Everything You Need to Know About Psoriasis

Psoriasis is a chronic autoimmune condition that affects millions worldwide, causing red, scaly patches of skin. Though not contagious, it’s often misunderstood, leading to stigma and misconceptions.

This guide covers the essentials of psoriasis, including its types, triggers, treatments, and lifestyle tips to help manage symptoms and improve quality of life. Whether living with psoriasis or seeking to learn more, this article offers valuable insights.

What is Psoriasis?

Psoriasis is a chronic autoimmune condition that accelerates the production of skin cells, leading to their rapid buildup on the skin's surface. This results in scaly patches, inflammation, and redness. The scales, often whitish-silver, typically form over thick, red patches of skin that may crack and bleed.

Usually, skin cells grow deep within the skin, gradually move to the surface, and shed over about a month. However, in individuals with psoriasis, this process happens in just a few days, causing skin cells to accumulate instead of shedding naturally. This overproduction leads to the buildup of thick scales.

Common Symptoms and Affected Areas

Psoriasis scales most commonly appear on the joints, such as the elbows and knees, but they can develop anywhere on the body, including:

• Hands
• Feet
• Neck
• Scalp
• Face

Less common types of psoriasis may also affect the nails, mouth, or areas around the genitals.

Prevalence and Associated Conditions

Approximately 7.4 million Americans are affected by psoriasis. Beyond the skin, it is often linked to other health conditions, including:

• Type 2 diabetes
• Inflammatory bowel disease
• Heart disease
• Psoriatic arthritis
• Anxiety and depression

Psoriasis is a complex condition with physical and emotional impacts, requiring comprehensive management to address its symptoms and associated health risks.

What Are the Different Types of Psoriasis?

Psoriasis has five primary types:

1. Plaque Psoriasis
   This is the most common form, affecting about 80% of people with psoriasis, according to the American Academy of Dermatology (AAD). It causes red, inflamed patches of skin covered with whitish-silver scales, often found on the elbows, knees, and scalp.
2. Guttate Psoriasis
   Common in childhood, guttate psoriasis presents as small pink spots, typically on the torso, arms, and legs. Unlike plaque psoriasis, these spots are not thick or raised.
3. Pustular Psoriasis
   Pustular psoriasis, more prevalent in adults, is characterized by white, pus-filled blisters surrounded by red, inflamed skin. It often affects localized areas like the hands and feet but can sometimes spread more widely.
4. Inverse Psoriasis
   This type causes bright red, shiny patches of inflamed skin. It typically develops in skinfolds, such as under the armpits, breasts, or around the groin and genitals.
5. Erythrodermic Psoriasis
   The rarest and most severe form covers large portions of the body with red, sunburn-like skin that sheds in large sheets. This type can cause fever or illness and requires immediate medical attention.

What Are the Symptoms?

Psoriasis symptoms vary depending on the type and severity. For plaque psoriasis, the most common symptoms include:

• Raised, inflamed patches that appear red on light skin and purple or brown on dark skin.
• Whitish-silver or gray scales over these patches.
• Dry, cracked skin that may bleed.
• Itching, burning, or soreness around the patches.
• Thick, pitted nails.
• Painful, swollen joints.

Symptoms often occur in cycles, with flare-ups followed by periods of remission where the condition is symptom-free.

Is Psoriasis Contagious?

Psoriasis is not contagious. Touching a psoriatic lesion will not transmit the condition to another person. Dispelling misconceptions is crucial for a better understanding of the disease.

What Causes Psoriasis?

While the exact cause is unknown, two primary factors contribute to psoriasis:

• Genetics: Psoriasis can run in families.
• Immune System: It’s an autoimmune condition where the immune system mistakenly attacks healthy skin cells, triggering rapid cell buildup and inflammation.

Ongoing research continues to deepen understanding of this complex condition.

Immune System and Psoriasis

Psoriasis is an autoimmune condition in which the body’s immune system mistakenly attacks its healthy tissues. In psoriasis, white blood cells, known as T cells, target skin cells as though they were harmful invaders, such as bacteria or viruses. This immune response triggers an overproduction of new skin cells. Usually, skin cells develop gradually and shed over weeks. In psoriasis, the sped-up production pushes immature skin cells to the surface too quickly, accumulating and forming the scaly plaques characteristic of the condition. These attacks also cause inflammation, leading to red, irritated patches of skin.

Genetics and Psoriasis

Psoriasis can run in families, but having a genetic predisposition doesn’t guarantee someone will develop the condition. According to the National Psoriasis Foundation (NPF), only 2 to 3 percent of people with the gene develop psoriasis. If an immediate family member has psoriasis, your risk is higher, but other factors typically trigger the condition.

Diagnosing Psoriasis

Diagnosing psoriasis usually involves one or two straightforward steps:

1. Physical Examination:
   Doctors can often diagnose psoriasis during a physical exam by observing the appearance of the skin. The symptoms of psoriasis are usually distinctive and easy to identify. Sharing details about family history or specific areas of concern with your doctor can also aid in diagnosis.
2. Biopsy:
   If the diagnosis isn’t precise, a doctor may perform a biopsy. This involves taking a small skin sample and sending it to a lab for microscopic examination. The biopsy can confirm the type of psoriasis and rule out other conditions. The procedure is typically done in a doctor’s office under local anesthesia.

Psoriasis Triggers: Stress, Alcohol, and More

External triggers can cause psoriasis flare-ups, which can vary widely between individuals. Common triggers include stress, alcohol consumption, and other environmental or lifestyle factors. Triggers may change over time, making monitoring patterns essential and identifying personal factors that exacerbate the condition.

Understanding the immune system, genetic predispositions, and external triggers can help individuals manage psoriasis more effectively and seek appropriate treatments.

Common Triggers for Psoriasis

Psoriasis flare-ups are often triggered by specific factors, which vary from person to person. Recognizing and avoiding these triggers can help manage the condition.

1. Stress
   High levels of stress can provoke psoriasis flare-ups. Learning to manage stress through relaxation techniques or therapy may reduce the frequency and severity of outbreaks.
2. Alcohol
   Heavy alcohol consumption can worsen psoriasis symptoms and trigger more frequent outbreaks. Reducing or eliminating alcohol intake is beneficial for managing psoriasis and overall health. If quitting is challenging, a doctor can provide support and resources.
3. Injury
   Physical trauma, such as cuts, scrapes, or even vaccinations, can trigger new psoriasis patches. Sunburns and accidents are also common culprits.
4. Medications
   Certain drugs may act as psoriasis triggers, including:
   • Lithium
   • Antimalarial medications
   • High blood pressure medications
5. Infection
   Infections like strep throat can overstimulate the immune system, leading to flare-ups. Since psoriasis is partly caused by immune system dysfunction, infections can exacerbate the condition.

Treatment Options for Psoriasis

While there is no cure for psoriasis, treatments aim to reduce inflammation, slow down the rapid growth of skin cells, and manage symptoms. Treatment approaches fall into three primary categories:

Topical Treatments

Creams and ointments applied directly to the skin are effective for mild to moderate psoriasis. Common topical treatments include:

• Corticosteroids
• Retinoids
• Anthralin
• Vitamin D analogues
• Salicylic acid
• Moisturizers

Systemic Medication

Doctors may prescribe oral or injectable medications for moderate to severe cases or when topical treatments aren’t effective. These treatments, often used for short periods due to potential side effects, include:

• Methotrexate
• Cyclosporine
• Biologics
• Retinoids

Light Therapy

Light therapy uses ultraviolet (UV) or natural sunlight to slow rapid cell growth by targeting the overactive white blood cells causing inflammation. Both UVA and UVB light can help manage mild to moderate symptoms.

Combination and Long-Term Treatment

Many individuals with moderate to severe psoriasis benefit from a combination of therapies, using multiple treatment methods to manage symptoms. Some people may use the same treatment for years, while others may need to switch approaches if their current treatment becomes less effective. Managing psoriasis often requires an ongoing, adaptable approach tailored to individual triggers and responses to treatment.

Medications for Psoriasis

When psoriasis becomes moderate to severe or stops responding to topical treatments and light therapy, doctors may recommend oral or injectable medications. These treatments are designed to suppress the immune system or regulate cell growth, though they often have significant side effects.

Biologics

Biologics target specific parts of the immune system to block interactions that lead to inflammation and psoriasis symptoms. These medications are administered via injection or intravenous (IV) infusion. They are effective for many people but require monitoring due to their impact on the immune system.

Retinoids

Retinoids work by reducing the production of skin cells. While effective during use, symptoms often return after discontinuing treatment. Side effects include hair loss and lip inflammation. Retinoids are not safe for individuals who are pregnant or planning to conceive within three years of treatment, as they carry a high risk of congenital disabilities.

Cyclosporine (Sandimmune)

Cyclosporine suppresses the immune system, easing psoriasis symptoms. However, it weakens the immune system, increasing the risk of illness. Long-term side effects include kidney problems and high blood pressure, so careful monitoring is essential.

Methotrexate

Methotrexate also suppresses the immune system and may have fewer side effects in low doses. However, long-term use can cause serious complications, including liver damage and reduced production of red and white blood cells, requiring regular blood tests and monitoring.

Diet Recommendations for Psoriasis

While diet alone cannot cure psoriasis, making healthier choices may reduce symptoms and flare-ups. These lifestyle changes can help:

1. Lose Weight
   If you’re overweight, losing weight can reduce psoriasis severity and improve the effectiveness of treatments. Even if psoriasis symptoms don’t improve, weight loss benefits overall health.
2. Eat a Heart-Healthy Diet
   Reduce saturated fats found in animal products like meat and dairy. Instead, opt for lean proteins rich in omega-3 fatty acids, such as salmon, sardines, and walnuts. Adding whole grains, fruits, and vegetables to your meals supports overall well-being.
3. Avoid Trigger Foods
   Certain foods can cause inflammation and potentially worsen psoriasis. Common triggers include red meat, refined sugar, processed foods, and dairy. Some people also find nightshade vegetables, like tomatoes, eggplants, and peppers, can exacerbate symptoms.
4. Reduce Alcohol Consumption
   Alcohol is linked to psoriasis flare-ups. Limiting or avoiding alcohol may help reduce symptoms and prevent frequent outbreaks. If quitting is difficult, consult a healthcare professional for support.
5. Consider Vitamins
   A nutrient-rich diet is preferable, but supplementation may be necessary if you’re not getting enough vitamins from food. Speak to your doctor about whether supplements could benefit your condition.

Living With Psoriasis

Managing psoriasis goes beyond diet. Addressing emotional health and stress and recognizing potential comorbidities can improve quality of life.

Stress Management

Stress is a known trigger for psoriasis. To manage stress and reduce flare-ups, incorporate activities like meditation, yoga, journaling, and deep breathing exercises.

Emotional Well-Being

Psoriasis can lead to depression, self-esteem challenges, and frustration from its chronic nature. Talking with a mental health professional or joining a support group can help navigate these feelings and foster community.

Psoriasis and Arthritis

About 30–33% of people with psoriasis develop psoriatic arthritis, a condition causing joint pain and swelling. It commonly affects the fingers, toes, lower back, wrists, knees, or ankles. While it may come and go like psoriasis, continuous symptoms are also possible. Early diagnosis and treatment can prevent severe complications, such as joint damage.

Key Statistics About Psoriasis

• Approximately 7.4 million people in the United States have psoriasis.
• Psoriasis can develop at any age, but most diagnoses occur between 15 and 35.
• Around one-third of individuals with psoriasis will develop psoriatic arthritis.
• Psoriasis is equally common in males and females, though it disproportionately affects white individuals.
• Psoriasis is associated with a higher risk of conditions such as type 2 diabetes, heart disease, kidney disease, and high blood pressure.

The incidence of psoriasis may be increasing, though it’s unclear whether this is due to rising cases or improved diagnosis rates.

Psoriasis is a complex condition that affects more than just the skin – it impacts overall well-being and quality of life. While there’s no cure, understanding its triggers, treatment options, and lifestyle adjustments can make a significant difference in managing symptoms. With the right approach and support, it’s possible to live a healthy and fulfilling life with psoriasis.