Medical Dermatology

Psoriasis

Psoriasis occurs when your body produces new skin cells more quickly than normal. The cells then pile up and create thick, scaly, silvery coated patches. There are several types of psoriasis. The most common being plaque psoriasis, which affects about 80-90% of patients with psoriasis. Plaque psoriasis is most commonly found on the elbows, knees, lower back, and scalp. It can appear red and flaky, and will sometimes itch and feel tight or painful. Though this can be a lifelong issue, there are ways to keep it controlled:

  • Learning and avoiding triggers (such as stress, cold dry weather, skin injury, infection, tobacco, and heavy drinking).
  • Good skin care routine and healthy lifestyle
  • Use prescribed medication when necessary

Other types of psoriasis include:

  • Guttate psoriasis: It is usually temporary and more common in children. It is often associated with a recent infection, and may never return following treatment. Guttate psoriasis often appears suddenly as small pink scaly bumps on the skin.
  • Inverse psoriasis:This type mostly occurs in areas where there is skin to skin contact (armpits, genitals, crease of buttocks).Guttate psoriasis has a red, raw looking and smooth appearance; the silvery-white coating seen in other forms of psoriasis is not seen with this type.
  • Pustular psoriasis: Regular plaque psoriasis findings are accompanied by pus filled bumps (typically on hands and feet) that look infected, but actually are not. Because these bumps are extremely painful, normal activities like walking or typing may become unbearable.
  • Erythrodermic psoriasis: This type of psoriasis is very serious and may be life threatening. A person with this type of psoriasis has large red areas covering almost the entire body.  Fevers, chills, muscle soreness, itch, and severe malaise may accompany this type of psoriasis.
  • Nail psoriasis: Patients with psoriasis may also develop abnormal nail findings such as:
    • Discoloration under nails (white, yellow, or brown)
    • “Nail pits” or dents in your nails
    • Crumbling or rough nails
    • Nail lifting so as it is no longer attached, often caused by buildup of cells
  • Psoriatic arthritis: Some forms of psoriasis are accompanied by joint pain. This may lead to joint swelling and redness. Joints in the fingers and toes are most commonly affected, but it may also impact the wrists, knees, ankles, and lower back. Although it cannot be cured, psoriatic arthritis can be treated, which can prevent progressive permanent joint damage.

There are various ways different types of psoriasis can be treated. Mild skin disease often responds to topical steroid creams or vitamin D derivative creams. More advanced psoriasis is usually treated with a systemic medication (pill or injection) targeting different parts of the immune system that may be overactive. Phototherapy is another frequently effective therapeutic modality.

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