Psoriasis Treatment: Symptoms, Causes, and Management Guide

Introduction

Psoriasis is a chronic skin condition that has been recognized for thousands of years, with descriptions dating back to ancient Greece. It is characterized by red, scaly patches that can appear on various parts of the body. While psoriasis is not contagious, it can significantly impact a person’s quality of life due to its visible symptoms and discomfort. Over the years, research has led to more effective treatments and improved management strategies. This article provides a comprehensive overview of psoriasis, including its risk factors, symptoms, diagnostic tests, treatment options, and home care strategies. Whether you have recently been diagnosed or are seeking more information, this guide will help you understand the condition and how to manage it effectively.

What is Psoriasis?

Psoriasis is a chronic autoimmune condition that primarily affects the skin. This article will explore its risk factors, symptoms, diagnostic tests, medications, procedures, and home care strategies to help manage the condition.

Description of Psoriasis

Psoriasis is a long-term autoimmune disease that causes the rapid buildup of skin cells, leading to scaling on the skin’s surface. In a healthy body, skin cells grow and shed over the course of a month. However, in psoriasis, this process accelerates, causing cells to accumulate in just a few days. This results in thick, red patches covered with silvery scales, which can be itchy, painful, or even crack and bleed. Psoriasis can affect any part of the body but is most commonly found on the scalp, elbows, knees, and lower back.

The progression of psoriasis varies from person to person. Some may experience mild symptoms with only a few small patches, while others may have more severe cases where large areas of the body are affected. Psoriasis can also go through cycles, with flare-ups followed by periods of remission where symptoms improve or disappear entirely.

According to the National Psoriasis Foundation, more than 8 million people in the United States are affected by psoriasis, making it one of the most common autoimmune diseases. Globally, the prevalence is estimated to be around 2-3% of the population. While psoriasis can develop at any age, it most commonly appears between the ages of 15 and 35. It affects men and women equally and can occur in people of all ethnic backgrounds.

Risk Factors for Developing Psoriasis

Lifestyle Risk Factors

Certain lifestyle choices can increase the likelihood of developing psoriasis or trigger flare-ups in those who already have the condition. Smoking is one of the most significant lifestyle risk factors, as it can increase the risk of developing psoriasis and worsen existing symptoms. Excessive alcohol consumption has also been linked to more severe psoriasis symptoms and can interfere with treatment effectiveness.

Obesity is another contributing factor, as it can lead to increased inflammation in the body, which may trigger or exacerbate psoriasis. Maintaining a healthy weight through diet and exercise can help reduce symptom severity. Stress is also a major trigger for psoriasis flare-ups. High stress levels can weaken the immune system, making symptoms more likely to worsen.

Medical Risk Factors

Several medical conditions are associated with an increased risk of developing psoriasis. Individuals with autoimmune diseases, such as rheumatoid arthritis or Crohn’s disease, are more likely to develop psoriasis due to shared immune system dysfunction. Additionally, people with metabolic syndrome, which includes conditions like high blood pressure, high cholesterol, and insulin resistance, are at a higher risk of developing psoriasis.

Infections, particularly streptococcal throat infections, have been known to trigger psoriasis in some individuals. This is especially true for a type of psoriasis called guttate psoriasis, which often appears after a strep throat infection. Certain medications, such as beta-blockers (used for high blood pressure) and lithium (used to treat bipolar disorder), can also trigger or worsen psoriasis symptoms.

Genetic and Age-Related Risk Factors

Psoriasis has a strong genetic component, meaning that if you have a family member with the condition, you are more likely to develop it yourself. Studies suggest that about one-third of people with psoriasis have a close relative who also has the condition. Specific genes, such as those involved in immune system regulation, have been linked to psoriasis.

Age can also play a role in the development of psoriasis. While it can occur at any age, psoriasis most commonly develops in early adulthood or later in life, particularly between the ages of 50 and 60. However, psoriasis can develop in children, although this is less common.

Psoriasis Symptoms and Clinical Manifestations

Red Patches of Skin

Red patches of skin, also known as erythematous plaques, are one of the most common symptoms of psoriasis, affecting approximately 90% of patients. These patches occur due to the rapid turnover of skin cells, leading to inflammation and the buildup of skin layers. The red color is caused by increased blood flow to the affected areas as the body attempts to heal the skin. These patches often appear on the scalp, elbows, knees, and lower back but can occur anywhere on the body. In early stages, the patches may be smaller and less noticeable, but as the disease progresses, they can become larger and more widespread.

Silvery Scales

Silvery scales, which cover the red patches, are another hallmark of psoriasis and occur in about 85% of patients. These scales are composed of dead skin cells that accumulate on the surface of the skin due to the accelerated skin cell production. Normally, skin cells take about a month to regenerate, but in psoriasis, this process is shortened to just a few days. As a result, the dead cells pile up, forming thick, silvery-white scales. These scales are most commonly seen in plaque psoriasis, the most prevalent form of the disease. They can be itchy and uncomfortable, and in severe cases, they may crack and bleed.

Dry Skin

Dry skin is a frequent issue for individuals with psoriasis, affecting roughly 70% of patients. The rapid turnover of skin cells can lead to areas of skin that are unable to retain moisture properly. This dryness can exacerbate the discomfort associated with psoriasis, leading to cracking and bleeding in more severe cases. Moisturizing regularly is crucial for patients to help manage this symptom. Dry skin is more common in colder climates or during the winter months when the air is less humid, which can worsen the condition.

Itching

Itching, or pruritus, affects about 80% of psoriasis patients. This symptom can range from mild to severe and is often described as one of the most bothersome aspects of the disease. Itching occurs due to the inflammation caused by the immune system’s attack on healthy skin cells. In some cases, scratching can lead to skin damage, further exacerbating the condition and increasing the risk of infection. Patients with more extensive or severe psoriasis tend to experience more intense itching.

Burning Sensation

A burning sensation is reported by approximately 30% of psoriasis patients, particularly those with more severe forms of the disease. This sensation is caused by the inflammation in the skin, which can irritate nerve endings. The burning feeling is often localized to areas where the skin is most inflamed, such as the elbows, knees, or scalp. In some cases, the sensation can be so intense that it interferes with daily activities, making it difficult to focus or sleep.

Thickened Nails

Thickened nails, also known as onychauxis, occur in about 50% of psoriasis patients. Psoriasis can affect the nails by causing an overproduction of keratin, the protein that makes up the nail. This leads to the nails becoming thicker than normal and may cause them to appear discolored or ridged. Nail thickening is more common in patients with psoriatic arthritis or those with long-standing psoriasis. In severe cases, the thickened nails may become painful or detach from the nail bed.

Pitted Nails

Nail pitting, which affects around 35% of psoriasis patients, is characterized by small depressions or pits on the surface of the nails. This occurs because psoriasis disrupts the normal growth of the nail plate. Nail pitting is more common in patients with psoriatic arthritis and can be an early sign of the disease. The pits can vary in size and depth, and in some cases, the nails may become brittle or crumble.

Swollen Joints

Swollen joints are a sign of psoriatic arthritis, a condition that affects about 30% of people with psoriasis. Psoriatic arthritis causes inflammation in the joints, leading to swelling, stiffness, and pain. The joints most commonly affected are those in the fingers, toes, and lower back, but any joint can be involved. Early diagnosis and treatment are crucial to prevent joint damage and improve quality of life for patients with this condition.

Cracked Skin

Cracked skin is a symptom that affects about 60% of psoriasis patients, particularly those with severe or untreated disease. The rapid turnover of skin cells can cause the skin to become dry and fragile, leading to cracks or fissures. These cracks can be painful and may bleed, increasing the risk of infection. Cracked skin is most commonly seen on the hands, feet, and areas of the body that experience frequent movement or friction.

Skin Lesions

Skin lesions are present in nearly all psoriasis patients and are the primary manifestation of the disease. These lesions can vary in size, shape, and severity, ranging from small, localized patches to large areas of affected skin. The lesions are caused by the overproduction of skin cells and the resulting inflammation. In some cases, the lesions may become infected or develop into pustules. The appearance and distribution of skin lesions can help healthcare providers determine the type and severity of psoriasis.

Diagnostic Evaluation of Psoriasis

The diagnosis of psoriasis is typically made through a combination of a physical examination, patient history, and diagnostic tests. During a physical exam, healthcare providers will carefully examine the skin, nails, and joints for signs of psoriasis, such as red patches, scales, or pitting in the nails. A detailed patient history is also crucial, as psoriasis often runs in families, and a history of similar symptoms in relatives can support the diagnosis. In some cases, additional diagnostic tests may be necessary to confirm the diagnosis, rule out other conditions, or assess the severity of the disease. These tests can include skin biopsies, blood tests, and imaging studies.

Skin Biopsy

A skin biopsy is a procedure in which a small sample of skin is removed and examined under a microscope. This test is performed to confirm the diagnosis of psoriasis and to rule out other skin conditions that may present with similar symptoms, such as eczema or fungal infections. The biopsy is typically done using a local anesthetic to numb the area, and a small piece of skin is removed with a scalpel or punch tool. The sample is then sent to a laboratory for analysis.

Results that Indicate Psoriasis

In patients with psoriasis, the biopsy will show characteristic changes in the skin, such as thickening of the epidermis, elongation of the dermal papillae, and the presence of inflammatory cells. The absence of a granular layer in the epidermis and the presence of Munro microabscesses (collections of neutrophils in the stratum corneum) are also indicative of psoriasis. If the biopsy results do not show these characteristic findings, the healthcare provider may consider other diagnoses, such as eczema or lichen planus. In cases where the biopsy is inconclusive, additional tests or a referral to a dermatologist may be necessary.

Family History Assessment

Psoriasis has a strong genetic component, and a family history assessment can be an important part of the diagnostic process. During this assessment, the healthcare provider will ask about any relatives who have been diagnosed with psoriasis or other autoimmune conditions. This information can help support the diagnosis, as having a close relative with psoriasis increases the likelihood of developing the condition. In some cases, genetic testing may be recommended to identify specific gene mutations associated with psoriasis.

Results that Indicate Psoriasis

A positive family history of psoriasis, particularly in first-degree relatives (such as parents or siblings), can strongly suggest a diagnosis of psoriasis. However, the absence of a family history does not rule out the condition, as psoriasis can also occur in individuals without a known genetic predisposition. If no family history is present, the healthcare provider will rely more heavily on clinical findings and other diagnostic tests to confirm the diagnosis.

Blood Tests

Blood tests are not typically used to diagnose psoriasis directly, but they can be helpful in ruling out other conditions and assessing the overall health of the patient. In some cases, blood tests may be used to check for signs of inflammation or to evaluate the function of the immune system. For example, elevated levels of C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) can indicate inflammation, which may be present in patients with psoriasis or psoriatic arthritis.

Results that Indicate Psoriasis

While blood tests alone cannot confirm a diagnosis of psoriasis, elevated levels of inflammatory markers such as CRP or ESR can support the diagnosis, particularly in patients with psoriatic arthritis. If these markers are elevated, the healthcare provider may recommend additional tests or imaging studies to assess the extent of joint involvement. If the blood tests are normal, other diagnostic tests, such as a skin biopsy or imaging studies, may be needed to confirm the diagnosis.

Nail Examination

A nail examination is an important part of the diagnostic process for psoriasis, as nail changes are common in patients with the condition. During the examination, the healthcare provider will look for signs of nail involvement, such as pitting, thickening, or separation of the nail from the nail bed (onycholysis). These changes can help differentiate psoriasis from other skin conditions, such as fungal infections or eczema.

Results that Indicate Psoriasis

Nail changes such as pitting, thickening, or onycholysis are highly suggestive of psoriasis, particularly in patients with other signs of the condition, such as red patches or silvery scales. If the nail changes are present but the skin is not affected, the healthcare provider may consider a diagnosis of nail psoriasis, which can occur independently of skin involvement. If the nail changes are not consistent with psoriasis, other conditions, such as fungal infections, may be considered, and additional tests, such as a fungal culture, may be performed.

What if all Tests are Negative but Symptoms Persist?

If all diagnostic tests come back negative but you continue to experience symptoms such as red patches, itching, or nail changes, it is important to follow up with your healthcare provider. Psoriasis can sometimes be difficult to diagnose, particularly in its early stages or when it presents with atypical symptoms. Your provider may recommend additional tests, refer you to a dermatologist, or explore other potential causes of your symptoms. It is essential to advocate for your health and continue seeking answers until a proper diagnosis is made.

Treatment Options for Psoriasis

Medications for Psoriasis

Topical Corticosteroids

Topical corticosteroids are anti-inflammatory creams or ointments that help reduce the redness, swelling, and itching associated with psoriasis. They are often the first-line treatment for mild to moderate cases.

These medications are applied directly to the affected areas, typically once or twice a day. Milder corticosteroids are recommended for sensitive areas like the face, while stronger formulations may be used on thicker plaques elsewhere on the body. The strength of the corticosteroid is determined by the severity of the condition.

Symptom improvement can be seen within a few days to weeks, depending on the severity of the psoriasis. However, long-term use should be monitored by a healthcare provider to avoid potential side effects, such as skin thinning.

Vitamin D Analogs

Vitamin D analogs, such as calcipotriene, are synthetic forms of vitamin D that help slow down the rapid growth of skin cells. These are commonly used to treat mild to moderate psoriasis.

They are usually applied once or twice daily and are often combined with topical corticosteroids for enhanced effectiveness. Vitamin D analogs are particularly effective in treating plaque psoriasis.

Patients may notice a reduction in scaling and plaque thickness within a few weeks, though full results may take several months to appear.

Retinoids

Retinoids are derivatives of vitamin A that help reduce skin cell production and inflammation. Tazarotene is a commonly prescribed retinoid for psoriasis treatment.

Topical retinoids are typically applied once a day, usually in the evening, and are often combined with other treatments like corticosteroids to boost their effectiveness. Retinoids are generally reserved for more persistent or widespread cases of psoriasis.

Patients may experience a reduction in plaque size and scaling over several weeks. However, side effects such as skin irritation and increased sensitivity to sunlight may occur.

Calcineurin Inhibitors

Calcineurin inhibitors, such as tacrolimus and pimecrolimus, work by reducing immune system activity, which helps decrease inflammation and plaque formation in psoriasis.

These medications are often used for sensitive areas like the face, groin, and underarms, where corticosteroids may not be suitable. They are applied twice daily.

Patients typically see improvements within a few weeks. Calcineurin inhibitors are particularly useful for treating psoriasis in delicate skin areas, with minimal risk of skin thinning.

Phototherapy for Psoriasis

Phototherapy, or light therapy, involves exposing the skin to ultraviolet (UV) light under medical supervision. This treatment helps slow skin cell growth and reduce inflammation.

Phototherapy is typically recommended for moderate to severe psoriasis that has not responded to topical treatments. It can be administered in a clinic or at home using a prescribed UV light device. Sessions are usually conducted two to three times per week.

Many patients experience significant improvements after several weeks, with some achieving long-term remission. However, multiple sessions are required, and prolonged use may increase the risk of skin damage.

Systemic Treatments for Psoriasis

Methotrexate

Methotrexate is an oral or injectable medication that suppresses the immune system to reduce inflammation and slow the rapid turnover of skin cells in psoriasis.

This medication is often used for moderate to severe psoriasis or psoriatic arthritis when other treatments have not been effective. It is typically taken once a week, either orally or by injection.

Patients may see improvements within a few weeks, but it can take up to three months for full effects. Regular blood tests are required to monitor for potential side effects, including liver damage.

Cyclosporine

Cyclosporine is an immunosuppressant that helps reduce inflammation and slow down the overactive immune response in psoriasis.

It is usually prescribed for severe cases of psoriasis that have not responded to other treatments. Cyclosporine is taken orally, typically once or twice a day.

Patients may notice significant improvements within a few weeks. However, long-term use is limited due to potential side effects, such as kidney damage and high blood pressure.

Biologics

Biologics are a class of medications that target specific parts of the immune system to reduce inflammation and prevent the overproduction of skin cells. Examples include adalimumab, etanercept, and ustekinumab.

These medications are typically used for moderate to severe psoriasis or psoriatic arthritis when other treatments have failed. Biologics are administered via injection or intravenous infusion, often every few weeks or months.

Patients may experience significant improvements within a few weeks to months. Biologics can provide long-lasting relief, but they may increase the risk of infections due to immune suppression.

Apremilast

Apremilast is an oral medication that helps reduce inflammation by inhibiting an enzyme called phosphodiesterase 4 (PDE4). It is used to treat moderate to severe psoriasis and psoriatic arthritis.

Apremilast is taken twice a day and is often prescribed for patients who cannot tolerate or have not responded to biologics or other systemic treatments.

Patients may see improvements within a few weeks to months. Side effects can include gastrointestinal issues, such as diarrhea and nausea.

Tazarotene

Tazarotene is a topical retinoid that helps reduce the rate of skin cell growth and inflammation in psoriasis.

It is applied once daily, usually in the evening. Tazarotene is often used in combination with corticosteroids to enhance its effectiveness, especially in treating plaque psoriasis.

Patients may notice improvements in plaque thickness and scaling within a few weeks. However, it can cause skin irritation and increased sensitivity to sunlight.

Improving Psoriasis and Seeking Medical Help

In addition to medical treatments, several home remedies can help alleviate psoriasis symptoms and improve overall skin health:

1. Aloe vera: Applying aloe vera gel can soothe irritated skin and reduce redness.
2. Oatmeal baths: Soaking in an oatmeal bath can help relieve itching and soften plaques.
3. Coconut oil: Moisturizing with coconut oil can help reduce dryness and scaling.
4. Epsom salt baths: Adding Epsom salts to a bath can help reduce inflammation and soften skin.
5. Moisturizing regularly: Keeping the skin hydrated can prevent flare-ups and reduce itching.
6. Reducing stress: Stress can trigger psoriasis flare-ups, so practicing relaxation techniques like meditation or yoga may help.
7. Avoiding triggers: Identifying and avoiding triggers like certain foods, medications, or environmental factors can help prevent flare-ups.
8. Eating anti-inflammatory foods: Incorporating foods like leafy greens, fatty fish, and nuts may help reduce inflammation.
9. Sun exposure: Limited sun exposure can help improve psoriasis, but it’s important to avoid sunburn.
10. Quitting smoking: Smoking can worsen psoriasis, so quitting may lead to fewer flare-ups.

If home remedies and over-the-counter treatments are not providing relief, it’s important to seek medical help. Telemedicine offers a convenient way to consult with healthcare providers from the comfort of your home. Through virtual visits, you can receive guidance on managing your psoriasis, adjusting treatments, and addressing any concerns you may have.

Living with Psoriasis: Tips for Better Quality of Life

Living with psoriasis can be challenging, but several strategies can help improve your quality of life:

1. Stay informed: Understanding your condition and treatment options can empower you to make informed decisions about your care.
2. Follow your treatment plan: Consistency is key when managing psoriasis. Stick to your prescribed treatments and communicate with your healthcare provider if you experience any side effects or changes in symptoms.
3. Practice self-care: Incorporate stress-relieving activities into your daily routine, such as exercise, meditation, or hobbies you enjoy.
4. Join a support group: Connecting with others who have psoriasis can provide emotional support and practical tips for managing the condition.
5. Communicate with your healthcare provider: Regular check-ins, whether in person or through telemedicine, can help ensure your treatment plan is working effectively.

Conclusion

Psoriasis is a chronic autoimmune condition that affects the skin, causing red, scaly patches. While there is no cure, early diagnosis and treatment can significantly improve symptoms and prevent complications. With a range of treatment options available, from topical treatments to biologics, patients can work with their healthcare providers to find the best approach for their condition.

If you’re struggling with psoriasis, don’t wait to seek help. Our telemedicine practice offers convenient, personalized care from the comfort of your home. Schedule a virtual consultation today to discuss your symptoms and explore treatment options tailored to your needs.

James Kingsley

Learn More