Psoriasis

Psoriasis is a chronic (long-lasting) disease that can affect the skin and/or the joints. It develops when a person’s immune system sends faulty signals that tell skin cells to grow too quickly. New skin cells form in days rather than weeks and the body does not have enough time to shed the excess skin cells. The skin cells pile up on the surface of the skin, causing patches of psoriasis to appear. Psoriasis is not contagious. Usually people with psoriasis have family members with this skin disorder, but not everyone who has a family member with psoriasis will get psoriasis. Most people get psoriasis between 15 and 30 years of age. By age 40, most people who will get psoriasis, have it. Small amounts of people develop psoriasis between 50 and 60 years of age. Psoriasis can be flared by a stressful event, a strep infection such as strep throat, certain medications, cold and dry weather, or trauma to the skin (a cut or scratch, or a bad sunburn). Having psoriasis can increase your risk of heart attack and cholesterol related events. It is important to see your primary physician regularly for check ups.

Types of psoriasis
◦ Plaque psoriasis: This is the most common type of psoriasis with reddish raised rough patches, often covered with silvery scales, appearing anywhere on the skin. Most commonly they appear on the elbows, knees, lower back and scalp. These lesions may itch, but scratching may worsen the areas.
◦ Guttate psoriasis: Small spots can show up all over the skin, and often occur after an illness (especially a Strep infection).
◦ Inverse psoriasis: Smooth red patches of skin (may look raw) develop in the creases where skin rubs against other skin. The skin often feels sore. This is more common in infants and small children.
◦ Pustular psoriasis: Red swollen skin develops with multiple dotted pus-filled bumps within. These areas often feel sore and painful. When the pustules dry out the areas can be crusty. The most common location for this is the hands and feet. When a person has this type of flare, they can also feel sick, exhausted, fever, chills, severe itching, muscle weakness, and loss of appetite.
◦ Erythrodermic psoriasis: This severe form is rare, and appears like red burnt skin over most or all of the body. Other symptoms include feeling very hot or cold, intense itching and intense pain. Someone with this type of psoriasis should get medical attention immediately.
◦ Nail psoriasis: Nail pitting, nail crumbling, and other nail dystrophy may develop.
◦ Psoriatic arthritis: This most commonly affects the joints in the hands, wrists, elbows, knees, ankles and toes. However it can also affect the lower back, and where muscles attach to bones.
◦ It is possible to get more than one type or to switch types.

Treatment:
◦ A dermatologist will ask about your medical history and family history, and then examine the skin, nails and scalp.
◦ Sometimes a dermatologist will perform a skin biopsy, which takes a small piece of skin for examination under a microscope. This can help to make a diagnosis and help to guide treatment. This procedure is performed with local anesthesia and is not painful.
◦ There are many treatment options for psoriasis, and your dermatologist will discuss which is appropriate, based on the symptoms and severity.
◦ Topical creams: corticosteroid creams, vitamin D analogs, retinoid creams, coal tar preparations.
◦ UV light treatment: Phototherapy (UV-B light) treatments, excimer laser treatments.
◦ Oral medications.
◦ Injectable medications / biologic medications.
◦ It is important to understand that psoriasis will never be ‘cured’ but can be managed over time. Flares are likely to occur at times. Some people get complete clearance of the skin lesions with medical treatments, while others get improvement but have persistent stubborn areas.