavelength of ultraviolet light called UVA. Patients using PUVA are generally sun sensitive and must avoid sun exposure for a period of time after PUVA. Common side effects with PUVA include burning, aging of the skin, increased brown spots called lentigines, and an increased risk of skin cancer, including melanoma. The relative increase in skin cancer risk with PUVA treatment is controversial. PUVA treatments need to be closely monitored by a physician and discontinued when a maximum number of treatments have been reached.

Narrow-band UVB phototherapy is an artificial light treatment using very limited wavelengths of light. It is frequently given daily or two to three times per week. UVB is also a component of natural sunlight. UVB dosage is based on time and exposure is gradually increased as tolerated. Potential side effects with UVB include skin burning, premature aging, and possible increased risk of skin cancer. The relative increase in skin cancer risk with UVB treatment needs further study but is probably less than PUVA or traditional UVB.

Sometimes UVB is combined with other treatments such as tar application. Goeckerman is a special psoriasis therapy using this combination. Some centers have used this therapy in a “day care” type of setting where patients are in the psoriasis treatment clinic all day for several weeks and go home each night.

Recently, a laser (excimer laser XTRAC) has been developed that generates ultraviolet light in the same range as narrow-band ultraviolet light. This light can be beneficial for psoriasis localized to small areas of skin like the palms, soles, and scalp. It is impractical to use in in extensive disease.

What is the long-term prognosis with psoriasis? What are complications of psoriasis?

Overall, the prognosis for most patients with psoriasis is good. While it is not curable, it is controllable. As described above, recent studies show an association of psoriasis and other medical conditions, including obesity, diabetes, and heart disease.

Is it possible to prevent psoriasis?

Since psoriasis is inherited, it is impossible at this time to suggest anything that is likely to prevent its development aside from indulging in a healthy lifestyle.

What does the future hold for psoriasis?

Psoriasis research is heavily funded and holds great promise for the future. Just the last five to 10 years have produced great improvements in treatment of the disease with medications aimed at controlling precise sites of the process of inflammation. Ongoing research is needed to decipher the ultimate underlying cause of this disease.

Is there a national psoriasis support group?

Yes, the National Psoriasis Foundation (NPF) is an organization dedicated to helping patients with psoriasis and furthering research in this field. They hold national and local chapter meetings. The NPF web site (http://www.psoriasis.org/home/) shares up-to-date reliable medical information and statistics on the condition.

Where can people get more information on psoriasis?

A dermatologist, the American Academy of Dermatology at http://www.AAD.org, and the National Psoriasis Foundation at http://www.psoriasis.org/home/ may be excellent sources of more information.

There are many ongoing clinical trials for psoriasis all over the United States and in the world. Many of these clinical trials are ongoing at academic or university medical centers and are frequently open to patients without cost.

Clinical trials frequently have specific requirements for types and severity of psoriasis that may be enrolled into a specific trial. Patients need to contact these centers and inquire regarding the specific study requirements. Some studies have restrictions on what recent medications have been used for psoriasis, current medication, and overall health.

Some of the many medical centers in the U.S. offering clinical trials for psoriasis include the University of California, San Francisco Department of Dermatology, the University of California, Irvine Department of Dermatology, and the St. Louis University Medical School.

Medically Reviewed on 2/1/2018

References

Alwan, W., and F.O. Nestle. “Pathogenesis and Treatment of Psoriasis: Exploiting Pathophysiological Pathways for Precision Medicine.” Clin Exp Rheumatol 33 (Suppl. 93): S2-S6.

Arndt, Kenneth A., eds., et al. “Topical Therapies for Psoriasis.” Seminars in Cutaneous Medicine and Surgery 35.2S Mar. 2016: S35-S46.

Conrad, Curdin, Michel Gilliet. “Psoriasis: From Pathogenesis to Targeted Therapies.” Clinical Reviews in Allergy & Immunology Jan. 18, 2015.

Dowlatshahi, E.A., E.A.M van der Voort, L.R. Arends, and T. Nijsten. “Markers of Systemic Inflammation in Psoriasis: A Systematic Review and Meta-Analysis.” British Journal of Dermatology 169.2 Aug. 2013: 266282.

Greb, Jacqueline E., et al. “Psoriasis.” Nature Reviews Disease Primers 2 (2016): 1-17.

National Psoriasis Foundation. “Systemic Treatments: Biologics and Oral Treatments.” 1-25.

Ogawa, Eisaku, Yuki Sato, Akane Minagawa, and Ryuhei Okuyama. “Pathogenesis of Psoriasis and Development of Treatment.” The Journal of Dermatology 2017: 1-9.

Villaseor-Park, Jennifer, David Wheeler, and Lisa Grandinetti. “Psoriasis: Evolving Treatment for a Complex Disease.” Cleveland Clinic Journal of Medicine 79.6 June 2012: 413-423.

Woo, Yu Ri, Dae Ho Cho, and Hyun Jeong Park. “Molecular Mechanisms and Management of a Cutaneous Inflammatory Disorder: Psoriasis.” International Journal of Molecular Sciences 18 Dec. 11, 2017: 1-26.

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Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis – What is Psoriasis? Basic Symptoms and Types

Articles OnWhat Is Psoriasis? What Is Psoriasis? What Is Psoriasis? What Is Psoriasis?

Unpredictable and irritating, psoriasis is one of the most baffling and persistent of skin disorders. It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised, red plaques covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and soles of the feet.

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis — the most common variety of the condition — include:

Psoriasis can also be associated with psoriatic arthritis, which leads to pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Other forms of psoriasis include:

Pustular psoriasis , characterized by red and scaly skin on the palms of the hands and/or feet with tiny pustules

Guttate psoriasis, which often starts in childhood or young adulthood, is characterized by small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and use of anti-malarial and beta-blocker medications.

Inverse psoriasis, characterized by bright red, shiny lesions that appear in skin folds, such as the armpits, groin area, and under the breasts

Erythrodermic psoriasis, characterized by periodic, fiery redness of the skin and shedding of scales in sheets; this form of psoriasis, triggered by withdrawal from a systemic psoriasis treatment, severe sunburn, infection, and certain medications, requires immediate medical treatment, because it can lead to severe illness.

People who suffer from psoriasis know that this uncomfortable and at times disfiguring skin disease can be difficult and frustrating to treat. The condition comes and goes in cycles of remissions and flare-ups over a lifetime. While there are medications and other therapies that can help to clear up the patches of red, scaly, thickened skin that are the hallmark of psoriasis, there is no cure.

A variety of factors — ranging from emotional stress and trauma to streptococcal infection — can cause an episode of psoriasis. Recent research indicates that some abnormality in the immune system is the key cause of psoriasis. As many as 80% of people having flare-ups report a recent emotional trauma, such as a new job or the death of a loved one. Most doctors believe such external stressors serve as triggers for an inherited defect in immune function.

Injured skin and certain drugs can aggravate psoriasis, including certain types of blood pressure medications (like beta-blockers), the anti-malarial medication hydroxychloroquine, and ibuprofen (Advil, Motrin, etc.).

Psoriasis tends to run in families, but it may be skip generations; a grandfather and his grandson may be affected, but the child’s mother never develops the disease. Although psoriasis may be stressful and embarrassing, most outbreaks are relatively harmless. With appropriate treatment, symptoms generally subside within a few months.

SOURCES:National Institute of Arthritis and Musculoskeletal and Skin Disease.National Psoriasis Foundation.The Psoriasis Foundation.American Academy of Dermatology.

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Psoriasis – What is Psoriasis? Basic Symptoms and Types

Psoriasis | Psoriatic Arthritis | MedlinePlus

Psoriasis is a skin disease that causes itchy or sore patches of thick, red skin with silvery scales. You usually get the patches on your elbows, knees, scalp, back, face, palms and feet, but they can show up on other parts of your body. Some people who have psoriasis also get a form of arthritis called psoriatic arthritis.

A problem with your immune system causes psoriasis. In a process called cell turnover, skin cells that grow deep in your skin rise to the surface. Normally, this takes a month. In psoriasis, it happens in just days because your cells rise too fast.

Psoriasis can be hard to diagnose because it can look like other skin diseases. Your doctor might need to look at a small skin sample under a microscope.

Psoriasis can last a long time, even a lifetime. Symptoms come and go. Things that make them worse include

Psoriasis usually occurs in adults. It sometimes runs in families. Treatments include creams, medicines, and light therapy.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

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Psoriasis | Psoriatic Arthritis | MedlinePlus


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