How To Check For Psoriasis

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.

What Is The Difference Between Scalp Eczema And Scalp Psoriasis

Scalp eczema and scalp psoriasis can look very similar. Theyre both inflammatory skin conditions. Scalp psoriasis typically has well-defined plaques, while scalp eczema is much itchier, even before you see the rash.

Your healthcare provider can tell the difference between scalp eczema and scalp psoriasis during an examination.

A note from Cleveland Clinic

Scalp psoriasis is an autoimmune condition that causes thick patches of skin to develop on your scalp or the skin around your scalp. You may feel self-conscious, and it can be unpleasant if its itchy or painful. However, it isnt contagious, and treatments can help your symptoms improve. Its important to pay attention to your skin, including your scalp. Contact your healthcare provider as soon as you notice any plaques developing on your scalp.

What Is A Rheumatologist

A rheumatologist is a specialist in the nonsurgical treatment of autoimmune, inflammatory, or other musculoskeletal conditions commonly referred to as rheumatic diseases.

Your rheumatologist is the best person to:

• Confirm your diagnosis after reviewing all test results and your medical history
• Direct you toward the best treatment depending on the severity of your psoriatic arthritis and whether the symptoms are mostly external , internal , or a combination of both.

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How Can I Care For Myself With Psoriasis

To help control your psoriasis and prevent flare-ups, you need to look after yourself and your skin.

• Have warm baths with a bath oil or tar solution to soften your psoriasis and lift the scale.
• Use bland soaps or soap substitutes and avoid antiseptics and harsh soaps.
• Use emollients or moisturisers to keep psoriasis soft and prevent it cracking and becoming sore.
• Cover small patches of psoriasis with waterproof adhesive dressings. If you haven’t used this type of dressing before, attach one to the inside of one forearm, leave for 30 minutes, then check for any reaction .
• Get sunshine in small doses to help clear psoriasis. Take care to avoid sunburn by using SPF 50+ sunscreen, as sunburn can cause flare-ups and lead to skin cancer.
• Get plenty of rest as it gives your body a chance to heal and recover.
• If you smoke, get support to quit, as smoking may make your symptoms worse.
• Avoid smoky or dusty conditions
• Avoid drinking too much alcohol as this can also make your symptoms worse. Read more about recommended alcohol limits.

Psoriasis assessment and management NICE Guidelines, UK, 2012

How Can You Measure Inflammation In The Body

While certain foods are known to cause inflammation, not everyone reacts the same way to these foods. Ive had some patients who felt that wheat was making their psoriasis worse. Another patient noticed more flare-ups when she ate nuts, says Wesdock.

Some tests can measure inflammation with biomarkers, which are substances in your blood that spike when your body reacts a certain way to foods such as fats or sugar. For example, a simple test can check for increased levels of C-reactive protein in your blood. The liver makes extra CRP if theres inflammation in your body. Doctors might use this test to determine how likely you are to develop a chronic condition like heart disease.

As you adjust your diet to ease psoriasis symptoms, be sure to work with your psoriasis doctor to monitor symptoms and inflammation levels.

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What Medications Or Treatments Are Used To Treat Scalp Psoriasis

Your healthcare provider may prescribe the following as a cream, lotion or gel to treat mild cases of scalp psoriasis:

• Anthralin.

In more severe or widespread cases of scalp psoriasis, your healthcare provider may prescribe:

• Medicine injections. Your healthcare provider will use a thin needle to inject medicine into your skin, a vein in your arm or directly into your plaques. These medicines may include adalimumab, etanercept or ustekinumab.
• Oral medicines. Oral medicines are pills or tablets you swallow with water. These medicines may include acitretin, cyclosporine or methotrexate.
• . Phototherapy uses ultraviolet light , usually ultraviolet B , from special lamps. The ultraviolet light waves in sunlight can help certain skin disorders, including scalp psoriasis.

Treating scalp psoriasis may be difficult. Your body is unique, and it might not respond to certain treatments. Talk to your healthcare provider about the best treatment for you.

Evaluation And Differential Diagnosis

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

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Risk Factors And Etiology

Approximately one-third of patients with psoriasis have a first-degree relative with the condition. Research suggests a multifactorial mode of inheritance.2,3 Many stressful physiologic and psychological events and environmental factors are associated with the onset and worsening of the condition. Direct skin trauma can trigger psoriasis . Streptococcal throat infection may also trigger the condition or exacerbate existing psoriasis. Human immunodeficiency virus infection has not been shown to trigger psoriasis, but can exacerbate existing disease. As the infection progresses, psoriasis often worsens.1

Smoking increases the risk of psoriasis and its severity.1,4 Obesity and alcohol use and abuse are also associated with psoriasis.4,5 These associations may not be causative patients with psoriasis may be more susceptible to unhealthy behaviors.4

What Are The Types Of Psoriasis

In children, common types of psoriasis include:

Plaque psoriasis. This is the most common type of psoriasis. It causes plaques and silvery scales, usually on the knees, elbows, lower back, and scalp. They can be itchy and painful and may crack and bleed.

Guttate psoriasis. This type often shows up after an illness, especially strep throat. It causes small red spots, usually on the trunk, arms, and legs. Spots also can appear on the face, scalp, and ears.

Inverse psoriasis. This causes smooth, raw-looking patches of red skin that feel sore. The patches develop in places where skin touches skin, such as the armpits, buttocks, upper eyelids, groin and genitals, or under a woman’s breasts.

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Nail Psoriasis Severity Index : Schuppenflechte An Den Ngeln Bewerten

Bei Menschen mit Nagelpsoriasis kann zusätzlich zum PASI-Verfahren der Nail Psoriasis Severity Index, kurz NAPSI, verwendet werden, um den Schweregrad der Schuppenflechte an Finger- und Fußnägeln zu beurteilen.

Der NAPSI ermittelt einen Wert für die Nagelveränderungen, die vom Nagelbett und von der Nagelmatrix ausgehen. Hierzu wird jeder Nagel in vier imaginäre Felder eingeteilt. So lässt sich festzustellen, welche Bereiche des jeweiligen Nagels betroffen sind. Jeder durch die Schuppenflechte veränderte Bereich kann jeweils einen Punkt für Veränderungen an Matrix und Nagelbett erhalten. So kommt man auf eine Summe zwischen 0 und 8 pro Nagel, wobei 8 für eine starke Veränderung des Nagels durch die Schuppenflechte steht.12

Wichtig:

Patienten mit Nagelpsoriasis entwickeln besonders häufig eine zusätzliche Gelenkbeteiligung . Wurde Schuppenflechte an den Nägeln diagnostiziert, sollten daher auch auftretende Gelenkbeschwerden von einem Arzt abgeklärt werden.

Einteilung Der Psoriasis In Schweregrade

Ärzte unterscheiden bei der Diagnose der Schuppenflechte die Schweregrade leichte Psoriasis und mittelschwere bis schwere Psoriasis.

Die Einteilung basiert auf international anerkannten Messverfahren, um den Schweregrad einer Schuppenflechte zu bestimmen. Die körperlichen Beschwerden werden oft mit dem Psoriasis Area and Severity Index gemessen. Zudem lässt sich mit dem BSA-Test grob der Anteil der Körperfläche erfassen, der von Psoriasis bedeckt ist. Die krankheitsbedingten Einschränkungen der Lebensqualität des Patienten ermittelt der Arzt mit dem Dermatologischen Lebensqualitäts-Index .

Dabei erfolgt die Einstufung in leichte Psoriasis und mittelschwere bis schwere Psoriasis nach diesem Model:6

• Wenn alle drei Scoring -Verfahren also BSA, PASI und DLQI einen Wert von 10 oder niedriger aufweisen, sprechen Mediziner von einer leichten Schuppenflechte.
• Wenn BSA oder PASI höher als 10 sind und gleichzeitig der DLQI- Wert über 10 angesetzt ist, liegt eine mittelschwere bis schwere Schuppenflechte vor.

Um den Schweregrad bei der Diagnose der Psoriasis realistisch bewerten zu können, sind Hautärzte darauf angewiesen, dass Patienten die Alltagsbelastungen ihrer Schuppenflechte-Erkrankung offen darlegen. Denn die Einteilung entscheidet über die weitere Behandlung: Je nach Schweregrad entscheiden Hautärzte, welche Medikamente und Wirkstoffe zum Einsatz kommen.

Schuppenflechte: Schweregrad und Lebenswirklichkeit immer übereinstimmend?

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Why Do I Need Blood Tests And What Are They

Blood tests are for screening purposes. We will check the fats in your blood , sugar , vitamin D level, liver function tests and kidney function tests together with a full blood count which checks you are not anaemic. We also screen for hepatitis B and C, HIV and whether youve had chicken pox, just in case we start you on a tablet form of medication.

Foods With Saturated Fats And Trans Fats

Fats in red meat, cheese, fried food, margarine, fast food and many processed snacks are known to trigger inflammation in the body. These fats increase the amount of low-density lipoprotein in your blood, also called bad cholesterol. Studies suggest there may be a link between excess fat in the body and development of psoriasis and worsening of psoriasis symptoms.

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What Are The Different Types Of Psoriasis

There are several different types of psoriasis.

• Chronic plaque psoriasis this is the most common type, affecting your elbows, knees, scalp and lower back.
• Guttate psoriasis this is often described as a raindrop pattern, and is most common following a sore throat. It is usually seen in children.
• Pustular psoriasis this type affects your palms and soles. It has a pattern of pus-filled spots .
• Erythrodermic psoriasis this rare type causes a widespread painful redness of your skin with a high fever. It needs urgent treatment in hospital.
• Nail psoriasis this type commonly affects your fingernails, causing pitting, yellowing and ridging of your fingernails. People with nail psoriasis are more likely to have psoriatic arthritis .

You can have only one type or a combination of different types of psoriasis.

How Do Dermatologists Diagnose 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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Psoriatic Arthritis Vs Rheumatoid Arthritis

PsA and RA are both inflammatory forms of arthritis that occur due to the immune system attacking healthy body cells and tissues.

The key difference between the two conditions is that PsA involves the skin as well as the joints. Other differences include:

• Disease symmetry: RA affects joints on both sides of the body, whereas PsA may affect joints on one side of the body.
• Joints affected: RA typically affects the middle joints of the fingers and toes, while PsA typically affects the joints closest to the fingernails and toenails.
• Diagnostic markers: Blood tests for RA will usually reveal a positive RF or CCP antibody, whereas blood tests for PsA will typically reveal a negative RF and CCP. Doctors may use such tests to help differentiate between the two diagnoses.

Foods Containing Refined Carbohydrates

Refined carbohydrates are highly processed . Theyve been stripped of fiber and whole grains and tend to contain a lot of sugar, which can cause your blood sugar to spike. Refined carbohydrates also increase advanced glycation end products, which are substances in your blood that can lead to inflammation.

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How To Talk To Your Health Care Provider About Symptoms

By taking this short screening assessment, the Psoriasis Epidemiology Screening Tool , you may help your health care provider make a diagnosis.

Bring your quiz results and the diagram to your appointment. Circle all of the places on the diagram where your body feels tender or sore. This way, you wonât forget to mention important symptoms. Even if youâre not feeling them on the day of your appointment, you should still bring them up with your provider.

Describe symptoms as precisely as possible. For example, instead of saying, âMy knee hurts,â say âThere is a sharp, piercing pain on the outside of my left knee, under the kneecap.â

Prepare five main questions youâd like to ask your provider. Youâre probably wondering about many things concerning your health right now. Boiling them down to five main questions will help focus your conversation with your provider, and give your provider enough time to give you complete answers.

For example, you could ask about:

• Symptoms you are experiencing
• New medications or dietary supplements
• Information from other health care providers you see
• Treatments you are interested in
• How treatments might affect you

Be specific, open and honest. If you donât understand anything your health care provider is saying, speak up. Also, if your provider is recommending a treatment that you donât think is right for you, say so. Itâs OK to ask about other treatment options.

Ways To Treat Psoriasis At Home

7.5 million American adults.

It tends to appear pink or red, usually with silvery-white scales, on those that have fair to light skin tones. On medium skin tones, it may look salmon-colored with a silvery-white scale, and on darker skin tones, it could look violet and the scale gray. Or it can also appear dark brown and difficult to see.

Even though it affects your skin, psoriasis actually begins inside your body in your immune system.

Psoriasis is a condition where your T-cells, a type of white blood cell, can become overactive to produce other immune markers that can cause an inflammatory reaction on the skin. The reaction on the skin shows up in the form of silvery-white scale, depending on the skin ton

Even though theres no cure, many treatments exist to ease the symptoms of psoriasis. Here are 12 ways to manage mild symptoms at home.

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Diese Anzeichen Lassen Auf Die Diagnose Schuppenflechte Schlieen

Zu Beginn der körperlichen Untersuchung begutachtet der Hautarzt die fleckenförmigen, entzündeten Hautveränderungen ganz genau. Patienten sollten den untersuchenden Arzt auf versteckte Stellen hinweisen. So können sich Plaques beispielsweise auf der Kopfhaut, am Bauchnabel oder im Po- und Genitalbereich verbergen. Auch Finger- und Fußnägel wird sich der Hautarzt ansehen, da eine Nagelpsoriasis bei vielen Betroffenen zusätzlich zu den schuppenden Hautbereichen auftritt.

Bei Verdacht auf Psoriasis kann der Dermatologe die schuppigen Plaques vorsichtig mit einem Holzspatel abschaben. Zeigen sich dann folgende Erscheinungsbilder, kann die Diagnose Schuppenflechte gestellt werden:

• Kerzenwachs-Phänomen: Die durch das Kratzen abgelösten Schuppen erinnern an Kerzenwachs.
• Phänomen des letzten Häutchens: Unter den Schuppen tritt ein glänzendes dünnes Häutchen zum Vorschein.
• Blutiger Tau: Wird das dünne Häutchen entfernt, kommt es zu punktförmigen Blutungen aus den feinen Blutgefäßen.1

In Einzelfällen veranlasst der Hautarzt zur Absicherung der Diagnose Schuppenflechte die Analyse einer Gewebeprobe . Hierzu entnimmt er unter örtlicher Betäubung eine kleine Hautprobe, die dann unter dem Mikroskop auf die Psoriasis-typischen Veränderungen untersucht wird.

Wichtig:

Laien können die Symptome von Schuppenflechte mit einem Ekzem oder einer Pilzinfektion der Haut verwechseln. Deshalb sollte man bei Rötungen der Haut, Juckreiz und Schuppen unbedingt zum Facharzt gehen.4

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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