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Psoriasis: Pictures, Symptoms, Causes, Diagnosis, Treatment

Articles OnPsoriasis Psoriasis Psoriasis – Psoriasis What Is Psoriasis?

Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times faster than normal. This makes the skin build up into bumpy red patches covered with white scales. They can grow anywhere, but most appear on the scalp, elbows, knees, and lower back. Psoriasis can’t be passed from person to person. It does sometimes happen in members of the same family.

Psoriasis usually appears in early adulthood. For most people, it affects just a few areas. In severe cases, psoriasis can cover large parts of the body. The patches can heal and then come back throughout a person’s life.

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:

People with psoriasis can also get a type of arthritis called psoriatic arthritis. It causes 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 types of psoriasis include:

No one knows the exact cause of psoriasis, but experts believe that its a combination of things. Something wrong with the immune system causes inflammation, triggering new skin cells to form too quickly. Normally, skin cells are replaced every 10 to 30 days. With psoriasis, new cells grow every 3 to 4 days. The buildup of old cells being replaced by new ones creates those silver scales.

Psoriasis tends to run in families, but it may be skip generations. For instance, a grandfather and his grandson may be affected, but not the child’s mother.

Things that can trigger an outbreak of psoriasis include:

Physical exam. Its usually easy for your doctor to diagnose psoriasis, especially if you have plaques on areas such as your:

Your doctor will give you a full physical exam and ask if people in your family have psoriasis.

Lab tests. The doctor might do a biopsy — remove a small piece of skin and test it to make sure you dont have a skin infection. Theres no other test to confirm or rule out psoriasis.

Luckily, there are many treatments. Some slow the growth of new skin cells, and others relieve itching and dry skin. Your doctor will select a treatment plan that is right for you based on the size of your rash, where it is on your body, your age, your overall health, and other things. Common treatments include:

Treatments for moderate to severe psoriasis include:

Theres no cure, but treatment greatly reduces symptoms, even in serious cases. Recent studies have suggested that when you better control the inflammation of psoriasis, your risk of heart disease, stroke, metabolic syndrome, and other diseases associated with inflammation go down.

Psoriasis affects:

SOURCES:

National Institute of Arthritis and Musculoskeletal and Skin Disease.

National Psoriasis Foundation.

The Psoriasis Foundation.

American Academy of Dermatology.

UpToDate: Epidemiology, clinical manifestations, and diagnosis of psoriasis.

FDA: “FDA approves new psoriasis drug Taltz,” FDA approves Amjevita, a biosimilar to Humira.

Medscape: “FDA OKs Biologic Guselkumab (Tremfya) for Plaque Psoriasis.”

National Psoriasis Foundation: Statistics.

PubMed Health: “Plaque Psoriasis.”

World Health Organization: Global report on psoriasis.

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Psoriasis: Pictures, Symptoms, Causes, Diagnosis, Treatment

Psoriasis Treatment, Causes, Pictures, Symptoms, Types & Diet

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.

Benhadou, Fairda, Dillon Mintoff, and Vronique del Marmol. “Psoriasis: Keratinocytes or Immune Cells — Which Is the Trigger?” Dermatology Dec. 19, 2018.

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: 266-282.

Georgescu, Simona-Roxana, et al. “Advances in Understanding the Immunological Pathways in Psoriasis.” International Journal of Molecular Sciences 20.739 Feb. 10, 2019: 2-17.

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

Kaushik, Shivani B., and Mark G. Lebwohl. “Review of Safety and Efficacy of Approved Systemic Psoriasis Therapies.” International Journal of Dermatology 2018.

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.

Stiff, Katherine M., Katelyn R. Glines, Caroline L. Porter, Abigail Cline & StevenR. Feldman. “Current pharmacological treatment guidelines for psoriasis and psoriaticarthritis.” Expert Review of Clinical Pharmacology (2018).

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, Pictures, Symptoms, Types & Diet

Psoriasis – Diagnosis and treatment – Mayo Clinic

Diagnosis

In most cases, diagnosis of psoriasis is fairly straightforward.

Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into three main types: topical treatments, light therapy and systemic medications.

Used alone, creams and ointments that you apply to your skin can effectively treat mild to moderate psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light therapy. Topical psoriasis treatments include:

Topical corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They reduce inflammation and relieve itching and may be used with other treatments.

Mild corticosteroid ointments are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches of damaged skin.

Your doctor may prescribe stronger corticosteroid ointment for smaller, less sensitive or tougher-to-treat areas.

Long-term use or overuse of strong corticosteroids can cause thinning of the skin. Topical corticosteroids may stop working over time. It’s usually best to use topical corticosteroids as a short-term treatment during flares.

Topical retinoids. These are vitamin A derivatives that may decrease inflammation. The most common side effect is skin irritation. These medications may also increase sensitivity to sunlight, so while using the medication apply sunscreen before going outdoors.

The risk of birth defects is far lower for topical retinoids than for oral retinoids. But tazarotene (Tazorac, Avage) isn’t recommended when you’re pregnant or breast-feeding or if you intend to become pregnant.

Calcineurin inhibitors. Calcineurin inhibitors tacrolimus (Prograf) and pimecrolimus (Elidel) reduce inflammation and plaque buildup.

Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. They may be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.

Coal tar. Derived from coal, coal tar reduces scaling, itching and inflammation. Coal tar can irritate the skin. It’s also messy, stains clothing and bedding, and has a strong odor.

Coal tar is available in over-the-counter shampoos, creams and oils. It’s also available in higher concentrations by prescription. This treatment isn’t recommended for women who are pregnant or breast-feeding.

This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight.

Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications.

Psoralen plus ultraviolet A (PUVA). This form of photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.

This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.

If you have severe psoriasis or it’s resistant to other types of treatment, your doctor may prescribe oral or injected drugs. This is known as systemic treatment. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.

Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments topical creams and ultraviolet light therapy (phototherapy) in those patients with typical skin lesions (plaques) and then progress to stronger ones only if necessary. Patients with pustular or erythrodermic psoriasis or associated arthritis usually need systemic therapy from the beginning of treatment. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

There are a number of new medications currently being researched that have the potential to improve psoriasis treatment. These treatments target different proteins that work with the immune system.

A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. None have definitively been proved effective. But some alternative therapies are deemed generally safe, and they may be helpful to some people in reducing signs and symptoms, such as itching and scaling. These treatments would be most appropriate for those with milder, plaque disease and not for those with pustules, erythroderma or arthritis.

If you’re considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Although self-help measures won’t cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:

Coping with psoriasis can be a challenge, especially if the disease covers large areas of your body or is in places readily seen by other people, such as your face or hands. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.

Here are some ways to help you cope and to feel more in control:

You’ll likely first see your family doctor or a general practitioner. In some cases, you may be referred directly to a specialist in skin diseases (dermatologist).

Here’s some information to help you prepare for your appointment and to know what to expect from your doctor.

Make a list of the following:

For psoriasis, some basic questions you might ask your doctor include:

Your doctor is likely to ask you several questions, such as:

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Psoriasis – Diagnosis and treatment – Mayo Clinic

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.

Viven Williams: Your fingernails are clues to your overall health. Many people develop lines or ridges from the cuticle to the tip.

Rachel Miest, M.D.: Those are actually completely fine and just a part of normal aging.

Viven Williams: But Dr. Rachel Miest says there are other nail changes you should not ignore that may indicate

Rachel Miest, M.D.: liver problems, kidney problems, nutritional deficiencies …

Viven Williams: and other issues. Here are six examples: No. 1 is pitting. This could be a sign of psoriasis. Two is clubbing. Clubbing happens when your oxygen is low and could be a sign of lung issues. Three is spooning. It can happen if you have iron-deficient anemia or liver disease. Four is called “a Beau’s line.” It’s a horizontal line that indicates a previous injury or infection. Five is nail separation. This may happen as a result of injury, infection or a medication. And six is yellowing of the nails, which may be the result of chronic bronchitis.

For the Mayo Clinic News Network, I’m Vivien Williams.

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:

Excerpt from:

Psoriasis – Symptoms and causes – Mayo Clinic

Psoriasis: Pictures, Symptoms, Causes, Diagnosis, Treatment

Articles OnPsoriasis Psoriasis Psoriasis – Psoriasis What Is Psoriasis?

Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times faster than normal. This makes the skin build up into bumpy red patches covered with white scales. They can grow anywhere, but most appear on the scalp, elbows, knees, and lower back. Psoriasis can’t be passed from person to person. It does sometimes happen in members of the same family.

Psoriasis usually appears in early adulthood. For most people, it affects just a few areas. In severe cases, psoriasis can cover large parts of the body. The patches can heal and then come back throughout a person’s life.

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:

People with psoriasis can also get a type of arthritis called psoriatic arthritis. It causes 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 types of psoriasis include:

No one knows the exact cause of psoriasis, but experts believe that its a combination of things. Something wrong with the immune system causes inflammation, triggering new skin cells to form too quickly. Normally, skin cells are replaced every 10 to 30 days. With psoriasis, new cells grow every 3 to 4 days. The buildup of old cells being replaced by new ones creates those silver scales.

Psoriasis tends to run in families, but it may be skip generations. For instance, a grandfather and his grandson may be affected, but not the child’s mother.

Things that can trigger an outbreak of psoriasis include:

Physical exam. Its usually easy for your doctor to diagnose psoriasis, especially if you have plaques on areas such as your:

Your doctor will give you a full physical exam and ask if people in your family have psoriasis.

Lab tests. The doctor might do a biopsy — remove a small piece of skin and test it to make sure you dont have a skin infection. Theres no other test to confirm or rule out psoriasis.

Luckily, there are many treatments. Some slow the growth of new skin cells, and others relieve itching and dry skin. Your doctor will select a treatment plan that is right for you based on the size of your rash, where it is on your body, your age, your overall health, and other things. Common treatments include:

Treatments for moderate to severe psoriasis include:

Theres no cure, but treatment greatly reduces symptoms, even in serious cases. Recent studies have suggested that when you better control the inflammation of psoriasis, your risk of heart disease, stroke, metabolic syndrome, and other diseases associated with inflammation go down.

Psoriasis affects:

SOURCES:

National Institute of Arthritis and Musculoskeletal and Skin Disease.

National Psoriasis Foundation.

The Psoriasis Foundation.

American Academy of Dermatology.

UpToDate: Epidemiology, clinical manifestations, and diagnosis of psoriasis.

FDA: “FDA approves new psoriasis drug Taltz,” FDA approves Amjevita, a biosimilar to Humira.

Medscape: “FDA OKs Biologic Guselkumab (Tremfya) for Plaque Psoriasis.”

National Psoriasis Foundation: Statistics.

PubMed Health: “Plaque Psoriasis.”

World Health Organization: Global report on psoriasis.

Pagination

Read the original:

Psoriasis: Pictures, Symptoms, Causes, Diagnosis, Treatment

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.

Viven Williams: Your fingernails are clues to your overall health. Many people develop lines or ridges from the cuticle to the tip.

Rachel Miest, M.D.: Those are actually completely fine and just a part of normal aging.

Viven Williams: But Dr. Rachel Miest says there are other nail changes you should not ignore that may indicate

Rachel Miest, M.D.: liver problems, kidney problems, nutritional deficiencies …

Viven Williams: and other issues. Here are six examples: No. 1 is pitting. This could be a sign of psoriasis. Two is clubbing. Clubbing happens when your oxygen is low and could be a sign of lung issues. Three is spooning. It can happen if you have iron-deficient anemia or liver disease. Four is called “a Beau’s line.” It’s a horizontal line that indicates a previous injury or infection. Five is nail separation. This may happen as a result of injury, infection or a medication. And six is yellowing of the nails, which may be the result of chronic bronchitis.

For the Mayo Clinic News Network, I’m Vivien Williams.

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:

See more here:

Psoriasis – Symptoms and causes – Mayo Clinic

Psoriasis Treatment, Causes, Pictures, Symptoms, Types & Diet

Psoriasis facts

What is psoriasis?

Psoriasis is a noncontagious, chronic skin disease that produces plaques of thickened, scaly skin. The dry flakes of silvery-white skin scales result from the excessively rapid proliferation of skin cells. Psoriasis is fundamentally an immune system problem. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-cells. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of this autoimmune disease ranges from mild with limited involvement of small areas of skin to severe psoriasis with 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, an immune-mediated inflammatory disease, 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 self-esteem and 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 the immune system 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 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 skin cells 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.

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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 psoriasis 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 over-the-counter 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 an anti-inflammatorydiet 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, Pictures, Symptoms, Types & 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: Pictures, Symptoms, Causes, Diagnosis, Treatment

Articles OnPsoriasis Psoriasis Psoriasis – Psoriasis What Is Psoriasis?

Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times faster than normal. This makes the skin build up into bumpy red patches covered with white scales. They can grow anywhere, but most appear on the scalp, elbows, knees, and lower back. Psoriasis can’t be passed from person to person. It does sometimes happen in members of the same family.

Psoriasis usually appears in early adulthood. For most people, it affects just a few areas. In severe cases, psoriasis can cover large parts of the body. The patches can heal and then come back throughout a person’s life.

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:

People with psoriasis can also get a type of arthritis called psoriatic arthritis. It causes 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 types of psoriasis include:

No one knows the exact cause of psoriasis, but experts believe that its a combination of things. Something wrong with the immune system causes inflammation, triggering new skin cells to form too quickly. Normally, skin cells are replaced every 10 to 30 days. With psoriasis, new cells grow every 3 to 4 days. The buildup of old cells being replaced by new ones creates those silver scales.

Psoriasis tends to run in families, but it may be skip generations. For instance, a grandfather and his grandson may be affected, but not the child’s mother.

Things that can trigger an outbreak of psoriasis include:

Physical exam. Its usually easy for your doctor to diagnose psoriasis, especially if you have plaques on areas such as your:

Your doctor will give you a full physical exam and ask if people in your family have psoriasis.

Lab tests. The doctor might do a biopsy — remove a small piece of skin and test it to make sure you dont have a skin infection. Theres no other test to confirm or rule out psoriasis.

Luckily, there are many treatments. Some slow the growth of new skin cells, and others relieve itching and dry skin. Your doctor will select a treatment plan that is right for you based on the size of your rash, where it is on your body, your age, your overall health, and other things. Common treatments include:

Treatments for moderate to severe psoriasis include:

Theres no cure, but treatment greatly reduces symptoms, even in serious cases. Recent studies have suggested that when you better control the inflammation of psoriasis, your risk of heart disease, stroke, metabolic syndrome, and other diseases associated with inflammation go down.

Psoriasis affects:

SOURCES:

National Institute of Arthritis and Musculoskeletal and Skin Disease.

National Psoriasis Foundation.

The Psoriasis Foundation.

American Academy of Dermatology.

UpToDate: Epidemiology, clinical manifestations, and diagnosis of psoriasis.

FDA: “FDA approves new psoriasis drug Taltz,” FDA approves Amjevita, a biosimilar to Humira.

Medscape: “FDA OKs Biologic Guselkumab (Tremfya) for Plaque Psoriasis.”

National Psoriasis Foundation: Statistics.

PubMed Health: “Plaque Psoriasis.”

World Health Organization: Global report on psoriasis.

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Psoriasis: Pictures, Symptoms, Causes, Diagnosis, Treatment

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.

Viven Williams: Your fingernails are clues to your overall health. Many people develop lines or ridges from the cuticle to the tip.

Rachel Miest, M.D.: Those are actually completely fine and just a part of normal aging.

Viven Williams: But Dr. Rachel Miest says there are other nail changes you should not ignore that may indicate

Rachel Miest, M.D.: liver problems, kidney problems, nutritional deficiencies …

Viven Williams: and other issues. Here are six examples: No. 1 is pitting. This could be a sign of psoriasis. Two is clubbing. Clubbing happens when your oxygen is low and could be a sign of lung issues. Three is spooning. It can happen if you have iron-deficient anemia or liver disease. Four is called “a Beau’s line.” It’s a horizontal line that indicates a previous injury or infection. Five is nail separation. This may happen as a result of injury, infection or a medication. And six is yellowing of the nails, which may be the result of chronic bronchitis.

For the Mayo Clinic News Network, I’m Vivien Williams.

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 Treatment, Causes, Pictures, Symptoms, Types & Diet

Psoriasis facts

What is psoriasis?

Psoriasis is a noncontagious, chronic skin disease that produces plaques of thickened, scaly skin. The dry flakes of silvery-white skin scales result from the excessively rapid proliferation of skin cells. Psoriasis is fundamentally an immune system problem. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-cells. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of this autoimmune disease ranges from mild with limited involvement of small areas of skin to severe psoriasis with 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, an immune-mediated inflammatory disease, 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 self-esteem and 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 the immune system 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 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 skin cells 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 psoriasis 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 over-the-counter 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.

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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 an anti-inflammatorydiet 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, Pictures, Symptoms, Types & Diet

Psoriasis – Diagnosis and treatment – Mayo Clinic

Diagnosis

In most cases, diagnosis of psoriasis is fairly straightforward.

Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into three main types: topical treatments, light therapy and systemic medications.

Used alone, creams and ointments that you apply to your skin can effectively treat mild to moderate psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light therapy. Topical psoriasis treatments include:

Topical corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They reduce inflammation and relieve itching and may be used with other treatments.

Mild corticosteroid ointments are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches of damaged skin.

Your doctor may prescribe stronger corticosteroid ointment for smaller, less sensitive or tougher-to-treat areas.

Long-term use or overuse of strong corticosteroids can cause thinning of the skin. Topical corticosteroids may stop working over time. It’s usually best to use topical corticosteroids as a short-term treatment during flares.

Topical retinoids. These are vitamin A derivatives that may decrease inflammation. The most common side effect is skin irritation. These medications may also increase sensitivity to sunlight, so while using the medication apply sunscreen before going outdoors.

The risk of birth defects is far lower for topical retinoids than for oral retinoids. But tazarotene (Tazorac, Avage) isn’t recommended when you’re pregnant or breast-feeding or if you intend to become pregnant.

Calcineurin inhibitors. Calcineurin inhibitors tacrolimus (Prograf) and pimecrolimus (Elidel) reduce inflammation and plaque buildup.

Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. They may be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.

Coal tar. Derived from coal, coal tar reduces scaling, itching and inflammation. Coal tar can irritate the skin. It’s also messy, stains clothing and bedding, and has a strong odor.

Coal tar is available in over-the-counter shampoos, creams and oils. It’s also available in higher concentrations by prescription. This treatment isn’t recommended for women who are pregnant or breast-feeding.

This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight.

Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications.

Psoralen plus ultraviolet A (PUVA). This form of photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.

This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.

If you have severe psoriasis or it’s resistant to other types of treatment, your doctor may prescribe oral or injected drugs. This is known as systemic treatment. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.

Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments topical creams and ultraviolet light therapy (phototherapy) in those patients with typical skin lesions (plaques) and then progress to stronger ones only if necessary. Patients with pustular or erythrodermic psoriasis or associated arthritis usually need systemic therapy from the beginning of treatment. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

There are a number of new medications currently being researched that have the potential to improve psoriasis treatment. These treatments target different proteins that work with the immune system.

A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. None have definitively been proved effective. But some alternative therapies are deemed generally safe, and they may be helpful to some people in reducing signs and symptoms, such as itching and scaling. These treatments would be most appropriate for those with milder, plaque disease and not for those with pustules, erythroderma or arthritis.

If you’re considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Although self-help measures won’t cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:

Coping with psoriasis can be a challenge, especially if the disease covers large areas of your body or is in places readily seen by other people, such as your face or hands. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.

Here are some ways to help you cope and to feel more in control:

You’ll likely first see your family doctor or a general practitioner. In some cases, you may be referred directly to a specialist in skin diseases (dermatologist).

Here’s some information to help you prepare for your appointment and to know what to expect from your doctor.

Make a list of the following:

For psoriasis, some basic questions you might ask your doctor include:

Your doctor is likely to ask you several questions, such as:

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Psoriasis – Diagnosis and treatment – Mayo Clinic

List of Psoriasis Medications (220 Compared) – Drugs.com

clobetasol Rx C N 59reviews

8.0

Generic name:clobetasol topical

Brand names: Clobex, Temovate, Dermovate, Olux, Clobevate, Cormax Scalp, Olux-E, Clodan, Cormax, Embeline, Embeline E, Impoyz, Olux / Olux-E Kit, Temovate E showall

Drug class: topical steroids

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

7.0

Generic name:adalimumab systemic

Drug class: antirheumatics, TNF alfa inhibitors

For consumers: dosage, interactions, side effects

For professionals: AHFS DI Monograph, Prescribing Information

8.0

Generic name:methotrexate systemic

Brand names: Otrexup, Trexall, Rasuvo

Drug class: antimetabolites, antirheumatics, antipsoriatics, other immunosuppressants

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

8.0

Generic name:ustekinumab systemic

Drug class: interleukin inhibitors

For consumers: dosage, interactions, side effects

For professionals: AHFS DI Monograph, Prescribing Information

6.0

Generic name:triamcinolone topical

Brand names: Kenalog, Triderm, Aristocort A, Aristocort R, Cinolar, Pediaderm TA, Trianex showall

Drug class: topical steroids

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

9.0

Generic name:mometasone topical

Drug class: topical steroids

For consumers: dosage, interactions, side effects

For professionals: AHFS DI Monograph, Prescribing Information

8.0

Generic name:clobetasol topical

Drug class: topical steroids

For consumers: dosage, interactions, side effects

For professionals: Prescribing Information

7.0

Generic name:fluocinonide topical

Brand names: Fluocinonide-E, Vanos

Drug class: topical steroids

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, Prescribing Information

6.0

Generic name:calcipotriene topical

Drug class: topical antipsoriatics

For consumers: dosage, interactions, side effects

For professionals: AHFS DI Monograph, Prescribing Information

9.0

Generic name:mometasone topical

Brand name: Elocon

Drug class: topical steroids

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

8.0

Generic name:tazarotene topical

Drug class: topical antipsoriatics

For consumers: dosage, interactions, side effects

For professionals: Prescribing Information

9.0

Generic name:triamcinolone systemic

Brand names: Kenalog-40, Clinacort, Kenalog-10, Aristospan showall

Drug class: glucocorticoids

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

6.0

Generic name:calcipotriene topical

Brand names: Dovonex, Calcitrene, Sorilux

Drug class: topical antipsoriatics

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

7.0

Generic name:acitretin systemic

Drug class: antipsoriatics

For consumers: dosage, interactions, side effects

For professionals: AHFS DI Monograph, Prescribing Information

7.0

Generic name:betamethasone / calcipotriene topical

Drug class: topical antipsoriatics

For consumers: dosage, interactions, side effects

For professionals: Prescribing Information

9.0

Generic name:desonide topical

Brand names: Desonate, DesOwen, LoKara, Verdeso showall

Drug class: topical steroids

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

6.0

Generic name:prednisone systemic

Drug class: glucocorticoids

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

9.0

Generic name:cyclosporine systemic

Brand names: Neoral, Gengraf

Drug class: calcineurin inhibitors

For consumers: dosage, interactions,

For professionals: A-Z Drug Facts, AHFS DI Monograph, Prescribing Information

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List of Psoriasis Medications (220 Compared) – Drugs.com

Psoriasis: Pictures, Symptoms, Causes, Diagnosis, Treatment

Articles OnPsoriasis Psoriasis Psoriasis – Psoriasis What Is Psoriasis?

Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times faster than normal. This makes the skin build up into bumpy red patches covered with white scales. They can grow anywhere, but most appear on the scalp, elbows, knees, and lower back. Psoriasis can’t be passed from person to person. It does sometimes happen in members of the same family.

Psoriasis usually appears in early adulthood. For most people, it affects just a few areas. In severe cases, psoriasis can cover large parts of the body. The patches can heal and then come back throughout a person’s life.

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:

People with psoriasis can also get a type of arthritis called psoriatic arthritis. It causes 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 types of psoriasis include:

No one knows the exact cause of psoriasis, but experts believe that its a combination of things. Something wrong with the immune system causes inflammation, triggering new skin cells to form too quickly. Normally, skin cells are replaced every 10 to 30 days. With psoriasis, new cells grow every 3 to 4 days. The buildup of old cells being replaced by new ones creates those silver scales.

Psoriasis tends to run in families, but it may be skip generations. For instance, a grandfather and his grandson may be affected, but not the child’s mother.

Things that can trigger an outbreak of psoriasis include:

Physical exam. Its usually easy for your doctor to diagnose psoriasis, especially if you have plaques on areas such as your:

Your doctor will give you a full physical exam and ask if people in your family have psoriasis.

Lab tests. The doctor might do a biopsy — remove a small piece of skin and test it to make sure you dont have a skin infection. Theres no other test to confirm or rule out psoriasis.

Luckily, there are many treatments. Some slow the growth of new skin cells, and others relieve itching and dry skin. Your doctor will select a treatment plan that is right for you based on the size of your rash, where it is on your body, your age, your overall health, and other things. Common treatments include:

Treatments for moderate to severe psoriasis include:

Theres no cure, but treatment greatly reduces symptoms, even in serious cases. Recent studies have suggested that when you better control the inflammation of psoriasis, your risk of heart disease, stroke, metabolic syndrome, and other diseases associated with inflammation go down.

Psoriasis affects:

SOURCES:

National Institute of Arthritis and Musculoskeletal and Skin Disease.

National Psoriasis Foundation.

The Psoriasis Foundation.

American Academy of Dermatology.

UpToDate: Epidemiology, clinical manifestations, and diagnosis of psoriasis.

FDA: “FDA approves new psoriasis drug Taltz,” FDA approves Amjevita, a biosimilar to Humira.

Medscape: “FDA OKs Biologic Guselkumab (Tremfya) for Plaque Psoriasis.”

National Psoriasis Foundation: Statistics.

PubMed Health: “Plaque Psoriasis.”

World Health Organization: Global report on psoriasis.

Pagination

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Psoriasis: Pictures, Symptoms, Causes, Diagnosis, Treatment

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.

Viven Williams: Your fingernails are clues to your overall health. Many people develop lines or ridges from the cuticle to the tip.

Rachel Miest, M.D.: Those are actually completely fine and just a part of normal aging.

Viven Williams: But Dr. Rachel Miest says there are other nail changes you should not ignore that may indicate

Rachel Miest, M.D.: liver problems, kidney problems, nutritional deficiencies …

Viven Williams: and other issues. Here are six examples: No. 1 is pitting. This could be a sign of psoriasis. Two is clubbing. Clubbing happens when your oxygen is low and could be a sign of lung issues. Three is spooning. It can happen if you have iron-deficient anemia or liver disease. Four is called “a Beau’s line.” It’s a horizontal line that indicates a previous injury or infection. Five is nail separation. This may happen as a result of injury, infection or a medication. And six is yellowing of the nails, which may be the result of chronic bronchitis.

For the Mayo Clinic News Network, I’m Vivien Williams.

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 Treatment, Causes, Pictures, Symptoms, Types & Diet

Psoriasis facts

What is psoriasis?

Psoriasis is a noncontagious, chronic skin disease that produces plaques of thickened, scaly skin. The dry flakes of silvery-white skin scales result from the excessively rapid proliferation of skin cells. Psoriasis is fundamentally an immune system problem. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-cells. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of this autoimmune disease ranges from mild with limited involvement of small areas of skin to severe psoriasis with 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, an immune-mediated inflammatory disease, 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 self-esteem and 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 the immune system 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 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 skin cells 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 psoriasis 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 over-the-counter 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.

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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 an anti-inflammatorydiet 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, Pictures, Symptoms, Types & Diet

Psoriasis Guide: Causes, Symptoms and Treatment Options

Medically reviewed on May 14, 2018

Psoriasis is a chronic skin disorder that causes scaling and inflammation.

Psoriasis may develop as a result of an abnormality in the body’s immune system. The immune system normally fights infection and allergic reactions.

Psoriasis probably has a genetic component. Nearly half of patients have family members with psoriasis.

Certain medications may trigger psoriasis. Other medications seem to make psoriasis worse in people who have the disease.

Psoriasis causes skin scaling and inflammation. It may or may not cause itching. There are several types of psoriasis:

Plaque psoriasis. In plaque psoriasis, there are rounded or oval patches (plaques) of affected skin. These are usually red and covered with a thick silvery scale. The plaques often occur on the elbows, knees, scalp or near the buttocks. They may also appear on the trunk, arms and legs.

Inverse psoriasis. Inverse psoriasis is a plaque type of psoriasis that tends to affect skin creases. Creases in the underarm, groin, buttocks, genital areas or under the breast are particularly affected. The red patches may be moist rather than scaling.

Pustular psoriasis. The skin patches are studded with pimples or pustules.

Guttate psoriasis. In guttate psoriasis, many small, red, scaly patches develop suddenly and simultaneously. Guttate psoriasis often occurs in a young person who has recently had strep throat or a viral upper respiratory infection.

About half of people with skin symptoms of psoriasis also have abnormal fingernails. Their nails are often thick and have small indentations, called pitting.

A type of arthritis called psoriatic arthritis affects some people with psoriasis. Psoriatic arthritis may occur before skin changes appear.

Your doctor will look for the typical skin and nail changes of this disorder. He or she can frequently diagnose psoriasis based on your physical examination.

When skin symptoms are not typical of the disorder, your doctor may recommend a skin biopsy. In a biopsy, a small sample of skin is removed and examined in a laboratory. The biopsy can confirm the diagnosis and rule out other possible skin disorders.

Psoriasis is a long-term disorder. However, symptoms may come and go.

There is no way to prevent psoriasis.

Treatment for psoriasis varies depending on the:

Treatments for psoriasis include:

Topical treatments. These are treatments applied directly to the skin.

Daily skin care with emollients for lubrication. These include petroleum jelly or unscented moisturizers.

Corticosteroid creams, lotions and ointments. These may be prescribed in medium and high-strength forms for stubborn plaques on the hands, feet, arms, legs and trunk. They may be prescribed in low-strength forms for areas of delicate skin such as the face.

Calcipotriol (Dovonex) slows production of skin scales.

Tazarotene (Tazorac) is a synthetic vitamin A derivative.

Coal tar

Salicylic acid to remove scales

Phototherapy. Extensive or widespread psoriasis may be treated with light. Phototherapy uses ultraviolet B or ultraviolet A, alone or in combination with coal tar.

A treatment called PUVA combines ultraviolet A light treatment with an oral medication that improves the effectiveness of the light treatment.

Laser treatment also can be used. It allows treatment to be more focused so that higher amounts of UV light can be used.

Vitamin A derivatives. These are used to treat moderate to severe psoriasis involving large areas of the body. These treatments are very powerful. Some have the potential to cause severe side effects. It’s essential to understand the risks and be monitored closely.

Immunosuppressants. These drugs work by suppressing the immune system. They are used to treat moderate to severe psoriasis involving large areas of the body.

Antineoplastic agents. More rarely, these drugs (which are most often used to treat cancer cells) may be prescribed for severe psoriasis.

Biologic therapies. Biologics are newer agents used for psoriasis that has not responded to other treatments. Psoriasis is caused, in part, by substances made by the immune system that cause inflammation. Biologics act against these substances. Biologic treatments tend to be quite expensive.

If you are unsure whether you have psoriasis, contact your doctor. Also contact your doctor if you have psoriasis and are not doing well with over-the-counter treatment.

For most patients, psoriasis is a long-term condition.

There is no cure. But there are many effective treatments.

In some patients, doctors may switch treatments every 12 to 24 months. This prevents the treatments from losing their effectiveness and decreases the risk of side effects.

National Psoriasis Foundation6600 SW 92nd Ave.Suite 300Portland, OR 97223-7195Phone: 503-244-7404Toll-Free: 1-800-723-9166Fax: 503-245-0626http://www.psoriasis.org/

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Psoriasis Guide: Causes, Symptoms and Treatment Options

Psoriasis – Diagnosis and treatment – Mayo Clinic

Diagnosis

In most cases, diagnosis of psoriasis is fairly straightforward.

Psoriasis treatments reduce inflammation and clear the skin. Treatments can be divided into three main types: topical treatments, light therapy and systemic medications.

Used alone, creams and ointments that you apply to your skin can effectively treat mild to moderate psoriasis. When the disease is more severe, creams are likely to be combined with oral medications or light therapy. Topical psoriasis treatments include:

Topical corticosteroids. These drugs are the most frequently prescribed medications for treating mild to moderate psoriasis. They reduce inflammation and relieve itching and may be used with other treatments.

Mild corticosteroid ointments are usually recommended for sensitive areas, such as your face or skin folds, and for treating widespread patches of damaged skin.

Your doctor may prescribe stronger corticosteroid ointment for smaller, less sensitive or tougher-to-treat areas.

Long-term use or overuse of strong corticosteroids can cause thinning of the skin. Topical corticosteroids may stop working over time. It’s usually best to use topical corticosteroids as a short-term treatment during flares.

Topical retinoids. These are vitamin A derivatives that may decrease inflammation. The most common side effect is skin irritation. These medications may also increase sensitivity to sunlight, so while using the medication apply sunscreen before going outdoors.

The risk of birth defects is far lower for topical retinoids than for oral retinoids. But tazarotene (Tazorac, Avage) isn’t recommended when you’re pregnant or breast-feeding or if you intend to become pregnant.

Calcineurin inhibitors. Calcineurin inhibitors tacrolimus (Prograf) and pimecrolimus (Elidel) reduce inflammation and plaque buildup.

Calcineurin inhibitors are not recommended for long-term or continuous use because of a potential increased risk of skin cancer and lymphoma. They may be especially helpful in areas of thin skin, such as around the eyes, where steroid creams or retinoids are too irritating or may cause harmful effects.

Coal tar. Derived from coal, coal tar reduces scaling, itching and inflammation. Coal tar can irritate the skin. It’s also messy, stains clothing and bedding, and has a strong odor.

Coal tar is available in over-the-counter shampoos, creams and oils. It’s also available in higher concentrations by prescription. This treatment isn’t recommended for women who are pregnant or breast-feeding.

This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight.

Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with medications.

Psoralen plus ultraviolet A (PUVA). This form of photochemotherapy involves taking a light-sensitizing medication (psoralen) before exposure to UVA light. UVA light penetrates deeper into the skin than does UVB light, and psoralen makes the skin more responsive to UVA exposure.

This more aggressive treatment consistently improves skin and is often used for more-severe cases of psoriasis. Short-term side effects include nausea, headache, burning and itching. Long-term side effects include dry and wrinkled skin, freckles, increased sun sensitivity, and increased risk of skin cancer, including melanoma.

If you have severe psoriasis or it’s resistant to other types of treatment, your doctor may prescribe oral or injected drugs. This is known as systemic treatment. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment.

Although doctors choose treatments based on the type and severity of psoriasis and the areas of skin affected, the traditional approach is to start with the mildest treatments topical creams and ultraviolet light therapy (phototherapy) in those patients with typical skin lesions (plaques) and then progress to stronger ones only if necessary. Patients with pustular or erythrodermic psoriasis or associated arthritis usually need systemic therapy from the beginning of treatment. The goal is to find the most effective way to slow cell turnover with the fewest possible side effects.

There are a number of new medications currently being researched that have the potential to improve psoriasis treatment. These treatments target different proteins that work with the immune system.

A number of alternative therapies claim to ease the symptoms of psoriasis, including special diets, creams, dietary supplements and herbs. None have definitively been proved effective. But some alternative therapies are deemed generally safe, and they may be helpful to some people in reducing signs and symptoms, such as itching and scaling. These treatments would be most appropriate for those with milder, plaque disease and not for those with pustules, erythroderma or arthritis.

If you’re considering dietary supplements or other alternative therapy to ease the symptoms of psoriasis, consult your doctor. He or she can help you weigh the pros and cons of specific alternative therapies.

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Although self-help measures won’t cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:

Coping with psoriasis can be a challenge, especially if the disease covers large areas of your body or is in places readily seen by other people, such as your face or hands. The ongoing, persistent nature of the disease and the treatment challenges only add to the burden.

Here are some ways to help you cope and to feel more in control:

You’ll likely first see your family doctor or a general practitioner. In some cases, you may be referred directly to a specialist in skin diseases (dermatologist).

Here’s some information to help you prepare for your appointment and to know what to expect from your doctor.

Make a list of the following:

For psoriasis, some basic questions you might ask your doctor include:

Your doctor is likely to ask you several questions, such as:

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Psoriasis – Diagnosis and treatment – Mayo Clinic

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 Treatment, Causes, Pictures, Symptoms, Types & Diet

Psoriasis facts

What is psoriasis?

Psoriasis is a noncontagious, chronic skin disease that produces plaques of thickened, scaly skin. The dry flakes of silvery-white skin scales result from the excessively rapid proliferation of skin cells. Psoriasis is fundamentally an immune system problem. The proliferation of skin cells is triggered by inflammatory chemicals produced by specialized white blood cells called T-cells. Psoriasis commonly affects the skin of the elbows, knees, and scalp.

The spectrum of this autoimmune disease ranges from mild with limited involvement of small areas of skin to severe psoriasis with 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, an immune-mediated inflammatory disease, 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 self-esteem and 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 the immune system 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 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 skin cells 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 psoriasis 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 over-the-counter 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.

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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 an anti-inflammatorydiet 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.

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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, Pictures, Symptoms, Types & Diet


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