Psoriasis is an ongoing, chronic skin condition that affects the daily lives of millions of people around the world. It is estimated that there are 125 million people that suffer from psoriasis, which is somewhere around 2 to 3 percent of the total world population. In the United States alone, over 8 million people are known to have psoriasis.
Psoriasis is characterized by areas of bumpy, scaly patches of built-up skin. This abnormal build up is caused when the skin cells are generating far too quickly. It is thought that an issue in the immune system is what initiates this sped up the growth of skin cells. When cells are created faster than they can be shed, then these visible patches of overgrowth are seen. They can appear anywhere on the body and are often itchy, flaky, and painful.
Although it is a fairly common diagnosis, psoriasis is often misunderstood. While psoriasis is a disease that may at first seem to be a primarily cosmetic concern, it is actually quite a serious condition. In fact, most people find that psoriasis has a negative effect on their ability to do daily tasks, and can take a toll on the quality of life.
Psoriasis ranges from mild to severe, with the most severe cases affecting more than ten percent of the skin’s surface. But even those with milder cases may find that their psoriasis causes them emotional and physical problems.
While psoriasis cannot be totally cured, it can be treated. There are a variety of treatment options that can address both the causes and symptoms of psoriasis.
Let’s first take a look at what is happening to the skin affected by psoriasis, and the symptoms that result.
The Life Cycle of Skin
Our skin is a very important organ, needed to protect our body from the outside elements. Skin serves to keep bacteria and viruses out, and moisture and nutrients in. It also helps the body maintain a healthy temperature, by keeping warmth in or by cooling the body via perspiration.
Skin is actually made up of three distinct layers: the epidermis, dermis, and subcutaneous layers. The only layer that we can actually see is the epidermis or outermost layer. This is a thin layer that is composed of dead skin cells, and these cells are constantly being replaced. This replacement happens in a cycle that usually takes about 28 days.
This cycle starts when new skin cells are formed in the lower portion of the epidermis. As new cells are formed they are pushed upward toward the surface of the skin, and this causes the oldest and topmost cells to flake away and fall off to make room for the newer cells. As cells continue to move upward from the bottom of the epidermis, they become hard and die.
So as you can see, both the generation of new cells ad the dying and sloughing off of old cells are important to maintaining this life cycle of the skin. But in people with psoriasis, this process becomes unbalanced.
Psoriasis causes new skin cells to be produced at a rapid rate, sometimes up to ten times faster than usual. With such a quick generation of cells, the process of shedding cannot keep up, and as a result, the skin piles up on the surface. This build-up is typically seen in areas known as scales—thickened areas of skin that appear red or silver in color. But, there are actually several forms of psoriasis that can exhibit different symptoms and can affect the body in a number of ways.
Types Of Psoriasis
- Erythrodermic psoriasis is a rare form of psoriasis that consists of a red rash that may cover your entire body. This rash is characterized by peeling, and is often itchy or produces a burning sensation.
- Guttate psoriasis is a type of psoriasis initially brought on by a bacterial infection and appears in the form of small lesions. It is usually found in children and young adults.
- Inverse psoriasis seems to mostly show up in skin folds that are easily subject to excessive sweating and friction; for example, the armpits and groin. It may be initiated by a fungal infection.
- Nail psoriasis is what it sounds like—psoriasis affecting the nails of the fingers and toes of those with the disease. Nails are a part of the skin and can be affected by the same processes that cause psoriasis. This type will cause abnormal growth, pitting, and discoloration of the nails. It can even cause nails to come off the nail bed or crumble.
- Plaque psoriasis is the most common type of psoriasis. It appears in the form bumpy, raised areas of skin called “plaques.” Plaques are red but are covered by silver-colored scales. Plaques may be found on any part of the body, even inside the mouth.
- Psoriatic arthritis is a bit different from the other types in that it can affect both the skin and the joints. It is called psoriatic arthritis because it primarily causes stiff and swollen joints, but may also present with scaly skin lesions like the other forms of psoriasis.
- Pustular psoriasis is another rare type of psoriasis, that often affects the smaller surfaces the hands and feet, although it can also cover larger areas. Unlike the more common plaque psoriasis, pustular psoriasis consists of pus-filled blisters and may also cause a fever, chills, and other symptoms.
What Causes Psoriasis?
While it is known that psoriasis is caused by problems in the immune system, the exact problem is not completely understood at this time. It is currently thought to be an overreaction that occurs in the immune system’s “T cells.”
Everyone has T cells throughout their body, and it is their job to protect the body from invading substances, like bacteria and viruses. These T cells defend by attacking these foreign cells. But in some people, the T cells begin unnecessarily attacking the normal and healthy cells. They may also cause the creation of new skin cells and white blood cells to increase. These extra cells in the skin then cause the redness, lesions and build up that we know as psoriasis.
Some people have these overactive T cells in their immune system but don’t see symptoms until something triggers an overreaction. These known psoriasis triggers can include cuts to the skin, infections, insect bites, medications, sunburn, stress and a lack of vitamin D.
Some medical conditions also increase your risk of developing psoriasis. Those who are severely overweight, smoke tobacco, or have other immune system problems may be more likely to have psoriasis than those who are healthier.
And, psoriasis seems to run in families. If one or both of your parents have the disease, you are also more likely to have it as well.
Treatments For Psoriasis
Medical treatments for psoriasis include medications that are taken by mouth, rubbed into the skin or injected. Some types of psoriasis medications are available over the counter, but most require a prescription from your doctor. And finally, there are some more intensive treatments that are given to you at the doctor’s office or another medical facility.
Keep in mind that psoriasis cannot be completely healed. However, with the right treatment and lifestyle changes, you may be able to experience remission. Remission is a period where your psoriasis symptoms are very minimal or even go away completely. Remission is temporary, but with the right treatment plan you may be able to maintain long periods without symptoms, and avoid the return or worsening of symptoms known as flare-ups.
Here is a brief overview of the different treatment categories for psoriasis:
1) Topical Ointments and Creams
Topicals include anything that is applied directly to the skin and is absorbed into the pores. One of the main benefits of treating psoriasis with topical medications is that you can target just the areas of skin that are showing symptoms.
This type of treatment works well for mild forms of psoriasis, and less than ideal for someone whose psoriasis covers large portions of their body. Still, topical treatments may be effective and often cause fewer side effects than some of the other options.
While there are a variety of ointments and other topicals that have been found to lessen symptoms of psoriasis, steroid creams are one of the main treatments doctors start with. These creams vary in strength, but they all should help stop itching, while also addressing inflammation and the overproduction of cells that are causing scales to appear.
Salicylic acid is another option that can help psoriasis sufferers by aiding the shedding of skin. While salicylic acid is a very effective exfoliator that can help break down scaly areas, it is not suitable for large areas of skin.
2) Oral Medications
When topical medications are not enough, or when psoriasis is particularly severe, there are oral drugs that can be prescribed that may work better at controlling symptoms. But pills you take by mouth will affect your entire body system, and can often cause some undesirable side effects. But for those whose psoriasis makes their daily routine more difficult, these medications may be worth it.
Among the pills used to treat psoriasis are oral retinoids. Retinoids are a form of vitamin A that is used in a variety of topical skin care products, because of the ways they can renew skin and make it look younger. For psoriasis, doctors often prescribe a retinoid called acitretin. This medication is accompanied by several side effects, so is often a short-term treatment used just long enough to get the patient to remission.
Another approach to treating psoriasis is the use of immunosuppressant drugs. These drugs suppress the immune system in order to stop the overactivity that causes cells to multiply too quickly.
These are just two of the more common types of oral medications that may be given to psoriasis patients. There are others, but severe cases of psoriasis are now frequently being treated using a type of drug called a biologic. These are drugs that can be injected or infused and are described below.
3) Injections and Infusions
Biologics are a type of drug that has great promise for helping people with moderate and severe cases of psoriasis, and especially psoriatic arthritis. Biologics are a more recently developed medication that is able to stop just the part of the immune system that has become overactive.
Some other psoriasis treatments reduce symptoms, but also have very negative effects on other internal organs, such as the liver and kidneys. But biologics are much less likely to cause damage to other body systems, making them a safer option for most patients.
There are several biologics currently approved for treating psoriasis. Some of them come in the form of a shot that patients can learn to inject themselves with at home. Others are given through an IV infusion at a medical office.
They are very good at controlling symptoms, and many patients find that they feel much better and have fewer flare-ups when using a biologic. And on top of this, most biologics only need to be taken once or twice a week, or even as little as every few months.
4) Light Therapy
Sunlight is thought to help people with psoriasis, and many patients may find that getting outside and into the sunshine can help relieve symptoms. And for those with severe cases of psoriasis, doctors may even prescribe light therapy. There are a few different types of light therapy available, but all involve exposure to ultraviolet light in a controlled setting. However, some of these may increase the risk of skin cancer, so may not be right for all patients.
There are just about as many treatments available for psoriasis as there are forms of the disease. This is important, as the appropriate treatment for any individual’s psoriasis depends on a number different factors: the location of psoriasis on the body, type of psoriasis, severity of symptoms, and the effect on the patient’s quality of life. For anyone who has psoriasis, working closely with a qualified doctor who specializes in the treatment of this type of disease will be essential to getting relief, reaching remission, and staying there.