Psoriasis

Psoriasis is a long-lasting condition that affects the skin, but it cannot spread from one person to another. People with psoriasis have patches of abnormal skin that are red, pink, or purple, dry, itchy, and scaly. These patches can be small or cover large areas of the body. Injury to the skin can sometimes cause new patches to appear at that spot.

There are several types of psoriasis. Plaque psoriasis is the most common, showing red patches with white scales, often on the arms, legs, belly area, or scalp. Other types can cause drop-shaped spots, red patches in skin folds, small pus-filled blisters, or very widespread rash. Psoriasis can also affect fingernails and toenails.

Psoriasis is believed to be caused by a combination of genetic and environmental factors. It often gets worse during winter or with certain medications, infections, or stress. The immune system plays a key role in the development of the condition. While there is no cure, treatments like steroid creams, vitamin D cream, ultraviolet light therapy, and certain drugs can help control the symptoms.

Signs and symptoms

Psoriasis is a common skin condition. It causes red, itchy patches with silvery scales. The most common type is called plaque psoriasis. It often appears on the elbows, knees, scalp, and back. These patches can be raised and may feel sore.

Other types of psoriasis include pustular psoriasis, which shows small bumps. There is also inverse psoriasis, which affects skin folds like armpits and groin areas. Psoriasis can appear in infants, on the scalp, or inside the mouth. It can also affect the nails, causing changes like pitting or discoloration. Sometimes, it can cause joint pain, known as psoriatic arthritis.

Causes

The exact reason for psoriasis isn't completely known. It seems that family history, changes in the seasons, damage to the skin, climate, certain infections, and some medicines can all play a role in causing different kinds of psoriasis.

Many people with psoriasis have family members who also have the condition, suggesting that genes are important. If one identical twin has psoriasis, the other often will too. Researchers have found several genes linked to psoriasis, especially those involved in the immune system. These genes can influence how the body’s defenses react, sometimes leading to skin changes.

Other factors that might make psoriasis worse include stress, infections, changes in temperature, hot water, scratching the affected skin, very dry skin, drinking too much alcohol, smoking, and being overweight. Sometimes, certain medicines can also trigger or worsen psoriasis.

Pathophysiology

Psoriasis happens when the skin grows too quickly. Normally, skin cells grow and replace themselves in about four weeks. But with psoriasis, they grow and replace themselves in just a few days. This fast growth causes red, scaly patches on the skin.

This quick growth is caused by the body’s immune system. Certain cells in the immune system send out signals that make skin cells grow faster. Scientists think that genes may also play a role in psoriasis.

Diagnosis

A diagnosis of psoriasis is usually made by looking at the skin. The skin will have scaly, red patches that may be itchy. Usually, no special blood tests are needed to diagnose psoriasis.

If it is not clear what is causing the skin problems, a small piece of skin may be taken to look at under a microscope. This helps to make sure it is psoriasis and not something else. There are other skin conditions that can look similar to psoriasis.

Co-morbidities

Psoriasis is more than just a skin problem. It can also affect a person’s overall health. Managing psoriasis can be difficult because it may bring extra health and money worries.

People with psoriasis may have a higher chance of heart problems, such as heart attacks and strokes. This might be because of ongoing inflammation in the body.

Depression is also more common in people with psoriasis. The visible skin changes can make some people feel self-conscious, which can affect their mood. Other factors related to the immune system might also be involved.

Psoriasis can also increase the risk of developing type 2 diabetes. Some genes linked to both conditions might play a role in these health challenges.

Management

While there is no cure for psoriasis, there are many ways to help manage it. For mild cases, doctors often use special creams or ointments applied to the skin. For more serious cases, treatments like controlled exposure to sunlight or stronger medicines might be needed.

Some common treatments include creams with ingredients that calm the skin, like certain types of vitamins. For psoriasis on the scalp, combining different creams often works best. Keeping the skin moisturized with oils or special lotions can also help reduce redness and scaling.

For more severe psoriasis, doctors might suggest treatments that use controlled sunlight or special light therapy. These can help slow down the growth of affected skin cells. In some cases, doctors may also prescribe medicines that are taken by mouth or injected to help control the condition. These treatments need careful monitoring.

Lifestyle changes, like eating certain types of food and avoiding others, might also help some people feel better. For example, eating more fish rich in omega-3 fatty acids, like salmon, and less red meat or sugary foods, can sometimes improve symptoms. However, what works best can vary from person to person.

Prognosis

Most people with psoriasis have small patches of skin that can be treated with creams. Depending on how big the patches are and where they appear, some people may feel uncomfortable, especially if the patches are on their hands, feet, or scalp. This can make daily activities, sleeping, or playing sports harder.

People with psoriasis might worry about how their skin looks, which can affect their confidence. They may also feel left out or treated differently because some people think psoriasis is contagious, which it is not. This can lead to feelings of sadness or loneliness. Some children with psoriasis might be teased by others.

Psoriasis is also linked to other health issues, especially in older adults. These can include problems with the heart and metabolism. People with psoriasis may have a higher chance of developing diabetes, high blood pressure, and other heart-related conditions. There are also links to other diseases, such as Crohn’s disease and ulcerative colitis. Some treatments for psoriasis can affect cancer risk, but this is usually linked to the medicines used rather than the disease itself.

Epidemiology

Psoriasis affects about 2–4% of people in the Western world. It is more common in people of European descent and less common in people of Asian, African American, and Native American descent. About 6.7 million Americans have psoriasis.

Psoriasis can start at any age, but it most often begins between the ages of 15 and 25. About one-third of people with psoriasis are diagnosed before they turn 20. It affects both males and females equally. People with certain health conditions, like Crohn’s disease or ulcerative colitis, have a higher chance of developing psoriasis.

History

People have talked about psoriasis for a very long time. Some think it might have been one of the skin problems called tzaraath in the Hebrew Bible. The Greeks used different names for skin issues, like lepra for scaly skin and psora for itchy skin. In the late 1700s, a doctor named Robert Willan helped show that psoriasis is different from other skin diseases.

Doctors have tried many ways to treat psoriasis over the years. Some old treatments were not safe. Even famous people like Admiral William Halsey had to stop fighting in World War II because of psoriasis. Today, we know more about how to help people with this condition.

Society and culture

Psoriasis affects many people around the world, and there are groups that help them. Organizations like the International Federation of Psoriasis Associations bring together experts and caregivers to share knowledge. Countries also have their own groups, such as the National Psoriasis Foundation in the United States and the Psoriasis Association in the United Kingdom. Each year on October 29, World Psoriasis Day is celebrated to raise awareness.

Cost

Treating psoriasis can be expensive. In the United States, the cost of care is high, with many resources used for medications.

Research

Scientists are learning more about how the body works with insulin and how this relates to psoriasis. Some natural things may help lessen redness and swelling from psoriasis.

In the 2010s, researchers tested new medicines. These medicines target parts of the body’s defense system to calm activity that causes psoriasis. Other studies looked at different treatments, like pills you can take by mouth instead of injections. These pills show promise but can sometimes affect the body’s defenses.