Items Tagged With Psoriasis

Surgery is not used to treat psoriasis on the skin or scalp. However, surgery may be used to treat severely disfigured or damaged nails from psoriasis. Surgical removal of a nail may be done in a clinic or doctor's office as an outpatient procedure.

Psoriasis  Psoriasis Surgery 

The classic symptoms of psoriasis are raised, red patches of skin topped with loose, silvery scales, usually on the knees or elbows.

There are several types of psoriasis. Symptoms for each type may vary in severity and appear in a wide array of combinations. In general, the major symptoms of psoriasis include:

• Bright red areas of raised patches (plaques) on the skin, often covered with loose, silvery scales. Plaques can occur anywhere, but commonly they occur on the knees, elbows, scalp, hands, feet, or lower back. Nearly 90% of people with psoriasis have plaque-type psoriasis.¹
• Tiny areas of bleeding when skin scales are picked or scraped off (Auspitz's sign).
• Mild scaling to thick, crusted plaques on the scalp.
• Itching, especially during sudden flare-ups or when the psoriasis patches are in body folds, such as under the breasts or the buttocks.
• Nail disorders. Nail disorders are common, especially in severe psoriasis. Nail symptoms include:
  • Tiny pits in the nails (not found with fungal nail infections).
  • Yellowish discoloration of the toenails and possibly the fingernails.
  • Separation of the end of the nail from the nail bed.
  • Less often, a buildup of skin debris under the nails.

Other symptoms of psoriasis may include:

• Symmetrical plaques on the same areas on both sides of the body (for example, both knees or both elbows).
• Flare-ups of many raindrop-shaped patches. Called guttate psoriasis, this condition often follows a strep infection and is the second most common type of psoriasis. It affects less than 10% of those with psoriasis.¹
• Joint swelling, tenderness, and pain (psoriatic arthritis).These symptoms may occur in up to 39% of people with psoriasis.²

Koebner's phenomenon can occur when a person with psoriasis has an injury (such as a cut, burn, or excess sun exposure) to an area of the skin that is not affected by psoriasis. Psoriasis patches then appear on the injured skin or any other part of the skin from several days to about 2 weeks after the injury. Because this response is common, it is important for people who have psoriasis to avoid irritating or injuring their skin.

Several other skin conditions have symptoms similar to psoriasis. Some medication reactions can cause symptoms (such as reddened skin) similar to psoriasis. Talk to your doctor about any medications you are taking.

Psoriasis  Psoriasis Symptoms 

What is psoriasis?

Psoriasis (say "suh-RY-uh-sus") is a long-term (chronic) skin problem that causes skin cells to grow too quickly, resulting in thick, white, silvery, or red patches of skin. Normally, skin cells grow gradually and flake off about every 4 weeks. New skin cells grow to replace the outer layers of the skin as they shed. But in psoriasis, new skin cells move rapidly to the surface of the skin in days rather than weeks. They build up and form thick patches called plaques (say "plax").

The patches range in size from small to large. They most often appear on the knees, elbows, scalp, hands, feet, or lower back. Psoriasis is most common in adults, but children and teens can get it too.

Having psoriasis can be embarrassing, and many people, especially teens, avoid swimming and other situations where patches can show. But there are many types of treatment that can help keep psoriasis under control.

See a picture of psoriasis.

What causes psoriasis?

Experts believe that psoriasis occurs when the immune system overreacts, causing inflammation and flaking of skin.

In some cases, psoriasis runs in families. Researchers are studying large families affected by psoriasis to find out how it is passed from parents to their children and what might trigger the condition.

People with psoriasis often notice times when their skin gets worse. Things that can cause these flare-ups include a cold and dry climate, infections, stress, and dry skin. Also, certain medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and medicines used to treat high blood pressure or depression, may trigger an outbreak or make your psoriasis worse.

Smoking, especially in women, makes you more likely to get psoriasis and can make it worse if you already have it.

Psoriasis is not contagious. It cannot be passed from person to person.

What are the symptoms?

Symptoms of psoriasis appear in different ways. Psoriasis can be mild, with small areas of rash. When psoriasis is moderate or severe, the skin gets inflamed with raised red areas topped with loose, silvery, scaling skin. If psoriasis is severe, the skin becomes itchy and tender, and the large skin patches may be uncomfortable and embarrassing. The patches can join together and cover large areas of skin, such as the entire back.

In some people, psoriasis causes joints to become swollen, tender, and painful. This is called psoriatic arthritis (say "sor-ee-AT-ik ar-THRY-tus"). This arthritis can also affect the fingernails and toenails, causing the nails to pit, change color, and separate from the nail bed. Dead skin may build up under the nails.

Symptoms often disappear (go into remission), even without treatment, and then return (flare up).

How is psoriasis diagnosed?

A doctor can usually diagnose psoriasis by looking at the patches on your skin, scalp, or nails. Sometimes a skin KOH test is used to rule out a fungal infection, but otherwise, special tests are usually not needed.

How is it treated?

How is psoriasis diagnosed?  Psoriasis  Psoriasis Symptoms  What causes psoriasis?  What is psoriasis? 

Currently there is no cure for psoriasis. However, many types of treatment are available, including products applied to the skin, phototherapy, and oral medications, that can keep psoriasis under control. Most cases are mild and can be treated with skin products. In some cases, psoriasis can be hard to treat if it is severe and widespread. Most psoriasis returns, even mild forms.

The purpose of treatment is to slow the rapid growth of skin cells that causes psoriasis and to reduce inflammation. Treatment is based on the type of psoriasis you have, its location, its severity, and your age and overall health. It also depends on how much you are affected by the condition, either physically (because of factors such as joint pain) or emotionally (because of embarrassment or frustration from a skin rash that may cover a large or visible area of the body).

Initial treatment

Treatment for mild psoriasis, characterized by a few isolated raised patches, begins with skin care, which includes keeping your skin moist and lubricated. Basic treatment approaches often involve combinations of therapies and products that can usually be purchased without a prescription, including:

• Creams, ointments, and lotions, to lubricate the skin.
• Shampoos, oils, and sprays, to treat psoriasis of the scalp.
• Ointments, to treat psoriasis of the nails.
• Some exposure to sunlight.

It is also important to eliminate factors that can trigger a flare-up of psoriasis or make the condition worse. Stress, skin injury, infection, and use of alcohol can all contribute to symptom flare-ups. Streptococcal infections, which usually affect the upper respiratory tract, are associated with guttate psoriasis.

Effective treatment will address the impact the condition has on overall well-being as well as the physical symptoms.

Ongoing treatment

Creams and ointments may be used in combination with sunlight or ultraviolet light (phototherapy) for moderate psoriasis that affects less than 20% of the skin surface (about equal to having both arms completely covered). However, creams, ointments, lotions, and topical (applied to the skin) medications work better for some people than for others. If one topical treatment does not clear up your psoriasis, your doctor will likely recommend that you try different combinations of treatments.

If you use phototherapy (brief exposures to ultraviolet light such as ultraviolet light B, also known as UVB), follow your doctor's instructions carefully to avoid serious skin damage.

• Exposure to UVB light can often improve psoriasis. UVB treatment, commonly done 3 times per week, combined with topical therapy, such as tar or calcipotriene, is well tolerated and has been shown to be effective.^{5, 6}
• Psoralen and UVA light therapy (PUVA) combines medication and treatment with ultraviolet A light. A photosensitizer such as methoxsalen is taken, either orally or by soaking in a tub containing the medication, before exposure to UVA in a walk-in chamber. Treatments are generally done 2 or 3 times per week, with clearing of symptoms occurring in most people after 19 to 25 treatments.⁷

Psoriasis  Psoriasis Treatment 

Psoriasis is usually long-lasting, returns often (chronic), and can be unpredictable. Symptoms may come on suddenly (flare) and then improve and go away (remission). This cycle continues over and over. In some cases, psoriasis may go away without treatment. However, in moderate to severe cases, it is best to treat psoriasis so that it does not get worse.

Several factors can make the condition worse, depending on the type of psoriasis. These factors include cold, dry climates; stress; infection; skin injury; and certain medications.

The severity of psoriasis is indicated by the amount of redness and scaling, the thickness of the large areas of raised skin patches (plaques), and the percentage of your skin that is affected.

Mild psoriasis causes plaques that cover a small portion of the body, such as the elbows or knees.

Moderate psoriasis causes:

• Several large areas of plaque. For example, most of the scalp may be affected.
• Plaques that may cover up to 20% of the skin (about equal to having both arms completely covered).
• Mild joint pain that is not disabling.
• Concern about plaques being visible to other people.

Severe psoriasis includes:

• Plaques that may cover large areas (20% to 30%) of the body. When determining the percent of coverage, consider that the palm of your hand equals about 1% of your body surface, and the total surface of both arms equals about 20%.
• Psoriasis on the face.
• Pustular psoriasis with large, fluid-filled plaque and severe scaling, or erythrodermic psoriasis with severe inflammation and shedding (sloughing) of the skin.
• Psoriatic arthritis, which includes ongoing joint swelling, tenderness, limitation of range of motion, or joint warmth or redness. Severe cases can result in joint destruction.

Psoriasis may persist for long periods of time without getting better or worse.

Psoriasis can cause significant stress and lowered self-esteem. In one study, people with psoriasis reported a reduction in functioning similar to that of people with cancer, arthritis, heart disease, depression, and other serious conditions.³Psoriasis day care centers can provide specialized treatment and emotional support. For more information on available resources, see the Other Places to Get Help section of this topic.

Moderate psoriasis causes  Psoriasis  Severe Psoriasis