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Psoriasis: Triggers, Symptoms, and Treatment


Psoriasis is a common skin disease caused by an autoimmune disorder. It is a chronic condition in which the skin cells multiply too quickly, typically becoming inflamed with scaly and itchy patches. It can be very uncomfortable and affects the quality of life of those who suffer from it. While there is no cure, it is treatable.

Who gets psoriasis?

Psoriasis typically begins in early adulthood and is more common in adults. It has been noted in children but is much less common. Men and women are equally affected, and it does not involve a particular race. However, some find symptoms start later in life.

What causes or triggers psoriasis outbreaks?

Psoriasis is an autoimmune disorder in which the body’s immune system becomes overactive and produces new skin cells quickly, as fast as every three to four days. New skin cells usually reproduce every 30 days. Generally, it is a combination of family history and environmental factors. External factors can trigger symptoms, commonly known as flare-ups or outbreaks, including:

  • Infections, particularly streptococcal and HIV
  • Medications
  • Smoking
  • Obesity
  • Injuries: cuts, surgery, or broken skin
  • Stress
  • Increased exposure to hot, dry indoor air with less humidity
  • Dry skin
  • Not enough sunlight

Symptoms of Psoriasis

Symptoms may vary between patients and based on the type of psoriasis. Psoriasis is not contagious, and patients cannot pass their symptoms on to others. Symptoms may get better and worse in cycles, usually improving for some time and then becoming more severe.

Symptoms include:

  • Thick red or pink areas with dry, silvery, or white patches
  • Itching or burning skin
  • Dry, cracked skin that bleeds
  • Painful skin
  • Scaly skin and scalp
  • Joint pain
  • Thick, pitted, cracked, ridged nails

The most commonly affected areas include elbows, knees, scalp, face, palms, soles of the feet, low back, and legs.

Psoriasis has multiple types

There are several types of psoriasis:

  • Plaque psoriasis. The most common kind has raised, red patches covered with silvery or white scales. Patches develop on the scalp, body, elbows, and knees.
  • Guttate psoriasis. Typically appears on children or young adults and looks like small red dots on the chest, back, arms, and legs. This type often occurs after an upper respiratory or streptococcal infection.
  • Pustular psoriasis. Pus-filled red bumps appear on the hands and feet. Medications, infections, stress, or chemicals trigger symptoms.
  • Scalp psoriasis. A form of plaque psoriasis on part or all of the scalp. It may be itchy or have no discomfort. Extreme cases may cause hair loss.
  • Inverse psoriasis. Smooth, red patches in the skin folds, under breasts, groin, or underarms. It becomes aggravated by rubbing and sweating.
  • Nail psoriasis. Nails become brittle, discolored, thickened, or potentially loose or separate from the nailbed.
  • Psoriatic arthritis. Skin symptoms like plaque psoriasis also cause pain and swelling of joints. This form can cause severe joint damage if untreated.

Diagnosing psoriasis

Your healthcare provider can examine your skin for signs and symptoms of psoriasis. They will evaluate your medical history and ask questions about the symptoms you have experienced. They will want to know if you have:

  • Itching or burning
  • Recent illness, stress, or injury
  • Your current medications
  • Any relatives with the disease
  • Any joint pain or tenderness

Your family provider may refer you to a specialist called a dermatologist, or your dermatologist may be the one to make the diagnosis. Specific testing is not required for diagnosis; however, providers may perform some blood tests to look for inflammation, infection, or rule out other causes. The provider may perform skin scrapings to rule out fungal infection. Additional bloodwork may be necessary for some treatments, which your healthcare provider will discuss with you if necessary.

Your provider may also include imaging studies of joints that are involved. It can help determine if the pain is related to psoriasis or other causes and assess the extent of any injury.

Treating and managing psoriasis

Psoriasis is treatable, but there is no cure. Treatments can help manage symptoms and improve daily living. Your healthcare provider or dermatologist will help determine which treatment option is best for you and your type of psoriasis, depending on how severe it is, where it is, and any possible side effects. Treatment options include:

Medications

  • Corticosteroids: Creams, injections, and eye drops can be used to treat symptoms directly
  • Coal tar
  • Keratolytic agents: Acids that breakdown plaques so medications can penetrate more effectively
  • Vitamin D ointment
  • Retinoids
  • Biologic medications
  • Artificial tears
  • Methotrexate

Other treatments

  • Creams, ointments, lotions, moisturizers, other unmedicated ointments, or thick creams can also lock moisture into the skin, helping soften and reduce itching and irritation
  • Light therapy or ultraviolet (UV) therapy - decreases inflammation and slow skin cell production
  • Stress reduction
  • Oatmeal baths
  • Medicated shampoos
  • Sun exposure in appropriate amounts
  • Mental health counseling - psoriasis may be associated with depression or anxiety due to the effects the symptoms have on the patient’s physical appearance

Untreated psoriasis can lead to complications. Joint damage can occur if not adequately addressed, and patients are at higher risk of diabetes, obesity, high cholesterol, stroke, or heart attack.

Life with psoriasis

Psoriasis is not preventable, but treatment can reduce occurrences and relieve symptoms.

  • Taking care of your skin can help keep symptoms under control as well.
  • Keep your skin well moisturized. Avoid using hot water for showers or bathing, and use mild soap. Apply heavy moisturizers after bathing while the skin is still damp.
  • Stop smoking or discuss with your healthcare provider if you need help.
  • Reduce or eliminate alcohol use.
  • Avoid known triggers that cause flare-ups: stress, injuries, medications, infections, or cold weather, when able.
  • Maintaining a healthy weight can help reduce the risk of outbreaks.
  • Appropriate amounts of sun exposure can help reduce symptoms. Limit 10 to 15 minutes of sun exposure two to three times per week to avoid risking sunburn or skin damage.
  • Psoriasis is a common, treatable, chronic skin disorder but has no cure. Symptoms can range from mild to severe and may come and go. Your healthcare provider can help you manage the disease with various available treatment options depending on your needs.

References

  1. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Psoriasis.
  2. Cleveland Clinic. Psoriasis.
  3. National Health Service. Psoriasis.
  4. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Psoriasis: Diagnosis, Treatment, and Steps to Take.
  5. Medscape. Psoriasis.
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