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How Do You Diagnose Psoriasis

What Are The Symptoms

Diagnosing Psoriasis

There are several types of psoriasis. Symptoms for each may vary. But major symptoms are itchy and tender skin and raised, bright red patches of skin , topped with loose, silvery scales. In some people, psoriasis causes joints to become swollen, tender, and painful. Symptoms may disappear, even without treatment, and then return.

How Can Parents Help

For some children, psoriasis is just a minor inconvenience. For others, it is a difficult medical condition.

To manage symptoms and make outbreaks less likely, your child should:

Kids and teens with psoriasis may feel uncomfortable with the way their skin looks. Help your child understand that psoriasis is common and treatments can help.

Whether your child’s psoriasis is mild or severe, learn about the condition together. Offer to help find a therapist or join a support group if that might help. Talk to your doctor or check websites like:

How Plaque Psoriasis Is Diagnosed

The diagnosis of plaque psoriasis is relatively straightforward but typically requires medical expertise to differentiate it from similar skin conditions. Plaque psoriasis, by far the most common form of psoriatic disease, is characterized by the appearance of raised scaly, white patches known as plaques. Dermatologists are usually able to diagnose psoriasis based on a review of your symptoms and medical history.

However, there are times when additional tests may be needed. This may involve a skin biopsy to look for definitive signs of the disease under the microscope. A differential diagnosis may be used to exclude other conditions that mimic plaque psoriasis, including other less common forms of psoriasis.

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Everything You Need To Know About Scalp Psoriasis

When youre dealing with an itchy, flaky, and straight-up unhappy scalp, your mind probably jumps to dandruffnot something like scalp psoriasis. The condition, which can be much more difficult to diagnose and treat than your run-of-the-mill dandruff, can cause scaly skin patches or plaques to develop on the scalp, and you may not even know it because theyre hiding under your hair1. To better understand what you may be dealing with, SELF asked a leading expert to explain what scalp psoriasis looks like, plus the conditions most common triggers and treatments, so you can finally get the relief you deserve.

What is scalp psoriasis? | What are scalp psoriasis symptoms? | What causes scalp psoriasis? | Whats the difference between scalp psoriasis and dandruff? | How to treat scalp psoriasis | Do scalp psoriasis home remedies work?

What Else Should I Ask My Healthcare Provider

What You Can Do to Help Your Psoriasis Symptoms ...

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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Signs And Symptoms Of Psoriasis

Psoriasis plaques can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. The diseases symptoms and appearance vary according to the type and severity of psoriasis.

Some common signs and symptoms include:

  • Discolored patches or raised plaques of skin that are covered with scales
  • Burning, itching, or soreness near the affected areas
  • Pitted or thickened fingernails or toenails

Whats The Difference Between Scalp Psoriasis And Dandruff

Dr. Bhutani says it can be really tough to tell scalp psoriasis and dandruff aparteven for doctors! Although both conditions can cause those annoying flakes, which may be the only visible symptom at first for some people, they tend to pop up for different reasons. Unlike scalp psoriasis, dandruff isnt an autoimmune issue and can be spurred by various factors, like having very dry or oily skin, which can lead to an overgrowth of a yeast-like fungus that thrives on a moist scalp10.

But you may be able to pick up on subtle differences if you look a bit closer. Dandruff flakes can be white or yellow, which is not common in scalp psoriasis. With scalp psoriasis, plaques have a dry scale with more clearly defined edges, and the scales themselves are often thicker with a silvery sheen.

If your scalp is extremely itchy or you have any other scalp psoriasis symptoms, then you may want to schedule an appointment with a dermatologist, who can thoroughly assess whats going on. If youre only noticing some flaking and have tried an over-the-counter dandruff shampoo but havent noticed improvement, then you may want to see a dermatologist anyway theyll be able to take a closer look and prescribe something a bit stronger if you need it.

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Is It Scalp Psoriasis Or Dandruff

More than half of all psoriasis patients have scalp psoriasis, according to the NPF. Itchy plaques can extend beyond the hairline onto the forehead, neck, and around the ears.

“Most people with scalp psoriasis have it on other parts of their body as well,” says Dina D. Strachan, MD, a dermatologist and assistant clinical professor of dermatology at NYU Langone Medical Center in New York City.

Scalp psoriasis is sometimes confused with seborrheic dermatitis, or dandruff. According to Dr. Strachan, dandruff which causes a flaky, itchy scalp without signs of inflammation tends to itch more than scalp psoriasis. It has a greasy-appearing yellow scale, Strachan says. In contrast, psoriasis whether it’s on your scalp or any other body part tends to have a thick, silvery scale.”

What To Expect After A Biopsy

Psoriasis Diagnosis

You may need a stitch or two to close the wound. Your doctor will make sure that the area is clean and bandaged correctly. Your doctor will give you careful instructions on how to keep it clean and prevent infection.

Your doctor will send the skin sample to a lab, where a specialist will look at it under a microscope. It might be a few days before you can find out the results of the test.

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Why Is It Important To Have An Accurate Diagnosis

  • Because psoriasis can look very much like a number of other skin conditions, it is important to be certain that your skin problem is due to psoriasis so the correct treatment can be chosen.
  • Too often, doctors not familiar with this condition will try treatments that are simply, just wrong. This usually leads to frustration for the patient and can result in a lack of trust that any doctor knows how to help their problem. In some cases, these wrong treatments can even lead to a worsening of the condition, making things even more complicated.

Tests For Psoriatic Arthritis

Psoriatic arthritis cant be diagnosed with any single test. Your doctor will probably order a number of tests and examine all of the evidence to make a diagnosis.

Your doctor will not only be looking for indications of PsA in your test results. They will also be looking for results that rule out other conditions as well as results that eliminate the possibility of PsA.

For example:

  • Blood tests can help rule out gout and rheumatoid arthritis .
  • A blood test that shows mild anemia points toward the possibility of PsA .
  • Presence of RH factor in your blood means you dont have PsA.

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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.

Evaluation And Differential Diagnosis

Psoriasis Symptoms And The Best Guide To Treating Them

Less common variants of psoriasis include inverse psoriasis, pustular psoriasis, guttate psoriasis, erythrodermic psoriasis, and annular psoriasis .6). These variants can be differentiated from the common plaque type by morphology. Differential diagnoses include atopic dermatitis, contact dermatitis, lichen planus, secondary syphilis, mycosis fungoides, tinea corporis, and pityriasis rosea . Careful observation often yields the diagnosis. For more atypical presentations, a skin biopsy might be helpful.

Differential diagnoses and distinguishing clinical features

DIFFERENTIAL DIAGNOSES DISTINGUISHING CLINICAL FEATURES
Atopic dermatitis Predominant symptom of pruritus and typical morphology and distribution
Contact dermatitis Patches or plaques with angular corners, geometric outlines, and sharp margins dependent on the nature of the exposure to the irritant or allergen
Lichen planus Violaceous lesions and frequent mucosal involvement
Secondary syphilis Copper-coloured lesions and frequent involvement of palms and soles
Mycosis fungoides Irregularly shaped lesions with asymmetric distribution, peculiar colour, and wrinkling due to epidermal atrophy
Tinea corporis Fewer lesions with annular configuration
Pityriasis rosea Tannish-pink, oval papules and patches with Christmas tree configuration on trunk with sparing of the face and distal extremities

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Is It Psoriasis Or Eczema

Like psoriasis, eczema is a very itchy skin condition. In fact, eczema usually results in a more intense itch than psoriasis. Scratching causes inflammation of the skin, leading to a worsening of the eczema. Scratching can also cause a secondary bacterial infection.

Eczema is not a specific disease, but rather a term referring to a group of rash-like conditions. The most common type of eczema is caused by a reaction to irritants, like detergents, soaps, or household cleansers.

Eczema often shows up on the back of the knees or the inside of the elbows.

Eczema can affect anyone and affects children more than psoriasis does.

What Should I Do To Help My Psoriasis Heal

I certainly feel a bit off, soreness and fatigue here and there, thats part of the P healing growing pains. It is so important to get a good amount of sleep through this time. I focus on 7-8 hours a night. Getting some water in as soon as I get up and before bed. The primary goal I have for everyday is 3-4 liters of water.

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Emotional Impact Of Psoriasis

Because of the effect that psoriasis can have on physical appearance, low self-esteem and anxiety are common among people with the condition. This can lead to depression, especially if the psoriasis gets worse.

Your GP or dermatologist will understand the psychological and emotional impact of psoriasis, so talk to them about your concerns or anxieties.

Psoralen Plus Ultraviolet A

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For this treatment, you’ll first be given a tablet containing compounds called psoralens, or psoralen may be applied directly to the skin. This makes your skin more sensitive to light. Your skin is then exposed to a wavelength of light called ultraviolet A . This light penetrates your skin more deeply than ultraviolet B light.

This treatment may be used if you have severe psoriasis that hasn’t responded to other treatment. Side effects of the treatment include nausea, headaches, burning and itchiness. You may need to wear special glasses for 24 hours after taking the tablet to prevent the development of cataracts. Long-term use of this treatment isn’t encouraged, as it can increase your risk of developing skin cancer.

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Imaging Tests For Psoriatic Arthritis

Imaging tests can help your doctor closely examine your bones and joints. Some of the imaging tests your doctor may use include:

  • X rays. X-rays arent always useful in diagnosing early stage psoriatic arthritis. As the disease progresses, your doctor may use imaging tests to see changes in the joints that are characteristic of this type of arthritis.
  • MRI scans. An MRI alone cant diagnose psoriatic arthritis, but it may help detect problems with your tendons and ligaments, or sacroiliac joints.
  • CT scans. These are used primarily to examine joints that are deep in the body and not easily seen on x-rays, such as in the spine and pelvis.
  • Ultrasounds. These tests can help determine the progression of joint involvement and pinpoint the location.

Healthy Eating And Exercise

People with psoriasis have a slightly higher risk of developing diabetes and cardiovascular disease than the general population, although it’s not known why. Regular exercise and a healthy diet are recommended for everyone, not just people with psoriasis, because they can help to prevent many health problems.

Eating a healthy, balanced diet and exercising regularly can also relieve stress, which may improve your psoriasis.

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What Causes Psoriasis Outbreaks

Psoriasis outbreaks differ from person to person. No one knows exactly what causes flare-ups. Common psoriasis triggers may include:

  • Skin injury .
  • Streptococcal or other infection that affects the immune system.
  • Certain prescription medications .
  • Cold weather, when people have less exposure to sunlight and humidity and more to hot, dry indoor air.

How Do Dermatologists Diagnose Psoriasis

#psoriasisdiet can toddlers have psoriasis

To diagnose psoriasis, a dermatologist will examine your skin, nails, and scalp for signs of this condition. Your dermatologist will also ask if you have any:

  • Symptoms, such as itchy skin

  • Joint problems, such as pain and swelling or stiffness when you wake up

  • Blood relatives who have psoriasis

  • Recent changes in your life, such as an illness or increased stress

Sometimes, a dermatologist also removes a bit of skin. By looking at the removed skin under a microscope, a doctor can confirm whether you have psoriasis.

Understanding psoriasis is key

Alexa Boer Kimball, MD, MPH100 Questions and Answers about Psoriasis

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How To Know If You May Have Psoriasis

  • How it feels: Patches of psoriasis plaques can feel very dry and flaky. Dry skin can feel itchy and is also prone to cracking. Cracked skin may cause bleeding, scabs, and is a risk for infection.
  • What it looks like: These patches typically look red and inflamed and are raised from the surrounding skin. Affected dry skin looks somewhat silvery or white.
  • Where its most often found: The most common areas of psoriasis on the body are found on the elbows, knees, lower back, scalp, face, palms of your hands, and soles of your feet. It can also be found on nails, your mouth and lips, eyelids, ears, and in your skin folds.

Questions To Ask Your Doctor

  • How long does treatment last?
  • Will I have to be on medicine for the rest of my life?
  • Should I make any changes to my skin care routine?
  • Are there any skin products or foods that I should avoid?
  • If symptoms get worse, when should I call the doctor?
  • If I have psoriasis, will my children get it?
  • Is there a support group that you recommend?

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How Is Psoriasis Diagnosed

It may be hard to diagnose psoriasis. This is because it looks like other skin problems, such as eczema. Talk to your doctor if you think you have psoriasis. The doctor will do a physical exam and review your symptoms. They may take a biopsy of skin and look at it in the lab to help with your diagnosis. They may refer you to a dermatologist .

There are different degrees of psoriasis:

  • Mild: symptoms cover less than 3% of your body.
  • Moderate: symptoms cover 3% to 10% of your body.
  • Severe: symptoms cover more than 10% of your body.

What Is Cdc Doing About Psoriasis

Scalp Problems: Dandruff or Scalp 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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