Persons with psoriasis have irritated patches of skin. The skin disorder is quite common and persons with psoriasis have thick, red skin with flaky, silver-white patches called scales. The redness is most often seen on the elbows, knees and trunk, but can appear anywhere on the body. For example, there may be flaky patches on the scalp. The skin patches or dots may be pink-red in color (like the color of salmon), dry and covered with silver, flaky skin (scales) or raised and thick. Additional symptoms may include genital lesions in males, joint pain or aching (psoriatic arthritis) and nail changes, including nail thickening, yellow-brown spots, dents (pits) on the nail surface and separation of the nail from the base. The disorder may affect people of any age, but it most commonly begins between ages 15 and 35. It can appear suddenly or slowly. In many cases, psoriasis goes away and then flares up again repeatedly over time. The condition is not contagious.
Psoriasis seems to be an inherited disorder. Doctors think it probably occurs when the body’s immune system mistakes healthy cells for dangerous substances. Skin cells grow deep in the skin and normally rise to the surface about once a month. In persons with psoriasis, this process is too fast and dead skin cells build up on the skin’s surface. Further, psoriasis may affect any or all parts of the skin. There are five main types of psoriasis:
- Erythrodermic — The skin redness is very intense and covers a large area.
- Guttate — Small, pink-red spots appear on the skin.
- Inverse — Skin redness and irritation occurs in the armpits, groin, and in between overlapping skin.
- Plaque — Thick, red patches of skin are covered by flaky, silver-white scales. This is the most common type of psoriasis.
- Pustular — White blisters are surrounded by red, irritated skin.
There are several things that may trigger an attack of psoriasis, or make the condition more difficult to treat. These include bacteria or viral infections, including strep throat and upper respiratory infections, dry air or dry skin, injury to the skin, including cuts, burns, and insect bites, some medicines, including anti-malaria drugs, beta-blockers, and lithium, stress, too little sunlight, too much sunlight (sunburn) or too much alcohol. In general, psoriasis may be severe in persons who have a weakened immune system. This may include persons who have AIDS, autoimmune disorders (such as rheumatoid arthritis) or cancer chemotherapy. Up to 30% of people with psoriasis may also have arthritis, a condition known as psoriatic arthritis.
The goal of treatment is to control your symptoms and prevent secondary infections. Psoriasis that covers all or most of the body is an emergency that requires a hospital stay. You may receive painkillers, medicines to make you sleepy (sedatives), fluids through a needle in your vein and antibiotics to fight any infection. Mild cases of psoriasis are usually treated at home. Your doctor may recommend any of the following: cortisone (anti-itch) cream, creams or ointments that contain coal tar or anthralin, creams to remove the scaling (usually salicylic acid or lactic acid), dandruff shampoos (over-the-counter or prescription), moisturizers and/or prescription medicines containing vitamin D or vitamin A (retinoids). Persons with very severe psoriasis may receive medicines to suppress the body’s immune response. These medicines include methotrexate or cyclosporine. Newer drugs called biologics specifically target the body’s immune response, which is thought to play a role in psoriasis. These drugs are used when other treatments do not work.
Psoriasis is a life-long condition that can be controlled with treatment. It may go away for a long time and then return. With appropriate treatment, it usually does not affect your general physical health. There is no known prevention for psoriasis, but keeping skin clean and moist and avoiding your specific psoriasis triggers may help reduce the number of flare-ups. Doctors recommend daily baths or showers for persons with the common disorder. Be sure to avoid scrubbing too hard, because this can irritate the skin and trigger an attack. There can be complications from the disorder, including pain, severe itching, secondary skin infections or side effects from the medicines used to treat psoriasis. Be sure to call your health care provider if you have these symptoms of psoriasis or if the skin irritation continues despite treatment. Additionally, make sure you tell your doctor if you have joint pain or fever with your psoriasis attacks or if you have a severe outbreak that covers all or most of the body.