Introduction
Psoriasis is an autoimmune skin disease affecting approximately 2–4% of the population. Both men and women may develop psoriasis and it may occur at any age. There are five types of psoriasis: plaque (makes up about 90% of cases), guttate, inverse, pustular, and erythrodermic. It is worth noting that psoriasis is a skin disease that may develop psoriatic arthritis. Psoriatic arthritis is an inflammatory, joint damaging condition affecting up to 30% of individuals with psoriasis. Psoriasis is also associated with an increased risk of lymphomas, cardiovascular disease, Crohn’s disease, and depression. It is worth noting that psoriasis is not contagious.
Causes
Psoriasis occurs when the immune system mistakenly identifies normal skin cells as foreign invaders (i.e. pathogens). Antibodies attack the normal skin cells resulting in unintelligible signals causing the skin cells to grow much faster and uncontrollably. The cause of psoriasis is not fully understood, yet there is evidence concluding that it is thought to be a genetic disease that may be triggered by environmental factors. Some environmental factors include: cold weather, medication (specifically NSAID’s and beta-blockers), stress/anxiety, and viral/bacterial infections.
Symptoms
Symptoms will vary depending on the type of psoriasis; for example, pustular psoriasis may appear as raised bumps filled with noninfectious pus. Plaque psoriasis generally presents as red patches with white scales on top. Areas of the body most commonly affected are: the back of the forearms, shins, around the navel, and the scalp. In general, all five types may present as skin patches that are typically red, itchy, and scaly. They may vary in severity from small and localized to complete body coverage. In some forms of psoriasis, the nails may appear whiter or a yellow-reddish discoloration (known as the salmon spot). Also, the nails may at times bleed due to hemorrhaging from the capillaries in the nail beds. Injury to the skin can trigger localized psoriatic skin changes, which is known as the Koebner phenomenon. As mentioned above, psoriatic arthritis is a form of chronic inflammatory arthritis that has a highly variable clinical presentation and frequently occurs in association with skin and nail psoriasis.
Diagnosis
We will begin by asking for your complete medical history; for example, whether you are on any medications, recent injuries or illnesses, mental health, and any family members with psoriasis. Next, we may complete a physical examination assessing your skin, nails, and scalp for sign of psoriasis. In some cases, we may order a skin biopsy where a portion of the skin is removed and sent to the laboratory to confirm whether psoriasis is present.
Treatment
There is no cure for psoriasis; however, various treatments can help manage psoriasis’ symptoms. Treatments include: steroid creams, vitamin D3 creams, ultraviolet light, and disease-modifying antirheumatic drugs (DMARD’s) such as methotrexate. About 75% of cases can be managed with creams alone.