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Psoriasis

What is it?

  • Psoriasis is a long-term skin disease. You may get it at any age. Most people get it in their twenties. Psoriasis usually looks like red, raised, patches on your skin. The red areas are covered with silver-colored scales. When the silver scales are scraped off, many tiny areas bleed. The patches on your skin may itch. About 2% of all people have psoriasis.
  • Skin cells are formed in the lowest, or basal, level of your skin. The skin cells grow up, then age as they slowly move from the bottom to the top layer of skin. The skin cell cycle is usually completed in about 28 days. Sometimes, the skin cell cycle is speeded up. An entire cycle is completed in 3 or 4 days. This fast cycle of skin growth causes the psoriasis patches on your skin.

What psoriasis is NOT: There are many wrong beliefs about psoriasis. Psoriasis cannot be spread from one person to another. It cannot be "caught." Psoriasis is not an infection (in-FECK-shun) because it is not caused by a germ. It is not skin cancer. It is not caused by poor health habits.

What causes psoriasis? Psoriasis is probably genetic (juh-NEH-tik). Many people with psoriasis have a relative who also has psoriasis. Scientists think that psoriasis may be caused by an immune system that is too active. Your body may work too hard to try to protect you from disease or harm. It usually takes two or more events to start a psoriatic (sore-e-AH-tik) breakout. Because of this, stress, like starting a new job, combined with a reaction to a new medicine, or skin damage from an injury or sunburn, may start a breakout. A type of psoriasis called guttate (GUT-ate) psoriasis may be caused by a previous infection. This type of psoriasis usually follows a sore throat.

Types of psoriasis: Psoriasis can be mild, moderate, or severe. This depends on how much skin area is involved in a breakout. The palm of your hand, not including your thumb or fingers, is about 1% of your skin area. Mild psoriasis affects 2% (about the size of both of your palms) or less of your skin area. Moderate psoriasis affects 2% to 10% of your skin area. Severe psoriasis affects over 10% of your skin area. About half of all people with psoriasis have fingernail changes. The changes may be pitting of the nails, thickening of nails, or lifting of nails off the nailbed.

There are 5 types of psoriasis:

Plaque (plak) type: The plaque type of psoriasis is the most common and mildest type. Plaques are reddened patches covered with rough-looking silvery scales. A breakout of the plaque type can be anywhere on your body. The most common places are your knees, elbows, scalp, trunk (stomach and back), and nails. Breakouts usually happen in about the same place on both sides of your body. For example, both knees or both elbows will have patches of plaques. About 80% of people with psoriasis have the plaque type.

Guttate (GUT-ate) type: Guttate psoriasis is most common in children and young adults. Guttate psoriasis is a moderate level of psoriasis. It usually breaks out after a sore throat infection caused by the streptococcus (strep-toe-KAH-kuss) germ. It may also break out after a cold or chicken pox. Scientists have found that breakouts may happen after you are hurt, are under stress, or after taking certain medicines. Guttate psoriasis looks like separate raised, red, "drops" on your skin. Each drop is about the size of a large pea. This type of psoriasis may heal on its own and never return. It may also come back as plaque-type psoriasis. You may need your tonsils removed if guttate psoriasis breaks out many times.

Inverse type: Inverse psoriasis is usually found in the moist areas of your body. It is a moderate level of psoriasis. You are most likely to have inverse psoriasis in skin folds. They may appear under your breasts, in your armpits, and between the cheeks of your buttocks (rear-end). Another area where inverse psoriasis may show up is your groin. The groin is the place where the inside of your legs and your body meet. Inverse psoriasis patches are dry, red, swollen and painful areas without silvery scales.

Erythrodermic (air-ith-ro-DER-mik) type: Erythrodermic psoriasis is a rare type of psoriasis. Erythrodermic psoriasis usually happens if you already had a lot of breakouts of plaque psoriasis. The plaques get bigger and do not form silvery scales. These plaques replace your normal skin. Your skin helps maintain your body temperature and provides a protective covering for your body. Erythrodermic psoriasis may be dangerous because without enough normal skin coverage your body cannot control its temperature. You may also lose body fluids through the plaques. Germs may enter through the plaques and cause infection. You may need to go into the hospital for treatment.

Pustular (PUS-tew-ler) type: Pustular psoriasis can be either generalized (all over your body) or localized (in just one part of your body). Pustular psoriasis is uncommon but may be very serious.

  • Generalized pustular: With generalized pustular psoriasis, large areas of reddened skin become painful. Pustules or blisters filled with pus may appear on the skin. The "pustules" (blisters) dry up, then come back in cycles lasting several days. Generalized pustular psoriasis may be dangerous because without enough normal skin coverage your body cannot control its temperature. You may also lose body fluids through the plaques. Germs may enter through the plaques and cause infection. You may need to go to the hospital for treatment.
  • Localized pustular: Localized pustular psoriasis usually affects the palms of your hands and the soles or sides of your feet. Sometimes just the fingers and rarely just the toes are affected. Pustular psoriasis is very painful. You may not be able to do the things you used to do. The breakouts may keep you from walking, feeding, and dressing yourself.

Psoriatic (sore-e-AH-tik) arthritis (arth-RI-tis): Some people who have psoriasis also have psoriatic arthritis. Psoriatic arthritis is a disease that makes your joints swollen and painful. The joints most commonly affected are the wrists, knees, ankles, lower back, and neck. Nail changes are found in almost all people with psoriatic arthritis. Many people with psoriasis have nail changes but they may not have psoriatic arthritis.

Wellness Recommendations:

  • Quit smoking. Smoking may increase the risk of psoriasis.
  • Avoid alcohol. Alcohol decreases the effectiveness of psoriasis treatments.
  • Learn to control stress.

Medical Care:

There are many treatments for psoriasis. Steroid creams may be used if you have mild to moderate psoriasis. Phototherapy, which exposes the affected skin to ultraviolet light, can be helpful. In severe psoriasis, chemotherapy medicine may be used.

Dietary Measures:

  • Allergies, including food, may play a role in psoriasis patients. Keep a diary to learn what food or other things in the environment may trigger a breakout.

Herbs and Supplements:

Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.

Herbs:

  • Aloe (Aloe vera) cream may be helpful for psoriasis and has been studied in people.
  • Burdock (Arctium lappa) has been used for many years, but has not been studied in people who have psoriasis.
  • Capsaicin creams (Capsicum frutescens) from the cayenne pepper, applied to the skin over the affected area, can help psoriasis. Initial applications are irritating but after the first couple of weeks the irritation goes away. The hands should be washed after application of the cream, unless the hands are the treated areas, in which case, they should be washed 30 minutes after application..
  • Khella (Ammi visnaga) cream may be helpful for psoriasis and has been studied in people.
  • Oregon grape (Mahonia aquifolium) cream, called Ribisan (R), is helpful for psoriasis and has been studied in people.

Supplements:

  • Fish oil (EPA, DHA) may be helpful for psoriasis and has been studied in people.
  • Vitamin D has been used, but has not been studied in people who have psoriasis.

Complementary Therapies:

  • Acupuncture may help psoriasis.
  • Biofeedback helps psoriasis.
  • Meditation is helpful in the treatment of psoriasis.
  • Salt baths in mineral springs or Dead Sea salts can be helpful for psoriasis.

Other ways of treating your symptoms : Other ways to treat your symptoms are available to you.

Talk to your caregiver if:

  • You would like medicine to treat psoriasis.
  • Your symptoms have not gone away or improved by these self-help measures.
  • You have questions about what you have read in this document.

SEEK CARE IMMEDIATELY IF:

  • You are having a plaque breakout that spreads very quickly.
  • Areas of psoriasis suddenly get bigger, redder, or become painful.
  • You have a sudden breakout of psoriasis after getting sunburned.
  • You get a rash after taking psoriasis medicine and then have a psoriasis breakout.

Care Agreement:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

References:

1. Abdel-Fattah A, Aboul-Enein MN, Wassel G et al: Preliminary report on the therapeutic effect of khellin in psoriasis. Dermatology 1983; 167(2):109-110.

2. Bernstein JE, Parish LC, Rapaport M et al: Effects of topically applied capsaicin on moderate and severe psoriasis vulgaris. J Am Acad Dermatol 1986; 15(3):504-507.

3. Clark AR: The incidence of allergic contact dermatitis in patients with psoriasis vulgaris. Am J Contact Dermat 1998; (2):96-99.

4. Gaston L, Crombez JC, Lassonde M et al: Psychological stress and psoriasis: experimental and prospective correlational studies. Acta Derm Venereol Suppl (Stockh) 1991; 156:37-43.

5. Gieler U, von der Weth A & Heger M: Mahonia aquifolium-a new type of topical treatment for psoriasis. J Dermatol Treat 1995a; 6:31-34.

6. Goodman M: A hypothesis explaining the successful treatment of psoriasis with thermal biofeedback: a case report. Biofeedback Self Regul 1999; 19(4):347-352.

7. Gunther S: Psoriasis vulgaris-sulfur brine therapy in 140 patients. Z Hautkr 1984; 59(18):1238-1243.

8. Kabat-Zinn J, Wheeler E, Light T et al: Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med 1998; 60(5):625-632.

9. Liao SJ & Liao TA: Acupuncture treatment for psoriasis: a retrospective case report. Acupunct Electrother Res 1992; 17(3):195-208.

10. Mayser P, Mrowietz U, Arenberger P et al: Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized, placebo-controlled, multicenter trial. J Am Acad Dermatol 1998; 38:539-547.

11. Monk BE: Alcohol consumption and psoriasis. Dermatologica 1986; 173(2):57-60.

12. Plunkett A: A review of the epidemiology of psoriasis vulgaris in the community. Australas J Dermatol 1998; 39(4):225-232.

13. Syed TA, Ahmad SA, Holt AH et al: Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health 1996; 1(4):505-509.


Last Updated: 11/4/2014

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