Risk Factors Include Infections And Genetics
Common predisposing factors that can trigger the disease in children include bacterial infections such as strep throat . Flare-ups may also occur after an earache, tonsillitis, or respiratory infection. In some cases, patches of psoriasis appear on areas of skin that have been injured a condition called Koebner phenomenon.
Genetics can raise your odds of developing psoriasis. If one parent has psoriasis, the child has a 10 percent chance of contracting it. If both parents have the condition, the odds rise to 50 percent.
We are also beginning to learn that overweight and obesity may trigger onset of psoriasis in susceptible children, says Cordoro.
Although children can get any type of psoriasis, plaque psoriasis and guttate are most common.
Adjusting Your Psoriasis Treatment Plan With Age
Many medications to treat psoriasis are considered safe as you get older, including corticosteroids, vitamin D analogues, tazarotene, acitretin, , methotrexate, and some biologics. Your doctor may be more cautious with topical steroids though, because both aging and topical steroids cause skin to thin. Let your doctor know if your skin appears more transparent or if it bruises easier, has purple spots, or has visible blood vessels.
Most important, make sure your dermatologist knows about every medication youre taking and any other diagnoses youve received. Some psoriasis medications arent safe for people with liver disease, kidney disease, or heart failure, all of which are more common in people over 65. Other medications, including biologics, may not be appropriate if you have certain infections, including hepatitis B, which is more common in older adults who were born before a hepatitis B vaccination existed.
Cancer is also more common with age. Its important to let your doctor know if youve been diagnosed with any kind of cancer. Your dermatologist needs to know, because it will affect treatments for psoriasis, says Unwala.
How Is Psoriasis Diagnosed And Treated
Psoriasis often has a typical appearance that a primary care doctor can recognize, but it can be confused with other skin diseases , so a dermatologist is often the best doctor to diagnose it. The treatment of psoriasis usually depends on how much skin is affected, how bad the disease is , or the location . Treatments range from creams and ointments applied to the affected areas to ultraviolet light therapy to drugs . Many people who have psoriasis also have serious health conditions such as diabetes, heart disease, and depression. Some people with psoriasis also have an inflammatory condition which affects their joints, called psoriatic arthritis.
Psoriatic arthritis has many of the same symptoms as other types of arthritis, so a rheumatologist is often the best doctor to diagnose it. The treatment of psoriatic arthritis usually involves the use of drugs .
Psoriatic disease may be treated with drugs or a combination of drugs and creams or ointments.
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Why Do People Get Scalp Psoriasis
According to the National Psoriasis Foundation , about 45-56% of people with psoriasis have scalp psoriasis. Additionally, the NPF states that scalp psoriasis is common in people of color.
“We don’t know why some people get it on the scalp and some don’t,” Adam Friedman, MD, professor of dermatology at George Washington School of Medicine and Health Sciences, tells Health.
He explains that while it’s not known exactly what causes plaque psoriasis, a combination of genetic makeup and environmental factors are believed to be involved.
While skin cells usually grow and fall off in a month’s cycle, the skin cells of those with plaque psoriasis grow faster, due to an overactive immune system. The skin cells tend to grow in about three to four days, yet they don’t fall off at the same pace, leaving dead skin cells to buildup on the skin.
While there isn’t a known reason for why people get psoriasis on different parts of the body, Dr. Friedman says he finds that those with scalp psoriasis also get inverse psoriasis, which occurs on the folds of skin like the groin and underarms. He notes that because those areas can be moist, psoriasis might look different.
“So, people who have this are often underdiagnosed because it doesn’t have that classic appearance. In the groin area, it can be assumed it’s a yeast infection or sexually transmitted disease. This is why it’s important to make a correct diagnosis,” Dr. Friedman says.
Steroid Creams Or Ointments
Steroid creams or ointments are commonly used to treat mild to moderate psoriasis in most areas of the body. The treatment works by reducing inflammation. This slows the production of skin cells and reduces itching.
Topical corticosteroids range in strength from mild to very strong. Only use topical corticosteroids when recommended by your doctor. Stronger topical corticosteroids can be prescribed by your doctor and should only be used on small areas of skin or on particularly thick patches. Overusing topical corticosteroids can lead to skin thinning.
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Can Alternative Treatments Help Late
Like at-home remedies, experts say that certain alternative medicine treatments can be used in conjunction with traditional therapies. A review of 13 randomized controlled studies showed that those who had acupuncture saw a significant improvement in their psoriasis compared to the placebo group, according to research published in JAMA Dermatology. So, if youre interested in trying acupuncture , it may be worth a shot.
Are There Complications Of Psoriasis
In some people, psoriasis causes more than itchiness and red skin. It can lead to swollen joints and arthritis. If you have psoriasis, you may be at higher risk of:
- Use medicated shampoo for scales on your scalp.
Other steps you should take to stay as healthy as possible:
- Talk to your healthcare provider about lowering your risk for related conditions, such as heart disease, depression and diabetes.
- Lower your stress with meditation, exercise or seeing a mental health professional.
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Can Diet Affect My Psoriasis
A healthy diet is important for wellbeing and can reduce your risk of many long-term illnesses. However, there is no clear link between what you eat and the severity of psoriasis symptoms.
- The British Nutrition Foundation suggests eating at least 300g of oily fish per week for general health .
- Aim to eat more green leafy vegetables, nuts, seeds and wholegrain cereals, which also contain important essential fatty acids.
- Cut back on saturated fats and vegetable oils and use more olive oil and rapeseed oil products.
- Eat fresh, homemade foods rather than pre-packaged convenience food.
- Excessive amounts of alcohol can make psoriasis worse and can also interfere with certain drug medications, for example methotrexate.
How Is Psoriasis Classified
Certain features of psoriasis can be categorised to help determine appropriate investigations and treatment pathways. Overlap may occur.
- Early age of onset < 35 years vs late age of onset > 50 years
- OMIM Online Mendelian Inheritance in Man
- Chularojanamontri L, Griffiths CE, Chalmers RJ. The Simplified Psoriasis Index : a practical tool for assessing psoriasis. J Invest Dermatol. 2013 133:195662. doi: 10.1038/jid.2013.138. PubMed PMID: 23807685.
- Feldman SR, Fleischer AB Jr, Reboussin DM, et al. The self-administered psoriasis area and severity index is valid and reliable. J Invest Dermatol. 1996 106:1836. doi:10.1111/1523-1747.ep12329912PubMed PMID: 8592072.
- Papp K, Gordon K, Thaçi D, et al. Phase 2 trial of selective tyrosine kinase 2 inhibition in psoriasis. N Engl J Med. 2018 379:131321. doi:10.1056/NEJMoa1806382. PubMed
- Fleming P. Tofacitinib: a new oral Janus kinase inhibitor for psoriasis. Br J Dermatol. 2019 180:1314. doi:10.1111/bjd.17323. PubMed
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Psoriasis Is An Inflammatory Skin Condition Diagnosed By A Physician
It usually manifests as itchy, well-delineated, red, scaly plaques in locations across the body, most often the scalp, elbows and knees, Wang explains.
Patients are typically diagnosed with psoriasis in their 20s or later on in adulthood, usually based on a clinical examination and family history, and sometimes with a skin biopsy to confirm the diagnosis.
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In addition, were finding psoriasis can be associated with a variety of other health problems, particularly when its more extensive, likely because there is inflammation beyond the skin, Wang says. For instance, patients are at risk for diabetes, high cholesterol, high blood pressure, fatty liver and cardiovascular disease. It also can be associated with arthritis, which often manifests with morning stiffness. Psoriatic arthritis can hinder peoples ability to do their normal activities.
What Are Treatment Options For Late
The treatments for psoriasisboth early and late-onsetare the same. Your doctor will likely prescribe topical ointments such as over-the-counter coal tar, salicylic acid, and prescription treatments, including retinoids, topical steroid creams, and vitamin D treatments. Moderate-to-severe cases may require phototherapy, a UVB light therapy treatment that reduces inflammation and slows down skin cell growth. Depending on the severity of your psoriasis, your doctor may choose to go with a systemic treatment such as an immunosuppressant or biologic drug.
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What Causes Fatigue In Psoriasis And Psoriatic Arthritis
Psoriasis and psoriatic arthritis are both inflammatory diseases involving molecules called cytokines. The immune system uses cytokines as signals to tell other immune-system cells what to do. Cytokines do not function properly for individuals with inflammatory conditions like psoriasis and PsA. This causes the immune system to attack when it doesnt need to, increasing inflammation throughout the body.
How Psoriasis Affects The Youngest Patients
Pediatric cases appear to be increasing worldwide for a variety of reasons.
Psoriasis, an autoimmune skin disease, doesn’t just affect adults.
People usually see their first psoriasis symptoms between ages 15 and 30. About one-third of patients are younger than 20, according to the National Psoriasis Foundation . While it’s less common, younger children can get psoriasis as well. The NPF estimates that about 20,000 youngsters under age 10 are diagnosed with the condition each year.
The numbers may be even higher, according to Kelly Cordoro, MD, a professor of dermatology and pediatrics and the division chief of pediatric dermatology at the University of California in San Francisco. Thats because some patients with mild disease may not seek care or may be misdiagnosed. There may also be racial and other disparities in prevalence and access to care.
We have seen a rise in recorded cases of pediatric psoriasis over the last few decades, which may result from increases in trigger factors such as stress, infection, and obesity, as well as increased awareness and recognition of the condition by physicians and the public, says Dr. Cordoro.
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Skin Aging And Psoriasis
With age, skin loses its elasticity and becomes thinner and drier, increasing the appearance of wrinkles. Beyond genetics, the number one factor impacting skin aging is sun damage. Skin thats been chronically damaged by the sun may also be harder to treat during psoriasis flares.
While medical-grade ultraviolet B treatment can help psoriasis by targeting skin inflammation, tanning beds and chronic exposure to natural sunlight expose skin to a more powerful, full-spectrum UV light that damages skin and increases the risk of premature skin aging and cancer. Overexposure to this type of UV light can prevent us from appropriately treating areas with psoriasis, because the surrounding skin has been so heavily sun damaged, says Rashmi Unwala, MD, a dermatologist specializing in psoriasis at Cleveland Clinic in Ohio.
Its essential to use a broad-spectrum SPF 30 sunscreen on exposed skin every time you head outside. Sun exposure is a leading driver of skin thinning and damage with aging, so we recommend sun protection to allow people to use the medications that they will benefit from, says Dr. Unwala.
One of the most important factors of both psoriasis and skin aging is smoking. If you smoke, talk to your doctor for tips on quitting.
Psoriasis Doesn’t Have To Be A Life
Peter Amento avoided shorts and short sleeves for most of his life, no matter how warm the weather. When he did wear them, People would comment: What have you got? Poison ivy? Thats how bad my psoriasis would look, says the 61-year-old husband and father of three from Hamden.
Weve worked together to find the best treatment for his condition. Its a great partnership.Keith Choate, MD, PhD
The skin disorder appeared when Amento was 15, and over the years he tried everything to make it go away. I started with sunlamps, which was the way to go back then, he says. It didnt do much. He moved on to ointments, slathering them on the red patches on his arms, legs and torso, then covering the areas with plastic wrap to help the medication seep in. Theyd go away for a couple of weeks, then youd have to repeat the whole process.
Later, he would fly to Florida and sunbathe on the beach until his skin was crisp. The sunburn killed me for a couple of days, but it got rid of the psoriasis for a month, he says.
Amento assumed he would struggle with the condition for the rest of his life. Then his local dermatologist referred him to Yale Medicine, where physicians had a new approach.
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Emollients For Washing And Bath/shower Equipment
Soaps, shower gels and bubble baths can dry out the skin. Its best to use an emollient wash product or a leave-on emollient as a soap substitute. The exception to this is washing the hands while Covid-19 remains a threat. The Covid-19 virus is not fat-soluble so it will not be removed by washing with emollients alone soap is needed. If you have hand eczema, any residual soap will aggravate the eczema, so wash your hands again with your emollient. Then pat them dry with a soft towel and re-apply emollient.
Your GP may refer you to the Community Occupational Therapy Service if you need special bath/shower equipment for safety or if you have difficulty getting in or out of the bath/shower. They can fit a bath seat, grab-rails, a seat in the shower or an alarm if you get into difficulties.
Emollient bath oils make the shower tray and bath more slippery. Use non-slip bath mats to help reduce the risk of slipping. Support bars fixed to the wall in the shower or by the bath will provide extra safety when showering/bathing. Pour bath emollient into the bath after you get in rather than before. As an extra precaution its a good idea to empty out bath water before getting out of the bath. Be careful not to knock your legs, as this could lead to ulcers.
See National Eczema Societys Emollients factsheet for more information.
What Will Happen If I Stop Treating My Psoriasis
One of three things happens when you stop treatment:
You may stay clear and have no psoriasis symptoms .
Your psoriasis may return, looking and feeling much like it did before .
The psoriasis may return and be worse than before .
What happens often depends on the medication you were using when you stopped, how well you manage your psoriasis triggers, and your medical history.
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What Are The Clinical Features Of Psoriasis
Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well-defined edges. The scale is typically silvery white, except in skin folds where the plaques often appear shiny with a moist peeling surface. The most common sites are scalp, elbows, and knees, but any part of the skin can be involved. The plaques are usually very persistent without treatment.
Itch is mostly mild but may be severe in some patients, leading to scratching and lichenification characterised by thickened leathery skin and increased skin markings. Painful skin cracks or fissures may occur.
When psoriatic plaques clear up, they may leave brown or pale marks that can be expected to fade over several months.
What Type Of Psoriasis Treatment Will I Need
Several treatment options can relieve psoriasis. Creams or ointments may be enough to improve the rash in small areas of skin. If the rash affects larger areas, or you also have joint pain, you may need other treatments. Joint pain may be a sign that you have arthritis.
Your provider will decide on a treatment plan based on:
- Severity of the rash.
- Vitamin A or retinoid creams.
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How Long Does It Take For Plaque Psoriasis To Heal
Although research is promising, doctors cannot yet cure psoriasis. Once a person has had a psoriasis flare, they are likely to have another one.
Patches of psoriasis may clear up after a few months, or they may stay the same, get bigger, or spread across the body. In some people, psoriasis will disappear and not return for years.
Treatment can help reduce the frequency of flares and the severity of symptoms.
People who find that environmental factors trigger their flares can often reduce flare frequency by controlling these triggers, which may include stress or allergies.
Psoriasis has a characteristic appearance that most doctors quickly recognize.
If a doctor suspects psoriasis but is unsure, they may perform a skin biopsy to rule out other causes. The biopsy will involve taking a sample of affected skin and examining it under a microscope.
Treatment depends on the severity of psoriasis. Some people can control their symptoms by avoiding triggers and using over-the-counter corticosteroid creams.
People with moderate or severe psoriasis may need medication to control their symptoms. A wide range of medications is available, including:
Other treatment strategies include:
other types of psoriasis include:
What Is Cdc Doing About Psoriasis
In 2010, CDC worked with experts in psoriasis, psoriatic arthritis, and public health to develop a public health perspective that considers how these conditions affect the entire population. The resulting report is Developing and Addressing the Public Health Agenda for Psoriasis and Psoriatic Arthritis pdf icon. You can read a short article about the agendaexternal icon in The American Journal of Preventive Medicine.
CDCs National Health and Nutrition Examination Survey , an intermittent source of national psoriasis data, has included questions about psoriasis as late as the 2013-2014 cycle. A recent analysis of NHANES data estimates that 7.4 million adults had psoriasis in 2013external icon.
- Psoriasis causes patches of thick red skin and silvery scales. Patches are typically found on the elbows, knees, scalp, lower back, face, palms, and soles of feet, but can affect other places . The most common type of psoriasis is called plaque psoriasis.
- Psoriatic arthritis is an inflammatory type of arthritis that eventually occurs in 10% to 20% of people with psoriasis. It is different from more common types of arthritis and is thought to be related to the underlying problem of psoriasis.
- Psoriasis and psoriatic arthritis are sometimes considered together as psoriatic disease.
Who is at risk for psoriasis?
Anyone can get psoriasis. It occurs mostly in adults, but children can also get it. Men and women seem to have equal risk.
Can I get psoriasis from someone who has it?
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