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Health Information | 09/09/2021

Psoriasis: Know the Symptoms, Triggers, and Treatments

By  Atrius Health
Psoriasis is a common chronic skin disease that affects more than 8 million Americans. It is characterized by red, itchy, and scaly patches on the knees, elbows, back, and scalp. Psoriasis runs on a cycle, with flare-ups usually occurring for a few weeks or months at a time. Although there is no cure for psoriasis, there are various treatments and lifestyle changes to manage symptoms and reduce the severity of flare-ups.

Symptoms and Diagnosis

Symptoms of psoriasis differ case-by-case, however, the disease often leaves the person itchy and uncomfortable. Symptoms typically start between the ages of 15 and 25 and affect both men and women. Common symptoms include:

  • Red patches of skin covered with thick, silvery scales
  • Small scaling spots
  • Dry, cracked skin
  • Itching, burning or soreness
  • Thick or ridged nails
  • Swollen and stiff joints
When diagnosing your psoriasis, your doctor will look for indications of the disease on your scalp, ears, elbows, knees, belly button, and nails. Your doctor also might look at your family medical history to see if relatives are prone to similar inflammation.

Types of Psoriasis

There are several types of psoriasis, and determining which type you have can help you and your doctor develop a customized treatment plan.

Plaque Psoriasis, otherwise known as "psoriasis vulgaris," is the most common type of psoriasis that affects about 80% of people with the condition. Plaque psoriasis can cause raised, inflamed, and red skin covered with silvery, white scales that may itch and burn.

Nail Psoriasis is extremely common – about 50% of people with psoriasis experience changes to their nails. Nail psoriasis is even more common in people who have psoriatic arthritis, which affects the joints. Specific symptoms include pitting of the nails, tender, painful nails, separation of the nail from the bed, color changes, and chalk-like material under the nails.

Inverse Psoriasis causes bright red, smooth, and shiny patches of skin in the armpits, groin, chest, and other skin folds on the body. This type of psoriasis typically gets worse with sweating, friction, and fungal infection.

Psoriatic Arthritis is a condition that involves both psoriasis and arthritis (joint inflammation). Psoriatic arthritis typically occurs in people who have had psoriasis for many years, and many people develop this condition in addition to nail changes.

Guttate psoriasis causes small, pink-red spots on the arms, thighs, scalp, and back. This type of psoriasis may go away within a few weeks and might not require treatment for mild cases. Guttate psoriasis is often associated with strep pharyngitis (“strep throat”) and makes up less than 2% of all psoriasis cases.

Pustular Psoriasis is uncommon and primarily affects adults. It causes pus-filled bumps (pustules) surrounded by red skin and can cover either one part of the body or the whole body, which is known as “generalized” pustular psoriasis. Additional symptoms of generalized pustular psoriasis include fever, chills, nausea, fast heart rate, and muscle weakness. These symptoms can be dangerous and may require medical attention.

Erythrodermic Psoriasis is the least common type of psoriasis and is a serious condition. It affects most of the body and causes widespread, fiery skin that appears to be burned. Extreme symptoms include severe itching, burning, and peeling, a faster heart rate, and changes and body temperature. These symptoms require immediate medical attention, as erythrodermic psoriasis can cause severe illness due to protein and fluid loss and can also cause infection, pneumonia, and congestive heart failure.

Causes and Triggers

Psoriasis is a disease with an unclear cause but is triggered by dysfunction of the immune system. Skin cells are normally replaced every 10 to 30 days. But with psoriasis, new cells grow every 3 to 4 days, causing a buildup of old cells that create a scaly texture.

Certain environmental, physical, or mental factors can also trigger psoriasis flare-ups and make symptoms worse. Stress, cuts and scrapes, allergies, and certain infections can trigger most types of psoriasis. In addition, medications such as Lithium, antimalarial drugs, Inderal, Quinidine, and Indomethacin have been linked to psoriasis flare-ups.

Treatment of Psoriasis

Although there is no cure for psoriasis, there are several treatment options that can help mitigate symptoms. Your doctor will work with you to develop a customized plan, but some common treatments include:

  • Steroid creams
  • Moisturizers for dry skin
  • Coal tar (a common treatment for scalp psoriasis available in lotions, creams, foams, shampoos, and bath solutions)
In addition, there are more aggressive treatments for moderate to severe psoriasis, including:

Light therapy: Shining ultraviolet light on the skin can slow the growth of skin cells. PUVA is a treatment that combines a medicine called psoralen with a special form of ultraviolet light. Light therapy should only be administered by a medical professional.

Retinoids: Retinoids are derivative of vitamin A and can come in pill, cream, foam, lotion, or gel form. Retinoids promote regulated cell turnover to mitigate symptoms. However, retinoids can also cause serious side effects, including birth defects, so they are not recommended for women who are pregnant or planning to become pregnant.

Biologic treatments: These treatments work by blocking the body's immune system to better control the inflammation caused by psoriasis.

Methotrexate: This drug has many serious side effects, such as bone marrow and liver disease, as well as lung problems. Patients taking Methotrexate are closely monitored by doctors and undergo frequent lab tests, chest X-rays, and sometimes a liver biopsy.

A healthy diet and active lifestyle can also help prevent severe psoriasis by reducing inflammation in the body. Natural treatments such as salt baths, colloidal oatmeal, aloe vera, and diluted apple cider vinegar have also been found to help ease painful and uncomfortable psoriasis symptoms, but further research is needed.
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About The Author

Atrius Health

Atrius Health, an innovative healthcare leader, delivers an effective system of connected care for adult and pediatric patients at more than 30 medical practice locations in eastern Massachusetts. By establishing a solid foundation of shared decision making, understanding and trust with each of its patients, Atrius Health enhances their health and enriches their lives.

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