Unraveling Psoriasis: Symptoms, Types, Causes & Treatment

Psoriasis is a chronic autoimmune condition that affects millions worldwide, yet its complexities can often be misunderstood. In this comprehensive guide, we delve into the intricacies of psoriasis, exploring its symptoms, various types, underlying causes, and the diverse treatment options available. Whether you're seeking a deeper understanding of this condition or navigating its challenges firsthand, this blog aims to shed light on psoriasis, empowering individuals to make informed decisions about their health and well-being.

What is Psoriasis?

Psoriasis is a skin condition that accelerates the skin cell turnover process, causing new cells to rapidly accumulate on the surface of the skin. This results in the formation of thick, scaly patches known as plaques. These plaques can appear anywhere on the body but are most common on the elbows, knees, scalp, and lower back. While genetics play a significant role in the development of psoriasis, environmental factors, and a compromised immune system can also trigger flare-ups.

Common Symptoms of Psoriasis

Symptoms of psoriasis vary depending on the type, with plaque psoriasis being the most prevalent. Common symptoms include:

• Plaques: These may appear red on lighter skin or dark brown/purplish on darker skin, often covered with silver-colored scales. They can be itchy painful, and may crack or bleed, merging to cover larger areas in severe cases.
• Nail Issues: Changes in color, small pits, crumbling, or detachment from the nail bed can occur in fingernails and toenails.
• Scalp Involvement: Plaques, scales, or crusts may develop on the scalp.

Additionally, individuals with psoriasis may develop psoriatic arthritis, causing joint pain and swelling, affecting 10% to 30% of those with psoriasis, according to the National Psoriasis Foundation.

Causes and Triggers of Psoriasis

While the exact cause of psoriasis is unknown, it is believed to be a combination of genetic, immune, and environmental factors. Genetic predisposition plays a significant role in the development of psoriasis, with a family history of the condition increasing one's risk. Immune system dysfunction also plays a role in psoriasis, as the body's immune response triggers inflammation and rapid skin cell growth. Environmental triggers such as stress, infections, certain medications, and cold weather can exacerbate psoriasis symptoms and lead to flare-ups.

Types Of Psoriasis

Psoriasis manifests in various types, including:

Chronic Plaque Psoriasis

There are two further types. Stable- which is characterized by clearly defined, consistent lesions that remain relatively unchanged over time. These plaques typically appear symmetrically across the body and maintain a consistent appearance. In contrast, unstable plaque psoriasis is marked by rapidly changing lesions in terms of size and appearance. The dynamic nature of these lesions makes it difficult to predict the progression of the condition. 

You may also like: Chronic Plaque Psoriasis: Causes, Symptoms, and Treatment

Pustular Psoriasis

Characterized by discolored, scaly skin accompanied by tiny pustules, typically occurring on the palms of the hands and soles of the feet. 

Must Read: What Is Pustular Psoriasis? The Condition and Its Management

Guttate Psoriasis

Often initiated in childhood or young adulthood, this type presents as small, pink, red, brown, or purple spots primarily on the torso and limbs. Triggers may include respiratory infections, stress, skin injury, or certain medications.

Read more: What is Guttate Psoriasis? Symptoms, Causes And More

Inverse Psoriasis

Recognized by shiny lesions in skin folds like the armpits, groin, and under the breasts. On lighter skin, lesions are bright red, while on darker skin, they appear darker than the surrounding skin, possibly purplish or brown.

Check Out: Exploring Effects Of Inverse Psoriasis And Its Management

Erythrodermic Psoriasis

Characterized by intense skin discoloration and shedding of scales in sheets, often triggered by severe sunburn, infections, medication changes, or cessation of certain psoriasis treatments. Immediate treatment of Erythrodermic Psoriasis is necessary due to its potential to cause severe illness.

Diagnosing Psoriasis

Diagnosing psoriasis typically involves a physical examination and a review of the individual's medical history. A dermatologist may examine the skin, nails, and scalp for signs of psoriasis, such as red patches, silvery scales, and pitted nails. In some cases, a skin biopsy may be performed to confirm the diagnosis. Additionally, blood tests may be conducted to rule out other conditions that may mimic psoriasis, such as eczema or fungal infections.

Is psoriasis contagious?

Psoriasis is non-contagious, meaning it cannot be transmitted through direct contact with someone who has the condition. Since it involves the immune system, it is an internal disorder despite its external manifestations on the skin.

Psoriasis Risk Factors

Genetics

Genes, which carry instructions for cell function, play a significant role in psoriasis. Over 80 genes have been identified in individuals with psoriasis, suggesting a multifactorial origin. While approximately 10 out of 100 people carry genes associated with psoriasis, only a fraction of them develop the condition.

Alcohol

Excessive alcohol consumption, particularly among younger males, increases the risk of psoriasis. Moreover, alcohol intake may diminish the effectiveness of treatments.

Smoking

Smoking can double the risk of developing psoriasis, especially in individuals with a familial predisposition. It is also associated with resistance to treatment and is closely linked to pustular psoriasis, a challenging-to-manage form of the condition affecting the hands and feet.

Psoriasis Demographics

Psoriasis affects approximately 2%-3% of the global population and about 3% of individuals in the United States. Its prevalence varies across different cultures, with higher occurrences observed in northern Europe and lower occurrences in eastern Asia.

Stages of Psoriasis

Psoriasis does not have distinct stages but may worsen over time if left untreated. Seeking medical advice promptly is crucial to prevent the progression to severe psoriasis or the development of complications.

Psoriasis Pathophysiology

Psoriasis arises from dysregulation of immune system signaling, where immune cells trigger inflammation and accelerate skin cell turnover instead of defending the body against pathogens. This aberrant immune response leads to the characteristic symptoms of psoriasis, including redness, scaling, and inflammation of the skin.

Complications of Psoriasis

Psoriasis may lead to several complications. Discuss these potential issues with your doctor upon receiving a diagnosis:

• Eye conditions such as conjunctivitis (pinkeye)
• Psoriatic arthritis
• Certain types of cancers
• Obesity
• Heart disease
• Mental health challenges, including depression and low self-esteem
• Type 2 diabetes
• Hypertension (high blood pressure)
• Other autoimmune diseases, such as Crohn's disease, celiac disease, and sclerosis

Treatment Options for Psoriasis

There is no cure for psoriasis, but various treatment options are available to manage symptoms and improve quality of life. 

Medical Management Of Psoriasis

• Corticosteroid creams
• Prescription topical cream roflumilast (Zoryve)
• Moisturizers for dry skin
• Salicylic acid
• Coal tar (used for scalp psoriasis in lotions, creams, foams, shampoos, and bath solutions)
• Vitamin D-based cream or ointment (a potent type prescribed by doctors)
• Retinoid creams
• Calcineurin inhibitors
• Anthralin

For moderate to severe cases, treatments may include:

• Methotrexate
• Retinoids (oral and topical)
• Cyclosporine
• Biologic treatments:
• Adalimumab (Humira)
• Brodalumab (Siliq)
• Certolizumab-pegol (Cimzia)
• Etanercept (Enbrel)
• Golimumab (Simponi)
• Guselkumab (Tremfya)
• Infliximab (Avsola, Inflectra, Remicade)
• Ixekizumab (Taltz)
• Risankizumab (Skyrizi)
• Secukinumab (Cosentyx)
• Tildrakizumab (Ilumya, Ilumetri)
• Ustekinumab (Stelara) 

Non-Biological Treatments include:

• Light therapy, including psoralen plus ultraviolet-A radiation (PUVA)
• Tofacitinib (Xeljanz)
• Enzyme inhibitors like apremilast (Otezla) and deucravacitinib (Sotyktu)
• Aryl hydrocarbon receptor (AHR) agonist tapinarof (Vtama)

Alternative treatments and home remedies may include:

• Topical creams containing Oregon grape
• Humidity
• Topical creams containing capsaicin
• Omega-3 fatty acids
• Aloe vera
• Oat baths

While these natural therapies may offer relief, their effectiveness varies, and they are considered complementary rather than primary treatments for psoriasis. Always consult with a healthcare professional before trying any alternative treatments. 

Living With Psoriasis

Lifestyle Changes 

In addition to medical treatment, certain lifestyle changes can help individuals manage psoriasis effectively. Avoiding triggers such as stress, smoking, and excessive alcohol consumption can also help prevent psoriasis flare-ups.

Exercise

Regular exercise is a cornerstone of managing psoriasis symptoms and promoting overall well-being. Engaging in physical activity not only helps to maintain a healthy weight but also contributes to stress reduction and improved sleep quality. By incorporating regular exercise into your routine, you can effectively manage psoriasis and enhance your overall quality of life.

Psoriasis Diet

While no specific foods are known to cause psoriasis, certain dietary choices may exacerbate symptoms. These include:

• Alcohol
• Dairy products
• Refined carbohydrates
• Saturated and trans fats
• Added sugars
• Gluten

Costs Associated with Psoriasis

The financial burden of psoriasis can be significant, with out-of-pocket expenses averaging at least $12,500 annually. This encompasses direct costs like medications, medical appointments, and procedures, as well as indirect costs such as missed workdays, transportation expenses, and therapy sessions. Individuals with moderate to severe psoriasis may face higher average costs, approximately $21,400 per year. Those treated with biologics typically incur the highest expenses, averaging around $29,800 annually. These discrepancies in costs stem from variations in the types of medications used for treatment.

Coping with Psoriasis Emotionally

Living with psoriasis can take a toll on one's emotional well-being, as the visible symptoms of the condition can impact self-esteem and confidence. It is essential for individuals with psoriasis to seek support from healthcare professionals, support groups, and loved ones to cope with the emotional impact of the condition. Cognitive-behavioral therapy, mindfulness practices, and relaxation techniques can also help you take care of yourself and manage stress and anxiety related to psoriasis.

Managing Psoriasis: Tips For Better Control

Develop a Skincare Routine:

Establish a daily skincare regimen, particularly in facial psoriasis, that includes gentle cleansing with mild, fragrance-free products and regular moisturizing to keep the skin hydrated and reduce irritation. 

Avoid Triggers:

Identify and avoid triggers that exacerbate your psoriasis symptoms. Common triggers include stress, certain foods, alcohol consumption, smoking, and environmental factors like cold weather or dry air.

Maintain a Healthy Lifestyle:

Prioritize a balanced diet rich in fruits, vegetables, lean proteins, and whole grains. Regular exercise can help reduce stress and inflammation, benefiting overall health and potentially improving psoriasis symptoms.

Manage Stress:

Practice stress-reduction techniques such as meditation, deep breathing exercises, yoga, or mindfulness to minimize the impact of stress on your psoriasis. Consider counseling or therapy if stress management becomes challenging.

Stay Hydrated:

Drink plenty of water to keep your skin hydrated from the inside out. Hydration can help prevent dryness and itching associated with psoriasis flare-ups.

Avoid Skin Trauma:

Be gentle with your skin to prevent exacerbating psoriasis lesions. Avoid scratching or picking at plaques, and use soft, non-abrasive fabrics for clothing and bedding.

Use Sun Protection:

While sunlight can benefit some individuals with psoriasis, excessive sun exposure can trigger flare-ups or worsen symptoms. Use sunscreen with a high SPF and protective clothing when spending time outdoors.

Follow Treatment Plans:

Adhere to your prescribed treatment plan, whether it includes topical creams, phototherapy, oral medications, or biologic injections. Consistency is key to managing symptoms and the side effects of Psoriasis treatment effectively.

Monitor Symptoms:

Keep track of your psoriasis symptoms, triggers, and treatment responses in a journal or app. This information can help you and your healthcare provider make informed decisions about adjustments to your management plan.

Seek Support:

Connect with support groups, online communities, or counseling services to share experiences, receive advice, and find emotional support from others living with psoriasis. 

Also read: 10 Best Shampoos for Psoriasis to Help Manage Your Condition

Remember that managing psoriasis is a journey, and finding the right combination of strategies may take time. Be patient with yourself, stay informed about your condition, and collaborate closely with your healthcare team to optimize your treatment and improve your quality of life.

Psoriasis Prognosis

Psoriasis typically manifests in early adulthood and can vary in severity, ranging from localized patches to widespread involvement. While psoriasis is a chronic condition characterized by periods of remission and flare-ups, effective treatment options can significantly alleviate symptoms and improve outcomes, even in severe cases. Although there is currently no cure for psoriasis, managing inflammation through treatment can reduce the risk of associated conditions such as heart disease and stroke.

Health Disparities Associated With Psoriasis

Psoriasis affects various racial and ethnic groups differently. Research indicates that White individuals exhibit the highest prevalence of psoriasis compared to other demographics. However, studies suggest that individuals from other racial and ethnic backgrounds may underreport their symptoms in comparison to White individuals. This disparity could stem from a lack of trust in the healthcare system and the financial burden associated with accessing treatment.

Research and Advances in Psoriasis Treatment

Ongoing research and clinical trials are continually improving our understanding of psoriasis and leading to innovative treatment options. New biologic medications, targeted therapies, and gene-based treatments are being developed to provide more effective and personalized care for individuals with psoriasis. By staying informed about the latest advancements in psoriasis research, individuals can access cutting-edge treatment options and improve their quality of life.

Conclusion

In conclusion, navigating psoriasis necessitates a multifaceted approach that encompasses understanding its symptoms, causes, treatment options, and coping mechanisms. By delving into these aspects, individuals can take proactive steps toward managing their condition and enhancing their overall well-being. From adopting lifestyle modifications to exploring innovative treatment modalities, there exists a spectrum of strategies to mitigate the impact of psoriasis. It's crucial to recognize that with the right support network and access to resources, individuals living with psoriasis can not only overcome challenges but also flourish and lead fulfilling lives despite the complexities of this chronic autoimmune disease.