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Psoriasis Vulgaris is the most common subtype of psoriasis, which is a common chronic inflammatory skin disease that develops from a genetic defect.

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

  • Chronic Plaque Psoriasis
  • Classic Plaque-type Psoriasis
  • Plaque Psoriasis

What is Psoriasis Vulgaris? (Definition/Background Information)

  • Psoriasis Vulgaris is the most common subtype of psoriasis, which is a common chronic inflammatory skin disease that develops from a genetic defect. The condition causes the skin to grow abnormally resulting in the formation of skin lesions. Psoriasis can run in families, but is not a contagious condition
  • Psoriasis Vulgaris is a chronic condition that is characterized by white scaly patches atop vivid red plaques (raised skin patches). These patches usually appear on certain contact pressure areas of the body, such as the knees and elbows, or on areas that are subject to repeat scratching or rubbing of skin
  • The signs and symptoms of Psoriasis Vulgaris may get better and worse over a period of time, sometimes without treatment. The presentations may also vary significantly from one individual to another and even within the same individual (in type and nature)
  • It is important to note that Psoriasis Vulgaris is currently incurable. However, the extent and activity of the condition may be controlled using medications and other treatment measures. The condition may also go into a state of remission, meaning that there may periods when the skin remains normal
  • The prognosis of Psoriasis Vulgaris depends upon its severity and response to treatment. However, it is a lifelong condition that needs to be regularly monitored and treated symptomatically. Psoriasis Vulgaris can cause severe long-term emotional and psychological distress

Who gets Psoriasis Vulgaris? (Age and Sex Distribution)

  • Over 90% of psoriasis cases are reportedly Psoriasis Vulgaris and, nearly 2% of the global population may be affected. More number of cases are reported in adults than children
  • The manifestation of Psoriasis Vulgaris occurs early in children between the ages of 5 and 10 years (early onset); or, in young adults around 22 to 30 years of age (late onset), usually before age 40. Some adults are known to be affected beyond this age too
  • Rarely, Psoriasis Vulgaris is present at birth (congenital)
  • Both men and women are affected, and no specific gender preference is observed; however, in children, a 2:1 female-male incidence ratio is reported in some studies
  • The condition affects all races and ethnic groups; although, fair-skinned Caucasians have a generally higher prevalence rate, while dark-skinned individuals are affected to a much lesser extent
  • Some populations belonging to West Africa, Japan, and northern Native Americans (Inuits) show very low incidence rates of Psoriasis Vulgaris

According to study reports, Psoriasis Vulgaris affects nearly 2% of the American population.

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

The following are the risk factors for Psoriasis Vulgaris:

  • Psoriasis Vulgaris has a strong association with genetic factors. Studies have shown a correlation between psoriasis and individuals with certain types of human leukocyte antigens (HLAs). HLAs are gene complexes that form a part of the immune system
  • Certain studies have also demonstrated that individuals with close relatives already affected by the condition are at a higher risk for psoriasis, in comparison to rest of the population. Hence, having a family member with psoriasis is a significant risk factor
  • Caucasians, who are fair-skinned are more susceptible to psoriasis
  • HIV-infected patients are at an increased risk for psoriasis
  • Individuals who are smokers, obese, diabetic, drink alcohol in excess, and with heart disease, are at an increased risk for developing severe forms of the condition. Whether these associations are causative or secondary is under investigation
  • The symptoms may get worse  during fall and winter

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 Vulgaris? (Etiology)

Psoriasis Vulgaris develops from an abnormal proliferation of the skin cells, referred to as keratinocytes. The exact reason behind this development is unknown. It is believed to be influenced by certain genetic factors.

  • There seems to be an association of the skin disorder with a dysfunctional immune system, which results in an abnormally rapid growth of skin cells
  • T-Lymphocytes migrate to the upper part of the dermis and initiate an inflammatory reaction. This cascades into an upregulated state, which triggers keratinocyte (epidermal skin cell) overgrowth
  • It is believed that the condition may be affected by certain environmental factors such as colder temperatures and less ultraviolet light exposure

What are the Signs and Symptoms of Psoriasis Vulgaris?

The signs and symptoms of Psoriasis Vulgaris can vary in type and severity from one individual to another. In some, the symptoms may be mild and involving only a small area of the body surface; while in others, it can be severe, involving most of the body surface.

Even in an individual, the symptoms may vary from time to time, since the condition waxes and wanes. An early onset disease is known to develop into a more severe Psoriasis Vulgaris with a longer course (lasting longer periods).

The signs and symptoms of Psoriasis Vulgaris may include:

  • Painful and well-demarcated red patches, called plaques, with white scaly borders and surfaces that usually develop on sites of repeat trauma and pressure. A plaque is a broad raised area on skin; it is usually wider than it is elevated above the surrounding normal, unaffected skin
  • The plaques are well demarcated from normal skin
  • When lesions appear at areas of recent minor skin trauma, it is termed the Koebner phenomenon. Trauma-induced psoriasis patches may develop within 7-14 days following the trauma/injury
  • The size of the lesions may range from large areas of the body, to tiny “pinpoint” papules (raised skin lesions)
  • Itchiness and rawness, irritability; scratching the plaques may cause it to bleed
  • Deliberately removing psoriasis scales leading to pinpoint bleeding at the site is termed Auspitz sign
  • Severe scaling can also cause dryness of skin
  • The skin lesions appear on both sides of the body (symmetrical presentation) such as on both elbows and knees. However, any part of the body, such as the torso, buttocks, and thighs, may present the bright red rashes covered by thick scales
  • Psoriasis Vulgaris very typically also includes  the skin  behind the ears, the scalp (forming white flaky spots), the umbilicus (belly button),  and nails (causing pitting of nails, color changes, and breaking of nails)
  • Psoriasis lesions usually do not develop on the face

Psoriasis Vulgaris is a chronic disease that can intermittently  improve and worsen, without any detectable cause; this is described as waxing and waning of the condition. Often, the symptoms get better and worse (flaring) over a period of time.

Psoriatic arthritis, affecting the hand, ankle, or knee joints with joint pain and inflammation, occurs in about 10-35% of the individuals with psoriasis. The psoriasis subtype that most is commonly involved in individuals with psoriatic arthritis is Psoriasis Vulgaris.

How is Psoriasis Vulgaris Diagnosed?

Severe Psoriasis Vulgaris is easily recognized, and a healthcare provider may diagnose the condition on the basis of a thorough physical examination; however, it may be difficult to diagnose mild or atypical cases.

A diagnosis of Psoriasis Vulgaris may involve the following tests and exams:

  • Complete physical examination and comprehensive medical history (including evaluation of family history of the condition): A diagnosis of psoriasis is normally evident, especially if the individual has the characteristic, and sometimes, extensive skin symptoms (i.e., red skin lesions with scaly borders)
  • Auspitz sign: Peeling of the white scales may show areas of bleeding, under the removed skin. This feature is characteristic of psoriasis
  • Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
  • Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
  • X-rays, CT, and MRI scans of the affected joint can help reveal the extent of damage due to inflammation in individuals with psoriatic arthritis
  • Skin biopsy: A skin tissue biopsy of the lesions may be performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

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 Vulgaris?

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

  • Severe pain and itchiness of skin leading to acute discomfort and irritation, including sleep disruption
  • The lesions may occasionally develop bacterial or fungal infections
  • Arthritis, causing pain, swelling, and destruction of  joints
  • In severe, erythrodermic psoriasis, there may loss of body fluids through the skin, resulting in fluid and electrolyte imbalance
  • Psychological issues such as social anxiety, stress, low self-esteem, depression, and often social isolation
  • Due to its chronic nature, some individuals may undergo severe emotional issues and psychological distress that may require counseling
  • Embarrassment in public places because of the visible plaques and red skin patches. In many cases, such cosmetic issues may impair one’s daily activities, affecting studies and work
  • Disfigurement and physical disability (from arthritis)
  • Severely affected quality of personal life and academic/professional life
  • Medication side effects that may be severe in some

How is Psoriasis Vulgaris Treated?

Psoriasis Vulgaris is incurable with currently available treatment measures; although, the extent of the disease and disease activity can be controlled with suitable medications. The goal behind the treatment is to help control the symptoms, prevent skin infections, and avoid long-term complications.

In general, the following medication/treatment methods are used to manage Psoriasis Vulgaris:

  • Mild conditions are treated topically by using recommended lotions, creams, and shampoos to help reduce or control the associated symptoms
  • Topical therapy is often used in mild cases and includes corticosteroid creams, lotions, and sprays that are applied to skin 
  • Oral medication such as acitretin or retinoids
  • Topical vitamin D analogues
  • A new topical cream, tapinarof, which stimulates the same receptor that was affected by coal tar
  • Oral apremilast
  • Phototherapy includes the use of PUVA (oral Psoralen with ultraviolet A wavelength light)  and UVB light (ultraviolet B wavelength light)
  • Immunosuppressive drugs such as cyclosporine and methotrexate
  • Biological therapy using TNF alpha inhibitors
  • Interleuekin-12 or Interleukin-12/23 inhibitors
  • Interleukin-17 Inhibitors

Medications can have significant side effects. Besides, since the medications are often needed for a long duration, side effects must be closely monitored.

How can Psoriasis Vulgaris be Prevented?

Currently, there are no preventative measures available for Psoriasis Vulgaris, since it is a genetic condition. Ensuring proper self-care and regular healthcare visits are helpful in mitigating the severity and discomfort.

  • Avoiding picking or scratching of the skin (or applying too much pressure on the skin) can help avoid aggravation of the skin lesions
  • Avoid exposure to cold temperatures for prolonged periods
  • Genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help in understanding the risks better during pregnancy
  • If there is a family history of the condition, then genetic counseling will help assess risks, before planning for a child

Active research is currently being performed to explore the possibilities for treatment and prevention of inherited and acquired genetic conditions.

What is the Prognosis of Psoriasis Vulgaris? (Outcomes/Resolutions)

  • The prognosis for Psoriasis Vulgaris depends on the extent of the condition and severity of signs and symptoms. It is generally good to excellent for mild cases
  • In severe cases, the prognosis depends on the set of signs and symptoms. Severe disease can significantly affect one’s quality of overall life and result in long-term stress and depression
  • Since, the skin condition lasts a lifetime, a close monitoring of the symptoms with appropriate treatment will help decrease the burden of the disease

Additional and Relevant Useful Information for Psoriasis Vulgaris:

  • There is no evidence to prove that oily foods and chocolate-based products have an influence on the development of this condition
  • Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
  • The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse

What are some Useful Resources for Additional Information?

American Academy of Dermatology
930 E. Woodfield Road Schaumburg, IL 60173
Phone: (866) 503-SKIN (7546)
Fax: (847) 240-1859
Website: http://www.aad.org

National Psoriasis Foundation
6600 SW 92nd Ave., Suite 300, Portland, OR 97223
Phone: (800) 723-9166
Email: getinfo@psoriasis.org
Website: http://www.psoriasis.org

References and Information Sources used for the Article:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001470/ (accessed on 12/20/19)

http://www.mayoclinic.com/health/psoriasis/DS00193 (accessed on 12/20/19)

https://www.sciencedirect.com/topics/medicine-and-dentistry/psoriasis-vulgaris (accessed on 12/20/19)

https://healthengine.com.au/info/psoriasis-subtypes#c2 (accessed on 12/20/19)

Helpful Peer-Reviewed Medical Articles:

Nast, A., Boehncke, W. H., Mrowietz, U., Ockenfels, H. M., Philipp, S., Reich, K., ... & Sterry, W. (2012). S3–Guidelines on the treatment of psoriasis vulgaris (English version). Update. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 10, S1-s95.

Gniadecki, R., Kragballe, K., Dam, T. N., & Skov, L. (2011). Comparison of drug survival rates for adalimumab, etanercept and infliximab in patients with psoriasis vulgaris. British Journal of Dermatology, 164(5), 1091-1096.

Coimbra, S., Oliveira, H., Reis, F., Belo, L., Rocha, S., Quintanilha, A., ... & Santos‐Silva, A. (2010). C‐reactive protein and leucocyte activation in psoriasis vulgaris according to severity and therapy. Journal of the European Academy of Dermatology and Venereology, 24(7), 789-796.

Armesto, S., Esteve, A., Coto-Segura, P., Drake, M., Galache, C., Martínez-Borra, J., & Santos-Juanesc, J. (2011). Nail psoriasis in individuals with psoriasis vulgaris: a study of 661 patients. Actas Dermo-Sifiliográficas (English Edition), 102(5), 365-372.

Zhang, P., Su, Y., Chen, H., Zhao, M., & Lu, Q. (2010). Abnormal DNA methylation in skin lesions and PBMCs of patients with psoriasis vulgaris. Journal of dermatological science, 60(1), 40-42.

Balta, I., Balta, S., Demirkol, S., Celik, T., Ekiz, O., Cakar, M., ... & Iyisoy, A. (2014). Aortic arterial stiffness is a moderate predictor of cardiovascular disease in patients with psoriasis vulgaris. Angiology, 65(1), 74-78.

Zhao, M., Wang, L. T., Liang, G. P., Zhang, P., Deng, X. J., Tang, Q., ... & Lu, Q. J. (2014). Up-regulation of microRNA-210 induces immune dysfunction via targeting FOXP3 in CD4+ T cells of psoriasis vulgaris. Clinical immunology, 150(1), 22-30.

Berki, D. M., Liu, L., Choon, S. E., Burden, A. D., Griffiths, C. E., Navarini, A. A., ... & Petrof, G. (2015). Activating CARD14 mutations are associated with generalized pustular psoriasis but rarely account for familial recurrence in psoriasis vulgaris. Journal of Investigative Dermatology, 135(12), 2964-2970.