What is psoriasis?

Psoriasis is a hereditary, chronic skin disease of scaling and inflammation that affects more than 3% of the population. In the United States there are nearly 7.5 million people with psoriasis, which affects men and women equally.  Although psoriasis can be seen in any age group, there are more adults with psoriasis than children.  People all over the world get psoriasis.

Psoriasis is an autoimmune disease, where the person’s own immune system mistakenly targets the skin, causing the skin cells to grow too quickly.  These new cells pile up on the surface, creating the typical red, scaling plaques of psoriasis.

Psoriasis is classified as:

  • mild (less than 3% body surface area)
  • moderate (3-10% body surface area
  • severe (greater than 10% body surface area).

30% of psoriasis patients complain of itching.  Up to 8% have joint pain from psoriatic arthritis, an inflammatory condition of the joints. Without treatment, psoriatic arthritis can become debilitating. Psoriasis can also affect the nails in 50% of patients.

Psoriasis affects every aspect of daily life in some people.  Psoriasis goes through cycles of exacerbations and remissions.  Often these cycles can bring on feelings of low self-esteem, depression, and embarrassment.

What are the types of psoriasis?

  • Plaque psoriasis
    • 80% of people with psoriasis have plaque psoriasis.  They develop red, thickened plaques, covered with a silvery scale.
    • Lesions vary greatly in shape, size and distribution. 
    • Most commonly, lesions occur in the scalp and on elbows and knees, but can be anywhere on the skin
  • Guttate psoriasis
    • Usually occurs in children and young adults
    • Drop-like orange-red papules with scale in a generalized distribution
    • Often happens after a Strep throat infection
    • Can clear by itself or with treatment and not come back
  • Inverse psoriasis
    • Red, smooth, moist plaques in the body fold areas – under the arms, under the breasts, the crease of the buttocks and groin area
    • Can be itchy and painful
  • Pustular psoriasis
    • Can be localized to the palms and soles or be wide-spread on the skin
    • Yellowish pustules scattered on red skin
    • People with generalized pustular psoriasis are quite ill. It can be life-threatening
  • Nail psoriasis
    • Most patients develop tiny pits in the nails
    • Nails may thicken, become yellow and detached from the skin
    • Nail psoriasis can be confused with a fungal infection of the nail
  • Erythrodermic psoriasis
    • The least common type, that causes severe redness and scaling over the entire skin surface.  The skin is itchy and painful. 
    • Erythrodermic psoriasis can be life-threatening

What causes psoriasis?

That is a complex question that scientists are trying to answer. We know that psoriasis is not contagious.  A family history of psoriasis seems to increase the risk of developing psoriasis.  However not all people with a family history of psoriasis will develop the disease.

The person’s immune system plays an important role.  In psoriasis, the immune system activates cells called T lymphocytes which cause the skin cells to develop at a much faster rate than normal.  These rapidly dividing cells are not shed off the surface of the skin, but instead pile up and cause red, scaling plaques.

HIV infection seems to increase the risk of psoriasis.

What triggers psoriasis?

  • Winter weather, most likely due to lack of sunlight and low humidity
  • Strep throat infections
  • Stress
  • Skin injury or a bad sunburn
  • Certain medications, including lithium, some blood pressure medications, non-steroidal pain medications, anti-malarial medications, interferon and systemic steroids.
  • Alcohol and smoking may worsen psoriasis

What does psoriasis look like?

Most commonly psoriasis consists of localized red, thickened plaques with a silver scale.  In certain cases it may consist of yellowish pustules or diffuse redness with scaling.

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What is psoriatic arthritis?

Joint pain in patients with psoriasis may be psoriatic arthritis.  This is particularly true of patients that have tiny pits or yellowish discoloration of the nails.

In psoriatic arthritis, joint pain is worse in the morning or after resting.  As the person moves, the pain and stiffness lessens.  There may be swelling or sausage-like appearance of the fingers or toes. 
Psoriatic arthritis may irreversibly damage the joints if not treated promptly. 

What other medical conditions are associated with psoriasis?

Patients with psoriasis often have other serious medical problems. There is an increased risk of death at a younger age in patients with severe psoriasis. 
Associated conditions:

  • High blood pressure
  • High cholesterol and triglycerides
  • Overweight
  • Diabetes
  • Depression

Together these factors comprise the so-called metabolic syndrome.  Patients with psoriasis should be screened for these disorders.

Other autoimmune conditions associated with psoriasis:

  • Crohn’s disease
  • Systemic lupus erythematosus
  • Multiple sclerosis
  • Type I diabetes

How is psoriasis diagnosed?

The majority of the time, psoriasis is diagnosed by its very characteristic clinical appearance.  Occasionally it may be difficult to differentiate psoriasis from other skin conditions, particularly in non-plaque psoriasis.  A skin biopsy may be required to make the diagnosis.

Treatments of psoriasis

Treatment depends on the type and extent of the disease and the condition of the patient.

  • Topical treatments for mild to moderate psoriasis
    • Steroid creams or ointments
    • Derivatives of vitamin D
    • Tar preparations
    • Retinoic acid preparations
    • Anthralin preparations
  • Phototherapy for moderate to severe psoriasis
    • Ultraviolet light treatments of the skin
      • Narrow-band UVB
      • PUVA, a combination of a light-sensitizing medication (psoralen) and exposure to UVA
      • XTRAC laser
  • Systemic treatments for severe psoriasis
    • Methotrexate
    • Acitretin
    • Cyclosproin
    • Biologics
      • Enbrel
      • Stelara
      • Amevive

Summit Medical Group is proud to provide medical, surgical and cosmetic dermatology services to women and men in the Tri-State Area, New York and New Jersey, including the following counties and cities: Essex County, Morris County, Bergen County, Union County, Passaic County, Somerset County and Sussex County, NJ - Livingston, Millburn, Short Hills, West Orange, Berkley Heights, Caldwell, Cedar Grove, Cedar Knolls, Chatham, East Hanover, Englewood Cliffs, Essex Fells, Fair Lawn, Florham Park, Fort Lee, Glen Ridge, Jersey City, Kinnelon, Madison, Maplewood, Mendham, Montclair, Montvale, Morristown, New Providence, North Caldwell, Parsippany, Randolph, Roseland, South Orange, Springfield, Summit, Union, Verona, West Caldwell, Whippany and Westfield, NJ.

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