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.
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.
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.
Experts believe that
psoriasis occurs when the
immune system overreacts, causing
inflammation and flaking of skin. In some
cases, psoriasis runs in families.
psoriasis often notice times when their skin gets worse. Things that can cause
these flare-ups include a cold and dry climate, infections,
stress, dry skin, and taking certain medicines.
Psoriasis isn't contagious. It
can't be spread by touch from person to person.
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 sometimes large patches form and may be uncomfortable. 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).
A doctor can usually
diagnose psoriasis by looking at the patches on your skin, scalp, or nails.
Special tests aren't usually needed.
Most cases of psoriasis are
mild, and treatment begins with skin care. This includes keeping your skin
moist with creams and lotions. These are often used with other treatments
including shampoos, ultraviolet light, and medicines your doctor
In some cases, psoriasis can be hard to treat. You
may need to try different combinations of treatments to find what works for
you. Treatment for psoriasis may continue for a lifetime.
at home can help control psoriasis. Follow these tips to care for
It's also important to avoid those things that can cause
psoriasis symptoms to flare up or make the condition worse. Things to avoid
Studies have not found that specific diets can cure or
improve the condition, even though some advertisements claim to. For some people,
not eating certain foods helps their psoriasis. Most doctors recommend that you
eat a balanced diet to be healthy and stay at a healthy weight.
Learning about psoriasis:
Living with psoriasis:
Health Tools help you make wise health decisions or take action to improve your health.
The exact cause of
psoriasis isn't known.
Doctors believe that the
immune system overreacts, causing inflammation and flaking of skin.
Many scientists believe that psoriasis can be inherited. About one-third of people who have psoriasis have one or more family members
with the condition.1 But it isn't clear that genetic
factors alone determine whether you get psoriasis.
contagious—it can't be spread by touch from person to person.
There are several
types of psoriasis. Symptoms for each type may vary, but the major symptoms are:
Other symptoms of psoriasis may include:
other skin conditions have symptoms similar to
psoriasis. And some medicine reactions can cause symptoms (such as reddened skin)
similar to psoriasis. Talk to your doctor about the medicines you are
Psoriasis is usually a long-term problem. Symptoms tend to come and go in a cycle of flares, when symptoms get worse, and remission, when symptoms improve and go away for awhile. In other cases psoriasis may persist for long periods of time without getting better or worse.
Several things can make
symptoms worse, depending on the
type of psoriasis. These factors, or triggers, include:
A few cases of psoriasis may go away without treatment. But it's usually best to treat psoriasis so that it doesn't get worse. If it becomes severe and widespread, it may be much harder to treat.
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.
When severe, psoriasis can be:
Learn more about the different types of psoriasis.
Many doctors believe that
psoriasis may be passed down from parents to their
children (inherited). This is because certain
genes are found in families who are affected by psoriasis.2 About one-third of people who have
psoriasis have one or more family members with the condition.1
Other factors that can contribute to the
development of psoriasis include:
Call your doctor if you have:
If you are currently being treated for psoriasis, call your
doctor if you:
Health professionals who can
diagnose and treat psoriasis include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor can often recognize
psoriasis by looking at your skin, scalp, and nails.
Tests aren't usually needed. But one or more of the following tests may be done:
Currently there is no cure for psoriasis. But many types of treatment are available, including products applied to the skin, phototherapy, and oral medicines, which can help control psoriasis. 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.
Treatment can also depend 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). For example, you may get more aggressive treatment if your psoriasis is severe or if the patches frequently upset you.
Most cases are mild and can be treated with:
Depending on what type of psoriasis you have, treatment may also include:
You may need to try different
treatments before you find one that works well for you. It's important to
discuss your treatment and progress with your doctor.
Many doctors will recommend that
treatments be changed or rotated after a certain period of time to make
treatment more effective and to reduce side effects.
People respond differently to
psoriasis treatments. A treatment that worked one time may not work again. A
treatment that didn't work the first time may work when tried again
It's also important to avoid anything 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 linked to guttate psoriasis.
nail psoriasis can be hard to treat. Both conditions are more likely to
improve with medicines taken by mouth (oral medicines). Treatment for the scalp often includes tar
shampoos, corticosteroid solutions, or zinc and selenium sulfide
Psoriasis can cause a lot of stress and
affect how you feel about yourself. Seek information or counseling from your doctor. For tips on dealing with stress, see Home Treatment. You can also get educational materials and find support networks by contacting the National Psoriasis
Foundation at www.psoriasis.org.
There is no way to prevent
psoriasis. But you can take steps to improve symptoms
or help reduce the number of psoriasis flare-ups. For more information, see Home Treatment.
Most of the time psoriasis can be treated at home. These tips may improve your symptoms or help reduce the number of psoriasis flare-ups:
Avoid these triggers:
Stress can make your symptoms worse. Some things that can help reduce stress include:
Treatment using more than one topical
medicine is often done. This can help prevent side effects from some of the
stronger medicines. For example, you may use one medicine during the week but
another on the weekend.
Your doctor may have you use occlusion therapy. This means wrapping the skin after applying moisturizers or medicated creams or gels. The wrap can be fabric or plastic. Occlusion keeps the area moist and can make the
medicated creams work better. Steroid cream may be used with the occlusion
treatment method for small areas, but not for more than a few days. Occlusion of large areas may cause side effects such as
thinning of the skin. Talk to your doctor before using occlusion therapy, to
make sure that you do it safely.
Medicines taken by mouth (oral medicines) may be
used to treat moderate to severe psoriasis.
Sometimes this type of medicine is given as shots instead of pills.
Medicines called biologics may be used to treat severe
psoriasis or psoriasis that hasn't improved after other treatments. Biologics
are similar to or the same as
proteins made by the body. These medicines block the harmful response of the body's
immune system that causes the symptoms of psoriasis.
These medicines are given through a needle (IV). Early clinical trials of biologic therapies for
moderate to severe psoriasis have produced promising results. But the medicines
are expensive, and long-term effects aren't known. Biologics may increase the
long-term risk of cancer or infections.4
There are many types of nonprescription products, including corticosteroid creams, for psoriasis. Examples of their active ingredients include:
These products are used to treat small patches of psoriasis and symptoms,
including itching, redness, flaking, and scaling of the skin and scalp. For some people, they may eliminate
scales and sores caused by psoriasis.
Biologics used to treat psoriasis or psoriatic arthritis include adalimumab (Humira) and other medicines, such as etanercept (Enbrel), infliximab (Remicade), and ustekinumab (Stelara).
Some medicines used to treat psoriasis can cause serious
side effects. You and your doctor will discuss how long to use treatments that
could cause harm. You will also need to see your doctor regularly and may have
blood tests while using some medicines.
Many oral or injected
medicines used to treat psoriasis aren't safe during pregnancy. If you are
pregnant, talk to your doctor before taking any medicines.
Surgery isn't used to treat
psoriasis of the skin or scalp. But surgery may be
used to treat nails that are severely disfigured or damaged from psoriasis.
Surgical removal of a nail may be done in a clinic or doctor's office as an
ultraviolet light to slow the rapid
growth of cells that occurs in psoriasis. This treatment can be effective, but your skin should be checked often by your
doctor (at least once or twice a year) for any skin damage or skin
Complementary or alternative therapies are often used by
people with skin diseases, including psoriasis.
These treatments include
the use of herbs, vitamins, certain diets, and stress reduction. They may relieve psoriasis symptoms in some people.
Some people notice that natural sunlight and seawater
help their psoriasis symptoms. People seeking this treatment
may go to seaside resorts, some of which have special programs and medical help
for people with psoriasis. For more information, see the website of the
National Psoriasis Foundation at www.psoriasis.org.
This U.S. based organization provides a monthly bulletin and pamphlets with
information about treatments, research, and self-care for psoriasis and
psoriatic arthritis. Membership is based on donations. A mail-order pharmacy
service is provided.
The American Academy of Dermatology (AAD) provides information
about the care of skin. You can locate a dermatologist in your
area by using their "Find a Dermatologist" tool. Or you can read the latest news in dermatology. "SPOT Skin Cancer" is the AAD's program to reduce deaths from melanoma. There is also a link called "Skin Conditions" that has information about many common skin problems.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
CitationsAbel E, Lebwohl M (2008). Psoriasis. In EG Nabel, ed., ACP Medicine, section 2, chap. 3. Hamilton, ON: BC Decker.Puchalsky D (2011). Papulosquamous eruptions—Psoriasis. In ET Bope et al., eds., Conn’s Current Therapy 2011, pp. 823-827. Philadelphia: Saunders.Fortes C, et al. (2005). Relationship between smoking and the clinical severity of psoriasis. Archives of Dermatology, 141: 1580–1584.Abramowicz M (2008). Drugs for acne, rosacea and psoriasis. Treatment Guidelines From The Medical Letter, 6(75): 75–82.Other Works ConsultedAloe (2010). In A DerMarderosian, J Beutler, eds., Review of Natural Products. St. Louis: Wolters Kluwer Health.Giezen TJ, et al. (2008). Safety-related regulatory actions for biologicals approved in the United States and the European Union. Journal of the American Medical Association, 300(16): 1887–1896.Kimball AB, et al. (2008). National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. Journal of the American Academy of Dermatology, 58(6): 1031–1042.Lebwohl MG, Kerkhof P (2010). Psoriasis. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 626–636. Edinburgh: Saunders Elsevier.Nestle FO, et al. (2009). Psoriasis. New England Journal of Medicine, 361(5): 496–509.Schmitt J, et al. (2008). Efficacy and tolerability of biologic and nonbiologic systemic treatments for moderate-to-severe psoriasis: Meta-analysis of randomized controlled trials. British Journal of Dermatology, 159(3): 513–526.
January 9, 2012
Adam Husney, MD - Family Medicine & Amy McMichael, MD - Dermatology
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