Psoriasis - Causes, Symptoms and Remedies

What is Psoriasis

Psoriasis is a condition classified as an immune-mediated disease, characterized by inflammation resulting from an immune system malfunction. This inflammation manifests in visible ways, such as raised plaques and scales on the skin, the appearance of which may vary among different skin types.

Psoriasis can affect any part of the body, although it is commonly observed on the elbows, knees, and scalp. Beyond skin manifestations, the inflammation induced by psoriasis can extend to impact other organs and tissues in the body. Individuals with psoriasis may also contend with additional health issues, with about one in three developing Psoriatic Arthritis (PsA). PsA is characterized by swelling, stiffness, and pain in the joints and surrounding areas. It often goes undiagnosed, especially in milder forms, emphasizing the importance of early intervention to prevent irreversible joint damage. While symptoms typically begin between ages 15 and 25, psoriasis can affect individuals of any age, irrespective of gender or skin color.

Location of Psoriasis

Psoriasis can manifest in various locations on the body, each presenting distinct challenges:

1. Genital Psoriasis: A prevalent occurrence, affecting up to two-thirds of individuals with psoriasis at some juncture. Genital psoriasis extends its impact to the skin in the genital area, as well as the inner and upper thighs.
2. Scalp Psoriasis: Affecting over 60 percent of people grappling with psoriasis, scalp psoriasis is known to influence the hairline, forehead, the back of the neck, and the skin around the ears.
3. Facial Psoriasis: Approximately 50 percent of individuals with psoriasis experience facial involvement. This variant can affect various facial regions, including the eyebrows, the skin between the nose and upper lip, and the upper forehead.
4. Hands, Feet, and Nails: Psoriasis can extend to the extremities, impacting the hands, feet, and nails. Palmoplantar psoriasis (PPP) specifically refers to psoriasis affecting the palms of the hands and/or the soles of the feet, with an incidence ranging from 12 to 16 percent among those with psoriasis. Nail changes, occurring in 50 percent of individuals with psoriasis, are also common.
5. Skin Folds: Psoriasis can manifest in skin folds, such as those under the arms and breasts. These areas, prone to irritation from rubbing and sweating, are susceptible to the effects of psoriasis.

Types of Psoriasis

Psoriasis manifests in various types, each presenting distinct characteristics:

1. Guttate Psoriasis: Afflicting approximately 8 percent of individuals with psoriasis, guttate psoriasis is identifiable by small, round, red, or discolored spots resulting from inflammation. While commonly found on the arms, legs, and torso, it can appear on any part of the body.
2. Pustular Psoriasis: Affecting around 3 percent of those with psoriasis, pustular psoriasis manifests as painful, pus-filled bumps (pustules) surrounded by inflamed or reddened skin. It may be localized to specific areas, such as the hands and feet, or extend across much of the body.
3. Plaque Psoriasis: The most prevalent type, impacting up to 80 percent of psoriasis sufferers. Plaque psoriasis is characterized by raised patches of inflamed, itchy, and painful skin with scales. The appearance of these plaques can vary, from red with silvery-white scales to a more purple hue, influenced by individual skin types. Common locations include the scalp, knees, elbows, and regions around the belly button, lower back, and other body areas.
4. Inverse Psoriasis: Affecting a quarter of individuals with psoriasis, inverse psoriasis presents as smooth, inflamed, deep-red, or darkened skin in skin folds, including underarms, beneath breasts, the genital area, and buttocks. It induces severe itching and pain, exacerbated by sweat and friction in these regions.
5. Erythrodermic Psoriasis: A rare type affecting around 2 percent of those with psoriasis, erythrodermic psoriasis is marked by intense redness, discoloration, and shedding of skin layers in large sheets. This severe form often involves nearly the entire body and can be life-threatening, accompanied by symptoms like severe itching, pain, changes in heart rate and temperature, dehydration, and nail alterations. Immediate medical attention is crucial during an erythrodermic flare.

Causes of Psoriasis

Psoriasis arises from an immune system that becomes overly responsive, leading to inflammation in the skin. While the immune system's primary role is to eliminate foreign invaders like bacteria, in individuals with psoriasis, it can misidentify healthy cells as threats. Consequently, the immune system triggers inflammation, visible on the skin surface as plaques.

Under normal circumstances, the skin undergoes a natural cycle where new cells take about 30 days to replace old ones. However, the hyperactive immune system in psoriasis accelerates this process to a mere three to four days. This rapid turnover results in the formation of scales and frequent shedding atop the skin plaques. Additionally, there is a familial predisposition to psoriasis, suggesting a potential genetic link as the condition may be inherited from biological parents to their children.

Symptoms of Psoriasis

The manifestations of psoriasis can vary depending on its type. The five most prevalent symptoms encompass:

1. Rashes or Patches: Areas of red, inflamed skin often covered with loose, silver-colored scales. In severe cases, these plaques may grow and merge, covering extensive skin areas.
2. Itchy, Painful Skin: Skin discomfort accompanied by itching, which can lead to cracking or bleeding.
3. Bleeding from Scratching: Small areas of bleeding can occur where the affected skin is scratched.
4. Nail Issues: Problems with fingernails and toenails, including discoloration, pitting, crumbliness, or detachment from the nail bed.
5. Scalp Involvement: Scaly plaques appearing on the scalp.

Triggers/Flare-ups of Psoriasis

The factors that provoke or exacerbate psoriasis can differ from person to person, making it a highly individualized experience. Common triggers include:

1. Stress: One of the most prevalent triggers, stress can both induce and result from a psoriasis flare-up. Managing stress through relaxation techniques can play a crucial role in mitigating its impact on psoriasis.
2. Skin Injury: Psoriasis may emerge in areas of the skin that have been injured or compromised. This phenomenon, known as the Koebner phenomenon, indicates that scratches, sunburns, insect bites, and vaccinations can trigger psoriasis flares.
3. Weather: Environmental conditions play a role, with cold weather often leading to flares due to reduced sunlight and humidity, along with indoor heating causing drier air. Conversely, warm weather can be beneficial due to natural sunlight and increased humidity.
4. Other Possible Triggers: While less common, some individuals suspect that allergies, specific foods, alcohol, or environmental factors may trigger their psoriasis. Tracking symptoms and triggers over time can help identify and manage individual flare-ups effectively.

Life with Psoriasis

Living with psoriasis extends beyond physical health and can impact emotional well-being, relationships, stress management, and even clothing choices. Despite the challenges, thriving with psoriasis is achievable. Some strategies for everyday management include:

1. Related Conditions (Comorbidities): Individuals with psoriasis face a higher risk of related conditions such as cardiovascular disease, depression, and metabolic diseases like type 2 diabetes.
2. Stress Management: Given stress's role as a common trigger, effective stress reduction strategies include meditation, exercise (with healthcare provider consultation), and seeking external support.
3. Day-to-Day Stigma: Psoriasis can be stigmatizing, but it's essential to recognize that it's neither infectious nor contagious. Managing and challenging misconceptions can contribute to a healthier perspective.
4. Relationships: Communicating with partners, friends, and family about psoriasis may be challenging but is crucial for garnering support. Embracing conversations rather than avoiding them helps build understanding.
5. Clothing Choices: While psoriasis is nothing to be embarrassed about, selecting specific clothes and fabrics, combined with proper moisturizing, can enhance comfort and confidence in various situations and seasons.

Managing Symptoms

Addressing the various symptoms associated with psoriasis is crucial for overall well-being. Consider the following strategies for symptom management:

1. Itch: The itch associated with psoriasis can significantly impact quality of life. To explore effective ways to manage itch, feel free to reach out to our complimentary Patient Navigation Center for guidance and support.
2. Dryness/Cracking: Dry, cracked skin prone to bleeding or itching is a common symptom of psoriasis. Additionally, heightened skin dryness may contribute to more severe psoriasis flares. Managing skin hydration is key to alleviating these symptoms.
3. Nails: Nail psoriasis, which can affect fingers and toes, may lead to pain and tenderness that interfere with daily activities. Recognizable signs include pitting, deformation, thickening, onycholysis, and discoloration. For more information on nail psoriasis, request our complimentary nail psoriasis fact sheet.
4. Swollen and Stiff Joints: Psoriasis can extend beyond skin symptoms to affect joints, causing swelling and stiffness. Exploring appropriate measures to address joint symptoms is vital for comprehensive symptom management.
5. Mental Health: Individuals with psoriasis have an increased likelihood of experiencing depression. Vigilance for symptoms of depression is crucial, and seeking treatment when needed is essential for mental well-being.