What is Psoriasis?
Psoriasis is an inflammatory disease found on the skin characterised by raised red patches coated with silvery colored scales. These patches are often itchy and can be painful.
This condition affects between two and four percent of the population in the western world. It varies geographically, being more prevalent in cooler climates. (1)
The exact cause of psoriasis remains unknown, but genetics and the immune system both play a part in its development. (2)
Psoriasis happens when the body’s immune system, which protects the body from diseases, reacts in a way that is detrimental (autoimmune).
Part of the body’s immune system involves white blood cells, known as T cells, which attack things such as viruses and bacteria. When a person has psoriasis these cells become overactive and trigger immune responses in the skin cells.
Skin cells, when healthy, begin to grow gradually from the lower layers of the skin. They rise to the surface of the skin where they are eventually shed (cell turnover). This process usually takes about a month.
Psoriasis and the immune response make the skin cells turnover at a much faster rate, sometimes rising to the surface in a few days.
When this happens the skin cells pile up at the surface of the skin presenting as psoriasis. (3, 4)
The exact causes are not known, but as well as genes, there are other factors that can predispose a person to this condition. These include infections, stress, cuts, burns or sunburn, some medications, cold weather, tobacco and alcohol. (5)
There are different types of psoriasis, each with different symptoms. These are:
This is the most common type of psoriasis accounting for between 80 to 90 percent of sufferers. It usually appears on, but is not limited to, the knees, elbows, scalp or lower back.
The symptoms include raised, thick red patches of skin (plaques) which can be very itchy. A thin, dry coating, silvery white in color, might cover some of the plaques.
The plaques can vary in size, sometimes joining to form larger plaques. (6)
This type of psoriasis presents as tiny sores or bumps on the skin which can appear suddenly. They might be found all over the legs, arms and torso, and sometimes the scalp, face and ears.
The bumps will be scaly and pinkish in color. Guttate psoriasis can clear within a few weeks or months of its own accord.
The incidence of guttate psoriasis could be once only, however, it can return and might also appear with plaque psoriasis. (7)
This psoriasis develops in places like the groin, armpits, genitals and between the buttocks, where there are creases in the skin.
It looks like red patches of skin which are smooth and raw with little or no silvery coating. The skin will likely be painful and sore. (8)
Typically appearing on the hands and feet, this psoriasis can look like a skin infection. It is seen as pus filled small bumps but don’t contain any bacteria. The pus is in fact white blood cells.
The skin where the bumps appear looks red and swollen and will be painful or extremely sore. Brown dots or scales might be present as the bumps dry out.
When pustular psoriasis is present any activities using your hands and feet will cause extreme discomfort and pain. (9, 10)
Von Zumbusch Psoriasis
Also called generalized pustular psoriasis, this rare condition can be extremely serious and life threatening.
Pus filled lumps appear over most of the body, and the skin becomes dry, red and tender. This can happen very quickly, often within hours. The bumps will burst leaking pus onto the skin causing the skin to dry out and peel.
The fresh skin underneath will appear smooth and glazed. This process happens over a period of a couple of days. Fresh pustules might appear within days, and the cycle then repeat itself.
Other symptoms which can be present are fever, muscle weakness and headache, and it will make a person feel very sick. Medical intervention might be necessary to preserve life. (11)
This is another life threatening type of psoriasis requiring emergency medical care. It appears as a fiery redness, looking like a burn, over all the body. This will be accompanied by chills and fever, pain, a severe itch, a rapid pulse and muscle weakness.
The person might not be able to keep warm and lose body heat, becoming hypothermic. Sometimes the skin can peel away in sheets.
This condition generally arises when a person has had another form of psoriasis. They might have been aware that their psoriasis was not responding to treatment or was getting worse. (12, 13)
Signs of any type of psoriasis can also be seen in the nails. The symptoms of this include small dents in the nails or brown, yellow or white discoloration in the nails. Weak, brittle, crumbling nails or a build of skin growth causing the nail to lift from the nailbed can also be seen. (14)
Psoriasis can also affect the joints causing psoriatic arthritis. While more common when psoriasis is severe, it can develop before, during or after the characteristic skin rash.
Symptoms of psoriatic arthritis include swollen or painful joints, particularly in the fingers or toes. Pain in the heel or swelling just above it, or stiffness in joints in the morning, improving during the day are further signs.
There is no cure for this condition, which left untreated can be disabling. (15)
Psoriasis can be mild, moderate or severe, dependent on how much of the body is affected. As an approximate measure, the size of the whole hand, including palm, fingers and thumb, equates to one percent of the body.
Stage #1 Mild Psoriasis
When psoriasis is mild it covers about up to three percent of the body.
Stage #2 Moderate Psoriasis
At this stage the condition affects between three and ten percent of the body.
Stage #3 Severe Psoriasis
Psoriasis affecting more than ten percent of the body is considered severe. (16)
There is no cure for psoriasis. There are however several treatments which can help manage the condition. These include:
There are a number of creams and ointments which can be applied directly to affected areas. These include corticosteroids, retinoids, coal tar and synthetic vitamin D. Some of these medications can be bought over the counter while others are only available by prescription. (17)
Light therapy or phototherapy uses ultraviolet light on the skin under medical supervision. This type of therapy can slow down the growth of skin cells, reduce inflammation and help stop itching. (18)
These treatments include taking drugs or having injections prescribed by a doctor. The type and combination of drugs used will be tailored to an individual’s needs dependent on the type and location of psoriasis.
One type of treatment, which is newer and possibly stronger, is called biologics. These are medications that target the part of the immune system which is overactive by blocking the body’s reactions. They can also help relieve the symptoms associated with psoriatic arthritis. (19, 20)
What is psoriasis? Psoriasis is an inflammatory disease characterised by raised red patches coated with silvery colored scales on the skin.
What are the signs of psoriasis? Psoriasis is characterised by a skin rash which, dependent on the type, can cover part or all of the body. Typically the symptoms are patches of red, thick skin which are covered in silvery scales. The patches of skin itch and can be painful.
How do you develop psoriasis? This autoimmune disease causes skin cells to grow too quickly. The exact reasons this happens are not known, however genes and other factors can predispose a person to this condition. These include infections, stress, cuts, burns or sunburn, some medications, cold weather, tobacco and alcohol.
How are you diagnosed for psoriasis? A visual examination by a doctor will usually indicate whether a person has psoriasis. Samples of skin tissue can be taken for confirmation.
What is the best treatment for psoriasis? Treatments will be tailored to an individual’s needs. They include topical creams, light therapy and prescription medications.
What are the long term complications of psoriasis? This is a chronic condition which can have many impacts on daily life. Learning what triggers it and how to manage the symptoms can help. (21)
Is psoriasis considered a disability? When severe, psoriasis can be disabling. There are occasions when a person might qualify for social security benefits. (22)
Is there a cure for psoriasis? While psoriasis can be managed, there is, a present, no cure.
Is psoriasis considered life threatening? Some forms of this condition can be life threatening.
Psoriasis is an inflammatory disease characterised by raised red patches coated with silvery colored scales the skin. It can be mild, affecting small areas of the body, or severe, covering more than 10 percent of the skin.
There is no cure for this chronic condition. Fortunately however, there are treatments which help manage it.
Keeping skin moisturized and following a healthy lifestyle can help. Joining a support group or having counselling might help individuals cope with living with psoriasis. (23)