Psoriasis is a chronic skin disorder, which means a skin condition that doesn’t go away. People with psoriasis have thick, pink or red patches of skin covered with white or silvery scales. The thick, scaly patches are called plaques.
Psoriasis usually starts in early adulthood, though it can begin later in life. People of any age, gender or race can get psoriasis. It can get better and worse throughout your life.
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What part of the body does psoriasis affect?
The rash can show up anywhere. In most people, it covers only a few patches of skin. In severe cases, the plaques connect and cover a large area of the body. Psoriasis can make you uncomfortable, itchy and self-conscious.
Psoriasis tends to affect the:
- Elbows and knees.
- Face, scalp and inside the mouth.
- Fingernails and toenails.
- Genitals.
- Lower back.
- Palms and feet.
What does psoriasis look like?
At first, you’ll see small red bumps. The bumps grow, and scales form on top. The surface scales might shed easily, but the scales beneath them will stick together. If you scratch the rash, the scales may tear away from the skin, causing bleeding. As the rash continues to grow, lesions (larger areas of damage) can form.
What are other types of psoriasis?
Plaque psoriasis is the most common type. About 80% to 90% of people with psoriasis have plaque psoriasis.
Other, less common types of psoriasis include:
- Inverse psoriasis appears in skin folds. It may look like thin pink plaques without scale.
- Guttate psoriasis may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots in children and young adults.
- Pustular psoriasis has small, pus-filled bumps on top of the red patches or plaques.
- Sebopsoriasis typically appears on the face and scalp as red bumps and plaques with greasy yellow scale. This type is a cross between psoriasis and seborrheic dermatitis.
Is psoriasis the same as eczema?
Psoriasis and eczema are two different skin conditions. They differ in where the disease appears on the body, how much it itches and how it looks. Eczema tends to appear more often behind the knees and inside the elbows. Eczema also causes more intense itching than psoriasis. Many people, especially children, can get both eczema and psoriasis.
How common is psoriasis?
Psoriasis affects millions of people. Approximately 3% of the U.S. population has psoriasis.
SYMPTOMS AND CAUSES
What causes psoriasis?
Psoriasis is an immune system problem. Your immune response overreacts, causing inflammation, which leads to new skin cells growing too fast.
Typically, new skin cells grow every 28 to 30 days. But in people with psoriasis, new cells grow and move to the skin surface every three to four days. The buildup of new cells replacing old cells creates the silvery scales of psoriasis.
Psoriasis runs in families. There may be a genetic component. Parents may pass it down to their children.
What causes psoriasis outbreaks?
Psoriasis outbreaks differ from person to person. No one knows exactly what causes flare-ups. Common psoriasis triggers may include:
- Skin injury (cuts, scrapes or surgery).
- Emotional stress.
- Streptococcal or other infection that affects the immune system.
- Certain prescription medications (such as lithium and beta blockers).
- Cold weather, when people have less exposure to sunlight and humidity and more to hot, dry indoor air.
What are the symptoms of psoriasis?
In addition to red, scaly patches, symptoms of psoriasis include:
- Itchiness.
- Cracked, dry skin.
- Scaly scalp.
- Skin pain.
- Nails that are pitted, cracked or crumbly.
- Joint pain.
Is psoriasis contagious?
The rash is not contagious. You can’t get it from (or give it to) another person.
DIAGNOSIS AND TESTS
How do I know if I have psoriasis?
Do regular skin self-exams to notice any changes in your skin. If you have a rash that’s not going away, contact your healthcare provider. They’ll look at the rash to figure out if it’s psoriasis or another condition. You may need to see a dermatologist, a skin care specialist, for a diagnosis.
How is psoriasis diagnosed?
In some cases, your healthcare provider or dermatologist may need to take a skin sample to view under the microscope.
MANAGEMENT AND TREATMENT
What type of psoriasis treatment will I need?
Several treatment options can relieve psoriasis. Creams or ointments may be enough to improve the rash in small areas of skin. If the rash affects larger areas, or you also have joint pain, you may need other treatments. Joint pain may be a sign that you have arthritis.
Your provider will decide on a treatment plan based on:
- Severity of the rash.
- Where the rash is on your body.
- Your age.
- Your overall health.
What psoriasis treatments are available?
Common psoriasis treatments include:
- Steroid creams.
- Moisturizers for dry skin.
- Anthralin, a medication to slow skin cell production.
- Medicated lotions, shampoos and bath solutions to improve scalp psoriasis. Your provider may combine it with ultraviolet (UV) light therapy for severe cases.
- Vitamin D3 ointment.
- Vitamin A or retinoid creams.
What if those psoriasis treatments don’t work?
If psoriasis doesn’t improve, your healthcare provider may recommend these treatments:
- Light therapy: UV light at specific wavelengths can decrease skin inflammation and help slow skin cell production.
- PUVA: This treatment combines a medication called psoralen with exposure to a special form of UV light.
- Methotrexate: Providers sometimes recommend this medication for severe cases. It may cause liver disease. If you take it, your provider will monitor you with blood tests. You may need periodic liver biopsies to check your liver health.
- Retinoids: These vitamin A-related drugs can cause side effects, including birth defects.
- Cyclosporine: This medicine can help severe psoriasis. But it may cause high blood pressure and kidney damage.
- Immune therapies: Newer immune therapy medications work by blocking the body’s immune system so it can’t jumpstart an autoimmune disease such as psoriasis.
PREVENTION
Can I prevent psoriasis?
You cannot prevent psoriasis. But treatment can reduce symptoms, even in people with severe psoriasis.
OUTLOOK / PROGNOSIS
Will psoriasis ever go away? Can it be cured?
Psoriasis has no cure. It may come and go throughout your life. Treatment can relieve symptoms so you can look and feel your best.
Are there complications of psoriasis?
In some people, psoriasis causes more than itchiness and red skin. It can lead to swollen joints and arthritis. If you have psoriasis, you may be at higher risk of:
If you have psoriasis, your provider will do regular blood pressure checks. It’s also important to quit smoking and maintain a healthy weight.
What is psoriatic arthritis?
In 1 in 3 people with psoriasis, the inflammation from psoriasis causes arthritis. Symptoms of psoriatic arthritis include joint swelling, stiffness and pain. See your healthcare provider if you have any of these symptoms. Early treatment can reduce damage to your joints.
LIVING WITH
How can I take care of myself?
To feel your best with psoriasis:
- Take medications as instructed.
- Use moisturizer regularly, especially after bathing.
- Avoid harsh soaps.
- Use medicated shampoo for scales on your scalp.
Other steps you should take to stay as healthy as possible:
- Talk to your healthcare provider about lowering your risk for related conditions, such as heart disease, depression and diabetes.
- Lower your stress with meditation, exercise or seeing a mental health professional.
What else should I ask my healthcare provider?
If you have psoriasis, ask your healthcare provider:
- How can I prevent outbreaks and control symptoms?
- What medication will work best for me?
- What else should I do to improve symptoms?
- What are my options if creams don’t work?
- Will psoriasis ever go away?
