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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Look For These Signs Of Plaque Psoriasis
You can spot plaque psoriasis by its very first symptoms. When any kind of psoriasis strikes, it affects the skin most obviously, and plaque psoriasis specifically can cause both plaques and a unique kind of rash.
Plaques are lesions on the skin that have clear boundaries. Theyre typically elevated, feel solid to the touch, look oval in shape, and grow to be more than one centimeter in size. However, when plaques first appear, they can start out very small and subtle and they can look like entirely different skin conditions.
Plaque psoriasis can cause small red bumps on your skin, as well as irregular patches of dry, pink or red spots. Over time, if left untreated or unnoticed, these little bumps can grow together and form plaques. And if you dont treat the underlying cause of these plaques, the plaques can lift away from your skin, causing cracking and bleeding.
The plaques that come with plaque psoriasis most commonly form in the following areas of the body:
- The elbows
- The front and back of the knees
- The stomach, back, and chest
- The buttocks
- The scalp
In addition to symptoms on your skin, plaque psoriasis can cause symptoms in other ways and areas of the body. Plaque psoriasis can cause changes and issues with your nails, so watch for changes like separating toe or finger nails, nail pitting, yellow or brown spots, or changes in the shape of your nails.
- Cardiovascular disease
- Inflammatory bowel disease
An Itching Or Burning Feeling On The Skin
Although psoriasis patches arent usually irritating, some people do report itchiness. People who have psoriasis of the scalp can report its very itchy or dry, says Anthony Rossi, MD, FAAD, a board-certified dermatologic surgeon at Memorial Sloan Kettering Cancer Center and assistant professor of dermatology at Weill Cornell Medical College.
The itching and pain can interfere with basic daily activities including self-care, sleep, and even walking.
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Measles: A Facial Rash That Can Cover The Body
Like guttate psoriasis, measles also follow symptoms of an upper respiratory infection in children and cause a skin rash of small, red spots. However, the measles skin rash usually starts on the face and spreads down to cover the body and is accompanied by fever, cough, and a runny nose. Measles rash is also flat, while the rash of psoriasis is typically raised. Measles is caused by a virus and is contagious, though the measles vaccination has made this a rare disease in the United States.
Types Symptoms And Treatment
Like psoriasis and PsA elsewhere on the body, psoriatic disease in the hands and feet can cause itchy, scaling, reddened skin plaques and painful, swollen joints. Specific types and symptoms of hand and foot psoriasis and PsA, however, can also cause less-familiar skin and joint issues.
Palmoplantar psoriasis, plaque psoriasis on the feet or hands, affects about 40 percent of people with plaque psoriasis, who often donât have much skin disease elsewhere. As noted, its substantial effects on function and quality of life mean dermatologists typically use advanced medications to control symptoms. Treating certain types of palmoplantar psoriasis is still challenging, despite the rapidly expanding list of medications for psoriasis and PsA. Often, palmoplantar psoriasis doesnât respond as well to treatment as does psoriasis on other parts of the body.
Most biologics, which work by targeting specific proteins that turn up inflammation in psoriatic disease, such as tumor necrosis factor or interleukin-17 , have some effect on certain people with palmoplantar psoriasis.
No one treatment works for everyone, and people with palmoplantar psoriasis may have to try several medications or combinations of treatments to relieve symptoms. Gary Bixby, for example, didnât get better with either a TNF or an IL-17 inhibitor. The third biologic he tried blocks another interleukin protein, IL-23, and, three months after his first injection, heâs getting better results.
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How Is Psoriasis Treated
Psoriasis is usually treated by a dermatologist . A rheumatologist may also help with treatment. Treatments can include:
- ultraviolet light from the sun or from home or office treatments. But in some people, sunlight can make psoriasis worse.
- creams, lotions, ointments, and shampoos such as moisturizers, corticosteroids, vitamin D creams, and shampoos made with salicylic acid or coal tar
- medicines taken by mouth or injected medicines
A doctor might try one therapy for a while and then switch to another. Or a doctor may combine different therapies. It’s all about finding one that works for each person.
Sometimes what works for a while might stop working. This is one reason why it’s important to work closely with a doctor. Trying out new treatments can get a little frustrating, but most people eventually find one that works.
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.
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Is Psoriasis The Same As Eczema
Psoriasis and eczema are two different skin conditions. They differ in where the disease appears on the body, how much it itches and how it looks. Eczema tends to appear more often behind the knees and inside the elbows. Eczema also causes more intense itching than psoriasis. Many people, especially children, can get both eczema and psoriasis.
How Is The Diagnosis Of Palmoplantar Psoriasis Made
Palmoplantar psoriasis is diagnosed by its clinical appearance, supported by finding chronic plaque psoriasis in other sites. Mycology of skin scrapings may be performed to exclude fungal infection. Skin biopsy is rarely needed.
The differential diagnosis of palmoplantar psoriasis includes:
- Other forms of acquired keratoderma.
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What Is Facial Psoriasis
Facial psoriasis is a chronic skin condition in which there are one or more, persistent, thickened, red and dry patches on the face.
Psoriasis is a common chronic inflammatory skin disease that may affect any skin site. Facial involvement occurs at some time in about half those affected by psoriasis. Although it is usually mild, facial psoriasis is occasionally very extensive involving the hairline, forehead, neck, ears and facial skin.
It is extremely rare to have psoriasis occurring solely on the face. Most patients also have scalp psoriasis and they may also have moderate to severe psoriasis at other sites.
Patients with facial psoriasis often suffer from psychosocial problems due to the presence of unsightly red, scalyplaques on highly visible areas.
Facial involvement presents as a therapeutic challenge because facial skin is thin, sensitive and more complicated to treat.
Work And Psoriatic Arthritis
Having psoriatic arthritis may make some aspects of working life more challenging. But, if youre on the right treatment, its certainly possible to continue working.
Help and support is available, and you have rights and options.
The Government scheme Access to Work is a grant that can pay for equipment to help you with activities such as answering the phone, going to meetings, and getting to and from work.
The 2010 Equality Act, and the Disability Discrimination Act in Northern Ireland makes it unlawful for employers to treat anyone with a disability less favourably than anyone else. Psoriatic arthritis can be classed as a disability if its making every-day tasks difficult.
Your employer may need to make adjustments to your working environment, so you can do your job comfortably and safely.
You might be able to change some aspects of your job or working arrangements, or train for a different role.
In order to get the support youre entitled to, youll need to tell your employer about your condition. Your manager or HR department might be a good place to start.
Other available support might include:
- your workplace occupational health department, if there is one
- an occupational therapist. You could be referred to one by your GP or you could see one privately
- disability employment advisors, or other staff, at your local JobCentre Plus
- a Citizens Advice bureau particularly if you feel youre not getting the support youre entitled to.
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Approach To The Patient
Evidence-based guidelines35 on the treatment of patients with chronic plaque psoriasis were published in 2004 by the Finnish Dermatological Society. Recommendations for the management of psoriasis in primary care, based on these guidelines, the evidence cited above, and considering common practice among American dermatologists, are shown in Figure 9.35
Management of Chronic Plaque Psoriasis
Figure 9
Algorithm for the management of chronic plaque psoriasis, based on recent guidelines,35 current evidence, and common practice among American dermatologists.
Management of Chronic Plaque Psoriasis
Figure 9
Algorithm for the management of chronic plaque psoriasis, based on recent guidelines,35 current evidence, and common practice among American dermatologists.
For the initial treatment of psoriasis on limited areas of skin, the most effective treatment is a combination of potent topical steroids and calcipotriene. This recommendation, however, is based on limited evidence.18,29,30 An alternative would be to start with a potent topical steroid, calcipotriene, or a topical retinoid alone. Calcipotriene and topical retinoids can be used long-term, but topical steroids must be used intermittently because of their side effects.35
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What Else Should I Ask My Healthcare Provider
If you have psoriasis, ask your healthcare provider:
- How can I prevent outbreaks and control symptoms?
- What medication will work best for me?
- What else should I do to improve symptoms?
- What are my options if creams dont work?
- Will psoriasis ever go away?
A note from Cleveland Clinic
Psoriasis, an itchy skin condition, can come and go throughout your life. Its related to an overactive immune response and is not contagious. If you have skin changes that arent going away, talk to your healthcare provider. There is no cure for psoriasis, but psoriasis treatments can improve symptoms. Your provider may prescribe a special cream or moisturizer or medications. Other therapies are available if creams or medicines dont work. Maintaining your overall health will also help improve symptoms.
Last reviewed by a Cleveland Clinic medical professional on 10/17/2020.
References
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What Are The Signs And Symptoms Of Guttate Psoriasis
Guttate psoriasis is the second most common type of psoriasis, affecting roughly 10 percent of people who have the disease, according to the National Psoriasis Foundation .
This type of psoriasis may clear up without any treatment, but it sometimes requires medical attention. It may appear for a single episode, typically following an illness like strep throat, or it may signal the start of plaque psoriasis.
The typical symptoms of guttate psoriasis include:
- Small, red spots that are most common on the trunk, arms, and legs, but can show up anywhere on your body
- Spots that clear up in a few weeks or months without treatment
What Does Psoriasis Look Like
Psoriasis usually appears as red or pink plaques of raised, thick, scaly skin. However, it can also appear as small, flat bumps or large, thick plaques. It most commonly affects the skin on the elbows, knees, and scalp, though it can appear anywhere on the body. The following slides will review some of the different types of psoriasis.
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What If Those Psoriasis Treatments Dont Work
If psoriasis doesnt improve, your healthcare provider may recommend these treatments:
- Light therapy: UV light at specific wavelengths can decrease skin inflammation and help slow skin cell production.
- PUVA: This treatment combines a medication called psoralen with exposure to a special form of UV light.
- Methotrexate: Providers sometimes recommend this medication for severe cases. It may cause liver disease. If you take it, your provider will monitor you with blood tests. You may need periodic liver biopsies to check your liver health.
- Retinoids: These vitamin A-related drugs can cause side effects, including birth defects.
- Cyclosporine: This medicine can help severe psoriasis. But it may cause high blood pressure and kidney damage.
- Immune therapies: Newer immune therapy medications work by blocking the bodys immune system so it cant jumpstart an autoimmune disease such as psoriasis.
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:
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Mild To Moderate Cases
Mild to moderate palmoplantar psoriasis may be treated with topical treatments, including:
- Emollient moisturizers: Apply thinly and frequently to treat dry, itchy, flaky skin and help prevent cracking.
- Salicylic acid: This keratolytic agent, available in lotions, soaps, foot balms, and shampoos, promotes the shedding of scales and reduces thickened plaques.
- Coal tar: Lotions, creams, and shampoos with this ingredient can reduce inflammation and slow skin growth.
- Anti-itch creams, containing ingredients like camphor, menthol, or benzocaine
- Calcipotriene: A vitamin D derivative, this appears to slow the hyperproduction of skin cells and reduce inflammation.
- Topical corticosteroids: Apply sparingly to temper local inflammation and reduce the size and appearance of plaques.
To improve absorption, a technique called occlusion may be used in which the hands or feet are covered with cling film, plastic gloves, or a plastic bag for several hours or overnight.
Speak with your healthcare provider about the appropriate use of occlusion to prevent skin irritation or the supersaturation of the skin .
A topical drug sometimes used to treat psoriasis, called anthralin, is not very successful for palmoplantar psoriasis. Anthralin is messy and impractical, requiring prolonged treatments, and may further dry and irritate delicate skin.
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When To See A Healthcare Provider
Psoriasis is not a medical emergency. However, you should see your healthcare provider if your symptoms are not improving as expected with treatment.
Plaque Psoriasis Healthcare Provider Discussion Guid
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
Psoriasis is not an infection. It is not contagious, and you cannot spread it to others.
People with psoriasis may be more likely to get skin infections like cellulitis, especially if their skin is actively irritated. People taking certain types of psoriasis medications are also more likely to get some kinds of infections. Call your healthcare provider if you have symptoms of an infection, like skin warmth, swelling, or a fever.
Some people with plaque psoriasis may have a higher risk of skin cancer, particularly after extensive exposure to PUVA light therapy treatments. See your healthcare provider promptly if you notice any skin changes unlike your normal pattern of psoriasis.
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Tlc For Hands And Feet
Avoiding injuries, even small ones , makes good sense for people with psoriasis or PsA affecting the hands and feet.
âThe Koebner phenomenon is the flaring of psoriasis in response to injury. Even minor trauma can cause a flare,â says Duffin. âFor example, if you use your nails to pry open a lid, youâre probably going to make your nail psoriasis worse.â
Similarly, shoving feet into shoes without enough room to wiggle toes or wearing high heels means youâre putting constant pressure on nails and joints, which can increase pain and nail problems.
âI generally recommend flats that have good cushioning and arch support that takes the weight off toe joints â which doesnât mean wearing ballet slippers that have no padding in the bottom,â says Gottlieb.
âYou donât want a triangle profile that squeezes the toes, because that elicits pain.â She also cautions that flip-flops, a summer favorite, expose toes and feet to trauma.
A consultation with a podiatrist, who can advise on the right footwear and design an orthotic for individual foot issues, is often helpful for people with PsA that affects the feet, Gottlieb says.