Psoriasis: Symptoms, Causes, Treatments, & Outlook

• Psoriasis is a chronic skin disease that causes skin cells to multiply rapidly, resulting in raised, red scaly patches of skin
• This disease is believed to be hereditary and caused by an overactive immune system 
• Depending on severity, treatment typically includes a combination of topical and oral medications

Psoriasis is an inherited disease that affects approximately 2–3% of the population in the United States. It’s characterized by thick, scaly plaques of skin which are itchy and uncomfortable. Psoriasis flare-ups can last for a few weeks or months and go into remission for months or years. No two people experience psoriasis in quite the same way.

Psoriasis affects self-esteem and can have a great impact on quality of life. While there is not yet a cure for this disease, there are many effective treatments available to limit the severity and frequency of flare-ups.

What Is Psoriasis?

Skin cell growth is an ongoing process, with new skin cells typically taking 6 weeks to mature and shed. For people with psoriasis, the entire process is completed in as few as 3–7 days, resulting in a buildup of cells on the skin’s surface, called plaques. These present as red patches of dry skin with silver scales, and mild to severe tightness, itching and burning.

The rapid production of new skin cells is due to an overactive immune response to external triggers. These triggers include stress, hot and cold temperatures, skin injuries, and certain infections such as the human immunodeficiency virus (HIV).  

In addition to affecting the skin, people with psoriasis can have problems with other organs and with their joints – a condition known as psoriatic arthritis. Because psoriasis is an autoimmune disease, it can raise the risk of other health conditions, such as liver disease, high blood pressure and heart disease.

Types of psoriasis

While the cause remains the same, psoriasis can manifest itself in different ways. Plaque psoriasis is the most common type, affecting up to 90% of all psoriasis patients. It is possible to have more than one type at a time or have one type deteriorate into a more severe form. 

Erythrodermic psoriasis is a serious but rare form of psoriasis. It can affect the entire skin of the body with red, peeling patches and can be caused by an allergic reaction, stopping a medication suddenly or when severe plaque psoriasis is not properly treated. It is considered life-threatening and should be treated as a medical emergency.

Guttate psoriasis

Guttate psoriasis often develops after a person with plaque psoriasis develops an infection such as strep throat or tonsillitis, and is typically seen in children and young adults. It is characterized by small, scaly spots that appear on the trunk and limbs. 

Inverse psoriasis  

Inverse psoriasis develops in skin folds, such as the underarms, underneath the breasts or inner thighs. They are a result of skin rubbing on skin. Unlike plaque psoriasis, skin remains smooth and moist but has patches of red inflammation. While the reason is not fully understood, many people with plaque psoriasis gain weight and develop this type.

Pustular psoriasis 

Pustular psoriasis is another serious but rare form of psoriasis and is a result of specific triggers including stopping certain medications, overexposure to sunlight, infections and stress. It presents as small, pus-filled bumps that can develop across the entire body.  

Symptoms

Plaques can develop anywhere on the body, but they most often appear on the scalp, elbows, knees and torso. They can be confined to one or two small patches of skin or extend over a large area. 

Depending on severity they may appear as flat bumps or raised thickened areas of skin that are dry and scaly. In more severe cases, skin can crack and bleed. Common symptoms include itching, tightness, stinging, burning and pain. Joint pain and stiffness may also occur, often signaling the start of psoriatic arthritis.

Flare-ups tend to be cyclical, presenting for weeks or months and then receding. Some people can be symptom-free for months or even years.

Causes

Psoriasis develops as a result of an abnormal immune system. When the immune system mistakenly believes a trigger is a threat, it activates white blood cells, called T-cells, which release cytokines, a type of protein responsible for the abnormal cell proliferation and inflammation. 

Triggers

A great number of triggers are associated with psoriasis flare-ups, and these will vary from one person to another.

Some common psoriasis triggers include:

• Alcohol
• Hot and cold weather extremes
• Infection
• Skin injury such as a scrape or sunburn
• Medications such NSAIDs, blood pressure and heart medications, and antibiotics
• Smoking
• Stress

Treatments

It is important to seek treatment for psoriasis as quickly as possible in order to control and prevent worsening of symptoms. If left untreated, inflammation can cause other diseases to develop.

Managing psoriasis effectively typically requires topical treatments and the addition of oral or injectable medications depending on your specific skin condition, its severity and your response to treatment. Oftentimes, it is a matter of trial and error, as you work with your doctor to find what treatments and combinations work for you. 

The goal of psoriasis therapy is to prevent the continued rapid growth of skin cells which in turn will reduce the discomfort and pain of this disease. 

Topical treatments

The most common first-line treatment for psoriasis is prescription topical corticosteroids which have anti-inflammatory and immunosuppressive properties to effectively reduce inflammation, slow skin cell production and ease itching.

As alternatives to corticosteroids, retinoids, synthetic forms of vitamin A, can also address inflammation. Among the more commonly prescribed for psoriasis is tazarotene. Calcitriol, a derivative of vitamin D, is another strong choice in psoriasis therapy. 

Calcineurin inhibitors, normally prescribed for atopic dermatitis, have been found to be very effective against moderate to severe psoriasis. These include tacrolimus, and to a lesser extent pimecrolimus, which can reduce inflammation and plaque buildup. Unlike other topical medications, they can be used on the delicate skin around the eyes, in place of steroid creams or retinoids which can be irritating or harmful.

For mild cases of psoriasis, over-the-counter (OTC) emollients can soothe dryness and irritation and act as a protective barrier on the skin’s surface. Another option is salicylic acid, a medication used to treat many skin conditions such as acne. Salicylic acid is a peeling agent and can soften and remove psoriasis scales.  

Oral treatments

Oral medications can effectively slow the growth of new skin cells  These include cyclosporine, and methotrexate. Research suggests that rotating methotrexate and cyclosporine may reduce the risk of medication side effects.

Over-the-counter pain relievers, such as ibuprofen (Advil) and naproxen (Aleve), can address pain and reduce inflammation.

Phototherapy

Phototherapy delivers concentrated beams of ultraviolet light to affected areas of skin and is a safe and well-tolerated treatment. Phototherapy sessions are usually had 2–3 times a week for several months to reduce the growth of new skin cells.

Injectable biologic treatments

Unlike oral medications that treat the entire immune system, biologics target only the part of the immune system that is directly responsible for the overactive response. These drugs are injected under the skin or onto a vein. 

Biologics are strong medications normally prescribed for people with psoriasis and psoriatic arthritis and for those with moderate-to-severe symptoms that haven’t responded to conventional treatments. They can reduce plaque symptoms, but more importantly can treat and prevent swelling, stiffness and pain within the joints.  

The main types of psoriasis treatments belong to a class of drugs called monoclonal antibodies, which prevent the release of cytokines, the protein that triggers inflammation. These drugs include ustekinumab, ixekizumab and etanercept.  

Complementary and alternative therapies

In addition to the therapy prescribed by your doctor, you may benefit by making some lifestyle changes such as following an anti-inflammatory diet and maintaining a healthy weight; obesity and poor overall health are risk factors for worsening psoriatic symptoms. 

Reducing your stress levels through exercise, sufficient sleep and relaxation techniques can also work to reduce symptom severity. 

A recent scientific review of alternative treatments found that in addition to diet, curcurmin, fish oil, meditation and acupuncture were found to be the most effective in reducing plaque psoriasis symptoms. 

Takeaway

Psoriasis is a lifelong skin disease that is caused by an overactive immune system and can vary in severity and type. It is important to seek treatment early for symptom relief but especially to reduce inflammation that can lead to worsening forms of psoriasis or other diseases.   

While psoriasis is not curable, there are many effective treatments available to reduce and control symptoms. These include prescription topicals and oral treatments, injectable biologics and phototherapy. It may take some time to find the right combination of treatment, but with time you should find relief from psoriasis symptoms.