Description

Psoriasis is a skin disease that causes a rash with itchy, scaly patches, most often on the knees, elbows, trunk and scalp.

Psoriasis is a common, long-term (chronic) illness that has no cure. It can be painful, interfere with sleep and make it difficult to concentrate. The disease tends to go through cycles, flaring for a few weeks or months, then subsiding for a time. The triggering factors more common in people with a genetic predisposition to psoriasis include infections, cuts or burns, and certain medications.

Treatments are available to help you manage the symptoms. And you can try to lifestyle habits and coping strategies to help you live better with psoriasis.

Symptoms

The signs and symptoms of psoriasis include:

  • A rash spot that varies widely in how it looks from person to person, ranging from spots of dandruff-like scaling to major eruptions during a large part of the body
  • The eruptions vary in color, which tends to be shades of purple with a gray scale in Black or brown skin and pink or red with silver scale white skin
  • Small scaling spots (commonly seen in children)
  • Dry, cracked skin that may bleed
  • Itching, burning or pain
  • Cyclic rashes that flare up for a couple of weeks or months and then disappear

There are several types of psoriasis, each of which varies in their signs and symptoms:

  • Plaque psoriasis. The most common type of psoriasis, plaque psoriasis causes dry, itchy, raised skin patches (plaques) covered with scales. There may be few or many. They usually appear on the elbows, knees, lower back and scalp. The patches vary in color, depending on the color of the skin. The affected skin may heal with temporary changes in color (post inflammatory hyperpigmentation), in particular, of brown or Black skin.
  • Nail Psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails may become loose and separate from the nail bed (onycholysis). The serious disease that can cause the nail to crumble.
  • Guttate psoriasis. This type of psoriasis affects mainly young adults and children. It is usually caused by a bacterial infection, such as strep throat. It is characterized by small, drop-shaped, scaling spots on the trunk, arms, or legs.
  • Inverse psoriasis. Inverse psoriasis mainly affects the skin folds of the groin, buttocks, and breasts. It causes smooth patches of inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.
  • Pustular Psoriasis. Pustular Psoriasis, a rare type, causes clearly defined pus-filled blisters. It can occur in widespread patches or in smaller areas of the palms of the hands or soles of the feet.
  • Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover the entire body with a peeling rash that can itch or burn intensely. May be short-lived (acute) or long term (chronic).

When to see a doctor

If you suspect that you may have psoriasis, consult your health care provider. Also seek medical attention if your condition:

  • It becomes severe or pervasive
  • It causes discomfort and pain
  • Cause for concern about the appearance of your skin
  • Do not improve with treatment

Causes

Psoriasis is believed to be an immune system problem that causes the skin cells grow faster than usual. In the most common type of psoriasis, known as plaque psoriasis, this rapid turnover of the cells results in dry, flaky patches.

The cause of psoriasis is not fully understood. It is believed that it is a problem with the immune system, where infection-fighting cells attack healthy skin cells by mistake. The researchers believe that both genetics and environmental factors play an important role. The condition is not contagious.

Triggers of Psoriasis

Many people who have a predisposition to psoriasis may be free of symptoms for years, until the disease is triggered by some environmental factor. Common psoriasis triggers include:

  • Infections, such as strep throat or skin infections
  • The climate, especially in cold, dry
  • Skin injury, such as a cut or scrape, a bug bite, or a severe burn
  • Smoking and exposure to second-hand smoke
  • The excessive consumption of alcohol
  • Certain medications — including lithium, high blood pressure medications and anti-malarial drugs
  • The rapid withdrawal of corticosteroids, oral or injected

Risk factors

Anyone can develop psoriasis. Around one-third of cases begin in childhood. These factors can increase the risk of developing the disease:

  • The history of the family. The condition runs in families. Having a parent with psoriasis increases your risk of getting the disease. And the fact of having two parents with psoriasis increases the risk even more.
  • The habit of smoking. Tobacco smoking not only increases the risk of psoriasis, but may also increase the severity of the disease.

Complications

If you have psoriasis, you are at greater risk of developing other conditions, including:

  • Psoriatic arthritis, which causes pain, stiffness and swelling in and around the joints
  • Temporary changes in the color of skin (post-inflammatory hypopigmentation or hyperpigmentation), where the plates have been healed
  • Diseases of the eye, such as conjunctivitis, blepharitis and uveitis
  • Obesity
  • Type 2 diabetes
  • High blood pressure
  • Cardiovascular disease
  • Other autoimmune diseases, such as celiac disease, multiple sclerosis and inflammatory bowel disease called Crohn's disease
  • Mental health conditions, such as low self-esteem and depression

Diagnosis

Your health care provider will ask you questions about your health, and examining your skin, scalp and nails. Your health care provider may take a small skin sample (biopsy) for examination under a microscope. This helps to determine the type of psoriasis and to rule out other disorders.

Treatment

Psoriasis treatments aim to stop the skin cells from growing so quickly and to remove the scales. The options include creams and ointments (topical therapy), light therapy (phototherapy), and oral or injected medications.

The treatment used depends on the severity of the psoriasis is, and how sensitive it has been to previous treatment and self-care measures. You might need to try different medications or a combination of treatments, before finding a method that works. Even with the success of the treatment, the disease usually is returned.

Topical therapy

  • Corticosteroids.These drugs are the most frequently prescribed drugs for the treatment of mild to moderate psoriasis. They are available as oils, ointments, creams, lotions, gels, foams, sprays, and shampoos. Mild ointments with corticosteroids (such as hydrocortisone) is recommended for sensitive areas, such as the face or skin folds, and for treating widespread patches. The use of topical corticosteroids can be applied once per day during the eruptions, and on alternate days or on the weekends during remission. Your health care provider may prescribe a cream or ointment corticosteroid — triamcinolone (Trianex) or clobetasol (Cormax, Temovate, other) — for smaller, less sensitive or more difficult to treat areas. The long-term use or excessive use of strong corticosteroids can thin the skin. Over time, the use of topical corticosteroids may stop working.
  • Analogues of vitamin D. The synthetic forms of vitamin D — such as calcipotriene (Dovonex, Sorilux) and calcitriol (Vectical) — slow skin cell growth. This type of medication can be used alone or with topical corticosteroids. Calcitriol may cause less irritation in sensitive areas. Calcipotriene and calcitriol are generally more expensive than topical corticosteroids.
  • The retinoids.Tazarotene (Tazorac, Avage, others) is available as a gel or cream. Apply once or twice a day. The most common side effects are skin irritation and increased sensitivity to light. Tazarotene is not recommended when you are pregnant or breastfeeding or if planning to become pregnant.
  • The calcineurin inhibitors.Calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) — the calm of the rash and reduce the accumulation of scales. Can be especially useful in areas of thin skin, such as around the eyes, where the steroid creams or retinoids are known to be irritating or harmful. Calcineurin inhibitors are not recommended when you are pregnant or breastfeeding or if planning to become pregnant. This medication is also not intended for long-term use because of a possible increase in the risk of skin cancer and lymphoma.
  • The salicylic acid. Salicylic acid shampoo and scalp solutions to reduce the scale of psoriasis of the scalp. They are available for sale with or without a prescription strengths. This type of product can be used alone or with other topics of the therapy, as it prepares the scalp to absorb the medication more easily.
  • Tar hulla.De coal tar reduces scaling, itching and inflammation. It is available in many over-the-counter and prescription strengths. It comes in many forms, such as shampoo, cream and oil. These products can irritate the skin. They are also dirty, stain clothing and bedding, and can have a strong odor. Coal tar treatment is not recommended when you are pregnant or breastfeeding.
  • Anthralin. Anthralin is a tar cream that slows skin cell growth. You can also remove the scales and the skin smoother. It is not intended for use on the face or genitals. Anthralin may cause irritation to the skin and the stains out of almost anything it touches. It is usually applied for a short time and then rinsed.

Corticosteroids. These drugs are the most frequently prescribed drugs for the treatment of mild to moderate psoriasis. They are available as oils, ointments, creams, lotions, gels, foams, sprays, and shampoos. Mild ointments with corticosteroids (such as hydrocortisone) is recommended for sensitive areas, such as the face or skin folds, and for treating widespread patches. The use of topical corticosteroids can be applied once per day during the eruptions, and on alternate days or on the weekends during remission.

Your health care provider may prescribe a cream or ointment corticosteroid — triamcinolone (Trianex) or clobetasol (Cormax, Temovate, other) — for smaller, less sensitive or more difficult to treat areas.

The long-term use or excessive use of strong corticosteroids can thin the skin. Over time, the use of topical corticosteroids may stop working.

The retinoids. Tazarotene (Tazorac, Avage, others) is available as a gel or cream. Apply once or twice a day. The most common side effects are skin irritation and increased sensitivity to light.

Tazarotene is not recommended when you are pregnant or breastfeeding or if planning to become pregnant.

The calcineurin inhibitors. Calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) — the calm of the rash and reduce the accumulation of scales. Can be especially useful in areas of thin skin, such as around the eyes, where the steroid creams or retinoids are known to be irritating or harmful.

Calcineurin inhibitors are not recommended when you are pregnant or breastfeeding or if planning to become pregnant. This medication is also not intended for long-term use because of a possible increase in the risk of skin cancer and lymphoma.

Coal tar. Coal tar reduces scaling, itching and inflammation. It is available in many over-the-counter and prescription strengths. It comes in many forms, such as shampoo, cream and oil. These products can irritate the skin. They are also dirty, stain clothing and bedding, and can have a strong odor.

Coal tar treatment is not recommended when you are pregnant or breastfeeding.

Light therapy

The light therapy is a first line of treatment for moderate to severe psoriasis, either alone or in combination with medications. It is the exposure of the skin to controlled amounts of natural or artificial light. Repeated treatments are necessary. Talk with your health care provider about whether the home phototherapy is an option for you.

  • The light of the sun. Brief, daily exposure to sunlight (heliotherapy) could improve psoriasis. Before you begin with the sunlight regime, ask your health care provider about the safest way to use natural light for the treatment of psoriasis.
  • Broad-band UVB. Controlled doses of UVB broadband light from a light source of artificial light can be treated in a single psoriasis patches, widespread psoriasis and psoriasis that does not improve with topical treatments. Short-term side effects may include inflamed, itchy, dry skin.
  • Narrow-band UVB. UVB narrow band of light therapy may be more effective than broadband UVB treatment. In many places has been replaced broadband therapy. It is usually given two or three times a week until the skin improves, and then less frequently for maintenance therapy. But UVB phototherapy can cause more serious side effects than broad-band UVB.
  • Psoralen plus ultraviolet light a (PUVA).This treatment consists of taking a light-sensitizing medication (psoralen) before exposing the affected skin to UVA light. UVA light penetrates deeper in the skin that UVB light, and psoralen makes the skin more sensitive to the exposure to UVA. This more aggressive treatment is constantly improving the skin and is often used for more severe psoriasis. Short-term side effects may include nausea, headache, burning and itching. Possible long-term side effects include dry and wrinkled skin, freckles, increased sensitivity to the sun, and the increased risk of skin cancer, including melanoma.
  • An Excimer Laser. With this form of light therapy, a strong UVB light is focused only on the affected skin. Excimer laser therapy requires a lower number of sessions that the traditional phototherapy because more powerful uv light is used. The side effects can include swelling and blisters.

Psoralen plus ultraviolet light a (PUVA). This treatment consists of taking a light-sensitizing medication (psoralen) before exposing the affected skin to UVA light. UVA light penetrates deeper in the skin that UVB light, and psoralen makes the skin more sensitive to the exposure to UVA.

This more aggressive treatment is constantly improving the skin and is often used for more severe psoriasis. Short-term side effects may include nausea, headache, burning and itching. Possible long-term side effects include dry and wrinkled skin, freckles, increased sensitivity to the sun, and the increased risk of skin cancer, including melanoma.

Oral or injected medications

If you have moderate to severe psoriasis, or if other treatments have not worked, your health care provider may prescribe oral or injected (systemic) drug. Some of these medications are used for only brief periods, and can be alternated with other treatments because they have the potential of serious side effects.

  • Steroids. If you have a couple of small, persistent psoriasis patches, your doctor may suggest an injection of triamcinolone to the right in them.
  • The retinoids. Acitretin and other retinoids are the pills that are used to reduce the production of skin cells. Side effects may include dryness of the skin, and muscle pain. These drugs are not recommended when you are pregnant or breastfeeding or if planning to become pregnant.
  • Biological products.These drugs are generally administered by injection, alter the immune system in a way that disrupts the cycle of the disease and improves the symptoms and signs of the disease in a matter of weeks. Several of these medications are approved for the treatment of moderate to severe psoriasis in people who have not responded to first-line therapies. Options include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), risankizumab-rzaa (Skyrizi), ixekizumab (Taltz), guselkumab (Tremfya), apremilast (Otezla), bimekizumab-bkzx (Bimzelx) and secukinumab (Cosentyx). Four of them — etanercept, ixekizumab, secukinumab and ustekinumab — are approved for children. These types of medications are expensive and may or may not be covered by health insurance plans. Biological products should be used with caution because they carry the risk of suppression of the immune system, in ways that increase the risk of serious infections. The people taking these treatments should be screened for tuberculosis.
  • The methotrexate.Usually administered weekly as a single oral dose, methotrexate (Trexall) decreases the production of skin cells and suppresses inflammation. It is less effective than adalimumab and infliximab. May cause upset stomach, loss of appetite, and fatigue. People who take methotrexate need an ongoing long-term tests to monitor your blood counts and liver function. People need to stop taking methotrexate for at least three months before trying to conceive. This medicine is not recommended for those who are breastfeeding.
  • Cyclosporine.Taken by mouth for severe psoriasis, cyclosporine (Gengraf, Neoral, Sandimmune) suppresses the immune system. It is similar to that of methotrexate efficacy, but may not be used continuously for more than a year. Like other immunosuppressants, ciclosporin increases the risk of infection and other health problems, including cancer. People who take cyclosporine need long-term course of tests to monitor your blood pressure and renal function. These drugs are not recommended when you are pregnant or breastfeeding or if planning to become pregnant.
  • Other medications. Thioguanine (Tabloid) and hydroxyurea (Droxia, Hydrea) are medications that can be used when you can not take other medicines. Talk with your health care provider about possible side effects of these drugs.

Biological products. These drugs are generally administered by injection, alter the immune system in a way that disrupts the cycle of the disease and improves the symptoms and signs of the disease in a matter of weeks. Several of these medications are approved for the treatment of moderate to severe psoriasis in people who have not responded to first-line therapies. Options include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), ustekinumab (Stelara), risankizumab-rzaa (Skyrizi), ixekizumab (Taltz), guselkumab (Tremfya), apremilast (Otezla), bimekizumab-bkzx (Bimzelx) and secukinumab (Cosentyx). Four of them — etanercept, ixekizumab, secukinumab and ustekinumab — are approved for children. These types of medications are expensive and may or may not be covered by health insurance plans.

Biological products should be used with caution because they carry the risk of suppression of the immune system, in ways that increase the risk of serious infections. The people taking these treatments should be screened for tuberculosis.

The methotrexate. Usually administered weekly as a single oral dose, methotrexate (Trexall) decreases the production of skin cells and suppresses inflammation. It is less effective than adalimumab and infliximab. May cause upset stomach, loss of appetite, and fatigue. People who take methotrexate need an ongoing long-term tests to monitor your blood counts and liver function.

People need to stop taking methotrexate for at least three months before trying to conceive. This medicine is not recommended for those who are breastfeeding.

Cyclosporine. Taken by mouth for severe psoriasis, cyclosporine (Gengraf, Neoral, Sandimmune) suppresses the immune system. It is similar to that of methotrexate efficacy, but may not be used continuously for more than a year. Like other immunosuppressants, ciclosporin increases the risk of infection and other health problems, including cancer. People who take cyclosporine need long-term course of tests to monitor your blood pressure and renal function.

These drugs are not recommended when you are pregnant or breastfeeding or if planning to become pregnant.

Treatment considerations

You and your doctor will choose a method of treatment based on your needs and the type and severity of psoriasis. It is likely to start with the mildest treatments, topical creams and ultraviolet light therapy (uv). So, if your condition does not improve, you can move on to the stronger of the treatments.

People with pustular or erythrodermic psoriasis usually need to start with the strongest (systemic) drug.

In any situation, the objective is to find the most effective way to slow cell turnover with the fewest possible side effects.

Alternative medicine

Some studies claim that alternative therapies (integrative medicine) — products and practices are not part of conventional medical care or that developed outside of the Western tradition, the practice — relieve the symptoms of psoriasis. Examples of alternative therapies used by people with psoriasis, which include special diets, vitamins, acupuncture, and herbal products applied to the skin. None of these approaches is supported by a strong evidence, but in general they are safe and can help reduce the itching and flaking in people with mild-to-moderate psoriasis.

  • The extract of Aloe cream. Taken from the leaves of the aloe vera plant, aloe vera extract cream can reduce the scaling, itching and inflammation. You might need to use the cream several times a day for a month or more to see any improvement in your skin.
  • Fish oil supplements. Oral fish oil therapy that is used in combination with UVB therapy can reduce the magnitude of the eruption. The application of fish oil to the affected skin and covered with a bandage for six hours a day for four weeks could improve the scale.
  • Oregon grape. Oregon grape — also known as the barberry — is applied to the skin and can reduce the severity of psoriasis.

If you are considering alternative medicine to relieve the signs and symptoms of psoriasis, talk to your health care provider about the pros and cons of these approaches.

Lifestyle and home remedies

Try these self-care measures to better manage your psoriasis:

  • Take daily baths. Wash it gently instead of rubbing the skin in the shower or bath. Use warm water and mild soaps that have added oils or fats. It might help to add the oil bath, Epsom salts, or oatmeal to your bath water and soak for at least 15 minutes.
  • Keep your skin moist.Apply moisturizer daily. If you're moisturizing after bathing, gently pat dry and apply your preferred product while the skin is still wet. For very dry skin, heavy oils or ointment-based moisturizer, it may be preferable that stay on the skin as creams or lotions that do. If moisturizer seems to improve the skin, apply the product more than once a day. If the air where you live is very dry, use a humidifier to add moisture to the air.
  • Cover the affected areas at night. Before going to bed, apply a moisturizer to the affected skin and wrap with plastic film. When you wake up, remove the plastic and wash and scales.
  • Expose your skin to small amounts of sunlight. Ask your health care provider about the best way to use natural light to treat the skin. A controlled amount of light from the sun can improve psoriasis, but too much sun can trigger or worsen outbreaks and increase the risk of skin cancer. Log your time in the sun, and protect the skin that is not affected by psoriasis with a hat, clothing or sunscreen with a sun protection factor (SPF) of at least 30.
  • To avoid scratching. Could you help to apply a prescription anti-itch cream or ointment containing hydrocortisone, or salicylic acid. If you have scalp psoriasis, try a medicated shampoo that contains coal tar. Keep nails trimmed, so it will not damage to your skin if you do scratch. Wear soft fabrics that do not contribute to the itching.
  • Avoid the triggers of psoriasis. Notice what triggers your psoriasis and take steps to prevent or avoid. Infections, injuries to the skin, the habit of smoking and intense sun exposure can all worsen psoriasis.
  • Stay cool. Being too hot can make you feel itching in the skin. Wear light clothing if you're out in the hot days. If you have air conditioning, use on hot days to keep cool. Keep cold packs in the freezer and apply it to the itchy spots for a couple of minutes of relief. You can try to storing your lotion in the refrigerator to add a cooling effect when applied
  • Try to maintain a healthy lifestyle. Try practicing other healthy habits of life to help manage psoriasis. These include being active, eating well, limit or avoid the consumption of alcohol, maintaining a healthy weight.

Keep your skin moist. Apply moisturizer daily. If you're moisturizing after bathing, gently pat dry and apply your preferred product while the skin is still wet. For very dry skin, heavy oils or ointment-based moisturizer, it may be preferable that stay on the skin as creams or lotions that do. If moisturizer seems to improve the skin, apply the product more than once a day.

If the air where you live is very dry, use a humidifier to add moisture to the air.

Coping and support

Dealing with psoriasis can be a challenge, especially if the affected skin covers a large area of your body or it is visible to other people. It can cause discomfort and embarrassment. The ongoing, persistent nature of the disease and the treatment challenges that only add to the burden.

Here are some ways to help you live with psoriasis and feel more in control.

  • Learn more about psoriasis. Find out all you can about the disease, and the investigation of their treatment options. To understand the potential triggers of the disease, so that you can better prevent outbreaks. Educate those around you, including family and friends, so that they can understand, recognize and support their efforts in dealing with the disease.
  • Follow your doctor's recommendations. Try to adhere to medical advice on the treatment and lifestyle changes. Ask questions if something is not clear.
  • Find a support group. Consider joining a support group of people who have the disease. Some people find comfort in sharing their experiences and get to know the people who are facing similar challenges. Ask your health care provider to get information on psoriasis support groups in your area or online.
  • The use of cover-ups as needed. On those days when you feel particularly self-conscious, the cover of psoriasis with the clothing or the use of cosmetic cover-up products, such as body makeup or concealer. These products can irritate the skin, so do not use on open wounds, cuts or unhealed patches.
  • Reduce stress. The relationship between stress and psoriasis is not clear and needs further study. But it is possible to alleviate the stress in your life can help reduce psoriasis, rashes, and itching. Try to do things that you enjoy and activities that focus your mind on something else other than your stress. Consider meditation, tai chi, yoga, and spending time with friends and loved ones.

Preparing for your appointment

It is likely that you first consult your primary care provider. In some cases, you may be referred directly to a specialist in skin diseases (dermatologist).

Here's some information to help you prepare for your appointment and know what to expect from your health care provider.

What you can do

Make a list of the following:

  • The symptoms you are experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment
  • All the medications, vitamins and herbs you are taking, including dose
  • Questions to ask your health care provider

For psoriasis, some basic questions you can ask include:

  • What could be causing my symptoms and signs?
  • I need diagnostic tests?
  • What treatments are available, and which do you recommend for me?
  • What types of side effects can I expect?
  • It will be the treatment you recommended because of the remission of the symptoms?
  • How quickly can I expect results?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other medical conditions. How can I manage these conditions?
  • What skin care routines and products are recommended to improve my symptoms?

What to expect from your doctor

Your health care provider is likely to ask several questions, such as:

  • When did you begin to have symptoms?
  • How often do you have these symptoms?
  • The symptoms been continuous or occasional?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Psoriasis