Overview and Facts
Psoriasis is a common, chronic skin condition, in which cells rapidly accumulate on the skin surface, forming red, scaly, irritated patches. The condition may be minor, affecting only a few small areas, or extensive, appearing anywhere on the body. It is not contagious. Psoriasis is an autoimmune disease, unlike eczema, which is generally attributed to external causes alone. Plaque psoriasis is the most common form, although there are several others. Eruptions may last for weeks or months before receding, and while psoriasis cannot be completely cured, the disease can go into complete remission. During outbreaks, numerous treatments can bring relief and improve symptoms.
Signs and Symptoms
Psoriasis symptoms and signs can vary depending on the form of the disease:
Plaque: The most common symptoms involve red, itchy patches of skin that produce silvery scales. These can occur anyplace, including as scalp psoriasis, where scales can flake and look like dandruff. Affected skin may become thick and raised, is usually dry, and may crack or bleed. Itching, soreness and burning are also common.
Nail psoriasis: This type affects fingernails and toenails, causing discoloration and pitting. The nails may become thickened, and might loosen from the nail bed. In extreme cases, nails may even crumble.
Guttate: Pinkish-red spots shaped like water drops appear like a skin rash, mostly on legs, arms, trunk and scalp. Younger people are most often affected.
Inverse: This form affects skin folds, such as armpits, groin areas and under breasts. It’s most common in overweight individuals, and appears as smooth, red patches that become inflamed.
Pustular: Whitish blisters surrounded by reddened skin appear quickly and may affect large areas, or could appear only on fingertips, hands and feet. The blisters usually recede within a few days, although they may reappear in days or weeks. Chills, fatigue and fever may also be present.
Erythrodermic: The least common form, erythrodermic psoriasis can cover a person’s entire body in a painful, itchy, burning rash that peels.
Psoriatic arthritis: Joint swelling and stiffness can accompany skin outbreaks, and may lead to eventual joint damage. Often less severe than other types of arthritis, intensity does vary, and any joint can be affected.
Causes and Diagnosis
Causes of psoriasis can be complex and are not always known. A genetic autoimmune condition reacting to environmental triggers may begin the process of outbreaks. The body’s white T-cells attack healthy skin as if it were infected, and cause the rapid overproduction of skin cells. The cells build up faster than they can be sloughed off, which initiates other immune reactions, and results in a repetitious cycle that must be interrupted with treatment.
People with compromised immune systems are also more likely to develop psoriasis. Such compromises may come from other autoimmune disorders, from cancer treatments like chemotherapy, or from HIV or AIDS. Recent bacterial infections, such as upper-respiratory infection or strep throat, can trigger an outbreak, as can sunburn, overindulging in alcohol, stress, dry air or skin, cold weather, smoking, and medications such as lithium, antimalarials, iodides and medications for high blood pressure.
Diagnosis generally involves examining the affected skin, checking the scalp and inspecting nails for typical signs.
Tests and Treatment Options
A physician will sometimes perform a skin biopsy, taking a small sample to study. This can help rule out other conditions with similar appearances, and may help determine the specific form of the disease. In cases of arthritis, an X-ray may be ordered.
Treatments for psoriasis are designed to stop the cycle of skin reactions, prevent or heal infections, and to sooth symptoms and return skin to its normal appearance. Many treatments are applied directly to affected areas. Products include topical psoriasis gels, and also creams, lotions, shampoos and moisturizers.
Corticosteroids have anti-inflammatory properties that slow the turnover of skin cells and reduce itching. Less-potent ointments may be prescribed for sensitive facial areas or for large outbreaks, while stronger ones may be used to treat small patches, or persistent problems on hands or feet. Due to possible side effects, long-term use is not recommended.
Simple moisturizers can relieve dryness and itching, but won’t provide actual healing. Prescription medication, such as a cream containing synthetic vitamin D, can slow skin-cell regeneration, and may be effective in mild cases. This treatment may be combined with other remedies.
Preparations containing vitamin A, or with salicylic acid or lactic acid, can help remove the scaly buildup on skin. Unfortunately, these creams and ointments can cause further skin irritation, and in the case of vitamin A retinols, may make the user more sensitive to sun exposure; sunscreen should be used to prevent further irritation.
Oral, injection or intravenous medication may be used to treat patients systemically, to affect the whole body. These often slow skin-cell production and reduce inflammation. Some medications suppress the immune system to reduce the overreaction that causes psoriasis, but may also make patients vulnerable to serious infections. Other side effects are common, and must be considered before beginning treatment.
Phototherapy uses UV light to slow cell regeneration, kill active T-cells, and reduce inflammation and scaling. Small amounts of natural sunlight can achieve this effect, although too much can cause more problems. Artificial sources can be used more directly, but may create side effects. Light therapy may be used along with topical or other medication.
Helpful Tips and Home Remedies
Home remedies that help calm symptoms include regular oatmeal baths to relieve itching and loosen scales. Epsom salts and bath oils can also be effective.
Avoiding hot water and using mild soaps will lessen irritation, while soaking for at least 15 minutes helps warm water and other products soften skin. Skin should be dried gently, with thick lotions or creams applied afterward to maintain softness. Applying moisturizer and wrapping affected areas overnight in plastic wrap provides intensive treatment. Aloe vera gel can also help relieve inflammation.
Avoiding alcohol, smoking and excessive sun will help reduce outbreaks, while stress reduction and a balanced diet can assist in maintaining a healthy immune system, further controlling occurrences.