Does Psoriasis Affect Your Immune System

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.

Myeloid Dendritic Cells In Psoriasis

The earliest indication that myeloid DCs may be important in psoriasis were experiments by Nestle et al. showing that psoriasis lesion-derived dermal DCs stimulated a T cell response with production of IL-2 and IFN-. It is now appreciated that myeloid DCs are key proximal cells in the pathogenic psoriatic pathway . CD11c+ DC cell counts were increased in psoriasis lesions and reduced with all successful treatments studied . However, in psoriasis lesions, there were many CD11c+ cells that did not costain BDCA-1+ or BDCA-3+, and were subsequently termed inflammatory myeloid DCs . We consider TIP-DCs to be a subset of the inflammatory DCs because not all CD11c+ cells express TNF and iNOS. BDCA-1+ DCs expressed markers of DC maturity, such as CD208 and CD205 , in contrast to BDCA-1- DCs, which showed increased CD209 .

Although the above markers describe inflammatory DCs in psoriasis, a recent paper defined CD11c+HLA-DRhi myeloid subsets in ascites fluid from cancer patients differently, using BDCA-1 to define a subset to inflammatory DCs and CD16 to define inflammatory macrophages . We have previously shown, by two-color immunofluorescence and flow cytometry, that cutaneous DCs are CD16+ , so CD16 does not appear to define two discrete inflammatory myeloid subsets in the skin. Additional studies are required, and the DCs may have different markers in specific organs or across various disease states.

Rheumatoid Arthritis And Psoriasis

Around one-third of people with psoriasis develop a type of arthritis called psoriatic arthritis. This affects the joints and bones.

It is also possible for people to develop other types of , such as rheumatoid arthritis. Indeed, the risk of developing rheumatoid arthritis is higher in people with psoriasis than in people without.

However, many of the symptoms of and psoriatic arthritis overlap. This may mean that doctors avoid giving multiple diagnoses where one is enough.

Talk with your doctor if you think you are developing symptoms of rheumatoid arthritis or , which include swelling and .

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How Do You Stop Psoriasis Flare

If you know your psoriasis triggers, avoiding them is a good first step. But this isnt always possible after all, you cant always avoid getting sick. And not every psoriasis flare has a clear-cut source, so prevention is complicated. But there are tried-and-true treatments and approaches that doctors have found to be successful.

What Are The Symptoms Of Scalp Psoriasis

Symptoms of scalp psoriasis vary.

Mild scalp psoriasis symptoms may involve only small, thin scales or flaking that looks like dandruff.

Moderate or severe scalp psoriasis symptoms include:

• Raised, discolored plaques with a white or silvery surface of dead skin cells.
• Plaques on most of your scalp or your entire scalp.
• Plaques along your hairline, forehead, the back of your neck or on the skin around your ears.
• Dryness.
• Irritation or pain.

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How To Treat Psoriasis

If your psoriasis treatment is working and youre doing well, but you suddenly have a flare, Dr. Fernandez says monitoring the situation is a good next step.

What we dont want to do is panic and change the old treatment regimen because youre flaring, he explains. Especially if youve generally done well on a given regimen. With all the great medicines that we have today, we can usually control psoriasis so that a patient has no more than about 1% body surface area of psoriasis on the skin. Thats about the size of one palm of your hand. But when youre flaring, youll have more of that.

Another good next step is sharing any recent health changes with your doctor. Maybe you recently had an upper respiratory infection theres a good chance this infection is whats causing your immune system to go a little haywire for a while and contribute to psoriasis flares, Dr. Fernandez says.He adds, Then well keep your maintenance regimen the same and figure out, Well, how are we going to control this flare? How do we get you through these few weeks of having more disease activity than you normally do without changing a treatment regimen that has generally worked well? Once your flare subsides, youll resume your regular maintenance treatment approach.

Additional medication

After a viral infection has come and gone, your psoriasis flare might be severe enough to require extra TLC .

Use moisturizer with salicylic acid

Avoid using alcohol on your skin

Psoriatic Disease Affects More Than Skin And Joints

The systemic inflammation that drives symptoms of psoriatic disease can raise your risk for other health problems.

If you have psoriasis or psoriatic arthritis , you may know that these diseases raise your risk for some other conditions as well. When one disease is triggered by or linked to another, the related condition is called a âcomorbidity.â PsA, for example, is a common comorbidity of psoriasis, affecting up to 33 percent of people with psoriasis.

According to the recent Joint AAD-NPF Guidelines of Care for the Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities, other comorbidities for which psoriatic disease raises risk include:

• Cardiovascular disease
• Mental health impacts, including depression and anxiety
• Inflammatory bowel disease
• Uveitis
• Nonalcoholic fatty liver disease

Just how this elevated risk happens for each comorbidity isnât fully understood. One underlying factor that likely plays an important role in triggering or contributing to development of many comorbidities, however, is systemic inflammation, explains dermatologist Paul S. Yamauchi, M.D., Ph.D.

The weapons the immune system uses for this attack are inflammatory immune cells that normally defend the body from injury and infection.

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What Is Psoriatic Arthritis Video

Psoriatic arthritis can cause pain, swelling and stiffness in and around your joints.

It usually affects people who already have the skin condition psoriasis . This causes patches of red, raised skin, with white and silvery flakes.

Sometimes people have arthritis symptoms before the psoriasis. In rare cases, people have psoriatic arthritis and never have any noticeable patches of psoriasis.

Psoriatic arthritis and psoriasis are autoimmune conditions. Our immune system protects us against illness and infection. In autoimmune conditions, the immune system becomes confused and attacks healthy parts of the body.

Both conditions can affect people of any age.

Its estimated that around one in five people with psoriasis will develop psoriatic arthritis.

People with psoriasis are as likely as anyone else to get other types of arthritis, such as osteoarthritis or rheumatoid arthritis. These conditions are not linked to psoriasis.

Psoriatic arthritis is a type of spondyloarthritis. These are a group of conditions with some similar symptoms.

Is Guttate Psoriasis The Same As Chronic Psoriasis

Guttate psoriasis is related to chronic psoriasis, but they arent the same condition. The majority of people who have guttate psoriasis will recover completely. However, its estimated that about one-third of the people who develop guttate psoriasis ultimately develop chronic psoriasis, which involves patches that form larger scaly areas called plaques. Psoriasis is an inflammatory disease, which means your bodys immune system overreacts for an unknown reason and causes the symptoms of psoriasis.

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Are There Any Home Remedies For Scalp Psoriasis

While home remedies are safe for most people, its a good idea to check with your healthcare provider before trying some of the following options. You may be at risk of developing an allergic reaction.

• Aloe vera. Aloe vera is a wound care gel. It can keep your skin hydrated while treating itchiness and irritation. Gently apply aloe vera to your plaques two to three times per day.
• Baking soda. Mix 2 teaspoons of baking soda with a small amount of warm water to make a paste. Gently apply the paste to your plaques and leave it on for up to 10 minutes to treat itchiness and irritation. Baking sodas gritty texture also helps remove dead skin cells . Gently rub it on your affected areas to soften your plaques.
• Coconut oil. Coconut oil moisturizes your skin. It also contains anti-inflammatory and antibacterial properties that help reduce inflammation.
• Olive oil. Olive oil helps moisturize your dry skin and minimize irritation and itching.

Skin: Hormones Target And Synthesis Organ

The skin, the central nervous system and the endocrine system have a common embryological origin and they all express the same, numerous mediators . For example, human skin produces, activates or inactivates neuropeptides like serotonin some opioid peptides and their receptors are also expressed in the skin .

The normal skin development and function is influenced by hormones: for example, the growth hormone stimulates keratinocyte proliferation , and thyroid hormones act directly on hair follicles . The skin is a neuroendocrine organ, capable of hormone synthesis and release : corticosteroids and sex hormones are synthesized and transformed catecholamines are synthesized by keratinocytes and melanocytes .

Dermal fibroblasts present strong circadian rhythm and melatonin is implicated in the regulation of hair growth cycle and is metabolized . Prolactin is also implicated in hair growth regulation, and scalp skin and hair follicles are sources of prolactin .

The cutaneous endocrine system is highly important in multiple systemic diseases .

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What Is The Difference Between Psoriasis And Inverse Psoriasis

Psoriasis and inverse psoriasis are both diseases that affect your skin.

Psoriasis features thick, discolored patches of skin covered with white or silvery scales. The thick, scaly patches are plaques.

Inverse psoriasis doesnt feature the thick, scaly plaques like other types of psoriasis, most likely because its present in moist areas of your body. An inverse psoriasis rash also looks shinier than a psoriasis rash.

Does Psoriasis Get Worse With Age

Aging doesnt make psoriasis worse. But as you get older, you may need to adjust your treatment plan. Your body may react differently to drugs youve taken over time. Or, it may no longer be safe for you to continue taking certain drugs.

According to the American Academy of Dermatology, some of the following factors can affect your treatment plan once you turn 65:

• It may be harder to reach areas of the body where you need to apply topical treatment.
• Skin may become thin, or it may bruise or tear more easily when you apply a topical corticosteroid.
• Light therapy may be challenging because of the time spent on your feet while standing in a light box.
• Skin may be sensitive to light due to medications youre taking for other health conditions, which makes light therapy more challenging.
• Some systemic drugs may be riskier to take because of differences in kidney function as you age.

Keep an open line of communication with your healthcare provider about your psoriasis treatment plan and whether it should be adjusted as you age.

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Pd And Your Immune System

With PD and other autoimmune diseases, your immune systemwhich is designed to keep you healthysuddenly makes you sick. The reason for this is autoimmunity, a process whereby the immune system launches inflammatory attacks against the body it is supposed to protect.

To some degree, autoimmunity is present in everyone and tends to be harmless for example, the body may produce antibodies against itself to help clean up after an infection. But it can also cause a broad range of autoimmune diseases, which can result in the gradual progression of autoimmunity. Such progression is related to genetics and environmental triggers.

When a person has PD, their immune system does not work properly. It makes too much of certain proteins that cause the body to think it is being attacked. In turn, the body responds with inflammation. Inflammation then affects skin cells and makes them grow too quickly. It also affects the joints, which become painful, stiff, tender, and swollen as a result of ongoing inflammatory processes.

What Can Trigger Psoriasis

Plenty of everyday things can act as a trigger, causing psoriasis to appear for the first time. Common psoriasis triggers include:

• Stress

• Skin injury, such as a cut or bad sunburn

• Infection, such as strep throat

• Some medications, including lithium, prednisone, and hydroxychloroquine

• Weather, especially cold, dry weather

• Tobacco

• Alcohol

These triggers can also cause psoriasis flare-ups. Different people have different triggers. For example, periods of intense stress may trigger your psoriasis but cold weather may not.

Thats why its so important for people who have psoriasis to know what triggers their psoriasis. Avoiding triggers can reduce psoriasis flares.

Youll find common triggers and what you can do to avoid them at: Are triggers causing your psoriasis flare-ups?

If you think you have psoriasis, its important to find out. Treatment can help relieve your discomfort and lead to clearer skin. You can find out how board-certified dermatologists diagnose and treat psoriasis at: Psoriasis: Treatment.

Related AAD resources

1 Gottlieb A, Korman NJ, et al. J Am Acad Dermatol 2008 58:851-64.2 Alexis AF, Blackcloud P. J Clin Aesthet Dermatol. 2014 7:16-24.

ImageGetty Images

References Alexis AF, Blackcloud P. Psoriasis in skin of color: epidemiology, genetics, clinical presentation, and treatment nuances. J Clin Aesthet Dermatol. 2014 7:16-24.

All content solely developed by the American Academy of Dermatology

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Complications Of Psoriasis And Covid

If you test positive for COVID-19, have symptoms, or think you have been exposed to the virus, you should reach out to your primary doctor right away. Be sure to tell them you are taking immunosuppressive drugs to treat psoriasis.

If you test positive, you should also reach out to the doctor who treats your psoriasis so they can tell you how to manage your psoriasis care while you are recovering. They might suggest you alter or delay your next dose or treatments that suppress your immune system.

Your doctor will also give you information about treatment options for preventing a flare-up during this time.

There isnt enough evidence on how COVID-19 affects people with psoriasis or if they might be affected differently than people without psoriasis. Regardless, COVID-19 is highly transmissible and spreads rapidly, which means everyone is at risk. Even if you dont have symptoms, you can still spread COVID-19.

Complications of COVID-19acute respiratory distress, cardiac injury, blood clots, and morecan affect anyone who contracts the infection, especially those with a higher risk for the condition.

But it is unknown whether people with psoriasis have an elevated risk for these types of complications. The small amount of research available seems to indicate that their risk isnt different from others in the general population.

Boost Your Immune System Under The Influence Of Methotrexate

If you take biologics or Methotrexate , you need to think about boosting your immune system in other ways.

While these solutions can be effective in minimizing the effect of psoriasis, they also reduce your immunity. This leaves you more vulnerable to illness and infection.

A few ways to boost your weakened immune system without cancelling the effects of your medication include:

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Langerhans Cells In Healthy Skin

The epidermis contains LCs that are immature antigen-presenting cells . If these LCs become activated by antigensor cytokines, they can migrate out of the epidermis and carry antigens to draining lymph nodes to activate T cell responses. The changing views on the role of LCs were recently thoroughly reviewed by Romani and colleagues . Initially, LCs were considered to be nerve endings, or effete melanocytes then studies in the 1980s led to an appreciation that they can produce an effective immune response. LCs in human skin preferentially activate Th2 and Th22 cells, based on ex vivo functional analyses . In a series of elegant experiments coculturing epidermal CD1a+ LCs and T cells from healthy skin of the same donor, Seneschal et al. showed that LCs could induce are gulatory T cell phenotype . However, when the LCs were pulsed with increasing doses of Candida albicans, more effector T cells and fewer Tregs were induced. This supports the concept that the type of immune response induced by the LCs depends upon their surrounding environment.

Clinical And Histological Features Of Psoriasis

Psoriasis is a common skin disease affecting 13% of the North American population. Classic psoriasis, called large plaque psoriasis or psoriasis vulgaris, is the most common type. It can be fairly easily diagnosed as characteristic red colored plaques with well-defined borders and silvery-white dry scale, located on elbows, knees, and scalp and in the lumbosacral area , although it can be more extensive . Other less common types of psoriasis also occur, such as guttate, inverse, pustular, erythrodermic, palmo-plantar, and drug-associated psoriasis .

The amount of psoriasis covering the body can be measured roughly as a percentage of body area, using the palm to represent 1% of the body. In approximately one-third of patients, more than 10% of the body is covered, and this is termed moderate to severe psoriasis. Clinical disease can also be assessed by a trained health-care practitioner, using the Psoriasis Activity and Severity Index score. This tool ranks severity and area of erythema , induration , and desquamation of the plaques in different body sections, with 72 as the maximal score. A baseline PASI score is assigned , the score is then reevaluated at various time points, and the improvement is calculated. Most clinical studies consider that an improvement of 75% from baseline is required for the treatment to be considered successful , although a PASI50 can also be very meaningful for an individual patient.

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