Psoriasis is a common chronic inflammatory skin disease. It occurs due to a genetic defect, which causes the skin to grow faster than normal, resulting in white scaly patches and plaques on the skin.
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 skin to grow faster than normal, resulting in white scaly patches and plaques on the skin
- 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 the condition may be controlled with medications
- Psoriasis is not a contagious skin condition. This means that one cannot get the condition by touching an individual with 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 over 125 million individuals worldwide
- It is mainly seen among adolescents and in 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 are found to have a much 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), as 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 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 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 ones 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 uncontrollable proliferation of the skin cells, referred to as keratinocytes. However, the exact cause of Psoriasis development, is still unknown
- 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
- It is believed that Psoriasis may be caused by certain environmental factors
- Currently, research for Psoriasis is underway to aid in better understanding of the cause factors and methods to treat the disorder
What are the Signs and Symptoms of Psoriasis?
Signs and symptoms of Psoriasis include:
- Some individuals have mild symptoms, while others may have severe symptoms.The symptoms may get worse during cold seasons
- Psoriasis causes severe itchiness, dryness, and painful red patches
- Noticeable changes in the appearance of nails are often observed. There is usually a small dip in the nail surface, called pinpoint depressions. The nail bed may have brown-yellow areas, which are called “oil spots”. 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 scratching
- White flaky spots on the scalp are often confused with a more common condition of the scalp, known as seborrhea dermatitis
- Psoriatic arthritis occurs in 10-35% of the individuals with Psoriasis. Any joint may be affected and joint pain may be the first signs of Psoriasis in some individuals. Most common joints affected are joints of the hands, knees, and ankles. Rarely, it is seen that patients with psoriatic arthritis may not have skin symptoms
Psoriasis can cause inflammation of the uvea of the eye, which is known as uveitis. This can result in the following associated signs and symptoms including:
- Small specks, called floaters, that may be seen moving through one's field of vision
- Presence of blind spots, or scotoma, causing partial vision loss
- Light-sensitivity or photophobia
- Blurred vision
- Eye pain
Psoriasis is a chronic disease, which can appear to be improving, but then there could be a relapse. Often, the symptoms get better and worse over a period of time (sometimes even without treatment). Hence, it is common to find patients returning back to the physician's office complaining of severe pain; even though, they may have mentioned that they were feeling better, during their last/previous visit.
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, when patient present themselves at the primary care physician's office.
A diagnosis of Psoriasis would involve:
- Physical examination and a thorough medical history: A diagnosis of Psoriasis is normally evident, especially if individual have the characteristic (and extensive) skin symptoms
- Peeling of the white scales may show areas of bleeding, under the removed skin. This is called Auspitz sign and is characteristic of Psoriasis
- X-rays, CT, and MRI scan, of the affected joint will reveal the extent of damage due to inflammation
- To confirm the condition, a skin biopsy is frequently performed which is examined by a pathologist under a 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), 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
In general, there are 4 different types of treatment methods to manage Psoriasis. These include topical therapy, oral therapy, phototherapy, and injection therapy.
- Topical therapy is often used in mild cases and includes creams, lotions, and sprays, applied to skin
- Oral medications include steroids, psoralens, and acitretin
- Phototherapy includes PUVA and UVB light; with both using artificial ultraviolet light
- Injectable drugs include immunosuppressive drugs (such as cyclosporine, methotrexate) and biologic drugs (biologic response modifiers). These drugs are recent developments and they control the immune system dysfunction that occurs in Psoriasis. Examples of such medications include alefacept, adalimumab, infliximab, etanercept, and ustekinumab
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 is unknown
- In those suffering from the condition; ensuring proper care and regular healthcare visits are helpful
- Individuals with Psoriasis should be advised not apply too much pressure on their skin; this would aggravate the skin rashes
What is the Prognosis of Psoriasis? (Outcomes/Resolutions)
- The prognosis for Psoriasis depends on the extent of the condition and the 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.
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
National Psoriasis Foundation
6600 SW 92nd Ave., Suite 300 Portland, OR 97223
Phone: (800) 723-9166
References and Information Sources used for the Article:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001470/ (accessed on 1/11/12)
http://www.mayoclinic.com/health/psoriasis/DS00193 (accessed on 1/11/12)
Helpful Peer-Reviewed Medical Articles:
Cohen, S. N., Baron, S. E., Archer, C. B., British Association of, Dermatologists, & Royal College of General, Practitioners. (2012). Guidance on the diagnosis and clinical management of psoriasis. Clin Exp Dermatol, 37 Suppl 1, 13-18. doi: 10.1111/j.1365-2230.2012.04337.x
Hsu, L. N., & Armstrong, A. W. (2012). Psoriasis and autoimmune disorders: a review of the literature. J Am Acad Dermatol, 67(5), 1076-1079. doi: 10.1016/j.jaad.2012.01.029
Laws, P. M., & Young, H. S. (2012). Current and emerging systemic treatment strategies for psoriasis. Drugs, 72(14), 1867-1880. doi: 10.2165/11634980-000000000-00000
Parrish, L. (2012). Psoriasis: symptoms, treatments and its impact on quality of life. Br J Community Nurs, 17(11), 524, 526, 528.
Rustin, M. H. (2012). Long-term safety of biologics in the treatment of moderate-to-severe plaque psoriasis: review of current data. Br J Dermatol, 167 Suppl 3, 3-11. doi: 10.1111/j.1365-2133.2012.11208.x
Feldman, S. R., Horn, E. J., Balkrishnan, R., Basra, M. K., Finlay, A. Y., McCoy, D., ... & Council, I. P. (2008). Psoriasis: improving adherence to topical therapy. Journal of the American Academy of Dermatology, 59(6), 1009-1016.
Menon, K., Van Voorhees, A. S., Bebo Jr, B. F., Gladman, D. D., Hsu, S., Kalb, R. E., ... & Foundation, N. P. (2010). Psoriasis in patients with HIV infection: from the medical board of the National Psoriasis Foundation. Journal of the American Academy of Dermatology, 62(2), 291-299.
Bae, Y. S. C., Van Voorhees, A. S., Hsu, S., Korman, N. J., Lebwohl, M. G., Young, M., ... & Foundation, N. P. (2012). Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation. Journal of the American Academy of Dermatology, 67(3), 459-477.
Gelfand, J. M., Neimann, A. L., Shin, D. B., Wang, X., Margolis, D. J., & Troxel, A. B. (2006). Risk of myocardial infarction in patients with psoriasis. Jama, 296(14), 1735-1741.
Lowes, M. A., Bowcock, A. M., & Krueger, J. G. (2007). Pathogenesis and therapy of psoriasis. Nature, 445(7130), 866.
Christophers, E. (2001). Psoriasis− epidemiology and clinical spectrum. Clinical and experimental dermatology, 26(4), 314-320.