Psoriasis is a skin disease that causes red, itchy scaly patches, most commonly on the knees, elbows, trunk and scalp.
Psoriasis is a common, long-term (chronic) disease with no cure. It tends to go through cycles, flaring for a few weeks or months, then subsiding for a while or going into remission. Treatments are available to help you manage symptoms. And you can incorporate lifestyle habits and coping strategies to help you live better with psoriasis.
What Is Psoriasis?
Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times faster than normal. This makes the skin build up into bumpy red patches covered with white scales. They can grow anywhere, but most appear on the scalp, elbows, knees, and lower back. Psoriasis can't be passed from person to person. It does sometimes happen in members of the same family.
Psoriasis usually appears in early adulthood. For most people, it affects just a few areas. In severe cases, psoriasis can cover large parts of the body. The patches can heal and then come back throughout a person's life.
Types
There are several types of psoriasis, including:
▪︎ Plaque psoriasis - The most common form, plaque psoriasis causes dry, raised, red skin patches (lesions) covered with silvery scales. The plaques might be itchy or tender, and there may be few or many. They usually appear on elbows, knees, lower back and scalp.
▪︎ Guttate psoriasis - This type primarily affects young adults and children. It's usually triggered by a bacterial infection such as strep throat. It's marked by small, drop-shaped, scaling lesions on the trunk, arms or legs.
▪︎ Nail psoriasis - Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
▪︎ Pustular psoriasis - This rare form of psoriasis causes clearly defined pus-filled lesions that occur in widespread patches (generalized pustular psoriasis) or in smaller areas on the palms of the hands or the soles of the feet.
▪︎ Inverse psoriasis - This mainly affects the skin folds of the groin, buttocks and breasts. Inverse psoriasis causes smooth patches of red skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.
▪︎ Psoriatic arthritis - Psoriatic arthritis causes swollen, painful joints that are typical of arthritis. Sometimes the joint symptoms are the first or only symptom or sign of psoriasis. And at times only nail changes are seen. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. It can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent joint damage.
▪︎ Erythrodermic psoriasis - The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely.
Causes
No one knows the exact cause of psoriasis, but experts believe that it’s a combination of things. However, thanks to decades of research, they have a general idea of two key factors:
1. The immune system.
2. Genetics
The Immune System
Psoriasis is an autoimmune condition. Autoimmune conditions are the result of the body attacking itself. In the case of psoriasis, white blood cells known as T cells mistakenly attack the skin cells.
In a typical body, white blood cells are deployed to attack and destroy invading bacteria and fight infections. This 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.
Genetics
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 percent of people with the gene develop the condition, according to the National Psoriasis Foundation (NPF).
Psoriasis tends to run in families, but it may be skip generations. For instance, a grandfather and his grandson may be affected, but not the child's mother.
Things that can trigger an outbreak of psoriasis include:
▪︎ Cuts, scrapes, or surgery
▪︎ Emotional stress
▪︎ Strep infections
▪︎ Drinking alcohol
▪︎ Medications, including
▪︎ Blood pressure medications (like beta-blockers)
▪︎ Hydroxychloroquine, antimalarial medication
Risk Factors
Anyone can develop psoriasis. About a third of instances begin in the pediatric years. These factors can increase your risk:
▪︎ Family history - The condition runs in families. Having one parent with psoriasis increases your risk of getting the disease, and having two parents with psoriasis increases your risk even more.
▪︎ Stress - Because stress can impact your immune system, high stress levels may increase your risk of psoriasis.
▪︎ Smoking - Smoking tobacco not only increases your risk of psoriasis but also may increase the severity of the disease. Smoking may also play a role in the initial development of the disease.
Complications
If you have psoriasis, you're at greater risk of developing other conditions, including:
▪︎ Psoriatic arthritis, which causes pain, stiffness and swelling in and around the joints
▪︎ Eye conditions, such as conjunctivitis, blepharitis and uveitis
▪︎ Obesity
▪︎ Type 2 diabetes
▪︎ High blood pressure
▪︎ Cardiovascular disease
▪︎ Other autoimmune diseases, such as celiac disease, sclerosis and the inflammatory bowel disease called Crohn's disease
▪︎ Mental health conditions, such as low self-esteem and depression.
Symptoms
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:
▪︎ red, raised, inflamed patches of skin
▪︎ whitish-silver scales or plaques on the red patches
▪︎ dry skin that may crack and bleed
▪︎ soreness around patches
▪︎ itching and burning sensations around patches
▪︎ thick, pitted nails
▪︎ painful, swollen joints
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’re symptom-free.
Is psoriasis contagious?
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.
It’s important to be educated on the condition, as many people think psoriasis is contagious.
Diagnosis
Two tests or examinations may be necessary to diagnose psoriasis.
1. ︎ Physical examination - It’s usually easy for your doctor to diagnose psoriasis, especially if you have plaques on areas such as your:
▪︎ Scalp
▪︎ Ears
▪︎ Elbows
▪︎ Knees
▪︎ Belly button
▪︎ Nails
Your doctor will give you a full physical exam and ask if people in your family have psoriasis.
2. ︎ Lab tests - The doctor might do a biopsy -- remove a small piece of skin and test it to make sure you don’t have a skin infection. There’s no other test to confirm or rule out psoriasis.
Treatment
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:
1. Topical treatments
Creams and ointments applied directly to the skin can be helpful for reducing mild to moderate psoriasis.
Topical psoriasis treatments include:
▪︎ topical corticosteroids
▪︎ topical retinoids
▪︎ anthralin
▪︎ vitamin D analogues
▪︎ salicylic acid
▪︎ moisturizer
2. Systemic medications
People with moderate to severe psoriasis, and those who haven’t responded well to other treatment types, may need to use oral or injected medications. Many of these medications have severe side effects. Doctors usually prescribe them for short periods of time.
These medications include:
▪︎ methotrexate
▪︎ cyclosporine (Sandimmune)
▪︎ biologics
▪︎ retinoids
3. Light therapy
This psoriasis treatment uses ultraviolet (UV) or natural light. Sunlight kills the overactive white blood cells that are attacking healthy skin cells and causing the 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 their entire lives. Others may need to change treatments occasionally if their skin stops responding to what they’re using.
Psoriasis Statistics
Psoriasis affects:
▪︎ 2%-3% of people throughout the world
▪︎ About 2.2% of people in the United States
▪︎ Some cultures more than others. Worldwide, psoriasis is most common in northern European and least common in eastern Asia.
Prevention
The symptoms of psoriasis may come and go, but there’s no cure for the condition. The best way to prevent symptoms is to avoid known triggers. Psoriasis triggers vary from person to person. So it’s important to identify the specific factors that make your symptoms worse and that help relieve them.
Diet recommendations for people with psoriasis
Food can’t cure or even treat psoriasis, but eating better might reduce your symptoms.
These five lifestyle changes may help ease symptoms of psoriasis and reduce flare-ups:
1. Lose weight
If you’re overweight, losing weight may reduce the condition’s severity. Losing weight may also make treatments more effective. It’s unclear how weight interacts with psoriasis, so even if your symptoms remain unchanged, losing weight is still good for your overall health.
2. Eat a heart-healthy diet
Reduce your intake of saturated fats. These are found in animal products like meats and dairy. Increase your intake of lean proteins that contain omega-3 fatty acids, such as salmon, sardines, and shrimp. Plant sources of omega-3s include walnuts, flax seeds, and soybeans.
3. Avoid trigger foods
Psoriasis causes inflammation. Certain foods cause inflammation too. Avoiding those foods might improve symptoms. These foods include:
▪︎ red meat
▪︎ refined sugar
▪︎ processed foods
▪︎ dairy products
4. Drink less alcohol
Alcohol consumption can increase your risks of a flare-up. Cut back or quit entirely. If you have a problem with your alcohol use, your doctor can help you form a treatment plan.
5. Consider taking vitamins
Some doctors prefer a vitamin-rich diet to vitamins in pill form. However, even the healthiest eater may need help getting adequate nutrients. Ask your doctor if you should be taking any vitamins as a supplement to your diet.
Living with psoriasis
Life with psoriasis can be challenging, but with the right approach, you can reduce flare-ups and live a healthy, fulfilling life. These three areas will help you cope in the short- and long-term:
1. Diet
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. These foods include refined sugars, dairy products, and processed foods.
There is anecdotal evidence that eating nightshade fruits and vegetables can trigger psoriasis symptoms. Nightshade fruits and vegetables include tomatoes as well as white potatoes, eggplants, and pepper-derived foods like paprika and cayenne pepper (but not black pepper, which comes from a different plant altogether).
2. Stress
Stress is a well-established trigger for psoriasis. Learning to manage and cope with stress may help you reduce flare-ups and ease symptoms.
Try the following to reduce your stress:
▪︎ meditation
▪︎ journaling
▪︎ breathing
▪︎ yoga
3. Emotional health
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. The constant cycle of the condition may be frustrating too.
All of these emotional issues are valid. 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.
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