Guido R. Zanni, PhD
Left untreated, psoriasis can lead to serious medical complications.
What Is Psoriasis?
Psoriasis is a skin disease that causes scaling and inflammation (pain, swelling, heat, and redness). Skin cells grow deep in the skin and slowly rise to the surface. This process normally takes 23 to 30 days. For individuals with psoriasis, the process happens in just a few days. Fast-rising cells then pile up on the skin’s surface. This causes patches of thick red skin with silvery scales to form. Patches may be itchy or painful. Patches generally occur around the elbows, knees, legs, scalp, lower back, face, palms, and the soles of the feet.1,2
Psoriasis was originally viewed as strictly a skin condition, but we now know that it is an immune system disorder. Our immune system contains white blood cells called T cells. T cells help protect against infection and disease. With psoriasis, T cells are activated by accident. This results in rapid skin cell growth.1
Several types of psoriasis exist, but 80% of cases are plaque psoriasis. The symptoms are raised and thickened patches of red skin covered by silvery white scales.
Another form of psoriasis is guttate psoriasis, which accounts for 10% of cases. Symptoms include small red dots, generally on the trunk, arms, and legs. These dots do not become scaly.3
See Table 1 for more facts about psoriasis.4-9
The National Psoriasis Foundation defines psoriasis severity by the percentage of skin affected. Mild psoriasis affects less than 3% of the skin. Moderate psoriasis affects 3% to 10% of the skin. Severe psoriasis involves more than 10% of the skin. For easy reference, a person’s hand represents approximately 1% of the skin surface. Up to 90% of all psoriasis cases are considered mild.9
The physical and emotional effects of psoriasis are significant—similar to the effects of cancer, heart disease, diabetes, or depression.10
Psoriasis has a negative psychological impact, especially if it involves the hands, feet, genitals, or face. While psoriasis affects men and women equally, women experience a greater negative impact on quality of life.6,9
How Do I Know if I Have Psoriasis?
The symptoms of psoriasis are similar to those of other skin conditions. Symptoms of an allergy, for example, may include small red dots and itching. A dermatologist is the best doctor to diagnose and treat psoriasis.
There is no cure for psoriasis. Treatment focuses on managing symptoms. The goal of treatment is to minimize or eliminate symptoms. While symptoms may go away, they often reappear at a later time. The type of treatment depends on the severity of psoriasis, the type of psoriasis, other medical conditions that the patient has, and how the patient reacted to previous psoriasis medications.10
lists common psoriasis treatments. For mild cases, 1 medication is often sufficient for treatment. A combination of medications is frequently needed for patients with moderate to severe psoriasis.
Coping with Psoriasis
Approximately 60% of people report psoriasis as a problem in everyday life. Many worry about symptoms getting worse or reappearing. Online Table 32,7,9,13-15
lists recommendations for living with psoriasis.
Table 3: Living with Psoriasis
Do not delay treatment because your symptoms are mild. Current symptoms do not predict future symptoms.
Learn as much as possible about psoriasis. This improves your understanding of the disease, triggers, and treatment options. The National Psoriasis Foundation (www.psoriasis.org) has easy-to-understand information. It also offers online support groups, which can help you learn how others have coped with psoriasis.
Psoriasis outbreaks are often triggered by external factors. Keeping a diary can help identify triggers.
Make an appointment with your dermatologist if you develop stiff or sore joints.
Inform your physician if you are pregnant or intend to get pregnant. Up to 25% of pregnant women experience worsening of symptoms. Your doctor may discontinue your medication during your pregnancy.
Take medication as directed to ensure maximum benefit. Never stop taking your medication without your dermatologist’s approval.
If you receive light therapy, your symptoms may worsen before improving. Do not experiment with light therapy (eg, do not go to tanning salons for self-treatment).
As psoriasis begins to heal, skin tends to flake and peel and may feel itchy. When itching is a problem, skin moisturizers may help.
Losing excess body weight may help. Overweight increases the severity of psoriasis and reduces the effectiveness of treatment.
Avoid tobacco products. Smoking plays a role in the onset of psoriasis and future flare-ups. Approximately 77% of nonsmokers experience 1 or more periods without symptoms compared with only 8.7% of smokers.
Limit alcohol. It increases flare-ups and may decrease the effectiveness of treatment.
Follow a healthy lifestyle. Hypertension, a high cholesterol level, and a lack of exercise increase the risk for psoriasis.
Adapted from references 2, 7, 9, 13-15.
Psoriasis is more than a cosmetic issue. Left untreated, it can lead to serious medical complications.
Dr. Zanni is a psychologist and health-system consultant based in Alexandria, Virginia.
What is psoriasis? National Institute of Arthritis and Musculoskeletal and Skin Diseases website. www.niams.nih.gov/Health_Info/Psoriasis/psoriasis_ff.asp. Accessed March 24, 2014.
Meffert J. Psoriasis differential diagnoses. http://emedicine.medscape.com/article/1943419-differential. Accessed March 30, 2014.
What psoriasis looks like. PsoriasisNet website. www.skincarephysicians.com/psoriasisnet/looks_like.html. Accessed March 24, 2014.
Psoriasis statistics. National Psoriasis Foundation website. www.psoriasis.org/learn_statistics. Accessed March 24, 2014.
Belge K, Brück J, Ghoreschi K. Advances in treating psoriasis. F1000 Prime Rep. 2014;6:4.
What is psoriasis? National Institutes of Health website. www.nlm.nih.gov/medlineplus/magazine/issues/fall13/articles/fall13pg24-25.html. Accessed March 24, 2014.
For teens: living with psoriasis. National Psoriasis Foundation website. www.psoriasis.org/teens/about-psoriasis/living-with-psoriasis. Accessed March 24, 2014.
Gelfand JM, Troxel AB, Lewis JD, et al. The risk of mortality in patients with psoriasis: results from a population-based study. Arch Dermatol. 2007;143:1493-1499.
Zanni GR. Psoriasis: issues far more serious than cosmetic. Consult Pharm. 2012;27:86-96.
Dubois Declercq S, Pouliot R. Promising new treatments for psoriasis.ScientificWorldJournal. 2013;2013:980419.
How is psoriasis treated? National Institutes of Health website. www.nlm.nih.gov/medlineplus/magazine/issues/fall13/articles/fall13pg26.html. Accessed March 24, 2014.
Moderate to severe psoriasis: biologic drugs. National Psoriasis Foundation website. www.psoriasis.org/about-psoriasis/treatments/biologics. Accessed March 29, 2014.
Are lifestyle choices affecting your psoriasis? PsoriasisNet website. www.skincarephysicians.com/psoriasisnet/lifestyle_choices.htm. Accessed March 24, 2014.
Psoriasis: tips for managing. American Academy of Dermatology website. http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/m---p/psoriasis/tips. Accessed March 24, 2014.
Zanni G, Wick J. Still a heartbreak: psoriasis, rosacea, and eczema. Pharm Times. 2005;71:80-81.