Psoriasis

Psoriasis is a chronic skin condition characterized by red (or silvery) patches of skin that can be itchy and uncomfortable. Psoriasis most commonly appears on the knees, elbows, trunk, and scalp but can present anywhere on the body. Psoriasis typically occurs in cycles in which the skin flares-up and improves, and in some cases, goes into temporary remission. Psoriasis has no known cure at this time however, the symptoms can be treated to help control and manage outbreaks. It is not a contagious condition.

Psoriasis Symptoms

Psoriasis symptoms can vary, but common signs include:

• Red patches of skin often covered by thick, silvery scales
• Itching, soreness, or burning around the affected skin
• Stiff or swollen joints
• Cracked, dry skin that may bleed
• Thick, pitted nails

Symptoms can differ depending on age and the type of psoriasis that is occurring.

Types of Psoriasis

There are several subcategories of psoriasis that can affect different areas of the body and present in various ways, including:

• Plaque psoriasis: Plaque psoriasis, also called psoriasis vulgaris, is the most common type (approximately 80% of cases) of the skin disorder. It usually presents with the characteristic red patches of skin covered by thick, silvery scales (plaques).
• Nail psoriasis: This psoriasis causes discoloration and abnormal nail growth and can affect the toenails and fingernails. Pitting, spotting, and thickening of the nails can also occur. Psoriatic nails may crumble or separate from the nailbed (onycholysis) or, in severe cases, crumble and fall off.
• Guttate psoriasis: Typically occurring in childhood, this psoriasis presents as small, pink spots that usually appear on the arms, legs, and/or torso. Guttate psoriasis can be the result of specific triggers, such as stress, infections (commonly strep throat), skin injury, or medications.
• Inverse psoriasis: Also called flexural psoriasis, this type appears as red, shiny, inflamed areas of skin. Inverse psoriasis can worsen with perspiration or friction and typically affects the skin folds of the groin, breast, buttocks, and armpits.
• Pustular psoriasis: This type of psoriasis appears as white, pus-filled blisters that are usually localized to small areas of the body (such as the palms of the hands or soles of the feet) but can be more widespread (generalized pustular psoriasis). The lesions are typically surrounded by red, inflamed skin.
• Erythrodermic psoriasis (also called exfoliative psoriasis): This rare form of psoriasis can cover the entire body and be quite severe. It is characterized by a red, peeling rash and can cause intense itching and burning.

Approximately 1/3 of those with psoriasis also have a painful condition called psoriatic arthritis, a condition in which the immune system attacks the joints, causing stiffness and swelling. It is also possible for an individual to have more than one type of psoriasis.

What Causes Psoriasis?

Psoriasis is an autoimmune disorder, meaning that the immune system malfunctions and attacks the body. When the white blood cells mistakenly attack the skin cells, the body speeds up skin cell production, and they develop too quickly. The new skin cells push to the skin’s surface and cause the plaque and redness associated with psoriasis.

While experts are unsure of why this process happens, they believe it to be associated with genetics, as well as specific environmental factors that can trigger flare-ups.

Some external psoriasis triggers include:

• Stress
• Heavy alcohol use
• Skin injury (such as sunburn, cut, scrape, or puncture)
• Exposure to smoke
• Infection (such as strep throat)
• Certain medicines (lithium, high blood pressure medicine, and antimalarial medications)
• Cold, dry weather
• Improperly stopping corticosteroids

Treating Psoriasis

Many treatment options are available to relieve psoriasis symptoms and slow new skin cell growth. The experts at Colleyville Dermatology develop personalized treatment plans based on each individual’s unique needs.

Treatment plans may include:

• Topical creams and ointments:
• Corticosteroids
• Retinoids
• Salicylic acid
• Moisturizers
• Vitamin D analogues
• Anthralin
• Medications (oral and/or injected):
• Retinoids (reduce skin cell production)
• Biologics (block the immune system)
• Cyclosporine/Sandimmune® (prevents immune system response)
• Methotrexate (suppresses immune system)
• Enzyme inhibitor (blocks the enzyme that leads to inflammation)
• Light therapy: This treatment, also called phototherapy, utilizes ultraviolet light to slow skin cell growth and reduce skin inflammation. Phototherapy occurs over multiple sessions per week typically spanning 2-3 months.

Additional Tips for Managing Psoriasis

• Eat a heart-healthy diet (low in saturated fats and high in lean proteins).
• Limit foods that can cause inflammation and trigger psoriasis (such as processed foods, refined sugar, dairy and red meat).
• Limit alcohol intake.
• Find ways to manage stress (such as yoga, meditation, or journaling).
• Maintain a healthy weight.
• Keep skin moisturized.
• Do not smoke.
• Avoid wearing rough clothing that rubs your psoriasis.

If you are experiencing psoriasis symptoms or your current treatments are no longer working, please contact the board-certified dermatologists at Colleyville Dermatology for an evaluation and a personalized treatment plan.