What is Psoriasis?
Psoriasis (sore-I-as-sis) is a common immune-mediated chronic skin disease that comes in different forms and varying levels of severity. Most researchers now conclude that it is related to the immune system. Psoriasis is often called an “immune-mediated” disorder.
It is not contagious. In general, it is a condition that is frequently found on the knees, elbows, scalp, hands, feet or lower back, but can affect the entire body. Many treatments are available to help manage its symptoms. About 1-2% or more than 4.5 million adults in the United States have Psoriasis.
Between 10 percent and 30 percent of people with psoriasis also develop a related form of arthritis, called psoriatic (sore-ee-A-tic) arthritis.
What does Psoriasis look like?
It generally appears as patches of raised skin covered by a flaky white scale. In certain kinds of psoriasis, it also has a pimple-like (pustular psoriasis) or burned (erythrodermic) appearance. Psoriasis can cause intense itching and burning, but this is usually mild.
What causes it?
Researchers believe the immune system sends faulty signals that speed up the growth cycles in cells. Certain people carry genes that make them more likely to develop psoriasis, but not everyone with these genes develops psoriasis. Instead, a “trigger” makes the psoriasis appear in those who have these genes. Also, some triggers may work together to cause an outbreak of psoriasis; this makes it difficult to identify individual factors.
Possible Psoriasis triggers:
- Emotional stress
- Injury to skin
- Some types of infection
- Reaction to certain drugs
Once the disease is triggered, the skin cells pile up on the surface of the body faster than normal. In people without psoriasis, skin cells mature and are shed about every 28 days. In psoriatic skin, the skin cells move rapidly up to the surface of the skin over three to six days. The body can’t shed the skin cells fast enough and the process results in patches, also called lesions, forming on the skin’s surface.
How is Psoriasis diagnosed?
There is no blood test for psoriasis. Dr. Jennifer Janiga completed a psoriasis fellowship and can usually diagnose psoriasis by examining the affected skin. Less often, a small piece of skin affected by the psoriasis is cut out and examined under a microscope.
Who gets Psoriasis?
- Psoriasis is partially a genetic disease. A family association exists in one out of three cases.
- It often appears between ages 15 and 35 or in adults over 60, but it can develop at any age.
- About 10 percent to 15 percent of those with psoriasis get it before age 10, and occasionally it appears in infancy.
- Psoriasis is not contagious – no one can “catch” it from another person
How serious is Psoriasis?
Psoriasis is measured in terms of its physical and emotional impact. Physically, if less than 2 percent of the body is involved, the case is considered mild. Between 3 and 10 percent is considered moderate, and more than 10 percent is severe. (The palm of one hand equals 1 percent).
Psoriasis is also measured by its impact on quality of life. When psoriasis involves the hands and feet, it may also be considered severe because of how it affects a person’s ability to function. If a person’s psychological or emotional well-being is considerably affected, the psoriasis may also be considered severe.
Are there different types of Psoriasis?
There are five different types of psoriasis. The most common form of psoriasis is called “plaque psoriasis,” which is characterized by well-defined patches of red, raised skin. About 80 percent of people with psoriasis have this type. Plaque psoriasis can appear on any skin surface, although the knees, elbows, scalp, trunk and nails are the most common locations.
The other types of Psoriasis are:
- Guttate: small, red, individual drips on the skin, this type are usually triggered by an infection.
- Inverse: smooth, dry areas of skin, often in folds or creases like the armpits, neck, or groin folds, that are red and inflamed but do not have much scale.
- Erythrodemic: periodic, widespread, fiery redness of the skin
- Pustular: involves either generalized, widespread areas of reddened skin, or localized areas, particularly the hands and feet (palmo-plantar pustular psoriasis)
Typically, people have only one form of psoriasis at a time. Sometimes two different types can occur together, one type may change to another type, or one type may become more severe. For example, a trigger may convert plaque psoriasis to pustular psoriasis.
Although the reasons for the changes are not well understood, some triggers may include abrupt withdrawal of medications or a recent infection such as strep throat; an allergic, drug-induced rash that brings on the skin response, and severe sun burning. The types of psoriasis differ not only in their appearances, but also may require different types of treatment. It is very important that you talk with a board certified dermatologist, like Dr. Janiga, about what course of action to take with your type of psoriasis.
What are the most difficult areas to treat in Psoriasis?
Scalp: Scalp psoriasis occurs in at least half of all people with psoriasis. It can range from very mild with fire scaling to very severe with thick, crusted plaques.
Genitals: Genital psoriasis acts similar to other affected parts of the body. But because of the sensitivity of the skin, this type may require special considerations.
Hands and Feet: Pustular psoriasis can impair a person’s ability to work. Plaque psoriasis can dry out skin and cause cracking and bleeding.
Nails: Nail changes occur in about half of those with psoriasis and 80 percent of those with psoriatic arthritis. The nails may have small holes (pitting), a changed shape (deformation), separation from the skin (onycholyosis) and discoloration (oil spots).
What treatments are available?
Psoriasis has no cure, but a wide range of treatments can give people good control over their condition. Many different treatments can reduce or nearly eliminate the symptoms of psoriasis. No single treatment works for everyone, but something is likely to work in most cases. Dr. Janiga can provide guidance in selecting the right therapy.
A number of factors determine which treatment to try:
- The type of psoriasis
- Its location on the body
- Its severity
- The patient’s age and medical history
What is the General Approach for treating psoriasis?
Many safe, effective treatments can improve the condition of the skin and reduce swelling, redness, flaking and itching. Some therapies can temporarily clear the skin (this is called a “clearance” or “remission” of psoriasis).
Because psoriasis is chronic and unpredictable, it can be challenging to treat. It often improves and worsens in a natural cycle over time. But people can usually find success by trying different with treatments under Dr. Janiga’ guidance.
The goal is to find a therapy that has the best results and the fewest side effects. People with psoriasis usually start with the least potent treatments and move to stronger ones until they find an acceptable combination of results and risks.
What are the Psoriasis Treatment Steps?
Treatments for psoriasis can be divided into three basic categories:
- Topical- creams, lotions, ointments, soaks, foams, or sprays
- Sunlight phototherapy (artificial ultraviolet light called narrow band ultra violet light or NVUVB.
- Systemic (internal) medications taken by pill or injection.
Psoriasis therapies can be pictured as a flight of stairs that lead up to a door marked “success”. The bottom steps (sunlight and topical treatments) are the weakest treatments that also usually have the fewest side effects. Treatments at the bottom of the stairs are used mostly for mild and moderate psoriasis.
At the top of the stairs, the treatments are more potent and have more serious side effects. They may be useful if psoriasis becomes more severe. They may also be used immediately for new cases or erythrodemic or pustular psoriasis.
Step 1: Topical Therapy
Topical treatments are used after determining the extent of the disease, location of disease, and disability produced by the disease.
- Moisturizers, Corticosteroids, Coal Tar
- Calcipotriene, Tazarotene
- Salicyclic acid, Urea
Step 2: Phototherapy
Phototherapy is used for patients with moderate to severe psoriasis who are not responding to topical treatments alone.
- Ultraviolet Light B (UVB)
Step 3: Systemic Medications
Systemic drugs usually are reserved for patients with moderate to severe psoriasis or disabling psoriatic arthritis. They are used for erythrodermic and pustular psoriasis also.
For more information, or to set up a consultation with Dr. Janiga for a psoriasis evaluation in our Reno / Tahoe dermatology office, please send us an email or call 775-398-4600.
Appointment length varies but is usually not more than 15-30 minutes.