Psoriasis is a condition that accelerates the growth of skin cells, causing the formation of raised red patches on the skin covered with white scales. In people with darker skin, these patches may have a purplish, violet, or brown appearance with gray scales. Although these patches can appear anywhere on the body, they are most commonly found on the scalp, elbows, knees, and lower back. It is important to note that psoriasis is not contagious and cannot be transmitted from one person to another. However, it may occur in multiple members of the same family.
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The condition causes the immune system to overproduce skin cells, resulting in the formation of thick, scaly, and itchy patches on the skin. There are several types of psoriasis, including plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis.
Plaque psoriasis, also known as psoriasis vulgaris, is the most common type of psoriasis, accounting for about 80% of cases. Plaque psoriasis is characterized by raised, inflamed, and scaly patches of skin, known as plaques. These plaques are usually reddish in color and covered with silver or grayish scales. They can appear on any part of the body but commonly occur on the scalp, elbows, knees, and lower back. In darker skin tones, plaques may appear brown or purplish.
The symptoms of plaque psoriasis can range from mild to severe. In some cases, the plaques may be itchy, painful, and prone to cracking and bleeding. When the plaques grow and merge, they can cover large areas of the skin. People with plaque psoriasis may also experience nail problems, such as discoloration, pitting, crumbling, and detachment from the nail bed.
Other types of psoriasis include:
Psoriasis is a chronic autoimmune disorder that can take different forms, including the more common plaque psoriasis, as well as other types such as pustular, guttate, inverse, and erythrodermic psoriasis.
Pustular psoriasis typically presents with scaly, discolored skin and small pustules that form on the palms of the hands and soles of the feet.
Guttate psoriasis often starts in childhood or young adulthood and is characterized by small spots that can be pink, red, brown, or purple in color, mainly appearing on the torso and limbs. It can be triggered by respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and taking certain medications such as antimalarials and beta-blockers.
Inverse psoriasis causes discolored and shiny lesions that appear in skin folds, such as the armpits, groin, and under the breasts. These lesions are typically bright red on light skin and darker than the surrounding skin, appearing purplish or brown in color on darker skin.
Erythrodermic psoriasis is a rare but severe form of the disease that causes intense discoloration of the skin and shedding of scales in sheets. It can be triggered by severe sunburn, infections, certain medications, and stopping some types of psoriasis treatment. It requires immediate medical attention, as it can lead to severe illness.
What Causes Psoriasis?
The exact cause of psoriasis is still unknown, but experts believe it’s a combination of factors that can trigger an immune response leading to inflammation, which in turn, causes the skin to produce new cells at an abnormally rapid rate. The usual replacement rate for skin cells is every 10-30 days, but with psoriasis, this process happens every 3-4 days, resulting in a buildup of old skin cells that creates the characteristic silver scales on the skin.
Although psoriasis can affect anyone at any age, it tends to run in families, indicating a genetic predisposition. However, it can also skip generations, so not all family members may be affected. Other risk factors that can contribute to the development of psoriasis include smoking, obesity, and a history of infections like strep throat.
Certain triggers can also exacerbate psoriasis symptoms, leading to a flare-up of the condition. These triggers include cuts, scrapes, or surgery, emotional stress, strep infections, and certain medications such as blood pressure drugs, anti-malarial drugs, lithium, and some antibiotics. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen can also trigger psoriasis symptoms in some people.
To diagnose psoriasis, a physical examination is usually sufficient. A doctor may look for plaques on areas like the scalp, ears, elbows, knees, belly button, or nails. In some cases, a skin biopsy may be necessary to confirm the diagnosis.
Fortunately, there are numerous treatments available for psoriasis. These treatments are prescribed by doctors based on various factors such as the size and location of the rash, the patient’s age, overall health, and other such considerations. Common treatment options include steroid creams, moisturizers for dry skin, coal tar, Vitamin D-based cream or ointment, retinoid creams, calcineurin inhibitors, and Anthralin.
For moderate to severe psoriasis, light therapy is a treatment option where a doctor uses ultraviolet light on the skin to slow down the growth of skin cells. Psoralen plus ultraviolet-A radiation (PUVA) is another treatment option that combines a medication called psoralen with a special form of ultraviolet light.
Methotrexate is a drug that can cause bone marrow and liver disease as well as lung problems, hence it is only prescribed for serious cases and requires close monitoring. Retinoids are a class of drugs related to vitamin A that can cause severe side effects, including birth defects. They are not recommended for pregnant women or those planning to have children.
Cyclosporine is a drug that suppresses the immune system and may be prescribed for serious cases that do not respond to other treatments. However, it can damage the kidneys and raise blood pressure, so the doctor will closely monitor the patient’s health.
Biologic treatments are medications that work by blocking the part of the body’s immune system that is overactive in psoriasis. These include adalimumab, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab-rzaa, secukinumab, tildrakizumab, and ustekinumab.
Enzyme inhibitors are new kinds of drugs for long-term inflammatory diseases such as psoriasis and psoriatic arthritis. Apremilast and deucravacitinib are pills that block a specific enzyme to help slow down other reactions that lead to inflammation. Another treatment option is an aryl hydrocarbon receptor (AHR) agonist called Tapinarof, which is a steroid-free, once-a-day topical cream that can be used on all body areas, including sensitive locations.