Psoriasis is a skin disease, which causes itchy, red patches of scaly skin often on the elbows, knees, and scalp, is the most prevalent autoimmune type disease in the US. It is often called an immune-mediated disease because unlike type 1 diabetes, for example, the cause of the immune system dysfunction and resulting inflammation is not clear. Symptoms often start between ages 15 and 25, but can occur in later adulthood. It affects about 2.2 percent of the US population, around 7.5 million people and is not contagious.
Psoriasis symptoms can vary from person to person. They include:
- Red patches of skin covered with thick, silvery scales
- Small scaling spots (commonly seen in children)
- Dry, cracked skin that may bleed or itch
- Itching, burning or soreness
- Thickened, pitted or ridged nails
- Swollen and stiff joints
- Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. The most commonly affected areas are the lower back, elbows, knees, legs, soles of the feet, scalp, face and palms.
Most types of psoriasis go through cycles, they flare up every few weeks or months, then calm down and sometimes go into remission.
Many of my patients with psoriasis go to great lengths to hide their skin and any outbreaks. People are understandably concerned about being judged and stigmatized by a skin condition they have little control over. I have patients with patches of psoriasis on their genitals and this can lead to a fear of being rejected by a partner or having to endure a long list of questions that are deeply personal and private. When the new biologic treatments became available and more people found their skin clearing up, many told me about finally feeling free to just be themselves when out in public and not fearing the staring and intrusive questions.
The inflammation caused by psoriasis can go deeper than the skin. One third of those with psoriasis also develop psoriatic arthritis. Symptoms of psoriatic arthritis include swelling, stiffness, and pain in the joints and areas around the joints. This can mimic osteoarthritis, so it is important to get a correct diagnosis and treatment to prevent joint damage.
It’s possible to have more than one type of psoriasis at one time and more than one type in a lifetime.
Other Types of Psoriasis– From the Mayo Clinic:
Plaque psoriasis: The most common form, plaque psoriasis causes dry, raised, red skin patches (lesions) covered with silvery scales. The plaques might be itchy or tender, and there may be few or many. They usually appear on elbows, knees, lower back and scalp.
Nail psoriasis: Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
Guttate psoriasis: This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, drop-shaped, scaling lesions on the trunk, arms or legs.
Inverse psoriasis: This mainly affects the skin folds of the groin, buttocks and breasts. Inverse psoriasis causes smooth patches of red skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.
Pustular psoriasis: This rare form of psoriasis causes clearly defined pus-filled lesions that occur in widespread patches (generalized pustular psoriasis) or in smaller areas on the palms of the hands or the soles of the feet.
Erythrodermic psoriasis: The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely.
Psoriatic arthritis. Psoriatic arthritis causes swollen, painful joints that are typical of arthritis. Sometimes the joint symptoms are the first or only symptom or sign of psoriasis. And at times only nail changes are seen. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. It can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent joint damage.
Someone may be predisposed to psoriasis but have very mild symptoms or none at all until the immune system is triggered. Common psoriasis triggers include:
- Infections, such as strep throat (especially in children) or skin infections
- Weather, especially cold, dry conditions
- Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn
- Smoking and exposure to secondhand smoke
- Heavy alcohol consumption
- Certain medications — including lithium, high blood pressure medications and antimalarial drugs
- Rapid withdrawal of oral or systemic corticosteroids
Nutrition, Exercise, and Your Gut
You knew I would get to this!
The latest research on psoriasis is focused on the healing and preventative benefits of good nutrition, keeping a healthy weight, and a good gut microbiome (those millions of bacteria, fungi, good bugs that live in your gut), as well as new drug therapies.
Studies show that excess body fat fuels inflammation, and that weight loss improved psoriasis symptoms. Giving your body good nutrition by eating a Mediterranean type diet including a wide variety of whole, unprocessed foods and lean proteins fights inflammation and is a great way to lose extra pounds. Also, some of those good bugs in your microbiome make fatty acids that control inflammation and help to keep your immune system response under control. The use of probiotics is being studied to boost the biome of those suffering from psoriasis.
New Treatments – Biologics
While there are topical and immunosuppressant therapies available to control symptoms, there is exciting new research and medications gaining attention. Cutting-edge treatments called biologics that target specific areas of the immune system have come out of research into autoimmune disease. These therapies are complex molecules manufactured using living microorganisms, plants, or animal cells. Many are developed using recombinant DNA technology. These lab-made proteins or antibodies are injected into your bloodstream and work to block an overactive immune response and slow the overgrowth of skin in psoriasis.
October 29th is World Psoriasis Day and the National Psoriasis Foundation will be celebrating a global united community 125 million strong.