Skip to Content

Psoriasis: What is Psoriasis, Types and Treatments

What is Psoriasis?

Psoriasis is a life-long skin disorder that causes red, scaly patches called lesions to appear on your skin. The lesions can show up on any area of the skin. There are several different kinds of psoriasis.

Nearly three percent of the world's population, men, women, and children, even new-born babies, endure the symptoms of psoriasis. Many tolerate constant pain from cracking and bleeding skin. Some wrestle with a crippling form of arthritis.

Yet, much of the world's population finds psoriasis a trivial matter requiring little understanding or sympathy. Some people still equate psoriasis with being unclean or self-imposed and shun those who bear its mark when, in fact, many people with psoriasis isolate themselves because of such a deep sense of shame.

 

Facts about Psoriasis

  • Plaque psoriasis is the most common form of psoriasis and it is characterised by red-looking skin lesions topped with silvery white scales.
  • Guttate psoriasis is also fairly common and it is characterised by red, small, dot-like lesions covered with silvery white scale.
  • Pustular psoriasis has blister-like lesions of fluid, which is not infectious, and intense scaling. It can appear anywhere on the body, but often it appears on the palms of the hands and the soles of the feet.
  • Inverse psoriasis produces very red lesions with little or no scales and appears in the skin folds, such as the arm pits, creases in the groin and under the breasts.
  • Erythrodermic psoriasis is rare but painful and is characterised by red, swollen skin and a lot of shedding of dead skin.
  • About 30 to 50 percent of people with psoriasis also get psoriatic arthritis, which causes pain, stiffness and swelling in and around the joints. This type of arthritis most often affects the hands, feet, wrists, ankles and lower back.
  • Psoriasis & psoriatic arthritis, a serious global health challenge. An IFPA's infographic.
  • Psoriasis affects more than 125M of the world's population. An IFPA's infographic.

Distribution of Psoriasis Severity [+info]

Psoriasis affects nearly three per cent of the world's population. It can develop in men or women of any race or age. It often appears between the ages of 15 and 35, although it can strike at any age including infants and the elderly.

Psoriasis can be mild (limited to a few areas of the skin) or moderate / widespread and severe. A normal skin cell matures in 28 to 30 days and sheds from the skin unnoticed. Psoriatic skin cells mature within seven days. They ‘heap up' and form scaly lesions. Psoriasis lesions can be painful and itchy and they can crack and bleed.
 

 

What causes Psoriasis?

No one knows exactly what causes psoriasis. Doctors believe it is related to the body's immune system and that it is genetic, meaning that it can run in families. In people with psoriasis, the immune system is mistakenly 'triggered', causing skin cells to grow too fast. The rapidly growing cells pile up in the skin's top layers, leading to the formation of lesions on the surface.

How Do I Know I Have Psoriasis?

There is no specific medical test for psoriasis. To make a diagnosis, your doctor will look at your skin and possibly take a skin biopsy for examination under a microscope. Pitting of the nails is sometimes a sign of psoriasis.

 

 

What are the treatments for PsO? 

Psoriasis is a disorder that most often needs lifelong treatment. Treatments are determined by the type and the severity of the psoriasis and the area of skin affected. As there are so many different medications, it may take some time to find the treatment or combination of treatments that work best.

 

 

 

Topical treatments.

Topical treatments are rubbed directly into the affected skin to bring local relief without the system-wide side effects of systemic medicines. Used alone, they can effectively treat mild to moderate psoriasis. When the disease is more severe, topical treatments are likely to be combined with systemic medication or phototherapy. Topical psoriasis treatments include:

  • Topical corticosteroids. They reduce inflammation and relieve itching.
  • Vitamin D analogues. Synthetic forms of vitamin D slow skin cell growth.
  • Anthralin. This medication helps to slow skin cell growth. It can also remove scales and make skin smoother.
  • Topical retinoids. Vitamin A derivatives that decrease inflammation.
  • Coal tar. Reduces scaling, itching and inflammation. It can irritate the skin.
  • Salicylic acid. Promotes sloughing of dead skin cells and reduces scaling.
  • Moisturizers. Used alone they do not heal psoriasis, but they can reduce itching, scaling and dryness.
 

Phototherapy.

This treatment uses natural or artificial ultraviolet light. The simplest and easiest form of phototherapy involves exposing the skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light, either alone or in combination with other medication. Exposure to ultraviolet (UV) rays in sunlight or artificial light slows skin cell turnover and reduces scaling and inflammation.

 

Systemic treatments.

Systemic medications are taken orally or by injection and work throughout the body. Systemic treatments are used in patients with moderate to severe psoriasis or psoriasis resistant to other types of treatment. Systemic psoriasis treatments include:

  • Retinoids. Decrease inflammation.
  • Methotrexate. Decreases the production of skin cells and suppresses inflammation. It may also slow the progression of psoriatic arthritis in some patients.
  • Cyclosporine. Suppresses the immune system.
  • Fumaric acid esters. They are small molecules with immunomodulating, anti-inflammatory, and anti-oxidative effect.
  • Biologics altering the immune system. Several of these drugs are approved for the treatment of moderate to severe psoriasis and are commonly used, when indicated, for people who have failed to respond to traditional therapy or who have associated psoriatic arthritis.


More information
National Psoriasis Foundation  NHS choices. Psoriasis Treatments

 

What are the different types of Psoriasis (PsO)?

People who have psoriasis can have one or more of these types of psoriasis:

1. Plaque PsO

Plaque psoriasis or psoriasis vulgaris is the most common form of the disease and affects nearly 90% of people with psoriasis. Plaque psoriasis shows up as dry, red circular to oval-shaped, 1 to 10 centimeters-wide patches covered with a silvery white buildup of dead skin cells that may shed. These patches or plaques can occur anywhere on your body but usually appear on the elbows, knees, scalp (extending beyond the hairline onto the forehead, the back of the neck and around the ears), or lower back, although it can crop up anywhere, including the genitals and inside the mouth. They are often itchy and painful and, around the joints, they can crack and bleed.

More information

2. Guttate PsO 

Guttate psoriasis, also known as ‘tear drop' or ‘rain drop' psoriasis (as derived from the Latin word, Guttae, which means drops), is a form of psoriasis that appears as numerous small, separate, bright pink-red drop-shaped spots on fair skin types, whilst people with darker skin types may notice less redness and more darkening. It is the second-most common type of psoriasis, after plaque psoriasis. About 2% of people who get psoriasis develop guttate psoriasis. Spots may be covered in a finer silver-white scale than those in plaque psoriasis, but they can be more persistent and develop into plaque psoriasis over time. Spots usually show up on the torso and limbs and also in the face and scalp and, in mild cases, clear up on its own after several weeks or months. Nevertheless, recurrent episodes of the disease may occur. Some patients say guttate psoriasis is itchy or sore, whilst others do not notice this. Guttate psoriasis often starts in childhood or young adulthood, and can be triggered by an upper respiratory infection such as streptococcal throat or tonsillitis, stress, a skin injury or certain drugs such as beta-blockers.

More Information

3. Inverse PsO 

Inverse psoriasis appears as bright shiny red (or dark on darker skin tones), smooth and well-demarcated lesions, with no scales, in body folds, such as behind the knees, in the armpits, in the groins, under the breasts or around the genitals and buttocks. Inverse psoriasis is common in overweight people and in those with deep skin folds and may be very uncomfortable and painful. It is exacerbated by sweating and skin-to-skin rubbing. Yeast overgrowth may trigger the skin lesions of psoriasis.

More Information

4. Pustular PsO 

Pustular psoriasis is characterized by white or yellow blisters of noninfectious pus surrounded by red, and often thick and flaky, skin. These pustules can also join together and scaling occurs. Pustular psoriasis can occur on any part of the body, but occurs most often on isolated areas, like the hands and feet. This kind of psoriasis is uncommon (less than 5% of people with psoriasis are affected by pustular psoriasis) and it mostly develop in adults. It can appear as a complication to plaque psoriasis, as a result of taking certain medicines, or from abruptly stopping a treatment which has been used continuously for a long period of time or also due to pregnancy, an infection, or to the exposure to certain chemicals or stress.

More Information

5. Erythodermic PsO 

Erythrodermic psoriasis or exfoliative psoriasis is a particularly severe form of psoriasis that leads to periodic, widespread, fiery redness over most of the body. It can cause severe itching and pain, and make the skin come off in sheets. Sometimes it may also be accompanied by an increased heart rate and an unregulated body temperature. It is rare, occurring in 3% of people who have psoriasis during their life time. Triggers of erythrodermic psoriasis may include another type of psoriasis, such as pustular psoriasis, poorly controlled plaque psoriasis, abrupt withdrawal of systemic psoriasis medication, and allergic drug reaction, severe sunburn, significant stress, infection, medications such as anti-malarial drugs, strong coal tar products, cortisone, or lithium. This form of psoriasis can be life-threatening, so patients undergoing an erythrodermic psoriasis flare should see a doctor immediately.

More Information

6. Psoriatic arthritis (PsA)

Even though psoriasis and psoriatic arthritis are sometimes referred to as psoriatic disease, PsA is not a type of psoriasis. Nevertheless, it is a condition that often occurs alongside psoriasis. It's estimated that up to 30 percent of people with psoriasis will eventually develop PsA.

PsA is a painful and physically limiting autoimmune condition where a person may have both psoriasis and arthritis (inflammation of the joints). PsA usually develops 5 to 12 years after psoriasis and approximately up to one-third of people with psoriasis will also develop psoriatic arthritis. The symptoms of psoriatic arthritis include pain, stiffness and swelling in and around the joints. It can affect many joints and often becomes quite severe in the hands. Skin symptoms usually appear before joint symptoms.

Usually, the more severe the skin symptoms are, the greater the likelihood a person will have psoriatic arthritis. It is most likely to develop in people between 30-50 years old. Both genes and environmental factors may play a role in the onset of the disease.

More Information

 

What is the PsO Life Impact?

  •   Reduced
    life expectancy
  •   Difficulty in getting
    a new job
  •   Effect on
    self-esteem
  •   Feelings/states of
    anxiety and depression

Psoriasis is not merely a skin condition. Severe psoriasis is a disabling disease affecting the physical and emotional well-being of patients, and its impact on quality of life is similar to that seen with other debilitating and life-threatening diseases such as high blood pressure, heart disease, diabetes, rheumatoid arthritis and cancer. These effects, which are not reflected in measures of skin disease severity, can include embarrassment, stigma, physical discomfort and psychological stress. Over time, these can take a huge toll on a person's overall emotional well-being, social functioning, self-preservation activities, productivity at work or school and self-esteem.

Some ways psoriasis can affect people physically, emotionally and socially are:

  • Reduced life expectancy

    Recent studies have shown that the substantial co-morbidity burden of psoriasis patients can reduce life expectancy by 3.5-10 years or more. It is important that physicians initiate therapy that will clear the psoriasis, improve quality of life, and potentially decrease the risk of premature death from a psoriasis-related co-morbidity.

  • Difficulty in getting a new job, or performing usual job tasks

    Psoriasis is associated with difficulties in finding employment. The disease can add to the stress of going for a job interview. Some patients worry that the appearance of psoriasis has made it hard to ‘look professional'. Although employers are not allowed to discriminate against people based on their appearance, the few fear that having psoriasis might hinder them in job interviews.

    Psoriasis can also pose many challenges in the workplace. 35% of people with psoriasis reported the condition affected their career, 20% stated it impaired their performance at work and 6% experienced some form of discrimination at work as a result. The visible nature of this autoimmune disease makes it difficult to conceal from coworkers, who may become curious or even mistakenly think the skin condition is contagious. That, in turn, can be very awkward or embarrassing for someone living with the condition.

    Absenteeism is a greater concern for people suffering from psoriasis than their co-workers without psoriasis with nearly 60% patients reporting missing an average of 26 days a year directly related to their psoriasis.

  • Effect on self-esteem

    Psoriasis patients often experience difficulties like maladaptive coping responses, problems with body image, self-esteem, and also have feelings of stigma, shame and embarrassment regarding their appearance. As well as having to put up with the itchiness and soreness of flare-ups and plaques, people with psoriasis may feel self-conscious about how it looks and worry about how other people may react or what they may think of them. Therefore, even though feelings of self-consciousness or embarrassment about psoriasis are completely natural, it doesn't mean that people with psoriasis have to put up with them. Studies have demonstrated the usefulness of some strategies to help people with psoriasis boost their self-esteem, feel more at ease and keep negative thoughts at bay, such as focusing on their own best attributes (remembering that appearance is only one amongst many aspects of who we are, and that other qualities, such as intelligence, kindness and humor also play a role in defining us) or finding the "feel-good factors" of life (e.g. seeing friends, dancing, playing your favorite sport, etc.).

  • Feelings/states of anxiety and depression

    Studies have proved that depression is the no. 1 co-morbidity of psoriasis. People with psoriasis are twice as likely to become depressed than the rest of the population. Depression can have a significant impact on quality of life. It's important to look out for symptoms of depression (such as inability to sleep, loss of energy, lack of interest in things, inability to focus, etc.) and seek treatment if necessary.

How can I live better with PsO? 

  •   Try a
    healthy diet
  •   Reduce
    stress
  •   Enjoy controlled
    sun exposure
  •   Avoid drinking too much
    alcohol and smoking
  •   Use
    emollients
  •   Link to local
    patients associations

Psoriasis is challenging, and not everyone copes the same way. Adopting these healthy habits can go a long way in reducing your risk of complications caused by psoriasis and an overall better state of health:

  • Try a healthy diet

    Eating a healthy, balanced diet and exercising regularly is beneficial for everyone's health. But, if you're living with psoriasis, making healthy choices is even more important. Although there's no evidence supporting a specific "psoriasis diet", people with psoriasis testify to feeling better when they avoid foods that have been shown to cause or increase inflammation (such as processed foods, nightshade vegetables, fatty red meats and refined sugar) and consume foods that are known to reduce inflammation (e.g. foods rich in omega-3s, such as salmon, albacore tuna, walnuts, flax, chia and hemp seeds, and colorful fruits and vegetables, such as spinach, carrots, and blueberries).

  • Reduce stress

    Although stress does not cause psoriasis, researchers have found a direct connection between flare-ups and stress. Therefore, patients with psoriasis should find effective ways to reduce stress such as exercising regularly, taking deep breaths, talking to a therapist or participating in patient support groups/forums.

  • Enjoy controlled sun exposure

    Light, whether natural sunlight or artificial ultraviolet (UV), rays often have a positive effect on psoriasis, and light therapy is one of the mainstay treatments for the condition. However, although sunlight can benefit psoriasis, patients with this condition –predominantly very fair skinned people, who are at a greater risk of sunburn and skin cancer– should take care to protect themselves from sunburn, which can lead to flares and other skin problems. Natural sunbathing is not monitored in a medical setting like phototherapy is, and medications you may be taking can increase photosensitivity. Thus, patients with psoriasis should consider options to maximize sun protection and avoid a bad reaction, such as applying a broad-spectrum sunscreen with a sun protection factor of at least 15, putting on protective clothing, wearing sunglasses or seeking shade.

  • Avoid drinking too much alcohol and smoking

    Neither of these habits is good for anyone. But they may be even worse for people with psoriasis. According to the National Psoriasis Foundation, the chemicals in tobacco may trigger inflammation that can both cause psoriasis and make flares more severe. In addition, excessive alcohol consumption may interfere with your response to psoriasis treatment and make it less effective.

  • Use emollients

    People with psoriasis have very dry skin. Therefore, it's important to moisturize the skin at least twice daily with products containing natural ingredients such as healing essential oils (e.g. lavender, tea tree, neem and geranium oils), hydrating lotions containing coconut oil or aloe or soothing witch hazel extracts. It's best to put on lotion immediately after a shower because the skin will retain more moisture. The thicker the moisturizer the better -creams and ointments lock in more moisture in the skin.

  • Link to local patients associations

    The following is a list of patient support groups for those suffering from psoriasis: