What is Psoriasis?: Psoriasis (sore-EYE-ah-sis) is a medical condition that occurs when skin cells grow too quickly. Faulty signals in the immune system cause new skin cells to form in days rather than weeks. The body does not shed these excess skin cells, so the cells pile up on the surface of the skin and lesions form.

What are the signs and symptoms?: The lesions vary in appearance with the type of psoriasis.

There are five types of psoriasis: Plaque, guttate, pustular, inverse, and erythrodermic. About 80% of people living with psoriasis have plaque (plak) psoriasis, also called “psoriasis vulgaris.” Plaque psoriasis causes patches of thick, scaly skin that may be white, silvery, or red. Called plaques (plax), these patches can develop anywhere on the skin. The most common areas to find plaques are the elbows, knees, lower back, and scalp.Psoriasis also can affect the nails. About 50% of people who develop psoriasis see changes in their fingernails and/or toenails. If the nails begin to pull away from the nail bed or develop pitting, ridges, or a yellowish-orange color, this could be a sign of psoriatic (sore-EE-at-ic) arthritis. Without treatment, psoriatic arthritis can progress and become debilitating. It is important to see a dermatologist if nail changes begin or joint pain develops. Early treatment can prevent joint deterioration.

What causes psoriasis?: Psoriasis is not contagious. You cannot get psoriasis from touching someone who has psoriasis, swimming in the same pool, or even intimate contact. Psoriasis is much more complex.So complex, in fact, scientists are still studying what happens when psoriasis develops. We know that the person’s immune system and genes play key roles. In studying the immune system, scientists discovered that when a person has psoriasis, the T cells (a type of white blood cell that fights unwanted invaders such as bacteria and viruses) mistakenly trigger a reaction in the skin cells. This is why you may hear psoriasis referred to as a “T cell-mediated disease.”

This reaction activates a series of events, causing new skin cells to form in days rather than weeks. The reason T cells trigger this reaction seems to lie in our DNA. People who develop psoriasis inherit genes that cause psoriasis. Unlike some autoimmune conditions, it appears that many genes are involved in psoriasis. Scientists are still trying to identify all of the genes involved. One of the genes that has been identified is called PSORS1 (SORE-ESS-1). This is one of several genes that regulates how the immune system fights infection. Scientists also have learned that not everyone who inherits genes for psoriasis gets psoriasis. For psoriasis to appear, it seems that a person must inherit the “right” mix of genes and be exposed to a trigger. Some common triggers are a stressful life event, skin injury, and having strep throat. Many people say that that their psoriasis first appeared after experiencing one of these. Triggers are not universal. What triggers psoriasis in one person may not cause psoriasis to develop in another.

Who gets psoriasis?: People worldwide develop psoriasis. In the United States, nearly 7.5 million people have psoriasis and about 150,000 new cases are diagnosed each year. Studies indicate that psoriasis develops about equally in males and females. Research also shows that Caucasians develop psoriasis more frequently than other races. A study conducted in the United States found the prevalence was 2.5% in Caucasians and 1.3% in African Americans. A family history of psoriasis seems to increase the risk of developing psoriasis. It is important to know that a family history of psoriasis does not guarantee that someone will develop psoriasis.

When do people get psoriasis?: Psoriasis can begin at any age, from infancy through the golden years. There are, however, times when psoriasis is most likely to develop. Most people first see psoriasis between 15 and 30 years of age. About 75% develop psoriasis before they turn 40. Another common time for psoriasis to begin is between 50 and 60 years of age.

Does psoriasis affect quality of life?: For some people, psoriasis is a nuisance. Others find that psoriasis affects every aspect of their daily life. The unpredictable nature of psoriasis may be the reason. Psoriasis is a chronic (lifelong) medical condition. Some people have frequent flare-ups that occur weekly or monthly. Others have occasional flare-ups. When psoriasis flares, it can cause severe itching and pain.

Sometimes the skin cracks and bleeds. When trying to sleep, cracking and bleeding skin can wake a person frequently and cause sleep deprivation. A lack of sleep can make it difficult to focus at school or work. Sometimes a flare-up requires a visit to a dermatologist for additional treatment. Time must be taken from school or work to visit the doctor and get treatment. These cycles of flare-ups and remissions often lead to feelings of sadness, despair, guilt and anger as well as low self-esteem. Depression is higher in people who have psoriasis than in the general population. Feelings of embarrassment also are common.

Types of Psoriasis: There are five types of psoriasis. Each has its own unique signs (what is seen) and symptoms (what is felt by the person):

Plaque Psoriasis: About 80% of people living with psoriasis have plaque psoriasis, which also is called “psoriasis vulgaris.” “Vulgaris” means “common.” How to recognize plaque psoriasis:

Raised and thickened patches of reddish skin, called “plaques,” which are covered by silvery-white scales. Plaques most often appear on the elbows, knees, scalp, chest, and lower back. However, they can appear anywhere on the body, including the genitals, Plaques vary in size and can appear as distinct patches or join together to cover a large area. In the early stages, the psoriasis may be unnoticeable.

The skin may itch and/or a burning sensation may be present, Plaque psoriasis usually first appears as small red bumps. Bumps gradually enlarge, and scales form. While the top scales flake off easily and often, scales below the surface stick together. The small red bumps develop into plaques (reddish areas of raised and thickened skin), Skin discomfort. The skin is dry and may be painful. Skin can itch, burn, bleed, and crack. In severe cases, the discomfort can make it difficult to sleep and focus on everyday activities.

Guttate Psoriasis: About 10% of people who get psoriasis develop guttate psoriasis, making this the second most common type. Guttate psoriasis most frequently develops in children and young adults who have a history of streptococcal (strep) infections. A mild case of guttate psoriasis may disappear without treatment, and the person may never have another outbreak of psoriasis. Some children experience flare-ups for a number of years. It also is possible for the psoriasis to appear later in life as plaque psoriasis. In some cases, guttate psoriasis is severe and disabling, and treatment may require oral medication or injections. How to recognize guttate psoriasis: Drop-sized, red dots form — usually on the trunk, arms, and legs. Lesions occasionally form on the scalp, face, and ears, Lesions widespread, Appears quickly, usually a few days after a strep throat or other trigger, such as a cold, tonsillitis, chicken pox, skin injury, or taking certain medications, Can first appear as another form of psoriasis, such as plaque psoriasis, and turn into guttate psoriasis.

Pustular Psoriasis: This type of psoriasis occurs in less than 5% of people who develop psoriasis and primarily occurs in adults. It may be the first sign of psoriasis or develop from plaque psoriasis. Pustular psoriasis can be triggered by infections, sunburn, or medications such as lithium and systemic cortisones. There are two forms of pustular psoriasis: localized and generalized. How to recognize localized pustular psoriasis: Psoriasis confined to certain areas (localized), usually the palms and soles. This is known as “palmoplantar psoriasis.”, Skin red, swollen, and dotted with pus-filled lesions, Pus-filled lesions dry, leaving behind brown dots and/or scale, Affected areas tender and sore. Using hands or walking often painful.

Generalized pustular psoriasis: It is a rare and severe form of psoriasis that can be life-threatening, especially for older adults. Hospitalization may be required. Generalized pustular psoriasis may be triggered by an infection such as strep throat, suddenly stopping steroids, pregnancy, and taking certain medications such as lithium or systemic cortisone. How to recognize generalized pustular psoriasis: Widespread areas of fiery-red swollen skin covered with small, white, pus-filled blisters, Person feels exhausted and ill, Fever, Chills, Severe itching, Rapid pulse rate, Loss of appetite, Muscle weakness, Anemia.

Inverse Psoriasis: Not common, inverse psoriasis also is called “skin-fold,” “flexural,” or “genital” psoriasis. This type of psoriasis can be severe and incapacitating. How to recognize inverse psoriasis: Red and inflamed plaques that only occur in skin folds — armpits, in the genital area, between the buttocks, and under the breasts, Scale usually does not form, and the lesions are shiny and smooth, Skin very tender, Lesion easily irritated, especially by rubbing and perspiration, More prevalent in people who are overweight,Many people have another type of psoriasis elsewhere on the body.

Erythrodermic Psoriasis: Also known as “exfoliative” psoriasis, this is the least common type. It occurs in about 1% or 2% of people who develop psoriasis. Erythrodermic psoriasis can be life-threatening because the skin loses its protective functions. The skin may not be able to safeguard against heat and fluid loss nor prevent harmful bacteria and other substances from entering the body. Patients are usually hospitalized and given intravenous fluids. Body temperature regulation may be required.

Erythrodermic psoriasis may occur suddenly in a person who has never had psoriasis or evolve from plaque psoriasis. Triggers include infection, emotional stress, alcoholism, and certain medications such as lithium, anti-malarial drugs, and a strong coal tar preparation. It also may be triggered by excessive use of potent corticosteroids, which is why it is important to use corticosteroids as instructed. Suddenly stopping a psoriasis medication, such as cyclosporine or methotrexate, also can trigger erythrodermic psoriasis. How to recognize erythrodermic psoriasis: Severe redness and shedding of the skin that covers a large portion of the body, Skin looks as if it has been burned, Fluctuating body temperature, especially on very hot or cold days, Accelerated heart rate due to increased blood flow to the skin — can complicate heart disease and cause heart failure, Severe itching and pain.

What is Psoriatic Arthritis?: Psoriatic arthritis is a lifelong condition that causes deterioration, pain, and stiffness in the joints. Some people experience only joint problems and never develop psoriasis. About 70% of people who get psoriatic arthritis develop psoriasis first. Studies show that in these cases, psoriasis usually precedes psoriatic arthritis by about 10 years. However, a person can develop psoriatic arthritis within a few months of getting psoriasis or decades later. Psoriatic arthritis most commonly involves the fingers and toes. Joints in the neck, back, knees, ankles, and other areas also may be affected. In addition to being painful and stiff, the involved areas usually feel hot.

Affected joints tend to have a purplish discoloration. Almost 90% of people who develop psoriatic arthritis see nail involvement first. The nails may pull away from the nail bed or develop pitting, ridges, or a yellowish-orange discoloration. Dermatologists urge their patients who have psoriasis that involves the nails to contact them if they experience any joint problems. Joint deterioration can be prevented with treatment. Early warning signs of psoriatic arthritis include hand pain, foot pain, and "tennis elbow." These early warning signs may be overlooked if psoriasis lesions are not present. Other indications are shoulder, neck, or back pain. Psoriatic arthritis ranges in severity. It can involve one digit or an entire hand. It can become so severe that it is disabling. According to the National Psoriasis Foundation, about 20% of patients living with psoriatic arthritis have more than five totally damaged joints, which significantly impairs their ability to perform everyday tasks and reduces their quality of life.

Who Gets Psoriatic Arthritis: About 1 million people in the United State are living with psoriatic arthritis, which occurs equally in men and women. Psoriatic arthritis occurs most frequently in people with active psoriasis, especially those who have pustular psoriasis. A higher incidence of psoriatic arthritis is found in people who have psoriatic nails. Psoriatic arthritis can begin at any age. However, swelling and stiffness in the joints usually first appears between 30 and 50 years of age.

People who have psoriasis usually experience skin flare-ups months to years before the joints become stiff and swollen. Children also can develop psoriatic arthritis. A pediatric form may appear as early as 2 to 4 years of age in girls. A peak time for psoriatic arthritis to occur in both boys and girls is 11 to 12 years of age. In rare cases, the arthritis appears before lesions on the skin. Psoriatic arthritis may appear in children several years before psoriasis. This can make recognizing psoriatic arthritis difficult, especially if there is no known family history of psoriasis.

Causes: Like psoriasis, psoriatic arthritis is believed to be caused by an abnormality in the immune system. Another similarity is that a "trigger,” such as stress, can cause psoriatic arthritis to develop in a genetically predisposed person.

What to Do if You Have Symptoms: Anyone who has psoriasis or a family history of psoriasis and experiences joint stiffness and swelling should make an appointment to see a dermatologist. Medication can help prevent joint deformities and disability if used early. Without treatment, joint degeneration and destruction can occur, making it painful if not impossible to perform some daily activities. Joint degeneration can develop quickly and is irreversible. More than 50% of people living with psoriatic arthritis have some limitations. More than 60% lose time from work. If allowed to progress, morning stiffness can last for a few hours.

Diagnosis: The goal is to diagnose psoriatic arthritis in its earliest stages. Diagnosis usually begins with a review of the patient’s medical history and examination of the patient’s skin, joints, and fingernails. Since symptoms resemble those of rheumatoid arthritis, blood and serum tests are often necessary to differentiate it from rheumatoid arthritis and other autoimmune (person’s own immune system develops a reaction against something in the person’s own body) conditions. X-rays are sometimes taken to distinguish psoriatic arthritis from other types of arthritis.

Treatment: Years of research have given dermatologists a better understanding of psoriatic arthritis. Today, new treatments and therapies offer renewed hope to patients with this lifelong condition. The goals of treatment are: Control symptoms, Inhibit deformities and joint damage, Prevent disability. No single psoriatic arthritis treatment works for everyone. Instead, the goal is to find the treatment that works best for each patient with the fewest side effects. Dermatologists will often recommend a treatment or a combination of treatments based on the type and severity of the psoriatic arthritis. Medications used to treat psoriatic arthritis include:

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) can help alleviate pain, swelling, and stiffness in the joints. Some NSAIDs require a prescription. Others can be purchased over-the-counter and include aspirin, ibuprofen, and naproxen sodium.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs) are an option when the pain and swelling from psoriatic arthritis are more severe or there is any sign of joint immobility. These medications are used to control signs and symptoms. Due to the potential for serious side effects, these are only available by prescription and should only be taken following consultation with a physician experienced in treating this condition. Cyclosporine, methotrexate, and sulfasalazine are some of the DMARDs used to treat psoriatic arthritis. Cyclosporine and methotrexate also can effectively treat psoriasis. One class of DMARD is the biologics, which are prescription therapies that target a specific part of the immune system to block the effects of the psoriatic arthritis. Some biologics have been shown to not only control symptoms but to slow progression of joint damage. Biologics can be used with other medications. Most observed side effects from the biologics have been mild.

However, long-term side effects are still not known but may include increased risk of malignancy and serious infections due to the ability of the biologics to alter the immune system. These potential side effects are not unique to biologics and have been demonstrated following use of other DMARDs. Etanercept and infliximab (two biologics) are proving effective for treating both psoriatic arthritis and psoriasis. Etanercept has been approved by the U.S. Food and Drug Administration (FDA) to treat both conditions. Infliximab is FDA-approved to treat the signs and symptoms of active psoriatic arthritis.

In clinical trials, many patients taking etanercept experienced rapid and effective treatment for their skin and joints. Etanercept has shown that it can significantly inhibit joint destruction, bone erosion, and narrowing of the joint spaces. Clinical trials for infliximab have shown that the drug can effectively clear the skin, reduce swelling in the joints of toes and fingers, as well as decrease inflammation of the tendons and ligaments. Before taking infliximab, a person must be tested for tuberculosis (TB). If TB is detected, it must be treated before infliximab therapy begins. Patients taking infliximab should be closely monitored for signs of infection. If infection begins, infliximab therapy should be stopped. It is important to remember that no one medication works for everyone. Equally important is the fact that failure of one biologic does not predict that other biologics will not work. Medication is not the only treatment for psoriatic arthritis. Other therapies that can help people manage the pain include:

Exercise can help patients keep up their strength, improve joint mobility, and control weight. Obesity puts further strain on impaired and inflamed joints.

Physical, occupational, and massage therapy involve physical treatment of the joints, muscles, ligaments, and tendons by a licensed therapist to reduce pain and improve joint function. Splints can be used during physical or occupational therapy to hold joints in place and reduce pain and swelling. In addition, temperature therapy may be used. It may involve soaking in a hot bath or placing an ice pack on painful joints to help reduce pain and swelling.

Surgery can help psoriatic arthritis patients with badly damaged joints by lessening pain and improving movement. However, this option is not necessary for most people with psoriatic arthritis.

Psoriasis Treatment: Currently, there is no cure for psoriasis. However, there are many treatment options that can clear psoriasis for a period of time. Each treatment has advantages and disadvantages, and what works for one patient may not be effective for another. Board-certified dermatologists have the medical training and experience needed to determine the most appropriate treatments for each patient.

Diagnosis: There are several forms of psoriasis, and each form has unique characteristics that allow dermatologists to visually identify psoriasis to determine what type, or types, of psoriasis is present. Sometimes a skin biopsy will be performed to confirm the diagnosis. To choose the most appropriate treatment method, dermatologists consider several factors: Type of psoriasis, Severity (the amount of skin affected), Where psoriasis is located, Patient’s age and medical history, Effects psoriasis has on patient’s overall physical and emotional, well-being.

Types of Treatment: Psoriasis treatments fall into 3 categories: Topical (applied to the skin) – Mild to moderate psoriasis, Phototherapy (light, usually ultraviolet, applied to the skin) – Moderate to severe psoriasis, Systemic (taken orally or by injection or infusion) – Moderate, severe or disabling psoriasis, While each of these therapies is effective, there are also drawbacks. Some topicals are messy and may stain clothing and skin. Phototherapy can require 2 to 5 weekly visits to a dermatologist’s office or psoriasis clinic for several weeks. Many of the systemic medications have serious side effects and must be combined or rotated with other therapies to maximize effectiveness and minimize side effects. Research is being conducted to find therapies that provide safe, effective, easy-to-use treatment options that provide long-term relief.