PSORIASIS

Psoriasis is a chronic skin condition that affects millions of people worldwide. Characterized by red, scaly patches on the skin. This chronic skin condition can be both physically and emotionally distressing. Psoriasis is a skin condition where skin cells grow much faster than usual, resulting in bumpy patches. These patches can look different depending on your skin tone, ranging from red with white scales on lighter skin to purplish or brown with gray scales on darker skin. They typically show up on the scalp, elbows, knees, and lower back. Importantly, psoriasis isn’t contagious, although it can run in families.

Causes of Psoriasis

The cause of this chronic skin condition is not entirely understood, but experts believe it involves a combination of factors. Something triggers the immune system, leading to inflammation, which in turn prompts the rapid formation of new skin cells. Normally, skin cells are replaced every 10-30 days, but in psoriasis, this process accelerates to every 3-4 days, resulting in the accumulation of old cells and the formation of scales.

This chronic skin condition often runs in families, although it may skip generations. For example, it may affect a grandfather and his grandson but not the child’s mother. Several factors can trigger psoriasis flare-ups, including cuts, scrapes, emotional stress, strep infections, and certain medications such as blood pressure drugs, antimalarials, lithium, antibiotics, and NSAIDs.

Importantly, psoriasis is not contagious. It’s an internal disease related to the immune system, even though it manifests externally on the skin.

Prevalence of Psoriasis

Psoriasis is a common skin condition, affecting approximately 2-3% of the global population. It can occur at any age, but most commonly develops between 15 and 35. Both men and women are equally affected by this chronic skin condition.

Types of Psoriasis

This chronic skin condition comes in various types, each with its own characteristics:

Pustular psoriasis: This type presents as discolored, scaly skin with small pustules, typically found on the palms of the hands and soles of the feet.
Guttate psoriasis: Often starting in childhood or early adulthood, this type manifests as small spots that can be pink, red, brown, or purple in color. They usually appear on the torso and limbs and can be triggered by respiratory infections, stress, skin injuries, or certain medications.
Inverse psoriasis: This type causes shiny lesions in skin folds like the armpits, groin, and under the breasts. On lighter skin, these lesions are bright red, while on darker skin, they may appear darker than the surrounding skin, ranging from purplish to brown.
Erythrodermic psoriasis: Characterized by intense skin discoloration and shedding of scales in sheets, this type requires immediate treatment due to its potential to cause severe illness. Triggers can include severe sunburn, infections, certain medications, or stopping some psoriasis treatments.

Symptoms of Psoriasis

This chronic skin condition symptoms can vary depending on the type of psoriasis you have. Here are some common symptoms of plaque psoriasis, which is the most prevalent type:

Plaques: These are raised, red patches of skin that may have silver-colored scales on lighter skin tones. On darker skin tones, plaques may appear dark brown or purplish with gray scales. These plaques can be itchy, painful, and may even crack and bleed. In severe cases, they may grow and merge, covering larger areas of the skin.
Nail Issues: Psoriasis can affect the nails, leading to changes such as discoloration, small pits, crumbling, or loosening from the nail bed.
Scalp Involvement: Plaques, scales, or crusts may appear on the scalp, causing discomfort and sometimes leading to hair loss.

Additionally, individuals with psoriasis may develop psoriatic arthritis, a type of arthritis characterized by joint pain and swelling. It’s estimated that between 10% to 30% of people with psoriasis also experience psoriatic arthritis, according to the National Psoriasis Foundation.

Risk Factors for Psoriasis

Several factors can influence your risk of developing psoriasis:

Stress
Obesity
Certain medications, such as lithium and beta-blockers
Genetics: Your DNA contains genes that control various aspects of your body’s functions, including your immune system. In people with psoriasis, certain genes related to immune system signaling become dysregulated. Instead of protecting the body, the immune system triggers inflammation and accelerates the production of skin cells. Scientists have identified over 80 genes associated with this chronic skin condition and believe that multiple genes contribute to the development of the disease. However, not everyone with these genes will develop this chronic skin condition; it’s estimated that about 10 out of 100 individuals have genes that predispose them to this chronic skin condition, but only a fraction of them develop the condition.
Alcohol Consumption: Heavy alcohol consumption, particularly among younger men, is linked to an increased risk of psoriasis. Additionally, alcohol can reduce the effectiveness of these chronic skin condition treatments.
Smoking: Smoking can double the risk of developing psoriasis. Individuals who have relatives with psoriasis and smoke are nine times more likely to develop the condition. Smoking also complicates the management of psoriasis symptoms and is closely associated with a challenging-to-treat type called pustular psoriasis, which affects the palms of the hands and soles of the feet.

As for the demographics affected by psoriasis:

Psoriasis affects approximately 2%-3% of the global population.
In the United States, around 3% of people have psoriasis.
Psoriasis prevalence varies among different cultures, with the condition being most common in northern Europe and less common in eastern Asia.

Diagnosis of Psoriasis

Diagnosing psoriasis typically involves:

Physical Examination: Your doctor will conduct a thorough examination and inquire about your family history to determine if psoriasis runs in your family. The characteristic plaques of psoriasis, especially when present on specific areas such as the scalp, ears, elbows, knees, belly button, and nails, are usually easily recognizable during the physical exam.
Lab Tests: In some cases, your doctor may perform a biopsy, which involves removing a small sample of skin for testing. This helps rule out other skin conditions or infections that may mimic psoriasis.

Stages of Psoriasis

Psoriasis doesn’t have distinct stages like some other conditions. Instead, it can progress over time, with symptoms fluctuating in severity. It’s crucial to monitor your symptoms closely and communicate any changes to your doctor promptly.

Treatments for Psoriasis

Psoriasis treatment options are diverse, aiming either to slow down the rapid growth of skin cells or to alleviate symptoms like itching and dryness. Your doctor will tailor a treatment plan based on factors such as the size and location of your rash, your age, overall health, and personal preferences. Here’s an overview of common treatments:

Medications for Psoriasis:

Steroid creams
Prescription topical cream roflumilast (Zoryve)
Moisturizers for dry skin
Salicylic acid
Coal tar (available in various formulations for scalp psoriasis)
Vitamin D-based cream or ointment (prescription-strength)
Retinoid creams
Calcineurin inhibitors
Anthralin

For moderate to severe psoriasis, treatment options may include:

Methotrexate: Requires close monitoring due to potential side effects on bone marrow, liver, and lungs.
Retinoids: Available in various forms but may cause serious side effects, especially in pregnant or planning-to-be-pregnant women.
Cyclosporine: Can be prescribed for severe cases unresponsive to other treatments but requires careful monitoring due to kidney and blood pressure concerns.
Biologic treatments: These target specific parts of the immune system involved in psoriasis, including various drugs such as adalimumab (Humira), etanercept (Enbrel), and ustekinumab (Stelara).
Non-biologic treatments: Includes medications like tofacitinib (Xeljanz) and enzyme inhibitors such as apremilast (Otezla).

Light Therapy:

Ultraviolet (UV) light therapy, administered by a doctor, can slow down skin cell growth. PUVA (psoralen plus ultraviolet-A radiation) is one type of light therapy combining a medication called psoralen with UV light.

Alternative Treatments and Home Remedies:

While not scientifically proven to be 100% effective, some natural therapies and home remedies may help alleviate psoriasis symptoms. These include using Oregon grape topical creams, maintaining humidity levels, applying capsaicin topical creams, consuming omega-3 fatty acids, using aloe vera, and taking oat baths.

Before starting any treatment regimen, it’s essential to consult with your doctor to discuss the most suitable options based on your individual circumstances and preferences. Regular communication with your healthcare provider ensures personalized care and effective management of psoriasis symptoms.

Home Care Tips

To manage this chronic skin condition effectively and improve quality of life, consider implementing the following strategies:

Skincare Routine: Take short, daily baths with warm water and allergen-free soap, and avoid drying your skin too roughly. Moisturize regularly with a thick, rich cream or ointment.
Light Therapy: Your doctor may recommend a light therapy box or advise getting at least 15 to 30 minutes of daily sunlight exposure.
Healthy Lifestyle: Incorporate regular exercise, prioritize sufficient sleep, and explore relaxation practices such as meditation.
Identify Triggers: Keep a journal to track what triggers your psoriasis flare-ups, helping you identify and avoid potential triggers in the future.

When living with psoriasis, it’s crucial to prioritize your mental health, as individuals with psoriasis have a higher risk of experiencing certain mental health conditions. Be open with your doctor about any symptoms you may be experiencing. Some common mental health conditions associated with this chronic skin condition include anxiety, depression, sexual dysfunction, substance use disorders, sleep disorders, eating disorders, and psychosis. Taking proactive steps to address mental health concerns can significantly improve overall well-being when managing this chronic skin condition.

Prevention of Psoriasis

While this chronic skin condition cannot be prevented entirely, certain lifestyle changes may help reduce the risk of developing the condition or experiencing flare-ups. These include:

Avoiding known triggers, such as stress and smoking
Maintaining a healthy lifestyle with regular exercise and a balanced diet
Managing chronic conditions, such as obesity and high blood pressure
Seeking prompt medical attention for any skin problems or symptoms

Health disparities

Psoriasis can affect different racial and ethnic groups in varying ways. Studies indicate that White individuals have the highest rates of this chronic skin condition compared to other groups. However, some studies suggest that individuals from other racial and ethnic backgrounds may underreport their symptoms compared to White individuals. This discrepancy could stem from a lack of trust in the healthcare system and the financial burden associated with accessing treatment.

Complications

This chronic skin conditions can also lead to several complications, so it’s essential to discuss these potential risks with your doctor upon receiving a diagnosis. These complications may include:

Eye conditions such as pinkeye
Psoriatic arthritis
Certain cancers
Obesity
Heart disease
Mental health issues like low self-esteem and depression
Type 2 diabetes
High blood pressure
Other autoimmune diseases like Crohn’s disease, celiac disease, and sclerosis

When living with this chronic skin condition, dietary choices can play a role in managing symptoms. While no specific foods are known to cause this chronic skin condition, certain types of foods and beverages may exacerbate symptoms. These include:

Alcohol
Dairy products
Refined carbohydrates
Saturated fats and trans fats
Added sugars
Gluten

Adopting a balanced and nutritious diet, along with discussing any dietary concerns with your healthcare provider, can contribute to better management of this chronic skin condition symptoms and overall health.

When to See a Doctor

It is essential to consult a doctor if you experience symptoms of this chronic skin condition or if your condition worsens despite home care measures. A dermatologist can provide an accurate diagnosis and recommend appropriate treatment options based on your individual needs.

Outlook/Prognosis

While psoriasis is a chronic condition with no cure, many individuals can effectively manage their symptoms with proper treatment and self-care measures. By working closely with healthcare providers and adopting healthy lifestyle habits, most people with this chronic skin condition can lead fulfilling lives without significant interference from their condition.

Sources

National Psoriasis Foundation.
American Academy of Dermatology Association.
National Institute of Arthritis and Musculoskeletal and Skin Disease.
The Psoriasis Foundation.
UpToDate
FDA
Medscape
PubMed Health
World Health Organization
CDC
Johns Hopkins Medicine
The Center for Biosimilars
NHS UK
JAMA Dermatology
Mayo Clinic