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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

Read more here:

Psoriasis | Psoriatic Arthritis | MedlinePlus

Psoriasis – What is Psoriasis? Basic Symptoms and Types

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

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

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

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

Other forms of psoriasis include:

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

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

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

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

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

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

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

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

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

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Psoriasis – What is Psoriasis? Basic Symptoms and Types

Psoriasis – Symptoms and causes – Mayo Clinic

Overview

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

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

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

Psoriasis care at Mayo Clinic

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

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

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

There are several types of psoriasis. These include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Psoriasis – Symptoms and causes – Mayo Clinic

Psoriasis | Psoriatic Arthritis | MedlinePlus

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

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

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

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

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

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

See the article here:

Psoriasis | Psoriatic Arthritis | MedlinePlus

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis facts

What is psoriasis?

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

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

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

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

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

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

What are psoriasis causes and risk factors?

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

What are the different types of psoriasis?

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

Can psoriasis affect my joints?

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

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

Can psoriasis affect only my nails?

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

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

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

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

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

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

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

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

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

How do health care professionals diagnose psoriasis?

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

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

Eczema vs. psoriasis

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

How many people have psoriasis?

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

Is psoriasis contagious?

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

Is there a cure for psoriasis?

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

Is psoriasis hereditary?

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

What health care specialists treat psoriasis?

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

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

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

What are psoriasis treatment options?

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

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

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

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

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

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

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

Are psoriasis shampoos available?

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

What oral medications are available for psoriasis?

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

What injections or infusions are available for psoriasis?

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

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

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

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

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

Is there an anti-psoriasis diet?

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

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

What about light therapy for psoriasis?

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

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

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

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

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

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

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

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

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

Is it possible to prevent psoriasis?

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

What does the future hold for psoriasis?

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

Is there a national psoriasis support group?

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

Where can people get more information on psoriasis?

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

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

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

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

Medically Reviewed on 2/1/2018

References

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

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

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

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

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

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

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

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

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

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Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis – What is Psoriasis? Basic Symptoms and Types

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

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

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

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

Other forms of psoriasis include:

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

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

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

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

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

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

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

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

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

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Psoriasis – What is Psoriasis? Basic Symptoms and Types

Psoriasis – What is Psoriasis? Basic Symptoms and Types

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

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

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

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

Other forms of psoriasis include:

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

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

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

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

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

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

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

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

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

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Psoriasis – What is Psoriasis? Basic Symptoms and Types

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis facts

What is psoriasis?

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

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

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

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

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

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

What are psoriasis causes and risk factors?

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

What are the different types of psoriasis?

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

Can psoriasis affect my joints?

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

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

Can psoriasis affect only my nails?

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

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

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

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

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

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

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

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

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

How do health care professionals diagnose psoriasis?

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

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

Eczema vs. psoriasis

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

How many people have psoriasis?

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

Is psoriasis contagious?

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

Is there a cure for psoriasis?

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

Is psoriasis hereditary?

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

What health care specialists treat psoriasis?

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

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

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

What are psoriasis treatment options?

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

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

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

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

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

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

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

Are psoriasis shampoos available?

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

What oral medications are available for psoriasis?

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

What injections or infusions are available for psoriasis?

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

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

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

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

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

Is there an anti-psoriasis diet?

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

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

What about light therapy for psoriasis?

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

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

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

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

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

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

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

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

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

Is it possible to prevent psoriasis?

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

What does the future hold for psoriasis?

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

Is there a national psoriasis support group?

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

Where can people get more information on psoriasis?

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

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

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

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

Medically Reviewed on 2/1/2018

References

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

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

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

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

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

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

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

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

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

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Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis – Symptoms and causes – Mayo Clinic

Overview

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

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

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

Psoriasis care at Mayo Clinic

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

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

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

There are several types of psoriasis. These include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Psoriasis – Symptoms and causes – Mayo Clinic

Psoriasis Types and Pictures | Psoriasis.com

People often think of psoriasis as a single skin condition. In fact, there are multiple types of psoriasis, though people will typically have only one type at a time.

Each type of psoriasis has very distinct symptoms and characteristics and can appear on the skin in a variety of ways.

It’s important to knowand share with othersthat no matter where it is on the body or what it looks like, psoriasis is not contagious.

Characterized by raised, inflamed, red lesions covered by silvery white scales. Typically found on the elbows, knees, scalp, and lower back. The most common type of psoriasis, about 80% of those who have psoriasis have this type.

Often starts in childhood or young adulthood. Appears as small, pink, individual spots on the skin of the torso, arms, and legs. These spots are not usually as thick as plaque lesions.

Found in the armpits, in the groin, under the breasts, and in other skin folds around the genitals and the buttocks. This type of psoriasis appears as bright-red lesions that are smooth and shiny.

Primarily seen in adults, pustular psoriasis is characterized by white blisters of noninfectious pus surrounded by red skin. It may either be localized to certain areas of the body, such as the hands and feet, or covering most of the body.

A particularly inflammatory form of psoriasis affecting most of the body surface, it is characterized by periodic, widespread, fiery redness of the skin and the shedding of scales in sheets.

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Psoriasis Types and Pictures | Psoriasis.com

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis facts

What is psoriasis?

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

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

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

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

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

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

What are psoriasis causes and risk factors?

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

What are the different types of psoriasis?

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

Can psoriasis affect my joints?

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

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

Can psoriasis affect only my nails?

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

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

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

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

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

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

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

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

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

How do health care professionals diagnose psoriasis?

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

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

Eczema vs. psoriasis

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

How many people have psoriasis?

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

Is psoriasis contagious?

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

Is there a cure for psoriasis?

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

Is psoriasis hereditary?

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

What health care specialists treat psoriasis?

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

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

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

What are psoriasis treatment options?

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

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

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

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

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

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

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

Are psoriasis shampoos available?

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

What oral medications are available for psoriasis?

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

What injections or infusions are available for psoriasis?

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

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

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

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

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

Is there an anti-psoriasis diet?

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

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

What about light therapy for psoriasis?

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

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

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

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

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

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

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

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

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

Is it possible to prevent psoriasis?

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

What does the future hold for psoriasis?

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

Is there a national psoriasis support group?

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

Where can people get more information on psoriasis?

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

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

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

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

Medically Reviewed on 2/1/2018

References

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

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

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

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

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

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

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

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

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

Excerpt from:

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis – What is Psoriasis? Basic Symptoms and Types

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

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

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

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

Other forms of psoriasis include:

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

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

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

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

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

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

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

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

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

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Excerpt from:

Psoriasis – What is Psoriasis? Basic Symptoms and Types

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis facts

What is psoriasis?

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

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

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

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

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

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

What are psoriasis causes and risk factors?

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

What are the different types of psoriasis?

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

Can psoriasis affect my joints?

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

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

Can psoriasis affect only my nails?

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

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

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

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

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

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

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

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

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

How do health care professionals diagnose psoriasis?

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

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

Eczema vs. psoriasis

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

How many people have psoriasis?

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

Is psoriasis contagious?

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

Is there a cure for psoriasis?

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

Is psoriasis hereditary?

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

What health care specialists treat psoriasis?

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

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

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

What are psoriasis treatment options?

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

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

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

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

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

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

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

Are psoriasis shampoos available?

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

What oral medications are available for psoriasis?

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

What injections or infusions are available for psoriasis?

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

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

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

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

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

Is there an anti-psoriasis diet?

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

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

What about light therapy for psoriasis?

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

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

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

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

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

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

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

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

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

Is it possible to prevent psoriasis?

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

What does the future hold for psoriasis?

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

Is there a national psoriasis support group?

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

Where can people get more information on psoriasis?

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

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

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

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

Medically Reviewed on 2/1/2018

References

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

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

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

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

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

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

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

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

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

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Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis – Symptoms and causes – Mayo Clinic

Overview

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

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

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

Psoriasis care at Mayo Clinic

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

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

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

There are several types of psoriasis. These include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Psoriasis – Symptoms and causes – Mayo Clinic

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Psoriasis is a disease in which red, scaly patches form on the skin, typically on the elbows, knees, or scalp. An estimated 7.5 million people in the United States will develop the disease, most of them between the ages of 15 and 30. Many people with psoriasis experience pain, discomfort, and self-esteem problems that can interfere with their work and social life.

Although the exact cause of psoriasis is unknown, researchers say the disease is largely geneticits caused by a combination of genes that send the immune system into overdrive, triggering the rapid growth of skin cells that form patches and lesions.

A dermatologist can likely tell the difference between psoriasis and eczema, but to the untrained eye, these skin conditions can appear similar. Generally speaking, psoriasis appears as thick, red patches that have a scaly buildup on top, according to the American Academy of Dermatology (AAD). These lesions are usually well defined, whereas eczema tends to cause a rash and be accompanied by an intense itch.

In addition, psoriasis tends to occur on the outside of the knees and elbows, and on the lower back and scalp; eczema usually covers the elbow and knee creases and the neck or face.

Research published in 2015 in the Journal of Clinical Medicine suggested that infants and children with psoriasis may be particularly likely to be misdiagnosed with eczema because they may have less scaling than adults.

RELATED: Whats That Rash?

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Psoriasis can range in severity, from mild patches to severe lesions that can affect more than 5% of the skin. There are five types of the disease: plaque psoriasis, pustular psoriasis, guttate psoriasis, inverse psoriasis, and erythrodermic psoriasis. Some people will have one form, whereas others will have two or more.

Plaque psoriasis appears as red patches with silvery white scales, or buildup of dead skin cells, called plaques. Its the most common type of psoriasis, affecting up to 90% of all people with the disease, according to the AAD. Most often found on the scalp, elbows, lower back, and knees, the plaques themselves will be raised and have clear edges; they may also itch, crack, or bleed.

Pustular psoriasis is a form of psoriasis in which white pustules (or bumps filled with white pus) appear on the skin. In a typical cycle, the skin will turn red, break out in pustules, and then develop scales. There are three types of pustular psoriasis: von Zumbusch pustular psoriasis (which appears abruptly and can be accompanied with fever, chills, and dehydration), palmoplantar pustulosis (which appears on the soles of the feet and the hands), and acropustulosis (a rare form of psoriasis that forms on the ends of the fingers or toes).

Guttate psoriasis is a type of psoriasis that appears as red, scaly teardrop-shaped spots. (The word guttate is Latin for drop.) During a flare-up, hundreds of lesions can form on the arms, legs, and torso, although they can also appear on the face, ears, and scalp. Guttate is the second most common type of psoriasis, occurring in about 10% of all people with the disease. Its most likely to appear in people who are younger than 30, oftentimes after they develop an infection like strep throat.

Inverse psoriasis is a type of psoriasis that appears as smooth, bright red lesions in the armpit, groin, and other areas with folds of skin. Because these regions of the body are prone to sweating and rubbing, inverse psoriasis can be particularly irritating and hard to treat.

Erythrodermic psoriasis is rare but can require immediate treatment or even hospitalization. The lesions look like large sheets rather than small spots, as if the area has been burned, and tend to be severely itchy and painful. A flare-up can trigger swelling, infection, and increased heart rate.

Psoriasis is not contagiousits a genetic, autoimmune disease. Psoriasis lesions cannot infect other people; likewise, people cant catch psoriasis from someone else, whether through touching, sexual contact, or swimming in the same pool. Its unclear, however, whether a majority of the general public is aware of this fact. In a small 2015 survey in the Journal of the American Academy of Dermatology, about 60% of people said they thought that psoriasis was infectious, while 41% said they thought the lesions looked contagious.

RELATED: 14 Ways to Manage Your Psoriasis

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The simplest answer to the question of what causes psoriasis: your genetics. An estimated 10% of people inherit at least one of the genes that can cause psoriasis. (There are as many as 25 genetic mutations that make someone more likely to develop psoriasis.) But only 2% to 3% of people will develop the disease, according to the National Psoriasis Foundation (NSF). Therefore, researchers believe that psoriasis is caused by a certain combination of genes that spring into action after being exposed to a trigger. Common triggers include stress, an infection (like strep throat), and certain medications (like lithium). Cold, dry weather and sunburns may also trigger psoriasis flares.

When someone with psoriasis is exposed to a trigger, their immune system scrambles to defend itself by producing T cells, a type of white blood cell that helps ward off infections and other diseases. With psoriasis, however, T cell-production goes into overdrive, eventually causing inflammation and faster-than-usual growth of skin cells, leading to psoriasis symptoms.

The signs and symptoms of psoriasis vary depending on the type and severity of the skin disease. Some people may have one form of psoriasis, while others can have two or more.

Raised reddish patches. People with plaque psoriasis can experience a flare-up of red, raised patches. These patches can be itchy or painful or crack and bleed.

Scaly patches. Often seen in plaque psoriasis, scales are patches of built-up dead skin cells that have a silvery-white sheen. They often appear on top of raised, red patches that can be itchy or painful or crack and bleed. People with plaque psoriasis can experience a flare-up of symptoms on their scalp, knees, elbows, and lower back.

White pustules. A characteristic of pustular psoriasis, these white pus-filled blisters can cluster on the hands and feet or spread to most of the body. After the pustules appear, scaling usually follows. In people with von Zumbusch psoriasis, the pustules will dry after 24 to 48 hours, leaving the skin with a glazed appearance. In people with palmoplantar pustulosis, the pustules will turn brown, then peel, then start to crust.

Red, smooth lesions.Seen in inverse psoriasis, these very red lesions are smooth and shiny and are found in parts of the body with folds of skin, like the armpits, groin, and under the breasts. Because these lesions tend to be located in sensitive areas, they are prone to irritation from rubbing or sweating.

Red spots. A telltale sign of guttate psoriasis, these small, red spots are shaped like drops and usually appear on the torso, arms, and legs. In most cases, they arent as thick as plaque psoriasis lesions, but they can be widespread, numbering into the hundreds.

Nail changes.About 50% of people with psoriasis experience changes to their finger or toenails, including pitting (the appearance of holes in the nail), thickening, and discoloration, according to the NPF.

RELATED: 10 Things Your Nails Can Tell You About Your Health

Areas of the body normally affected by psoriasis

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There are no special diagnostic tests for psoriasis. Instead, a psoriasis diagnosis is made by a dermatologist, who will examine the skin lesions visually. In some cases, psoriasis can resemble other types of skin conditions, like eczema, so doctors may want to confirm the results with a biopsy. That involves removing some of the skin and looking at the sample under a microscope, where psoriasis tends to appear thicker than eczema.

Doctors may also take a detailed record of your familys medical history: About one-third of people with psoriasis have a first-degree relative who also has the condition. Health care providers may also try to pinpoint psoriasis triggers by asking whether their patients have been under stress lately or are taking a new medication.

Theres no one-size-fits-all psoriasis treatment, and the medications that work for some people may not work for others. The goal, however, is the same for everyone: to find psoriasis medications that can reduce or eliminate psoriasis symptoms. Here are some of the most commonly prescribed therapies.

Topical medications. A first-line form of therapy for mild to moderate conditions, topicals (in psoriasis cream, gel, and ointment forms) are applied directly to the skin in the hopes of reducing inflammation and slowing down skin cell growth. Some are available over-the-counter, like products with salicylic acid and coal tar as active ingredients, while others, like calcipotriene (a form of vitamin D3) and tazarotene (a vitamin A derivative known as a retinoid) are available by prescription. There are also special psoriasis shampoos that can help clear up scalp psoriasis; many contain coal tar and salicylic acid.

Phototherapy. Also called light therapy, phototherapy exposes a persons skin to ultraviolet light, which is thought to kill the immune cells contributing to psoriasis. Phototherapy can be administered in the form of UVB rays, a combination of UVA and UVB, or UVA rays alongside an oral or topical medication called psoralen (a treatment called PUVA). The catch: These treatments have to be done in a doctors office, a psoriasis clinic, or with a specialized phototherapy unit and usually require several visits, which can become expensive. Because indoor tanning increases the risk of skin cancer (especially melanoma), its not considered a safe substitute for phototherapy under medical supervision.

Systemic medications. If topical medications and phototherapy dont work, doctors may recommend taking systemics, or prescription drugs that affect the entire body. These meds can be taken orally or via an injection, and include cyclosporine (which suppresses immune system activity and slows skin cell growth), acitretin (an oral retinoid, or form of vitamin A, that slows down the speed at which skin cells grow and shed), and methotrexate (a medication that was originally used as a cancer treatment, but can also slow down the growth of skin cells).

Biologic drugs. Biologics contain human or animal proteins and can block certain immune cells that are involved in psoriasis. Theyre usually recommended for people with moderate to severe psoriasis and are administered via an injection or IV infusion. There are currently three types of biologics that can help treat psoriasis, all of which block immune system chemical messengers that promote inflammation called cytokines. The three types of biologics block the cytokines tumor necrosis factor alpha (TNF-alpha), interleukin 12, interleukin 23, and interleukin 17-A (IL-12, IL-23, and IL-17A, respectively).

RELATED: 21 Tips and Tricks for Treating Psoriasis

Alternative and complementary therapies. Some alternative therapiesincluding acupuncture, massage, and Reikimight help relieve certain psoriasis symptoms, like pain. They may also help control stress, a common psoriasis trigger. Other stress-relievers include meditation, mindfulness, exercise, yoga, and Tai Chi. Always talk to your doctor before beginning any alternative psoriasis treatments.

There is currently no cure for psoriasis. As a chronic autoimmune disease, most people with psoriasis will always have it. But it is possible to treat the condition. In fact, the right medications and therapies can reduce symptoms and even clear up the skin entirely in some people.

More psoriasis treatments may be available in the future. Researchers are currently trying to uncover what causes the lesions on a cellular level and how to prevent flare-ups caused by the immune system.

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For the millions of Americans who have psoriasis, the skin condition can pose many challenges. Not only can the pain and itching interfere with their ability to sleep or work, but research shows that many people with psoriasis feel unattractive; worse, if they feel self-conscious, they may withdraw from their friends and family and become isolated.

People with psoriasis are also twice as likely to be depressed as those who dont have the skin condition, according to the NPF, and they can also be more likely to have suicidal thoughts. If youre feeling a loss of energy, lack of interest in once-enjoyable activities, or an inability to focus, talk to your doctor about whether you may have depression or should see a mental health specialist.

An estimated 30% of people with psoriasis will also develop psoriatic arthritis, a disease which causes joint pain, stiffness, and swelling. Having psoriasis may also make people more likely to develop cardiovascular disease, obesity, and diabetes, according to the NPF.

RELATED: 12 Best and Worst Foods for Psoriasis

There are many ways that people living with psoriasis can manage the condition. This includes avoiding tobacco, alcohol, and unhealthy foods. Although there is no psoriasis diet, per se, eating healthy meals may help you feel better. You should also keep tabs on whether your joints feel stiff or sore or whether your nails are pitting or turning yellowtwo possible signs of psoriatic arthritis. Recognizing these symptomsand getting treatmentcan help prevent further damage to the joints.

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Anyone can develop psoriasiseven the most beautiful people on the planet. And as people who are paid to look flawless, many celebrities with psoriasis say that the skin condition delivers a serious blow to their self-esteem and fear that it can interfere with their careers.

In 2011, Kim Kardashian revealed her psoriasis diagnosis on an episode of Keeping Up With the Kardashians. Although her mother, Kris Jenner, was diagnosed with psoriasis at the age of 30, Kim was surprised to learn that she had the skin condition too. My career is doing ad campaigns and swimsuit photo shoots, she said in the episode. People dont understand the pressure on me to look perfect. Imagine what the tabloids would do to me if they saw all these spots.

Model and actress Cara Delevingne also has psoriasis, which she struggled to manage while runway modeling. She told Londons The Times in an interview that people would paint her body with foundation to cover up the patches. It was every single show, she said. People would put on gloves and not want to touch me.

Other models also struggle with psoriasis, like CariDee English, who won Americas Next Top Model in 2006. Partly in response to the hurtful tabloid headlines that called out the lesions on her legs, she posted before-and-after photos of one of her flare-ups, saying, I knew I didnt want anyone capturing my psoriasis in a way that wasnt empowering.

Other celebs who have psoriasis include golfer Phil Michelson, country singer LeAnn Rimes, and pop star Cyndi Lauper.

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Psoriasis – Causes, Symptoms and Treatment – Health.com …

Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis facts

What is psoriasis?

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

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

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

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

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

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

What are psoriasis causes and risk factors?

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

What are the different types of psoriasis?

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

Can psoriasis affect my joints?

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

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

Can psoriasis affect only my nails?

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

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

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

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

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

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

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

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

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

How do health care professionals diagnose psoriasis?

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

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

Eczema vs. psoriasis

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

How many people have psoriasis?

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

Is psoriasis contagious?

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

Is there a cure for psoriasis?

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

Is psoriasis hereditary?

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

What health care specialists treat psoriasis?

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

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

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

What are psoriasis treatment options?

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

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

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

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

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

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

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

Are psoriasis shampoos available?

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

What oral medications are available for psoriasis?

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

What injections or infusions are available for psoriasis?

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

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

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

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

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

Is there an anti-psoriasis diet?

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

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

What about light therapy for psoriasis?

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

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

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

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

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

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

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

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

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

Is it possible to prevent psoriasis?

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

What does the future hold for psoriasis?

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

Is there a national psoriasis support group?

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

Where can people get more information on psoriasis?

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

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

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

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

Medically Reviewed on 2/1/2018

References

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

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

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

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

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

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

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

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

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

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Psoriasis Treatment, Causes, Symptoms, Pictures & Diet

Psoriasis – Symptoms and causes – Mayo Clinic

Overview

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

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

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

Psoriasis care at Mayo Clinic

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

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

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

There are several types of psoriasis. These include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Psoriasis – Symptoms and causes – Mayo Clinic

Psoriasis Types and Pictures | Psoriasis.com

People often think of psoriasis as a single skin condition. In fact, there are multiple types of psoriasis, though people will typically have only one type at a time.

Each type of psoriasis has very distinct symptoms and characteristics and can appear on the skin in a variety of ways.

It’s important to knowand share with othersthat no matter where it is on the body or what it looks like, psoriasis is not contagious.

Characterized by raised, inflamed, red lesions covered by silvery white scales. Typically found on the elbows, knees, scalp, and lower back. The most common type of psoriasis, about 80% of those who have psoriasis have this type.

Often starts in childhood or young adulthood. Appears as small, pink, individual spots on the skin of the torso, arms, and legs. These spots are not usually as thick as plaque lesions.

Found in the armpits, in the groin, under the breasts, and in other skin folds around the genitals and the buttocks. This type of psoriasis appears as bright-red lesions that are smooth and shiny.

Primarily seen in adults, pustular psoriasis is characterized by white blisters of noninfectious pus surrounded by red skin. It may either be localized to certain areas of the body, such as the hands and feet, or covering most of the body.

A particularly inflammatory form of psoriasis affecting most of the body surface, it is characterized by periodic, widespread, fiery redness of the skin and the shedding of scales in sheets.

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Psoriasis Types and Pictures | Psoriasis.com

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 – What is Psoriasis? Basic Symptoms and Types

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

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

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

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

Other forms of psoriasis include:

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

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

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

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

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

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

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

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

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

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