Types of Psoriasis: Medical Pictures and Treatments

Psoriasis is an autoimmune disorder in which your skin cells rapidly reproduce, creating raised, red and scaly patches of skin. It is not contagious. It most commonly affects the skin on your elbows, knees, and scalp, though it can appear anywhere on your body.

Anyone can have psoriasis. More than 8 million Americans are affected, and it occurs equally in men and women. Psoriasis can occur at any age but is most often diagnosed between the ages of 15 and 25. It is more frequent in white people.

Psoriasis is a non-curable, chronic skin condition, and there will be periods when the condition will improve, and other times it will worsen. The symptoms can range from mild, small, faint dry skin patches where a person may not suspect they have a skin condition to severe psoriasis where a person's entire body may be nearly covered with thick, red, scaly skin plaques.

The cause of psoriasis is unknown, but several risk factors have been identified. There seems to be a genetic predisposition to inheriting the illness, as psoriasis is often found in family members. Environmental factors may play a part in conjunction with the immune system. What causes certain people to develop an outbreak of psoriasis? The triggers vary from person to person, and may include:

• Stress
• Illness
• Weather
• Skin Injury

Psoriasis usually appears as red or pink plaques of raised, thick, scaly skin. However, it can also appear as small, flat bumps or large, thick plaques. It most commonly affects the skin on the elbows, knees, and scalp, though it can appear anywhere on the body. The following slides will review some of the different types of psoriasis.

The most common form of psoriasis that affects about 80% of all sufferers is psoriasis vulgaris ("vulgaris" means common). It is also referred to as plaque psoriasis because of the well-defined areas of raised red skin that characterize this form. These raised red plaques have a flaky, silver-white buildup on top called scale, made up of dead skin cells. The scale loosens and sheds frequently.

Psoriasis that causes small, salmon-pink colored drops on the skin is guttate psoriasis, which affects about 10% of people with psoriasis. There is usually a fine silver-white buildup (scale) on the drop-like lesion that is finer than the scale in plaque psoriasis. This type of psoriasis if commonly triggered by a streptococcal (bacterial) infection. About two to three weeks following a bout of strep throat, a person's lesions may erupt. This outbreak can go away and may never recur.

Inverse psoriasis (also called "intertriginous psoriasis") affects about 20% to 30% of people with psoriasis. Inverse psoriasis appears as very red lesions in body skin folds, most commonly under the breasts, in the armpits, near the genitals, under the buttocks, or in abdominal folds. Sweat and skin rubbing together irritate these inflamed areas.

Pustular psoriasis consists of well-defined, white pustules on the skin. These are filled with pus that is non-infectious. The skin around the bumps is reddish, and large portions of the skin may redden as well. It can cycle from redness of the skin to pustules and scaling.

Erythrodermic psoriasis is a rare type of psoriasis that is extremely inflammatory and can affect most of the body's surface causing the skin to become bright red. It appears as a red, peeling rash that often itches or burns.

Psoriasis commonly occurs on the scalp, which may cause fine, scaly skin or heavily crusted plaque areas. This plaque may flake or peel off in clumps. Scalp psoriasis may resemble seborrheic dermatitis, but in that condition the scales are greasy.

Psoriatic arthritis is a type of arthritis (inflammation of the joints) accompanied by inflammation of the skin (psoriasis). Psoriatic arthritis is an autoimmune disorder in which the body's defenses attack the joints of the body, causing inflammation and pain. Psoriatic arthritis usually develops about 5 to 12 years after psoriasis begins. About 30% of people with psoriasis will develop psoriatic arthritis.

In some cases, psoriasis may involve only the fingernails and toenails, although more commonly, nail symptoms will accompany psoriasis and arthritis symptoms. The appearance of the nails may be altered, and affected nails may have small pinpoint pits or large yellow-colored separations on the nail plate called "oil spots." Nail psoriasis can be hard to treat but may respond to medications taken for psoriasis or psoriatic arthritis. Treatments include topical steroids applied to the cuticle, steroid injections at the cuticle, or oral medications.

Right now, there is no cure for psoriasis. The disease can go into remission periods when there are no symptoms or signs present. Current research is underway to find better treatments and a possible cure.

Psoriasis is not contagious even with skin-to-skin contact. You cannot catch it from touching someone who has it, nor can you pass it on to anyone else if you have it.

Psoriasis can be passed on from parents to children, as there is a genetic component to the disease. Psoriasis tends to run in families, and often this family history is helpful in making a diagnosis.

There are several types of doctors who may treat psoriasis. Dermatologists specialize in the diagnosis and treatment of skin disorders, including psoriasis. Rheumatologists specialize in the treatment of joint disorders, including psoriatic arthritis. Family physicians, internal medicine physicians, rheumatologists, dermatologists, and other medical doctors may all be involved in the care and treatment of patients with psoriasis.

There are some home remedies that may help minimize outbreaks or reduce symptoms of psoriasis:

• Exposure to sunlight.
• Apply moisturizers after bathing to keep skin soft.
• Avoid irritating cosmetics or soaps.
• Do not scratch to the point you cause bleeding or excessive irritation.
• Over-the-counter cortisone creams can reduce itching of mild psoriasis.

A dermatologist may prescribe an ultraviolet B unit and instruct the patient on home use.

The first line of treatment for psoriasis includes topical medications applied to your skin. The main topical treatments are corticosteroids (cortisone creams, gels, liquids, sprays, or ointments), vitamin D-3 derivatives, coal tar, anthralin, and retinoids. These drugs may lose potency over time, so often they are rotated or combined. Ask your doctor before combining medications, as some drugs should not be combined.

Ultraviolet (UV) light from the sun slows the production of skin cells and reduces inflammation and can help reduce psoriasis symptoms in some people, and artificial light therapy may be used for other people. Sunlamps and tanning booths are not proper substitutes for medical light sources. There are two main forms of light therapy:

• Ultraviolet B (UV-B) light therapy is usually combined with topical treatments and is effective for treating moderate-to-severe plaque psoriasis. There is a risk of skin cancer, just as there is from natural sunlight.
• PUVA therapy combines an orally administered psoralen drug that makes the skin more sensitive to light and the sun, with ultraviolet A (UV-A) light therapy. With this therapy, 85% of patients report relief of disease symptoms with 20-30 treatments. Therapy is usually given 2-3 times per week on an outpatient basis, with maintenance treatments every 2-4 weeks until remission. Nausea, itching, and burning are side effects. Complications include sensitivity to the sun, sunburn, skin cancer, and cataracts.

If topical treatment and phototherapy have been tried and have failed, medical treatment for psoriasis includes systemic drugs taken either orally or by injection. Drugs include:

• Methotrexate
• adalimumab (Humira)
• ustekinumab (Stelara)
• secukinumab (Cosentyx)
• ixekizumab (Taltz)
• infliximab (Remicade)

These psoriasis drugs block inflammation to help slow skin cell growth. Systemic drugs may be recommended for people who have psoriasis that is disabling in any physical, psychological, social, or economic way.

The prognosis for patients with psoriasis is good. Though the condition is chronic and is not curable, it can be controlled effectively in many cases. Studies on future treatments look promising, and research to find ways to battle psoriasis is ongoing.