What is Psoriasis?

Psoriasis is a inflammatory skin condition that affects about 7.5 million Americans and approximately 2-3 percent of the world’s population. Although Psoriasis is not contagious, it is a lifelong battle for those individuals that have it.

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There are 5 main types of Psoriasis that occur, each with unique signs and symptoms: Plaque, Guttate, Inverse, Erythrodermic and Pustular. Typically people will only have one type of Psoriasis at a time. However, it is possible to develop multiple types at once, or have the type change from one to another.

The 5 Main Types of Psoriasis:

  • Plaque – This is the most common type of Psoriasis. Approximately 80% of all Psoriasis cases have Plaque Psoriasis. The symptoms are inflamed, raised red lesions covered with silvery white scales. These patches, or plaques, usually form on the knees, elbows, scalp and lower back. However, they can occur anywhere on the body.

  • Guttate – Another form is Guttate Psoriasis, which starts in children and teenagers. The symptoms are small red spots on the skin. The sudden onset of symptoms is usually triggered by a variety of conditions, such as upper respiratory infections, tonsillitis, stress, streptococcal infections, injury to the skin and use of certain drugs.

  • Inverse – The symptoms are usually very red lesions (without scales) that appear shiny and smooth. The lesions are subject to irritation associated with sweating and rubbing because of the locations where it normally occur, which include armpits, under the breasts, groin, and skin folds near genitals and buttocks. This type of Psoriasis usually develops in people that are overweight or have deep skin folds. Treatment is difficult on the sensitive areas where the lesions are found.

  • Pustular – Usually seen in adults, Pustular Psoriasis consists of white pustules surrounded by red skin. Usually localized to the hands and feet, it can develop across the entire body.

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There are four types of Pustular Psoriasis:

  • Localized – One or more patches of Psoriasis spontaneously develop small pustules. Irritation and aggressive over-treatment may also induce this form of Psoriasis.

  • Palmo-Planter – The second type of pustular Psoriasis is palmo-plantar pustulosis, which results in pustules on the palms and soles. The pustules are about the size of a pencil’s eraser and usually occur at the base of the thumb and/or the side of the heel. A studded pattern of pustules develop on the red skin then turn brown and begin to peel causing the area to become crusty. The pustules will reform and continue the cycle even if there is a time of low activity.

  • Acropustulosis – Acropustulosis is a localized form of pustular Psoriasis that affects fingers, thumbs and toes. Pustules appear then burst leaving bright red areas that may ooze, become scaly and/or crusty. The nails are often abnormal, crumbly and may lift up because of underlying lakes of pus. This type of Psoriasis is very rare.

  • Generalized (von zumbusch) – The initial symptom is an onset of widespread red skin. The skin is painful and tender with pustules that develop within hours. For the next 24-48 hours the pustules dry and peel. The skin then looks smooth and glazed. The pustules then reappear and the cycle continues for days or weeks. Other symptoms can include chills, fever, severe itching, dehydration, exhaustion, rapid pulse rate, anemia, weight loss and muscle weakness. Often occurring in adults, it can be triggered by suddenly stopping steroids, infection, pregnancy, and use of drugs such as high blood pressure drugs, iodides and indomethacin. This type can be life threatening and requires immediate medical attention which may include hospitalization.

Suggested Treatment: Due to the extreme seriousness of this form of Psoriasis, we DO NOT recommend treating it yourself. If you think you have this form of Psoriasis, you should seek immediate medical attention.

  • Erythrodermic – The type that affects most of the body’s surface is Erythrodermic Psoriasis. The symptoms include widespread periodic redness of the skin, shedding of the skin and severe itching and pain. This form can lead to severe illness from protein and fluid loss. This form can lead to life threatening infections, pneumonia or congestive heart failure. Some triggers include the use of cortisone, stopping systemic treatment abruptly, a rash from an allergic drug reaction, or severe sunburn.

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Suggested Treatment: Due to the extreme seriousness of this form of Psoriasis, we DO NOT recommend treating it yourself. If you think you have this form of Psoriasis, you should seek immediate medical attention.

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What is Psoriatic Arthritis?

Psoriatic arthritis accompanies Psoriasis in about 10-30 percent of patients. It is a chronic inflammatory disease in the joints and connective tissue which cause stiffness, pain and swelling in the joints. It usually develops between the ages of 30 and 50. Men are slightly more likely to be affected than women. The immune system, genetics and the environment all play a part in the development. If untreated it can be crippling and disabling. Most people have the skin disease first. However, it can have a quick and severe onset. It can actually go years without being detected if the development is slow and mild enough.

Suggested Treatment: While we can not treat the cause of Psoriatic Arthritis, we can help relieve the pain associated with it. For more information on Arthritis and its treatment, please visit our informative DermaTechRx guide on Arthritis.

The Five Main Types of Psoriatic Arthritis:

  • Symmetric – The first is similar to rheumatoid arthritis. However, symmetric arthritis is milder and less deforming but still can be disabling. It usually occurs in the same joint on both sides of the body.
  • Asymmetric -Asymmetric arthritis does not occur in the same joint on both sides of the body. It can be in a few or many joints and can affect any joint in the body such as the knee, hip, wrist or ankle. The fingers may become enlarged. The symptoms include red warm and tender joints with periodic joint pain. While this can be disabling at times, it is usually mild.
  • Distal Interphalangeal Predominat – The third type is only in about 5 percent of patients and is called distal interphalangeal predominant. It is found in the joint of the finger or toe farthest from the body. It can be confused with osteoarthritis if the nail changes are not noted.
  • Spondylitis – This is the fourth type which causes an inflammation in the spine. This form occurs in about 5% of patients. The symptoms include inflammation with stiffness in the lower back, neck and vertebrae which make motion difficult and painful. The disease can show up in the hands, hips, arms, legs and feet.
  • Mutilans – The last type is a deforming, destructive and severe arthritis that occurs in less than 5% of patients. It is commonly seen in the hands and feet with pain in the neck or lower back. Any of the symptoms listed below can be a sign of psoriatic arthritis. However it can be difficult to diagnosis due to mimicking cartilage tear, lack of joint swelling, and need for repeated episodes.

Symptoms of Psoriatic Arthritis:

  • Red and painful eye such as conjunctivitis
  • Nail changes which may look like fungal infections, separation from the nail bed or pitting
  • Morning stiffness and tiredness
  • Reduced range of motion
  • Stiffness, pain, throbbing, swelling and tenderness in one or more joints
  • Swollen toes and fingers
  • Tenderness, swelling, and pain over tendons
  • Generalized fatigue

Triggers of Psoriasis

Although Psoriasis is not contagious and it is genetic, a trigger is usually what causes it to appear. Some triggers are listed below.

  • Stress
  • Weather
  • Skin injury
  • Infection
  • Medication
  • Hormones
  • Smoking
  • Heavy alcohol consumption
  • Allergies
  • Diet

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Stress can cause an initial outbreak or a flare up and can even worsen symptoms including itching. Psoriasis itself causes stress due to the embarrassment and shameful feelings caused by the way that people treat patients. The inability to perform daily tasks when lesions are on hands and feet is very stressful. Treatment’s financial and time costs along with ineffectiveness can be stressful. Ways to relieve stress include counseling, support groups, mediation, other relaxation techniques and exercise.

Cold winter weather is a common trigger. The cold dry air and indoor heat can dry the skin and worsen symptoms. The stress of winter holidays and winter illness can compromise the immune system worsening symptoms even further. Although hot and sunny weather can clear symptoms, the air conditioning can dry the skin. However, moisturizer can treat psoriasis.

Some injuries that can trigger a flare up are vaccinations, acupuncture, bites, bruises, burns, chafing, chemical irritation, scrapes, pressure on the skin, shaving, adhesive tape on the skin, tattoos, peeling, sunburn, cut, rubbing and scratches. This is called the Koebner phenomenon. About 50 percent of all Psoriasis patients experience this phenomenon. There are other skin conditions such as boils, dermatitis, herpes blisters, Lichen planus, scabies and vitiligo that can also cause a flare up.

Strep throat can trigger guttate Psoriasis. Thrush can trigger inverse Psoriasis. Other infections that can trigger Psoriasis are HIV, boils and upper respiratory infection.

Certain medications can trigger a flare up. In fact, about 50 percent of the people with Psoriasis who take Lithium have a flare up. A high blood pressure medication, Inderal, can worsen the symptoms in about 25-30 percent of people with Psoriasis. Symptoms can worsen with Quinidine a heart medication. An arthritis drug, Indomethacin, can worsen symptoms. However, some find the side effect is worth it because of the beneficial help with psoriatic arthritis. The first time an anti-malarial medication is taken a flare up can occur. Overuse or suddenly stopping use of a corticosteroid can aggravate Psoriasis.

Hormone effects are not fully understood. However, the first outbreak is often noted after puberty when hormone levels fall. An improvement in symptoms is noted with an increase in hormones during pregnancy and worsens after birth with a fall in hormone levels.

Smoking effects are also not fully understood. Although, pustular Psoriasis is noted in smokers. There is also believed to be a link between smoking and plaque Psoriasis and severe Psoriasis. Quitting can help symptoms.

Some research has shown that heavy drinking is noted to trigger Psoriasis and lessen the effectiveness of the treatments.

The effects of allergies are also not understood. However, allergies have been noted as a trigger to Psoriasis.

Dietary effects on Psoriasis treatment is not completely understood. However, changing the diet as has been noted to improve symptoms and avoid flare ups.

How to prevent flare ups?

  • Help the immune system stay strong so the body can fight infection which lowers the chance of skin aggravation. This can be done by eating a balanced diet, drinking plenty of water, getting plenty of sleep and taking the appropriate amount of vitamins and minerals. This will also lower stress and avoid feeling tired.
  • Learning one’s triggers can help to avoid them. Although avoiding is not always possible, knowledge allows for informed decision making.
  • Smoking can also help to trigger flare ups in a person with Psoriasis. However, nicotine patches or supplements can also be a trigger.
  • Moderate drinking or no drinking is best with Psoriasis. However, patients on Methotrexate should not drink at all because serious side effects can result.
  • Reducing stress can help. Stress reduction can occur with counseling, support groups, exercise or meditation.
  • Avoid scratching which can worsen symptoms or cause infection. Relieve the itch with cold compresses, lukewarm bath and moisturizer. Lukewarm not hot water is best because hot warm can trigger a histamine response in the skin causing more itching. Use cleanser not soap to prevent drying. Patting dry after bathing can prevent irritation from rubbing.
  • Do not pick a lesion because this can worsen symptoms or cause infection.
  • Use sunscreen to prevent sunburn from triggering a flare up.
  • Wearing cotton cloths can help prevent irritation and overheating.
  • Winter tips include taking extra time for stress reduction, moisturize at least twice a day including after bathing, use a humidifier at home and at the office, do not use synthetics or insulation down. Instead layer cotton cloths to keep warm and dry.

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