Is Psoriasis Caused By Inflammation

Can I Get Financial Support

Many people worry about what happens if they cannot work or need financial help because of the effects of psoriatic arthritis. Fortunately for many, with good therapy and management the condition can be controlled and allow for a full and active working life. But if you do find that even for a short period of time you are likely to need help, visit the national government websites online. If it is easier, contact your local government or council office, where you should be directed to the appropriate resource and information.

Always consult your doctor or healthcare provider.

This article is adapted from the What is Psoriatic Arthritis? leaflet.

Other leaflets are also available to or order FREE from our shop and include the following:

• About Us
• Occupational Therapy and Psoriatic Arthritis
• Physiotherapy and Exercise: Psoriatic Arthritis
• Psoriasis and Sensitive Areas
• Psoriatic Arthritis – Did you know?
• Psoriatic Arthritis – When to treat?
• Psoriatic Fatigue
• Treatments for Psoriasis: An overview
• Treatments for Psoriatic Arthritis: An overview
• What is Psoriasis?

Who Gets Psoriatic Arthritis

This joint pain affects about 30% of people with psoriasis. It’s common among men and women and can start at any age. But there are a few things that make you more likely to have it.

• If you already have psoriasis, especially lesions on your nails
• If someone in your family has psoriatic arthritis
• If you are between the ages of 30 and 50

Itâs possible to have psoriatic arthritis without the skin condition. Sometimes a viral or bacterial infection can trigger it if your body is already prone to get it.

For those with both conditions, joint pain usually starts about 5 to 12 years after psoriasis symptoms begin.

How Is Psoriatic Arthritis Diagnosed

Psoriatic arthritis is easier to confirm if you already have psoriasis. If you donthave the skin symptoms, diagnosis is more difficult. The process starts with a healthhistory and a physical exam. Your healthcare provider will ask about your symptoms. Youmay have blood tests to check the following:

• Erythrocyte sedimentation rate . This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the bloods proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
• Uric acid. High blood uric acid levels can be seen in psoriatic arthritis but are not used for diagnosis or monitoring.
• Imaging. X-rays, CT scans, ultrasound, MRI, and skin biopsies may all be used to help diagnosis.

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Psoriasis Support Groups And Counseling

Education of psoriasis patients is one of the foundations for managing this chronic and typically relapsing disorder. Patients should be familiar with the treatment options in order to make proper informed decisions about therapy. The National Psoriasis Foundation is an excellent organization that provides support to patients with psoriasis.

Psoriasis: More Than Skin Deep

The first accurate medical discussion of psoriasis dates back to 1801, but the disease itself is much older. In fact, its very name is borrowed from an ancient Greek word meaning an itchy or scaly condition. About 7 million Americans are plagued by this itching and scaling, and many of them have serious complications involving other organs. Although psoriasis is classified as a dermatologic disease, it doesn’t start in the skin, and its damage may be more than skin deep.

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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.

How Is Psoriasis Diagnosed

There arent any special tests to help doctors diagnose psoriasis. Typically, a dermatologist will examine your skin and ask about your family history.

Youll likely be given a diagnosis based on this physical exam.

In some situations, doctors will remove a small sample of the skin and examine it under a microscope. This might allow them to get a better look at the affected area and make a more accurate diagnosis.

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New Insights Into How Psoriasis Arises And How It Heals

Psoriasis is a chronic skin condition characterized by itchy red patches and silvery scales, usually on the elbows, knees or scalp. It affects about 2 percent of Americans, and is sometimes associated with other health problems, such as arthritis, diabetes and heart disease. The causes are not fully understood, but the condition is related to an abnormal immune assault on skin cells that triggers inflammation.

Scientists have been trying to understand the molecular details of what causes psoriasis. Now, two studies funded in part by the NIHs National Institute of Arthritis and Musculoskeletal and Skin Diseases and published in Nature and the Journal of Clinical Investigation have uncovered some contributing factors. The findings shed light on how psoriasis arises and how the body works to repair the damage, offering potential new strategies for treating the condition.

Are There Alternative Therapies For Psoriasis

Conventional therapy is one that has been tested with clinical trials or has other evidence of clinical effectiveness. The FDA has approved several drugs for the treatment of psoriasis as described above. Some patients look to alternative therapy, diet changes, supplements, or stress-reducing techniques to help reduce symptoms. For the most part, alternative therapies have not been tested with clinical trials, and the FDA has not approved dietary supplements for treatment of psoriasis. There are no specific foods to eat or to avoid for patients with psoriasis. However, some other therapies can be found on the National Psoriasis Foundation web site. Individuals should check with their doctors before starting any therapy.

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Be Mindful Of Alcohol Consumption

Alcohol and Psoriasis

Some studies show a link between heavy drinking and psoriasis flares. It seems that men who drink heavily are more likely to suffer from psoriasis than men who do not drink alcohol. Alcohol consumption negatively impacts treatment and reduces the likelihood of remission. Alcohol may interact with certain psoriasis medications. Ask your doctor if it is safe for you to consume alcohol if you have psoriasis.

Tips to Stop Drinking

If you’re trying to cut back or stop drinking all together, managing triggers can help you reach your goal. In general, avoid high-risk situations where you anticipate it will be difficult to avoid temptation. If you can’t avoid a situation where you are concerned you might be triggered, have some strategies in place to help you stay on track and cope.

• Distract yourself by calling or texting a friend or watching a funny video online. Go for a walk or take a few minutes to practice deep breathing or meditation.
• Review your reasons for not wanting to drink. Write the reasons on a card that you keep in your purse or wallet to revisit when you need to.
• Talk to a trusted friend when you’re tempted to drink and discuss the reasons you’re trying to abstain.

What Can I Do At Home For Inflammation Treatment

You may choose to follow an anti-inflammatory diet. Some research shows that people who follow a Mediterranean diet have lower levels of inflammation in their bodies.

You may choose to eat more foods that have anti-inflammatory properties, such as:

• Oily fish, such as mackerel, salmon or sardines.
• Leafy greens like spinach and kale.
• Olive oil.
• Tomatoes.

Eating too much of certain foods may increase inflammation. If you have chronic inflammation, you may feel better if you avoid:

• Fried foods, including many fast food items.
• Cured meats with nitrates, such as hot dogs.
• Highly refined oils and trans fats.
• Refined carbohydrates, such as sugar, pastries or white bread.

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Effects Of Inflammation On Psoriasis

Inflammation is the bodys natural response to defend and repair. When a healthy person becomes sick, their immune system triggers inflammation. White blood cells rush in to protect against invaders and repair the damage. When the illness stops , the inflammation stops.

But for people with inflammatory conditions, that inflammation continues. In people with psoriasis, that widespread inflammatory response pushes new skin cell growth before old skin cells have had an opportunity to shed.

New skin cells then push up old cells to the surface leading to plaques and scales. These become visible on the skins outermost layer.

The effects of psoriasis dont always stop at the skin. Up to 30% of people with psoriasis will go on to develop a type of arthritis called psoriatic arthritis . PsA is a chronic, inflammatory kind of arthritis. The ongoing inflammation wreaks havoc on the joints and areas where the tendons and ligaments connect to bone .

Studies have found people with psoriasis are at a higher risk for many different health conditions, including heart attacks, strokes, diabetes, inflammatory bowel disease, and depression. The same inflammatory processes that promote psoriasis also play a role in the development of many of these other very serious conditions.

What Are Medications And Treatment Options For Psoriatic Arthritis

The medical treatment of the arthritis aspects of psoriatic arthritis is described below. The treatment of psoriasis and the other involved organs is beyond the scope of this article.

Generally, the treatment of arthritis in psoriatic arthritis involves a combination of anti-inflammatory medications and exercise. If progressive inflammation and joint destruction occur despite NSAIDs treatment, more potent medications such as methotrexate , corticosteroids, and antimalarial medications are used.

Exercise programs can be done at home or with a physical therapist and are customized according to the disease and physical capabilities of each patient. Warm-up stretching, or other techniques, such as a hot shower or heat applications are helpful to relax muscles prior to exercise. Ice application after the routine can help minimize post-exercise soreness and inflammation. In general, exercises for arthritis are performed for the purpose of strengthening and maintaining or improving joint range of motion. They should be done on a regular basis for best results.

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Different Drugs Work On Different Cytokines

You may wonder why we are discussing different cytokines. The reason is that cytokines function as the targets of different medications, which work to reduce the number of cytokines that are activated. A lower level of cytokines results in less inflammation and ultimately the improvement of psoriasis.

Table 1. Biologics and Their Drug Target in the Treatment of Psoriasis

What Exactly Is Inflammation

Inflammation reflects an immune system that is activated or triggered. Most of the time, the activation is appropriate, such as when it is fighting foreign bacteria. But sometimes, the immune system can be activated in the absence of foreign invaders and mistakenly attacks your own body. We call this autoimmune disease. Psoriasis is one such autoimmune disease.

There are two important components of the activation of the immune system:

If you take a small sample of the skin from patients with psoriasis and examine it under the microscope, you will see abnormally abundant immune cells, including dendritic cells, macrophages, T cells, and neutrophils, present in different layers of the skin or even in the blood vessels. At the same time, the level of cytokines are significantly elevated. If the immune cells were the soldiers, the cytokines can be considered the bullets/bombs. You can imagine the immune cells and cytokines working hand in hand to contribute to the initiation of the skin inflammation in psoriasis.

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Foods High In Sugar And Fat Disrupt The Gut And Trigger Psoriasis Flares

The secret to healthier skin and joints may reside in gut microorganisms. A study led by UC Davis Health researchers has found that a diet rich in sugar and fat leads to an imbalance in the guts microbial culture and may contribute to inflammatory skin diseases such as psoriasis.

The study, published in the Journal of Investigative Dermatology, suggests that switching to a more balanced diet restores the guts health and suppresses skin inflammation.

Earlier studies have shown that Western diet, characterized by its high sugar and fat content, can lead to significant skin inflammation and psoriasis flares, said Sam T. Hwang, professor and chair of dermatology at UC Davis and senior author on the study. Despite having powerful anti-inflammatory drugs for the skin condition, our study indicates that simple changes in diet may also have significant effects on psoriasis.

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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Treatment Options For Psoriasis

There are a variety of psoriasis treatments available, and they each work in different ways to help treat psoriasis. How do you know which is right for you? Start by talking to a dermatologist who can explain how each option works. Then you can work together to choose an appropriate treatment option for you.

Is it really psoriasis? Learn more about the symptoms:

Psoriasis Can Affect Internal Organs As Well As The Skin

Not only can psoriasis affect the skin, but it can have devastating effects that can affect your internal organs.

The systemic inflammation inside the body that accompanies the disease is often overlooked.

Patients may think that they are having success with their treatments if they cannot see the thick psoriasis plaques on their skin.

However, patients can have serious consequences on their joints, arteries and other organs if not properly treated early to decrease the inflammation.

It is important to know that psoriasis is an autoimmune disease. It is not contagious and is caused when the immune system attacks the skin.

As a result, scaly red patches or plaques occur on the skin.

In addition to skin problems, some patients can develop psoriatic arthritis. Signs and symptoms of this are painful, stiff and swollen joints that can come and go.

Psoriatic arthritis can affect any joint in the body, including the back or neck.

An early and accurate diagnosis of psoriatic arthritis is essential because persistent inflammation can cause damage to the joints.

Nobody knows exactly what causes psoriatic arthritis, but it can affect anyone.

Psoriatic arthritis typically occurs in people with skin psoriasis, but it can occur in people without skin psoriasis, particularly in those who have relatives with psoriasis.

Sometimes certain heart medications like B-blockers can cause a psoriasis flare on the skin or it may be triggered by a streptococcal throat infection.

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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?

Psoriasis Cortisol And Inflammation

Even though the most people think that high cortisol is bad they utterly omit the fact that after years of suffering with chronic inflammation and even specific diagnosis like psoriasis the chances they have high cortisol levels are poor.

Psoriasis is an inflammatory condition and cortisol is a strong anti-inflammatory hormone so having high cortisol levels in psoriasis is logically inexplainable.

Also we should take into the consideration the fact that having high cortisol levels does not necessarily mean the body reacts to it adequately. The receptors in the cells may be downregulated so much that even significantly higher levels of cortisol wont cool the inflammation enough.

I believe that cortisol resistance explains a lot of problems with inflammation we face these days.

Generally it is not about the high cortisol. In most cases it is about the cortisol resistance if it has something to do with cortisol.

Image source: F. Z. Zangeneh and A. Fazeli. THE SIGNIFICANCE OF STRESS HORMONES IN PSORIASIS. Acta Medica Iranica 2008 46: 485-488.

Cortisol significantly modulates the inflammatory pathways thus affecting the symptoms of chronic inflammatory diseases. And it is not just the diseases we all know about to be explicitly inflammatory like rheumatoid arthritis, psoriasis, Crohns disease, Lupus,

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