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Psoriasis is a skin condition that causes red, itchy and scaly patches called “plaques” to develop on different parts of the body. It is a chronic skin disease, which means that it lasts for longer than 3 months, and tends to stay there throughout an affected person’s life. Although it mainly affects the skin, it can also affect other parts of the body too including the joints and internal organs.
The symptoms of psoriasis can come and go in phases. This means that you may not have any symptoms for a while, then you may develop some mild or severe symptoms, and after some time these may go away again.
There are several different types of psoriasis. Most people have only one type of psoriasis at a time, however they can sometimes develop another type alongside their existing one, or at a later stage in life.
Psoriasis vulgaris, which is also called “plaque-type psoriasis”, “plaque psoriasis” or “common psoriasis” is the most common type of psoriasis. It usually causes red, flaky patches of skin to develop called “plaques”. These plaques are clearly marked with a border, and are often covered in white or silver scales. They can be:
Sometimes, small plaques can join together to form larger plaques, and some people also develop new plaques in areas of skin that have been injured, or had pressure applied to them.
Often the plaques that develop in psoriasis vulgaris are symmetrical, meaning that they develop in the same place on either side of the body.
Smaller plaques often respond well to light therapy, however the larger plaques are usually more difficult to treat. Large plaques also often develop sooner than smaller ones do.
Where can these plaques appear on the body?
Although these plaques can develop anywhere in the body, in psoriasis vulgaris the most common places that they appear include the:
What are the different types of psoriasis vulgaris?
Depending on the part of the body that is affected, psoriasis vulgaris can be given specific names, such as:
Inverse psoriasis, which can also be called “flexural psoriasis”, “intertriginous psoriasis” or “psoriasis of the skin folds”, is a form of psoriasis that affects areas of the body where there are skin folds, such as:
Usually, the psoriasis patches in these areas are:
The symptoms of inverse psoriasis can sometimes become worse when there is friction or sweating in these areas, for example when clothes rub against an affected area or when the weather is hot.
Seborrhoeic psoriasis, which is also called “sebopsoriasis”, creates patches of skin that are thin, red and can have different amounts of flaky scales on them. This type of psoriasis most commonly affects the following areas of skin:
This type of psoriasis can sometimes look similar to another skin condition called seborrhoeic dermatitis, however a specialist skin doctor (known as a dermatologist) should be able to distinguish between the two.
One of the most common locations for people to get psoriasis is on their scalp. The scalp is the skin at the top of the head underneath where the hair grows.
In many cases, the scalp is the first place where people notice symptoms of psoriasis. The severity of the symptoms on the scalp can vary greatly from just a few small patches, to the entire surface of the scalp being affected.
It can be difficult to treat psoriasis on the scalp, and unlike the patches found on other parts of the body, the psoriasis patches on the scalp are often asymmetrical. In very severe cases, scalp psoriasis can cause hair loss, however this is usually only temporary.
Many people with psoriasis can also experience some symptoms in their nails. The most common nail symptoms people have include:
Patches can also develop on the palms of the hands and soles of the feet. This type of psoriasis causes yellow-brown spots filled with pus (pustules) to develop on the palms and soles.
Symptoms usually start developing when people are in their 40s or 50s, and unlike other types of psoriasis, it is more frequently seen in women, especially those who have previously smoked or who are currently smoking.
Guttate psoriasis is the second most common type of psoriasis after plaque psoriasis, and it most commonly develops in children and young adults. Guttate psoriasis can also be called:
The symptoms of guttate psoriasis can appear quite suddenly. People usually develop lots of small, red scaly patches and “drop-like spots” that are spread across a wide area of skin, and mainly appear in the following regions:
Guttate psoriasis is very common in children and young adults who already have a family history of psoriasis, and it can also develop after someone has had:
Guttate psoriasis often goes away by itself within 3 to 4 months.
Some people with regular plaque psoriasis can also have guttate psoriasis “flare ups”.
This type of psoriasis causes several small spots filled with spots (pustules) to develop around the body. The pus in these small spots is caused by white blood cells, and it is not a sign of infection.
There are two types of pustular psoriasis that can occur:
1. Generalised Pustular Psoriasis
This causes the pus-filled spots to develop across the body, in non-specific areas. The spots usually develop quite suddenly, and the skin around them is often very red and very tender. Some people may also have a fever or other symptoms such as anorexia and nausea during a pustular psoriasis flare up.
The pus filled spots can sometimes join together, and after a while they can “dry out” leaving behind dry, peeling skin.
2. Localised Pustular Psoriasis
This form of pustular psoriasis causes the small pus filled spots to develop in a specific part of the body, usually the hands and the feet. There are two kinds of localised pustular psoriasis:
This is a rare type of psoriasis that develops quite suddenly. It causes around 90% of the skin on the body to become very red and itchy. It usually develops in people who already have another type of psoriasis.
Erythrodermic psoriasis can affect the way that the skin functions, causing people to become very unwell, which means that people who develop it need emergency treatment.
Can psoriasis be deadly?
Most types of psoriasis are not dangerous, however erythrodermic psoriasis can cause very severe problems to develop in the body, and can indeed be life-threatening. That is why it is so important to seek medical attention as soon as possible if this type of psoriasis develops.
The patches of skin that are affected by psoriasis are usually most “active” around the edge of the patch. Sometimes this causes a ring of affected skin to form around some normal skin, and this is called “annular psoriasis”.
Psoriasis affects both children and adults, and it can start at any age. Usually, people start to first notice symptoms between the ages of 16 to 22 years, or between the ages of 57 to 60 years, however these numbers can vary in different countries.
Although psoriasis is seen all over the world, it seems to be less common in Asians, and some Africans, and more common in Caucasians and Scandinavians.
Psoriasis tends to run in families, which suggests that your genetics may determine whether or not you get this skin condition. This means that if you have a close family member who has psoriasis, you are more likely to develop it too at some stage, but it does not mean that you will definitely get it.
For many people however, psoriatic symptoms can start (or become worse) because of certain “triggers”. Examples of these triggers can include:
Certain medical conditions can also trigger symptoms to start or become worse. These include:
Babies who develop psoriasis usually get a red rash around the diaper area. Some babies can also develop it on their scalps.
Young children tend to develop red, small, scaly patches on different parts of the body. Although it most commonly develops on the scalp, symptoms can also develop in other areas such as the:
In school-aged children, it can also affect the ears and upper eyelids.
Some women find that their symptoms get better during their pregnancy, whilst others find that it gets worse.
Having psoriasis should not affect your pregnancy or your fertility, however it is important to consider that some treatments should not be used whilst you are pregnant. The best thing to do if you have psoriasis and want to have children is to speak to your doctor first.
Psoriasis is caused by more than one factor, and it is classed as an autoimmune disease. An autoimmune disease develops when the body’s immune system does not work properly, and accidentally starts to attack the body when it shouldn’t.
Although it is not fully understood how the immune system affects people with psoriasis, we do know that it causes the body to produce too many skin cells. When these extra skin cells start to build up, they create abnormal patches of skin (called plaques).
Is psoriasis a bacteria, virus or fungus?
No, it is none of these things. Although there are certain bacterial and viral infections that can trigger symptoms to start, psoriasis itself is not a bacteria, virus or fungus.
Is psoriasis contagious?
No, psoriasis is not contagious, so you cannot catch it from other people or give it to other people. It is also not a sexually transmitted disease.
Psoriasis mainly affects the skin. The types of psoriasis that are described above can cause different types of skin symptoms to develop in different people. Examples of skin symptoms that may develop include:
Other symptoms that may develop include:
The severity of psoriasis can be categorised as follows:
Symptoms can come and go. When people get symptoms this is often called a “flare up”, and flare ups can last for a few weeks to months. After this period is over, the symptoms usually become a little better or stop, but they can reappear again during another flare up.
In between these flare ups, the scaly patches of skin can leave behind brown or pale marks, which can take several months to fade.
Flare ups are usually caused by certain triggers. These can include:
Figuring out what triggers make your symptoms reappear or become worse can help you manage the symptoms whenever they do occur.
When you get a tattoo, the skin in that area can become irritated and injured. In some people, this can trigger new symptoms to develop, or make existing ones worse.
It can develop anywhere on the body, but it most commonly develops in the following areas:
It can however, also develop around these less common areas:
Usually, doctors can diagnose psoriasis just by looking at the parts of the skin that are affected. However, they may also need to do the following:
If your family doctor is unsure of the diagnosis, or if your symptoms are severe, they will likely refer you to see a specialist skin doctor called a dermatologist.
If your doctor thinks that you have psoriasis and that your joints are being affected because of psoriatic arthritis, they will likely refer you to see a specialist joint doctor called a rheumatologist.
If your doctor is unsure what is causing your skin problems, they may scrape off a bit of the affected skin (this is called a biopsy), and send it to a lab to be tested.
The lab can run some tests to check whether your skin condition is actually psoriasis or if it is something else.
Your doctor may also need to take some blood tests so they can rule out other medical conditions.
If you are having problems with your joints, your doctor may also ask you to have an X-ray done to check the joints.
Aside from causing skin problems, psoriasis can unfortunately cause a number of other diseases or conditions to develop in the body, such as:
Some people with psoriasis can develop a condition called psoriatic arthritis. This is a condition that causes long-term inflammation of the joints in the body. The symptoms can develop slowly over time, or they can develop rapidly.
Usually, people will first have skin symptoms, and after a few years they will start to develop problems with their joints. In some cases however, people may develop joint problems before they develop any skin problems.
Which joints does psoriatic arthritis affect?
Psoriatic arthritis can affect both small joints and large ones, and usually causes pain, tenderness and swelling to develop around these joints. It can affect any joint in the body, but it mainly affects the:
If your family doctor suspects that you have psoriatic arthritis, they may refer you to a specialist joint doctor called a rheumatologist.
It is important that psoriatic arthritis is diagnosed and treated as soon as possible, as this can help reduce the severity of the symptoms later down the line.
People who develop psoriasis in the following areas have a higher risk of develop psoriatic arthritis:
Some people with psoriasis may also develop problems with their eyes. Their eyes may become inflamed, and develop conditions such as uveitis. Uveitis is an eye disease that can cause the eyes to become red and painful, and may also cause blurry vision.
Having psoriasis can also increase the risk of developing a condition called inflammatory bowel disease (IBD), and in particular a type of inflammatory bowel disease that is called Crohn’s disease.
Psoriasis can have a very large impact on quality of life. For some, symptoms are mild, and do not affect their daily lives too much. For other people however, symptoms can be more severe and can deeply affect their quality of life, and their mental health too.
Having this skin condition can affect people’s emotions for various reasons. It can make people feel:
People with psoriasis do have a slightly higher risk of developing certain kinds of cancer such as:
Another disease that people are more at risk of developing is non-alcoholic fatty liver disease (NAFLD). Non-alcoholic fatty liver disease is a term that is used to cover a range of conditions that develop when someone has too much fat in their liver. It occurs in 4 different stages:
Metabolic syndrome is a name that is used to describe a group of conditions including:
People with psoriasis have a higher risk of developing these conditions, and having these conditions can make it more likely for you to get other diseases such as a stroke or heart disease.
There are some skin conditions that can have similar symptoms to psoriasis. These include:
The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.
If your symptoms are mild then your family doctor will usually be able to help you treat your symptoms. If the symptoms are more severe, then your doctor may send you to see a specialist skin doctor (dermatologist). If you have some joint problems as well, then they would likely send you to see a specialist joint doctor (rheumatologist).
Can psoriasis be cured?
Unfortunately, psoriasis cannot be cured. There are however, many treatments and lifestyle changes available to help people cope with their symptoms. Some lifestyle changes can significantly benefit your psoriasis. These include:
The different types of treatments can be split into the following categories:
For most people with mild or moderate symptoms, the first type of treatment that a doctor may recommend is a topical treatment such as a cream or a lotion that you can put directly on your skin. It’s important to be patient when using these topical treatments because it can take a few weeks before you start to see any improvements in your symptoms.
Emollients are moisturisers that you can put directly on your skin to soothe and hydrate it. You can buy them in a pharmacy without needing a prescription from your doctor. Your pharmacist or family doctor should be able to recommend the best type of emollient for your symptoms.
There are different types of emollients available which include:
How do emollients work?
Emollients can help prevent psoriasis flare ups by trapping moisture into the skin and therefore reducing:
They do this by creating a “protective layer” on top of the skin, so that any moisture underneath this layer can stay there and hydrate the skin.
Do emollients have any side effects?
Different emollients may have different side effects. Some of them can sometimes cause the following:
If you notice any of these side effects whilst using an emollient, the best thing to do is to speak to your pharmacist or doctor. They should be able to recommend a better treatment for you.
Your doctor may prescribe a specific type of steroid called a corticosteroid to help treat your symptoms. An example of a topical corticosteroid that is used to treat psoriasis is hydrocortisone. It is really important to understand that these are not the same as the anabolic steroids that are sometimes used by weightlifters and athletes.
Some mild corticosteroid treatments can sometimes be bought over the counter at a pharmacy, but stronger ones can only be prescribed by your doctor.
Topical corticosteroids are applied directly on top of the skin, and come in different strengths ranging from mild to very strong. They are available as:
How do these steroids work?
The corticosteroid can help make the symptoms better by reducing:
Are there any side effects?
Corticosteroids don’t usually have any serious side effects if they are used correctly. You should follow the instructions given by your pharmacist or doctor whenever you start to use a corticosteroid treatment.
Some side effects of topical corticosteroids can include (but are not limited to):
These side effects are more likely to occur in people who are using strong steroids, have been using them for a while, or are not using them correctly.
If you are pregnant, breastfeeding or using this treatment on a child, it is best to speak to your doctor first to make sure that you are safe to use topical corticosteroids. Most treatments should be fine for you to use, but some strong ones may not be safe.
Vitamin D analogues are a type of “man-made” vitamin D and are also known as synthetic vitamin D. They are often one of the first topical treatments that your doctor may ask you to try. Examples of synthetic vitamin D include:
How does synthetic vitamin D work?
These medications can help reduce symptoms by reducing inflammation, and also by slowing down the growth of new skin cells.
Does synthetic vitamin D have any side effects?
The side effects of synthetic vitamin D are usually minimal, but they can include:
Another type of treatment that is used to treat moderate to severe symptoms is something called light therapy (also called phototherapy). This type of treatment involves shining UV light onto the skin, but it is not the same as using a sunbed.
Phototherapy is usually recommended for people who have already tried to use topical medications, and haven’t found them helpful. It is usually given to people in specialist centres under the care of a specialist skin doctor (dermatologist).
The different types of light therapy you can get include:
Narrowband UVB therapy is the most common type of light therapy that is recommended to people with psoriasis. It helps slow down the production of new skin cells, and can help patients with specific types of psoriasis such as plaque psoriasis and guttate psoriasis, especially in the winter.
Although the treatment itself only takes a few minutes, you may need to go to the specialist centre 2 or 3 times a week to receive this light therapy, which can be quite difficult for some people.
Can pregnant women get narrowband UVB light therapy?
Narrowband UVB therapy is usually considered safe to use during pregnancy, but this is something that you should double check with your doctor.
PUVA therapy can also be called photochemotherapy. Before you are given the UVA light therapy itself, you will have to take a tablet containing a natural substance called psoralen. You are usually asked to take this tablet 2 hours before you have your light therapy.
If you only need a specific part of your body treated, then instead of a tablet you may be given a foot or hand bath with psoralen in it, or a topical treatment containing psoralen to put directly on your skin. The psoralen helps to make your skin more sensitive to light.
After you have had your psoralen, you will have UVA light therapy shone onto your skin. Because UVA light is stronger than UVB light, there is a higher risk of developing skin cancer when using UVA light therapy. This is why you can only have a limited number of UVA light treatments throughout your life.
Can pregnant women get PUVA light therapy?
Psoralens and PUVA light therapy are not recommended for women who are pregnant or breastfeeding.
For some people, using topical treatments like mosturisters, creams and gels may not be enough to help soothe their symptoms. If this is the case, their doctor may prescribe something called a “systemic treatment”, which is a type of treatment that affects the whole body, and not just the skin.
Acitretin is a man-made (synthetic) medication that is used to treat moderate or severe psoriasis. It is sometimes used alongside some other medications.
How does acitretin work?
Acitretin is part of a group of medications called “retinoids”. It works by slowing down the production of new skin cells. It can take a few weeks before people notice an improvement with their symptoms.
Does acitretin have any side effects?
The side effects of acitretin can include (but are not limited to):
WARNING: Acitreitn can badly harm a growing baby. It is incredibly important that women do not become pregnant when they are taking acitretin, and that they use contraception whilst they are using this medication. Women should not become pregnant for at least 3 years after taking this medication. It is safe however, for men to take this medication and to father a baby.
Methotrexate is a medication that is used to treat severe forms of psoriasis. It is usually taken as a tablet only once a week.
How does methotrexate work?
Methotrexate works by slowing down the production of new skin cells, and also reducing inflammation.
Does methotrexate have any side effects?
The side effects of methotrexate can include (but are not limited to):
Because methotrexate can damage the liver, people with liver disease should not use this medication, and anyone using methotrexate should also not drink alcohol because this can increase some of its side effects.
WARNING: Methotrexate can badly harm a growing baby. It is incredibly important that women do not become pregnant when they are taking methotrexate, and that they use contraception whilst they are using this medication. Women should not become pregnant for at least 3 months after taking this medication. Men should also try not to father a baby for at least 3 months after they stop taking this medication.
Ciclosporin is a medication that is used to treat moderate to severe psoriasis. It is usually taken by mouth, once a day.
How does ciclosporin work?
Ciclosporin works by making your immune system less active by suppressing it. Medications that do this are called “immunosuppressants”.
Does ciclosporin have any side effects?
Some side effects of cyclosporine can include (but are not limited to):
If you are taking ciclosporin, you should avoid eating certain foods (e.g. grapefruit), and avoid taking certain medications as they can react badly with the ciclosporin. Your doctor should be able to give you a list of all the foods and medications you should avoid.
Biologics are medications that are made from living materials such as plants, animals, or humans. They are usually prescribed to people who have severe symptoms that are not responding to other types of medications. Examples of different types of biologics include:
The biologics may either be given to you as an injection or put directly into your veins (IV infusion).
How does biologic therapy work?
Biologics work by targeting specific parts of your immune system that cause the symptoms of psoriasis to develop. That is why they are sometimes called “targeted therapies”.
Does biologic therapy have any side effects?
Each type of biologic has its own set of side effects, which can include (but are not limited to):
More and more patients are becoming interested in trying to control their symptoms through their diet. For example, people may try the following:
Although some people find that sticking to a certain diet helps improve their symptoms, there still needs to be more research done in this area to determine the real benefits of these diets.
Although you cannot cure psoriasis or prevent yourself from having the condition itself, you can reduce the number of flare ups you get by:
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