Psoriasis is a chronic autoimmune condition that causes the rapid build-up of skin cells. This build-up of cells causes scaling on the skin’s surface. Inflammation and redness around the scales is fairly common. Typical psoriatic scales are whitish-silver and develop in thick, red patches. Sometimes, these patches will crack and bleed. Psoriasis is the result of a sped-up skin production process. Typically, skin cells grow deep in the skin and slowly rise to the surface. Eventually, they fall off. The typical life cycle of a skin cell is one month. In people with psoriasis, this production process may occur in just a few days. Because of this, skin cells don’t have time to fall off. This rapid, overproduction leads to the build-up of skin cells. Scales typically develop on joints, such as elbows and knees. They may develop anywhere on the body, including the hands, feet, neck, scalp, and face. Less common types of psoriasis affect the nails, the mouth, and the area around genitals.
Psoriasis symptoms differ from person to person and depend on the type of psoriasis. Areas of psoriasis can be as small as a few flakes on the scalp or elbow or cover the majority of the body. The most common symptoms of plaque psoriasis include:
Not every person will experience all of these symptoms. Some people will experience entirely different symptoms if they have a less common type of psoriasis. Most people with psoriasis go through “cycles” of symptoms. The condition may cause severe symptoms for a few days or weeks, and then the symptoms may clear up and be almost unnoticeable. Then, in a few weeks or if made worse by a common psoriasis trigger, the condition may flare up again. Sometimes, symptoms of psoriasis disappear completely. When you have no active signs of the condition, you may be in “remission.” That doesn’t mean psoriasis won’t come back, but for now, you are symptom-free.
Psoriasis isn’t contagious. You can’t pass the skin condition from one person to another. Touching a psoriatic lesion on another person won’t cause you to develop the condition.
Scientists are unclear as to what causes psoriasis. However, thanks to decades of research, they have a general idea of two key factors: genetics and the immune system.
Psoriasis is an autoimmune condition. Autoimmune conditions are the result of the body attacking itself. In a typical body, white blood cells are deployed to attack and destroy invading bacteria and fight infections. The mistaken attack causes the skin cell production process to go into overdrive. The sped-up skin cell production causes new skin cells to develop too quickly. They are pushed to the skin’s surface, where they pile up. This results in the plaques that are most commonly associated with psoriasis. The attacks on the skin cells also cause red, inflamed areas of skin to develop.
Some people inherit genes that make them more likely to develop psoriasis. If you have an immediate family member with the skin condition, your risk for developing psoriasis is higher. However, the percentage of people who have psoriasis and a genetic predisposition is small. Approximately 2 to 3 per cent of people with the gene develop the condition.
Two “tests” or examinations may be necessary to diagnose psoriasis.
Most doctors are able to make a diagnosis with a simple examination. Symptoms of psoriasis are typically evident and easy to distinguish from other conditions that may cause a similar symptom.
If the symptoms are unclear or if your doctor wants to confirm their suspected diagnosis, they may take a small sample of skin. This is known as a biopsy. The skin will be sent to a lab, where it will be examined under a microscope. The examination can diagnose the type of psoriasis you have. It can also rule out other possible disorders or infections.
Psoriasis triggers: Stress, alcohol, and more External “triggers” may start a new bout of psoriasis. These triggers aren’t the same for everyone. They may also change over time for you.
The most common triggers for psoriasis include stress. Unusually high stress may trigger a flare. If you learn to reduce and manage your stress, you can reduce and possibly prevent flares.
Alcohol: Heavy drinking or alcohol consumption can trigger psoriasis flares. If you binge drink or drink heavily, psoriasis outbreaks may be more frequent. If you have a problem with alcohol, talk with your doctor about getting help to quit drinking. Reducing alcohol consumption is smart for more than just your skin.
Injury: If you have an accident, cut yourself, or scrape your skin, you may trigger a psoriasis outbreak. Shots, vaccines, and sunburns can also trigger a new bout with the skin condition.
Medications: Some medications are considered psoriasis triggers. These medications include lithium, antimalarial medicines, and high blood pressure medication.
Infection: Psoriasis is caused, at least in part, by the immune system mistakenly attacking healthy skin cells. If you’re sick or battling an infection, your immune system will go into overdrive to fight the infection. This might start another psoriasis bout. Sore throat is a common trigger.
Psoriasis has no cure. Treatments aim to reduce inflammation and scales, slow the growth of skin cells, and remove plaques. Psoriasis treatments fall into three categories: topical treatments, systemic medications, and light therapy.
Creams and ointments applied directly to the skin can be helpful for reducing mild to moderate psoriasis.
Topical psoriasis treatments include:
People with moderate to severe psoriasis, and those who have not responded well to other treatment types, may need to use oral or injected medications. Many of these medicines have severe side effects, so doctors usually prescribe them for short periods of time. The medications include:
This psoriasis treatment uses ultraviolet (UV) or natural light. Sunlight kills the overactive white blood cells that are attacking healthy skin cells and causing rapid cell growth. Both UVA and UVB light may be helpful in reducing symptoms of mild to moderate psoriasis. Most people with moderate to severe psoriasis will benefit from a combination of treatments. This type of therapy uses more than one of the treatment types to reduce symptoms. Some people may use the same treatment for their entire lives. Others may need to change treatments occasionally if their skin stops responding to what they’re using.
If you have moderate to severe psoriasis, or if psoriasis stops responding to other treatments, your doctor may consider an oral or injected medication. The most common oral and injected medicines used to treat psoriasis include: Biologics: This class of medications alters your immune system and prevents interactions between your immune system and inflammatory pathways. These medications are injected or given through intravenous (IV) infusion. Retinoids: These medicines reduce skin cell production. Once you stop using them, symptoms of psoriasis will likely return. Side effects include hair loss and lip inflammation. Women who are pregnant or may become pregnant within the next three years shouldn’t take retinoids because of the risk of possible birth defects. Cyclosporine: This medicine prevents the immune system’s response, which can ease symptoms of psoriasis. It also means you have a weakened immune system, so you may become sick more easily. Side effects include kidney problems and high blood pressure. Methotrexate: Like cyclosporine, this medicine suppresses the immune system. It may cause fewer side effects when used in low doses, but over the long-term it can cause serious side effects. These include liver damage and reduced production of red and white blood cells.
Life with psoriasis can be challenging, but with the right approach you can reduce flares and live a healthy, fulfilling life. These three areas will help you cope in the short-term and long-term:
Losing weight and maintaining a healthy diet can go a long way toward helping ease and reduce symptoms of psoriasis. This includes eating a diet rich in omega-3 fatty acids, whole grains, and plants. You should also limit foods that may increase your inflammation, such as refined sugars, dairy products, and processed foods.
Stress is a well-established trigger for psoriasis. Learning to manage and cope with stress may help you reduce flares and ease symptoms. Meditation, journaling, breathing, and yoga are just a few of the ways you may find success at reducing stress.
People with psoriasis are more likely to experience depression and self-esteem issues. You may feel less confident when new spots appear. Talking with family members about how psoriasis affects you may be difficult, and the constant cycle of the condition may be frustrating. All of these emotional issues are valid, and it’s important you find a resource for handling them. This may include speaking with a professional mental health expert or joining a group for people with psoriasis.
About 15 percent of people with psoriasis will develop psoriatic arthritis. This type of arthritis causes swelling, pain, and inflammation in affected joints. It’s commonly mistaken for rheumatoid arthritis and gout. The presence of inflamed, red areas of skin with plaques usually distinguishes this type of arthritis from others. Psoriatic arthritis is a chronic condition. Like psoriasis, the symptoms of psoriatic arthritis may come and go, alternating between flares and remission. Psoriatic arthritis can also be continuous, with constant symptoms and issues. This condition typically affects large joints of the lower body, including your knees and ankles. It can also affect your fingers, toes, back, and pelvis. Most people who develops psoriatic arthritis have psoriasis. However, it’s possible to develop the joint condition without having been diagnosed with psoriasis. Most people who are diagnosed with arthritis without the skin condition have a family member with psoriasis. Treatments for psoriatic arthritis may successfully ease symptoms, relieve pain, and improve joint mobility. As with psoriasis, losing weight, maintaining a healthy diet, and avoiding triggers may also help reduce psoriatic arthritis flares. An early diagnosis and treatment plan can reduce the likelihood of severe complications, including joint damage.
Psoriasis may begin at any age, but most diagnoses occur in adulthood. The average age of onset is 33 years old. About 75 percent of psoriasis cases are diagnosed before age 46. A second peak period of diagnosis occurs in the late 50s and early 60s. Males and females are affected equally, but Caucasians are affected disproportionately. People of color make up a very small proportion of psoriasis diagnoses. Having a family member with the condition increases your risk for developing psoriasis. However, many people with the condition have no family history at all, and some people with a family history won’t develop psoriasis. About 15 percent of people with psoriasis will be diagnosed with psoriatic arthritis. In addition, people with psoriasis are more likely to develop conditions such as type 2 diabetes, kidney disease, cardiovascular disease, and high blood pressure. Though the data isn’t complete, research suggests cases of psoriasis are becoming more common. Whether that’s because people are developing the skin condition or doctors are just getting better at diagnosing it is unclear.