Wednesday, July 10, 2024

How To Diagnose Plaque Psoriasis

How Is Psoriasis Treated

Diagnosing Psoriasis

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 children, 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 and then switch to another, or recommend combining treatments. It’s not always easy to find a therapy that works, and sometimes what works for a time stops helping after a while.

How Is Psoriasis Diagnosed

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Psoriasis is a chronic autoimmune condition that causes symptoms called plaques to develop on the skin. Plaques are patches of raised, reddened skin that are covered in a layer of silvery scales. People with psoriasis have an immune system that is overactive and with chronic levels of inflammation. This inflammation causes the body to produce too many new skin cells, pushing older skin cells to the surface where they build up as plaques.

A person can develop symptoms at any age, although around three-quarters of people with psoriasis are diagnosed before the age of 401. Many people are diagnosed with psoriasis when they tell their primary care provider about symptoms that they have developed on their skin.

If a person has symptoms that look like they may be caused by psoriasis, the healthcare provider carries out a physical examination of the symptoms on the affected skin, as well as taking the persons medical history. At this time, there is no specific blood test or other test that can be used to diagnose psoriasis. Usually, physical exam and medical history are enough for the healthcare provider to make the diagnosis2.

What Happens During The Physical Examination

During the physical examination, healthcare providers look closely at the area of skin that are affected by symptoms. They may lift a small layer of scale from the top of a plaque to see if it leaves a smooth, red surface with tiny spots of blood. This is called the Auspitz sign, which is common in psoriasis plaques1. The healthcare provider also examines your skin, scalp, nails, and the inside linings your eyelids, nose, and mouth.

During the exam, the healthcare provider will also check to see if you have symptoms of other types of health conditions that occur more commonly among people with psoriasis3. These include:

However, some people may need to have a biopsy to find out if the symptoms are being caused by psoriasis or some other condition, such as eczema, that causes similar types of symptoms to develop on the skin2. A biopsy involves taking a very sample of the affected skin so that it can be examined more closely under a microscope. Biopsies are generally quick procedures that that can be performed in a healthcare providers office.

Read more information about physical examinations and diagnosing psoriasis.

Read more information about biopsies.

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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 Else Should I Ask My Healthcare Provider

Psoriasis: Symptoms and Complications

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.


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Physical Exam And Medical History Remain The Primary Tools

Psoriasis is an autoimmune disorder primarily affecting the skin. The diagnosis typically involves a physical examination to identify the signs of the disease.

A review of your medical history would also be conducted to assess your symptoms and to rule out any other explanations for your condition. Less commonly, a tissue sample may be obtained to examine skin cells from the affected area with a microscopic.

Unlike some autoimmune disorders, there are no blood tests or imaging studies that can aid in the diagnosis of psoriasis.

Plaque Psoriasis And The Geography Of The Body

The distribution of psoriasis patches on the body can appear randomly. Some patches may cover large portions of the body, while others may be no larger than a dime.

Once a person has developed psoriasis, it may appear in a number of different forms in many different places. Unlike inverse psoriasis, plaque psoriasis doesnt usually affect the genitals and armpits.

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Why Do Symptoms Come And Go

There are many reasons why your psoriasis symptoms may come and go or get worse at certain times. Triggers can include certain infections, skin trauma or injury, stress, alcohol, smoking, cold or dry weather, starting some medications, stopping medication, or even the natural course of the disease. Triggers can differ from person to person. Its a good idea to keep track of your symptoms and triggers to help you manage them. Talk to your doctor about how best to keep track of your symptoms.

Why Does The Healthcare Provider Need To Take A Medical History

Psoriasis Diagnosis

During the process of diagnosing psoriasis, your healthcare provider will take your medical history. This involves asking you questions about your symptoms as well as questions about your general health, your familys health history, and your overall lifestyle2. These are important questions because it helps your healthcare provider get a better understanding about things in your life that may be making your symptoms worse or better, as well as risk factors that make you more likely to develop the condition.

Learning about your familys health history is important because the tendency to develop psoriasis has a genetic link that is passed down through families: around one-third of people with psoriasis have a family member who also has the condition1. For example, if your parent or sibling has psoriasis, then it is more likely that your own symptoms are being caused by psoriasis as well.

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What Are Other Types Of Psoriasis

Plaque psoriasis is the most common type. About 80% to 90% of people with psoriasis have plaque psoriasis.

Other, less common types of psoriasis include:

  • Inverse psoriasis appears in skin folds. It may look like thin pink plaques without scale.
  • Guttate psoriasis may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots in children and young adults.
  • Pustular psoriasis has small, pus-filled bumps on top of the red patches or plaques.
  • Sebopsoriasis typically appears on the face and scalp as red bumps and plaques with greasy yellow scale. This type is a cross between psoriasis and seborrheic dermatitis.

What Kind Of Doctor Is Needed To Diagnose Plaque Psoriasis

A board-certified dermatologist or rheumatologist is the best doctor to see to diagnose and treat your plaque psoriasis, but many other doctors can recognize it. Primary care physicians, like family or internal medicine doctors, can certainly recognize plaque psoriasis, and are knowledgeable and experienced enough to recommend effective self-treatment for mild cases. In more moderate or severe cases, these doctors may opt to refer you to a dermatologist, or rheumatologist though, since its their specialty after all.

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What Is Psoriasis And What Causes It

Psoriasis is a chronic autoimmune condition. If you have psoriasis, it means your skin cells regenerate much faster than usual, causing them to build up. Anyone can get psoriasis, but its not contagious.

There are several types of psoriasis and, like other autoimmune diseases, they may involve flare-ups and periods of remission. You can even have more than one type.

Some common triggers for psoriasis are:

  • certain medications

What Is Chronicplaque Psoriasis

psoriasis , diagnosis and treatment

Chronic plaque psoriasis is the most common presentation of psoriasis. It presents as small to large, well-demarcated, red, scaly and thickened areas of skin. It most likely to affect elbows, knees, and lower back but may arise on any part of the body.

It tends to be a relatively persistent or chronic pattern of psoriasis that can be improved with treatment but is difficult to clear completely with topical treatments alone. It is characterised by large flat areas of psoriasis with a typical silvery scale. These plaques may join together to involve very extensive areas of the skin, particularly on the trunk and limbs. It is often accompanied by scalp and nail psoriasis.

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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

Does Psoriasis Go Away On Its Own

Doctors Response. Psoriasis is a chronic skin condition that is not curable and it will not go away on its own. However, the disease fluctuates and many people can have clear skin for years at a time, and occasional flare-ups when the skin is worse. The course of the illness varies from person-to-person and some people will have milder symptoms

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Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 88,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with plaque psoriasis? How do you manage your symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.

What Causes Plaque Psoriasis

Addressing Itch Symptoms in Plaque Psoriasis

While it’s not exactly known why some people get psoriasis and others don’t, Dr. Friedman says the cause is believed to be a mix of nature and nurture.

“We know there is a genetic connection, but we don’t know enough about that yet, and we think there are certain triggers in the environment, so both might release psoriasis,” he says.

Robert T. Brodell, MD, chair of the Department of Dermatology at the University of Mississippi Medical Center, says a phenomenon called Koebnerization named for a 19th century dermatologistexplains some instances of plaque psoriasis. It occurs where the skin has been traumatized. “So, if you have surgery for your appendix, you may heal from your surgery, but psoriasis may develop all along that scar,” he tells Health.

While scientists can’t explain exactly why this might occur, they do know what’s happening in the body when plaque psoriasis develops. Essentially, people with plaque psoriasis have an overactive immune system that causes skin cells to develop too quickly. Instead of growing and shedding over the course of a month, new cells appear in a matter of three to four days. But they don’t fall off quickly they pile up on the surface of the skin, creating a buildup of plaque and scales.

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When To Contact A Medical Professional

Contact your provider if you have symptoms of psoriasis or if your skin irritation continues despite treatment.

Tell your provider if you have joint pain or fever with your psoriasis attacks.

If you have symptoms of arthritis, talk to your dermatologist or rheumatologist.

Go to the emergency room or call the local emergency number if you have a severe outbreak that covers all or most of your body.

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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What Is Plaque Psoriasis

Plaque psoriasis, which is recognizable due to the scaly plaques it produces on the skin, is the most common type of psoriasis. An estimated 80 to 90 percent of people with psoriasis develop plaques.

Some people will have more than one type of psoriasis. People who have plaque psoriasis may later develop other forms of the condition, such as psoriatic arthritis.

Usually, the turnover of peoples skin cells takes 21 to 28 days. In people with psoriasis, the body attacks healthy skin cells, so new cells develop every 4 to 7 days.

Psoriasis damages patches of skin, leaving areas of redness and irritation. This damage causes the skin to appear scaly and gray and to peel off.

Plaque psoriasis is not an infection, and it is not contagious. However, irritated patches of psoriasis can become infected.

In some people, an infection or injury to the skin can trigger an outbreak of psoriasis. People experiencing their first psoriasis flare-up may mistake their symptoms for an allergic reaction or skin infection.

Approach To The Patient

Psoriasis: the reality of this common disease of the skin ...

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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Research And Statistics: Who Has Psoriasis

According to the National Psoriasis Foundation, about 7.5 million people in the United States have psoriasis. Most are white, but the skin disease also affects Black, Latino, and Asian Americans as well as Native Americans and Pacific Islanders.

The disease occurs about equally among men and women. According to the National Institutes of Health , it is more common in adults, and you are at a greater risk if someone in your family has it. A study published in September 2016 in the journal PLoS One concluded that interactions between particular genes as well as genetic and environmental factors play an important role in the diseases development.

People with psoriasis generally see their first symptoms between ages 15 and 30, although developing the disease between 50 and 60 years of age is also common.

The biggest factor for determining prognosis is the amount of disease someone has, says Michael P. Heffernan, MD, a dermatologist at the San Luis Dermatology and Laser Clinic in San Luis Obispo, California.

Other Types Of Plaque Psoriasis

Uncommon subtypes or descriptions of chronic plaque psoriasis include:

  • Rupioid psoriasis: limpet-like cone-shaped hyperkeratotic lesions of psoriasis
  • Lichenified psoriasis: chronically rubbed or scratched areas of psoriasis that have become very thickened
  • Elephantine psoriasis: very persistent, very thickly scaled, large areas of psoriasis
  • Ostraceous psoriasis: very thickly scaled, ring-like areas of psoriasis, resembling an oyster shell
  • Linear psoriasis: psoriasis arranged in lines along the body
  • Koebnerised psoriasis: psoriasis developing within an area of skin trauma such as injury, infection, a surgical wound or scratch mark.
  • Photosensitive psoriasis: psoriasis worst in the sun-exposed areas of the face, neck, hands and forearms. Most patients with psoriasis find ultraviolet light very helpful for their psoriasis. A small group experience exacerbations of their rash following sun exposure. In these people, sometimes clear ‘sunburn‘ lines are seen. They may also have typical plaque psoriasis elsewhere. Strict sun protection, usually in combination with other treatment, is required to control this type of psoriasis.
Uncommon forms of plaque psoriasis

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