Psoriasis

What is psoriasis?

Psoriasis is an immune-mediated inflammatory disease   (when the immune system becomes overactive) that causes red, itchy, scaly patches on your skin. This makes your skin cells grow more quickly than usual and creates thick patches on your skin.

Usually, skin cells grow and then fall off your body in about a month. When you have psoriasis, skin cells cycle in just three to four days. Because of the speed, the skin cells pile up on top of the skin’s surface instead of falling off.

These patches may appear red with silvery white scales on lighter skin or brown or purple with gray or brown scales on darker skin.

Psoriasis is usually chronic (ongoing) meaning it can’t be cured and can flare up unexpectedly, but treatment can help keep symptoms under control.

What are the signs and symptoms of psoriasis?

There are several types of psoriasis, and symptoms vary depending on which type you have.

• Plaque psoriasis is the most common type. Signs of plaque psoriasis include dry, raised, itchy, scaly skin patches called plaques. You could have a few or many of these patches, and they are commonly found on the elbows, knees, scalp and back. When the skin heals, it can appear to be a different color temporarily, especially in people with brown or Black skin.
• Guttate psoriasis often starts after a bacterial infection such as strep throat. With it, you'll have small scaly spots shaped like drops on your torso, arms or legs. It's usually found in children and young adults.
• Inverse psoriasis can start after a fungal infection. It usually develops in places where your skin folds and rubs together, such as the breasts, buttocks and groin. It causes smooth patches of skin that get worse when you sweat.
• Pustular psoriasis is rare. It causes blisters that are full of pus. You could develop it in small areas on the palms of your hands or soles of your feet, or it could cover a bigger part of your body.
• Erythrodermic psoriasis is the least common type. With it, you can have a rash that itches, burns or peels and can cover your whole body. It can clear up quickly or last for a long time.
• Nail psoriasis affects your fingernails and toenails. With it, your nails could be pitted or discolored and they might not grow properly. Your nails could also loosen, separate from your nail bed and, in severe cases, crumble.

What causes psoriasis?

It's unclear exactly what causes the immune system issues leading to psoriasis. Most likely, genetics plays a role. Psoriasis runs in families (can be found in about 40% of all cases), but it can skip a generation. It often starts between ages 15 and 25, but you can get psoriasis at any age and is most common in adults. Psoriasis affects both men and women equally.

Environmental factors are also probably part of the cause. We know that smoking increases your risk and makes psoriasis more severe. Psoriasis is not contagious, so you can't catch it from other people.

Psoriasis can also be linked to other health conditions, including high blood pressure, diabetes, atherosclerosis, obesity, metabolic syndrome, cardiovascular disease and other autoimmune diseases. 

How is psoriasis diagnosed?

If you have a skin condition that concerns you, see your primary care provider or a dermatologist (skin doctor). It’s important to see your provider if your symptoms are severe or painful, or if you’re concerned about how your skin looks.

Your health care provider will check to see if you have psoriasis or another skin condition - its symptoms are similar to eczema, lupus, rosacea, shingles and ringworm. They will ask if you have other family members with psoriasis.

To diagnose psoriasis, your provider will check how much skin is affected, how many patches you have, how painful they are and where on the body they are located. They might remove a small piece of skin, called a biopsy, to send to a lab for testing.

How is psoriasis treated?

If you have psoriasis, you’ll want a treatment to stop your cells from growing so quickly. Your doctor will create a treatment plan based on your symptoms, their severity and your medical history. You may find that a combination of treatments works best for you.

Treatments you apply topically (directly to the affected skin) are usually the first choice for mild or moderate psoriasis (psoriasis covering less than 10% of your body):

• Corticosteroids are prescribed most often. You can find them in ointments, creams, lotions, gels, oils, foams, sprays and shampoos. In some cases, you might need a stronger version, such as triamcinolone (Trianex) or clobetasol (Cormax or Temovate).
• Synthetic types of vitamin D, called vitamin D analogs. They help slow the growth of your skin cells and can be used with corticosteroids. They include calcipotriene (Dovonex and Sorilux) and calcitriol (Vectical).
• Retinoids, which you apply to your skin once or twice a day. They include tazarotene (Tazorac and Avage). You shouldn't use retinoids if you plan to become pregnant or are pregnant or breastfeeding.
• Salicylic acid shampoos and solutions, which you can find in both over-the-counter (OTC) and prescription versions.

Doctors often recommend light therapy for moderate to severe psoriasis (psoriasis covering more than 10% of your body). You might benefit from exposure to:

• Sunlight
• UVB narrowband or UVB broadband from artificial light sources
• Psoralen plus ultraviolet A (PUVA), where you take medication before exposure to UVA light
• Excimer laser, which targets only the affected skin

If other treatments aren’t working, drugs that you take as a pill (orally), injection (shot) or intravenously (IV) might be options:

• Injected steroids (triamcinolone)
• Retinoids (Acitretin)
• Biologic agents, including adalimumab (Humira), apremilast (Otezla), certolizumab (Cimzia), etanercept (Enbrel), guselkumab (Tremfya), infliximab (Remicade), ixekizumab (Taltz), secukinumab (Cosentyx), tildrakizumab (Ilumya) and ustekinumab (Stelara)
• Methotrexate (Trexall)
• Cyclosporine (Gengraf, Neoral, Sandimmune)

Long-term management of psoriasis may include lifestyle modifications. It can help to:

• Manage stress: Stress is one of the most common triggers for psoriasis, so learning relaxation strategies may help.
• Try to stay healthy: Any illness that affects your immune system could trigger psoriasis.
• Maintain a healthy diet: It may be best to limit dairy, sugar, white carbs (like pasta, rice and flour) and saturated (solid) fats.
• Stay hydrated: Drinking plenty of water can help keep your skin healthy.
• Avoid smoking and drinking alcohol.
• Maintain a healthy body weight.
• Spend more time in a warmer climate (if possible): Cold, dry air can be a trigger.
• Get regular exercise.

How should you care for your skin if you have psoriasis?

When you have psoriasis, treat your skin well. It’s important to clean your skin gently, keep it moisturized and avoid harsh or irritating products. Take warm (not hot) baths and add oil to the water to seal moisture into your skin.

How can you control psoriasis flares?

Even with treatment, psoriasis may return sometimes. Flares can last from a few weeks to a few months. To keep your psoriasis under control, you’ll want to identify your triggers and take steps to avoid them. Some of the most common psoriasis triggers are:

• Stress
• Certain medications, such as high blood pressure drugs, antimalarial drugs, lithium, mood stabilizers, antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs, like Advil/Motrin, Aleve and aspirin)
• Skin infections
• Bacterial infections such as strep throat
• Skin injuries, including sunburns, bug bites, cuts and scrapes
• Cold, dry weather
• Smoking and exposure to secondhand smoke
• Excess body weight
• Stopping the use of steroids quickly

It’s a good idea to work closely with your health care team. They can help you find ways to track your symptoms and monitor triggers. With that information, they can help you create a personalized psoriasis plan.

What other health conditions are associated with psoriasis?

Many people who have psoriasis also have heart disease, diabetes, obesity, high cholesterol or depression. You may also have inflammation (swelling) in part of your eye (called conjunctivitis, blepharitis or uveitis, depending on the part of the eye that’s affected).

If you have psoriasis, you’re more likely to have another autoimmune condition, such as celiac disease, multiple sclerosis, thyroid problems or Crohn’s disease. And about 10% to 20% of people with psoriasis also have an autoimmune disorder called psoriatic arthritis that affects their joints. When both of these diseases occur at the same time, it's called psoriatic disease.

What is the emotional impact of living with psoriasis?

When you have psoriasis, you may have anxiety, depression or low self-esteem because of how your skin looks during a flare. You are not alone. Here are some resources where you can get more information and connect with other people who understand your experiences, so you can find the emotional support you need.

• The National Psoriasis Foundation
• The American Academy of Dermatology
• Psoriasis and Psoriatic Arthritis Alliance
• International Psoriasis Council

At Banner Health, our expert providers understand how hard it can be to live with psoriasis. They can work with you to keep your skin as healthy as possible.