Psoriasis

Definition

Psoriasis is a common skin condition that causes skin redness and irritation. Most people with psoriasis have thick, red skin with flaky, silver-white patches called scales.

Alternative Names

Plaque psoriasis

Causes

Psoriasis is very common. Anyone can get it,  but it most commonly begins between ages 15 and 35.

You cannot catch psoriasis or spread it to others.

Psoriasis seems to be passed down through families. Doctors think it may be an autoimmune condition. This occurs when the immune system mistakenly attacks and destroys healthy body tissue.


Usually, skin cells grow deep in the skin and rise to the surface about once a month. When you have psoriasis, this process takes place is too fast. Dead skin cells build up on the skin's surface.


The following may trigger an attack of psoriasis or make the
condition harder to treat:

•            Bacteria or viral infections, including strep throat and upper respiratory infections

•            Dry air or dry skin

•            Injury to the skin, including cuts, burns, and insect bites

•            Some medicines, including antimalaria drugs, beta-blockers, and lithium

•            Stress

•            Too little sunlight

•            Too much sunlight (sunburn)

•            Too much alcohol

Psoriasis may be worse in people who have a weak immune system. This may be due to: 

Some people with psoriasis may also have arthritis (psoriatic arthritis).

Symptoms

Psoriasis can appear suddenly or slowly. Many times, it goes away and then comes back.


The main symptom of the condition is irritated, red, flaky patches of skin. Patches are most often seen on the elbows, knees, and middle of the body, but can appear anywhere including the scalp.


The skin may be:

Other symptoms may include:

There are five main types of psoriasis:

Exams and Tests

Your doctor or nurse can usually diagnose this condition by looking at your skin.

Sometimes, a skin biopsy is done to rule out other possible conditions. If you have joint pain, your doctor may order x-rays.

Treatment

The goal of treatment is to control your symptoms and prevent infection.

Three treatment options are available:

TREATMENTS USED ON THE SKIN (TOPICAL)

Most of the time, psoriasis is treated with medications that are placed directly on the skin or scalp. This may include:

SYSTEMIC (BODY-WIDE) TREATMENTS

If you have very severe psoriasis, your doctor will likely recommend medicines that suppress the immune system's faulty response. These medicines include methotrexate or cyclosporine. Retinoids such as acitretin can also be used.

Newer drugs called biologics are used when other treatments do not work. Biologics approved for the treatment of psoriasis include:

 PHOTOTHERAPY

Some people may choose to have phototherapy.

OTHER TREATMENTS

If you have an infection, your doctor will prescribe antibiotics.

AT HOME CARE

Follow these tips at home:

Support Groups

Some people may benefit from a psoriasis support group.

Outlook (Prognosis)

Psoriasis is a life-long condition that can be controlled with treatment. It may go away for a long time and then return. With proper treatment it does not affect your overall health. Some people with psoriasis have a type of arthritis.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of psoriasis or if the skin irritation continues despite treatment.

Tell your doctor if you have joint pain or fever with your psoriasis attacks.

If you have symptoms of arthritis, talk to your dermatologist or rheumatologist.

Go to the emergency room or call the local emergency number (such as 911) if you have a severe outbreak that covers all or most of your body.

Prevention

There is no known way to prevent psoriasis. Keeping the skin clean and moist and avoiding your specific psoriasis triggers may help reduce the number of flare-ups.

Doctors recommend daily baths or showers for persons with psoriasis. Avoid scrubbing too hard, because this can irritate the skin and trigger an attack.

References

Gottlieb A, Korman NJ, Gordon KB, Feldman SR, Lebwohl M, Koo JY, et al. Guidelines for the management of psoriasis and psoriatic arthritis. Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on biologics. J Am Acad Dermatol. 2008;58:851-864.

Menter A, Korman NJ, Elmets Ca, Feldman SR, Gelfand JM, Gordon KB, et al. American Academy of Dermatology guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60:643-659.

Menter A, Gottlieb A, Feldman SR, Voorhees ASV, Leonardi CL, Gordon KB, et al. Guidelines for the management of psoriasis and psoriatic arthritis. Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;5:826-850.

Stern RS. Psoralen and ultraviolet a light therapy for psoriasis. N Engl J Med. 2007;357(7):682-690.


Review Date: 11/20/2012
Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.
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