What is Psoriasis?
Psoriasis is a chronic immune-mediated inflammatory disease. It has a peak incidence from 0.1 to 0.3% of the world population and it affects the skin and joints. There is a higher incidence in people with light skin, affecting men and women equally and also affects more people living in colder weather countries, especially those closer to the North Pole.
It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume is raised, red plaques covered with white scales. Psoriasis typically occurs on the knees, elbows, and scalp, and it can also affect the torso, palms, and sole of the feet.
When you have psoriasis, the genes that control your immune system signals get mixed up. Instead of protecting your body from invaders as it is designed to do, it promotes inflammation and turns skin cells on overdrive.
Scientists have found about 25 different genetic mutations in people with psoriasis. It is believed that it takes more than one genetic mutation to cause the disease (polygenetic), and they are looking for the main ones. About 10 in every 100 people have genes that make them more likely to get psoriasis, but only two or three of them actually do.
If you’ve got the right combination of genes, something can turn Psoriasis “on” or start a flare.
- Skin injury: A cut, scrape, bug bite, infection, bad sunburn, or even too much scratching can trigger the condition.
- Infections: Strep infections, in particular, are linked with guttate psoriasis, which looks like small, red drops. Kids will often have strep throat before their first flare. Earaches, bronchitis, tonsillitis, or a respiratory infection such as a cold, the flu, or pneumonia can also set off your skin problems.
- HIV: Psoriasis usually is worse in the beginning stages of the disease, but then it gets better after you start certain treatments.
Some can make psoriasis worse.
- Lithium, which treats bipolar disorder and other mental illnesses
- High blood pressure and heart medicines, including propranolol (Inderal) and other beta blockers, ACE inhibitors, and quinidine;
- Antimalarial, including chloroquine, and hydroxychloroquine (Plaquenil), and quinacrine.
- Indomethacin (Indocin), which treats inflammation;
- Stress: Scientists think your immune system may respond to emotional and mental pressures the same way it does to physical problems like injuries and infections.
- Weight: People who are obese tend to get plaques in their skin creases and folds.
- Smoking: Lighting up can double your risk of getting psoriasis. If you also have a family history of the disease, you’re nine times more likely. And smoking makes it harder to get rid of symptoms. It’s closely linked with a kind of pustular psoriasis on your palms and soles that’s difficult to treat.
- Alcohol: Heavy drinkers have a higher risk, especially younger men. Alcohol can make treatments less effective, too.
- 1. Patches of red, inflamed skin. These are often covered with loose, silvery scales. They may be itchy and painful, even crack and bleed. In serious cases, they grow and run into each other, making large areas of irritated skin.
- 2. Fingernail and toenail problems. Your nails may change color or become pitted. They may also begin to crumble or detach from the nail bed.
- 3. Scalp problems. Patches of scales or crust may form on your head.
What causes flare ups?
Every person with this condition has their own triggers. Things that cause psoriasis to become active may not affect another person.If you find out what causes your skin to flare up, you will be better able to control your symptoms. Psoriasis is an immune system problem. Certain triggers may make your symptoms worse. They include:
- Cold, dry weather Any climate that relieves dry skin will help. Try to spend some time in warm sunny weather and high humidity.
- Stress Keep calm and try to stay relaxed. Outbreaks are more likely to pop up when you are anxious.
- Skin Injury In some patients, the tiniest cuts, bruises, and burns can cause an outbreak. Even tattoos and bug bites might trigger a new lesion. You can wear gloves or put on an extra layer of clothes to avoid a break in your skin.
- Some medicines These include some ”beta-blocker” drugs used to treat high blood pressure and heart disease; lithium, a treatment for bipolar disorder; and pills taken to treat malaria.
- Infections There is a short list of infections including strep throat and tonsillitis that can trigger a special kind of psoriasis outbreak. It looks like small drops that show up mainly on your torso and limbs. HIV infection can also make it worse.
- Alcohol Drinking, especially heavy drinking in young men, may trigger or worsen symptoms and interfere with treatments. Combining certain psoriasis medications with alcohol can have dangerous side effects, especially for women in their child-bearing years.
- Smoking Using tobacco or being around second hand smoke raises your risk of getting psoriasis and makes existing conditions worse.
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- Plaque Psoriasis is the most common type. Patches of skin are red, raised and have silvery-white flakes, called scales. They usually show up on your scalp, elbows, knees, and lower back. They may crack and bleed and they feel sore and itchy. The more you scratch, the thicker they can get. A patch can be as wide as 4 inches; sometimes more. It’s more common in adults.
- Scalp Psoriasis about half the people with psoriasis have this type. It looks like dandruff, but it’s not the same thing. Dandruff flakes are yellow and greasy. Scalp psoriasis is powdery and silver or white. Sometimes, the skin on the scalp is just a little bit crusty or flaky. This type can cover the whole head. It can also appear on your forehead, the back of your neck, and around your ears.
- Guttate Psoriasis Kids and young adults are more likely to get this type. Small red dots with raised edges appear suddenly, usually on the middle of your body. Other common sites are the arms, legs, scalp, ears, and face. Things that trigger this kind of psoriasis include strep throat, the flu, a cold, and other upper respiratory infections. About 1 in 10 people with psoriasis has it.
- Inverse Psoriasis is defined by patches that are shiny, bright red, and very sore. The area around them is usually smooth and doesn’t have silver scales. They appear only where skin touches skin, places called folds. Common areas are the armpits, groin, genitals, buttocks, under the breasts, and behind the knee. Rubbing and sweating can make the condition worse. Many people who have it also have another type of psoriasis.
- Pustular Psoriasis This rare type might be a reaction to an infection, stress, medications, or contact with certain chemicals. It causes red, swollen patches of skin with pus-filled bumps (called pustules). When these dry out, they turn yellow-brown and scaly. It usually shows up on the palms of your hands or the bottoms of your feet. The blisters may break open, leaving skin cracked and painful.
- Erythrodermic, or exfoliative This rare form causes large areas of skin to turn bright red, like a bad sunburn, then fall off your body. Symptoms include extremely itchy and painful skin, rapid heartbeat and feeling very cold or hot. It’s life-threatening, it makes you lose the control of your temperature. Causes include medications like corticosteroids, or untreated plaque psoriasis. It also affects people with von Zumbusch pustular psoriasis.
- Psoriatic Nail Disease About half of people with psoriasis also have skin cells build up under their nails, which become thick. They often split or crack. In severe cases, they could crumble or fall off. There may be brownish red or yellow spots underneath. Sometimes, the surface has tiny dents in it, like pin pricks. When they lift off the skin underneath (the nail bed), it’s called onycholysis.
- Psoriatic Arthritis About one-third of people with psoriasis have joint pain, stiffness, and swelling. When both these problems show up, it’s called psoriatic arthritis or psoriatic disease. The symptoms don’t have to happen at the same time. Dry, red skin patches with silvery scales usually come first, but not always. Nail crumbling and color changes are common in people with this condition.
How to diagnosis Psoriasis?
In most cases, your primary care doctor or dermatologist will be able to diagnose psoriasis by examining your skin. However, since psoriasis can look like eczema and other skin diseases, diagnosing it can sometimes be difficult. If your doctor isn’t sure whether you have psoriasis, he or she may order a biopsy. Your doctor will remove a small sample of your skin and have it looked by a pathologist.
If you have symptoms of psoriatic arthritis, such as swollen and painful joints, your doctor might run blood tests and take X-rays to rule out other forms of arthritis.
Understanding your condition
There are few proven triggers for Psoriasis. But many people with Psoriasis feel a connection between certain activities or exposures and their Psoriasis outbreaks. Tracking Psoriasis flares can help you feel more in control of your condition. It can also help you reduce your Psoriasis symptoms.
Understand your triggers
Any time there is a change in your psoriasis look for associations. Did the weather change? Was your skin recently broken? Did you forget to take a psoriasis medicine? Did you start taking a new diet?
Although these psoriasis triggers aren’t all proven, individual people have found triggers they feel spark their own psoriasis outbreaks
- Emotional stress
- Medications, including beta-blockers, anti-malaria drugs, NSAIDs such as ibuprofen, and lithium
- Severe weather
- Shaving or any lesion to your skin such as from vaccinations, scratches, or sunburns
- Infection (strep throat)
- Fatty meats
- Use moisturizing lotions. Symptoms get worse when your skin is dry, so keep it moist with creams and lotions.
- Take care of your skin and scalp. Be careful with your skin. Never pick at patches or scales, as you may make your psoriasis worse.
- Use caution when trimming your nails. If you cut yourself, it might make symptoms flare. If you have psoriasis on your scalp, rub your topical treatments, such as tar shampoos, into your scalp.
- Regular bathing with soothing products, such as tar solutions, may bring relief, too.
- Avoid dry, cold weather. Climate can have a big effect on Psoriasis. For many people, cold, dry weather makes symptoms worse. Hot weather usually makes it better, but not always.
- Use a humidifier. It’s important to keep your skin moist. Turn on the humidifier when it’s dry.
- Avoid medications that cause flare-ups.
- Avoid scrapes, cuts, bumps, and infections. It’s extra important for people with Psoriasis to avoid bumps and cuts. Trauma to the skin can cause a flare, a condition called “Koebner’s phenomenon”. Infections can also cause problems. Be especially careful when shaving. Avoid acupuncture, tattoos, and do your best to prevent insect bites and chafing.
- Get some sun, but not too much. The ultraviolet rays in sunlight slow the growth of skin cells, so getting moderate doses of sun is good. But make it brief — about 20 minutes or so at a time. And use sunscreen. Sunburn can trigger psoriasis, and it raises your risk of skin cancer. Some medications can make your skin more sensitive to ultraviolet rays, so talk to your doctor first.
- Manage stress. Although it hasn’t been proven, many people link flare-ups to stress. So, try to relieve your anxiety. That may be easier said than done, but you can try relaxation techniques like meditation or yoga, for starters.
- Avoid alcohol consumption. The connection between alcohol and Psoriasis isn’t clear, but some think it can worsen symptoms, especially in men.
- Exercise, eat right, and maintain a healthy weight. Although no studies have shown a link between diet and Psoriasis, experts recommend that people with the condition eat a well-balanced diet that’s high in complex carbohydrates and fiber. Some people say their symptoms improve when they remove or lower intake of dairy or gluten.
- Exercise may also help. Some studies show excess weight can trigger flares, so stay at a healthy weight.
Despite the fact that Psoriasis is incurable, it responds well to many topical and systemic treatments. Even people with severe psoriasis can get relief during flare-ups in about 85% to 90% of cases.
Topical Treatments for Psoriasis
Topical treatments are rubbed directly into the affected skin to bring local relief without the system-wide side effects of medicines taken by mouth. Topical treatments for psoriasis include:
- Salicylic acid – Some doctors recommend salicylic acid ointment, which smoothes the skin by promoting the shedding of psoriatic scales. Using salicylic acid over large areas of skin, however, may cause the body to absorb too much of the medication, leading to side effects. Salicylic acid may also cause skin irritation and weaken hair shafts, which can cause breakage and temporary hair loss. The effectiveness of these preparations are modest at best.
- Steroid-based creams. The mainstay of psoriasis treatment, steroid creams decrease inflammation, relieves itching, and block the production of cells that are overproduced in psoriasis. Stronger preparations, which are more effective than milder ones, can cause side effects that include burning, dryness, irritation, and thinning of the skin.
- Calcipotriene -containing topical ointment. Calcipotriene, which is related to vitamin D, has proven to be effective for treating psoriasis, especially when combined with a topical corticosteroid cream. It’s best to use only limited amounts to avoid side effects.
- Coal-tar ointments and shampoos; These products can help slow the rapid growth of skin cells and alleviate symptoms, but some people are vulnerable to the side effects, especially folliculitis, a pimple-like rash affecting the hair follicles.
- Prescription retinoids; these topical preparations containing a synthetic form of vitamin A can help improve psoriasis. These preparations don’t work as quickly as steroids.