What are the other Names for this Condition? (Also known as/Synonyms)

• Psoriasis, NOS

What is Psoriasis? (Definition/Background Information)

• Psoriasis is a common chronic inflammatory skin disease. It occurs due to a genetic defect, which causes the epidermis to grow faster than normal, resulting in white scaly patches and plaques on the skin
• In addition to the classic plaques, other manifestations include pustules, nail changes, and many other findings. The symptoms may get better and worse over a period of time (sometimes, even without treatment)
• This skin disorder is not curable with the current available treatment methods. However, the extent and activity of Psoriasis may be controlled with medications
• Psoriasis is not a contagious skin condition. This means that one cannot get the condition by coming into contact with an individual having Psoriasis

There are different types of Psoriasis, which include:

• Psoriasis Vulgaris (which is the most common variety)
• Guttate Psoriasis
• Inverse Psoriasis
• Pustular Psoriasis
• Palmoplantar Psoriasis (affecting the palms and soles)

Who gets Psoriasis? (Age and Sex Distribution)

• Psoriasis affects approximately 2-3% of the world's population, which is about 125 million individuals worldwide
• It is mainly seen among adolescents and elderly adults over the age of 60 years
• Psoriasis affects all races, ethnic groups, and both male-female sex groups (it is not a gender-specific condition)
• African Americans and other population groups are found to have a lower incidence of the disorder in comparison to Caucasians

What are the Risk Factors for Psoriasis? (Predisposing Factors)

• Psoriasis has a strong relation to genetic factors. Studies have shown a correlation between individuals with certain types of human leukocyte antigens (HLA) having an increased incidence of the disease
• Certain studies have also demonstrated that individuals with close relatives already affected by the condition are at a higher risk of getting the disease in comparison to the rest of the population. Hence, having a family member with Psoriasis is a risk factor
• There is also evidence that individuals with particular genes, such as SLC9A3R1, NAT9, and RAPTOR, may be responsible for causing the disease.
• HIV-infected patients have an increased risk of getting the condition
• Individuals who are smokers, obese, diabetic, and with heart disease are at an increased risk for developing severe forms of Psoriasis. In the obese, the risk of acquiring Inverse Psoriasis is high
• The symptoms may get worse during the cold season
• Psoriasis is not a contagious condition, and one cannot contract the condition through contact with an individual affected by the condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Psoriasis? (Etiology)

Psoriasis is due to increased proliferation of the epidermal cells, referred to as keratinocytes. However, the exact cause of Psoriasis development is still unknown.

• An association of the skin disorder with a mildly dysfunctional immune system, which leads to lymphocytes near the epidermis, results in an abnormally rapid growth of keratinocytes
• Psoriasis may be triggered  by certain environmental factors, medications, and infections
• Currently, research for Psoriasis is underway to aid in a better understanding of the cause factors and methods to treat the disorder

What are the Signs and Symptoms of Psoriasis?

The signs and symptoms of Psoriasis include:

• Severe itchiness, dryness, and painful red patches
• Noticeable changes in the appearance of nails are often observed. There can be small nail pits, as though made by a small pin. The nail bed may have translucent yellowish areas beneath the nail plate, which are called “oil spots”. The nail plate itself may be thickened, with a crumbly free edge. Such changes may be confused for nail fungal infections
• Rashes and dry patches are commonly seen in areas around the elbow, scalp, knees, and lower portions of the back. Any part of the body may be affected. Rashes occur more often in areas prone to recurrent microtrauma
• White flaky spots on the scalp are often confused with a more common condition of the scalp, known as seborrhea dermatitis, as well as fungal infections of the scalp
• Psoriatic arthritis occurs in 10-35% of the individuals with Psoriasis. Any joint may be affected, and joint pain may be the first sign of Psoriasis in some individuals. The most common joints affected are the joints of the hands, knees, and ankles. Rarely, patients with psoriatic arthritis may not have any skin findings or develop diagnostic skin lesions later in the disease course

In general, some individuals have mild symptoms, while others may have severe symptoms. The symptoms of Psoriasis may get worse during seasons with low sunshine and cold temperatures.

Psoriasis is a chronic disease that can appear to be improving but then relapse. Often, the symptoms get better and worse over a period of time (sometimes even without treatment). A waxing/waning course is not uncommon, with some patients having persistent or permanent remission.

How is Psoriasis Diagnosed?

A diagnosis of Psoriasis may be difficult if the symptoms are mild. Often, in more severe cases, Psoriasis is a condition that is generally recognizable.

A diagnosis of Psoriasis would involve:

• Physical examination, a thorough medical history, and complete family history: A diagnosis of Psoriasis can be straightforward, especially if the individual has the characteristic (and extensive) skin symptoms. At times, the diagnosis is provisional until similar conditions can be ruled out or the findings become more characteristic
• Pulling off the white adherent scales may lead to pinpoint areas of bleeding at the site. This is called the Auspitz sign and is characteristic of Psoriasis
• Examination, X-rays, CT, and MRI scan of the affected joint(s) will reveal signs of Psoriatic Arthritis, if present
• To confirm Psoriasis, a skin biopsy is frequently performed, which is examined by a pathologist under the microscope

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Psoriasis?

Psoriasis can cause a variety of complications depending on the severity of the disease activity. Some of these include:

• Severe pain and itchiness of skin, which may occasionally get infected with bacterial or fungal infections
• Arthritis, causing destruction of the joint
• In severe Psoriasis (especially with the pustular subtype when extensive), there may loss of body fluids through the skin, resulting in fluid and electrolyte imbalance
• Psychological problems, such as social anxiety, stress, low self-esteem, depression, and often social isolation, are present in severe cases
• Individuals may undergo emotional issues, which can cause severe psychological distress and may require counseling
• Individuals with Psoriasis may feel embarrassed to be in public places because of the visible plaques (scaly skin patches). In many cases, such cosmetic issues may impair daily activities, even affecting their job

How is Psoriasis Treated?

Psoriasis is incurable with currently available treatment measures, but the disease extent and activity can be controlled with medications. The treatment depends on the combination of signs and symptoms, and the symptom severity. The goal behind the treatment is to help control the symptoms, prevent skin infections and long-term complications.

• Mild conditions are treated topically by using recommended lotions, creams, and shampoos, or by taking steroids. These help reduce or control the associated symptoms
• In case of severe Psoriasis signs and symptoms, more intensive treatment methods are needed
• It has been observed that ‘nail’ Psoriasis and arthritis are difficult to treat
• For joint arthritis, oral or injection medications are often needed

Functionally, there are four treatment approaches to manage Psoriasis. These are topical therapy, oral therapy, phototherapy, and systemic therapy.

• Topical therapy is often used in mild cases and includes creams, lotions, and sprays, applied to skin
• Oral medications include steroids, psoralens, cyclosporin, apremilast,  and acitretin. Also given orally are the biologically directed drugs tofacitinib and deucravacitinib
• Phototherapy includes PUVA and UVB light, with both using artificial ultraviolet light
• Other biologic drugs (biologic response modifiers) that control the immune system dysfunction in Psoriasis are given by injection. Examples of such medications include  adalimumab, infliximab, etanercept, ustekinumab, brodalumab, abatacept, certolizumab pegol, golimumab, guselkumab, ixekizumab, risankizumab-rzaa,  and secukinumab

Medications can have significant side effects. Besides, since the medications are often needed for a long duration of time, it is recommended that combinations of medications be used to reduce side effects. This is known as rotational therapy.

How can Psoriasis be Prevented?

Currently, there are no preventative methods for Psoriasis since the cause of development of this skin condition is unknown.

• In those with the condition, ensuring proper care and regular healthcare visits are helpful
• Individuals with Psoriasis should be advised to not apply too much pressure on their skin; this can aggravate the skin rashes

What is the Prognosis of Psoriasis? (Outcome/Resolutions)

The prognosis for Psoriasis depends on the extent of the condition, and severity of signs and symptoms.

• It is excellent for mild cases
• In severe cases, the prognosis depends on the set of signs and symptoms
• The skin condition lasts a lifetime; hence, close monitoring of the symptoms with appropriate treatment will help decrease the burden of the disease

Additional and Relevant Useful Information for Psoriasis:

Many clinical trials are presently underway to test newer treatments methods for Psoriasis.