Treating Severe Plaque Psoriasis
Severe forms of plaque psoriasis will additionally require the use of systemic agents. Oral retinoids like acitretin will be prescribed to slow down the growth rate of skin cells. This will permit the accumulated cells to shed and gradually become less thick.
Cyclosporine works like a immunosuppressant, targeting the activity of those immune substances that are responsible for causing psoriasis.
Methotrexate is found to be very useful in the treatment of severe widespread plaque psoriasis. These work by inhibiting the activity of those enzymes involved in triggering the rapid growth rate of skin cells.
In severe cases of plaque psoriasis, sufferers also tend to suffer from psychological problems. Their quality of life will also seem to be affected drastically. Along with medications, regular counseling will also have to be provided to them.
Learn About All Your Plaque Psoriasis Treatment Options
With so many medicines available for the treatment of moderate-to-severe plaque psoriasis, you may be wondering which approach is best. Make sure to talk with your dermatologist about your treatment options, and ask if ILUMYA® can give you the long-lasting results youve been waiting for.
Topical medicines are treatments applied directly to your skin. Creams and ointments are examples of topical medicines. Topical treatments are usually one of the first medicines people try after they are diagnosed with plaque psoriasis.
Oral treatments are prescription pills taken by mouth. Oral medications are also called systemic treatments because they work throughout the body to fight plaque psoriasis.
Some biologics called TNF-alpha inhibitors block the TNF-alpha molecule that triggers inflammation in your body. In plaque psoriasis, too much TNF-alpha is produced in the skin. This leads to the rapid growth of skin cells. Biologic medicines that block TNF-alpha help stop the inflammation in psoriasis.
There are also other types of biologics for psoriasis.
ILUMYA® is an IL-23 blocker, an advanced biologic medicine used for moderate-to-severe plaque psoriasis treatment to help balance or regulate an overactive immune system.
ILUMYA® is different from topicals and pills. It works within your body to help reduce the redness, flaking, and scales you see on your skin.
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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
|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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What Is Plaque Psoriasis Caused By
The causes of plaque psoriasis are not fully understood.2,6 It is thought to be caused by genetic factors and environmental factors .6,7 Scientists believe that mutations in genes are an important reason for psoriasis. While around 10 in every 100 people carry these mutated genes, only 2 or 3 in every 100 develop psoriasis.3,7 It is thought that environmental triggers, in combination with genes, are responsible for psoriasis.7 These triggers may include: stress, certain medications, skin injuries, allergies, diet, weather, smoking or alcohol.2,8
As your immune cells attack your skin cells, your skin constantly renews itself. Healthy skin cells are usually shed and replaced every month. In psoriasis, this process speeds up to several days. As a result, red plaques consisting of dead skin layers build up.4
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Home Treatment For Psoriasis
There are some home remedies that may help minimize outbreaks or reduce symptoms of psoriasis:
- Exposure to sunlight.
- Apply moisturizers after bathing to keep skin soft.
- Avoid irritating cosmetics or soaps.
- Do not scratch to the point you cause bleeding or excessive irritation.
- Over-the-counter cortisone creams can reduce itching of mild psoriasis.
A dermatologist may prescribe an ultraviolet B unit and instruct the patient on home use.
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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Can Psoriasis Affect Only My Nails
In some cases, psoriasis may involve only the fingernails and toenails, although more commonly, nail symptoms will accompany psoriasis and arthritis symptoms. The appearance of the nails may be altered, and affected nails may have small pinpoint pits or large yellow-colored separations on the nail plate called “oil spots.” Nail psoriasis can be hard to treat but may respond to medications taken for psoriasis or psoriatic arthritis. Treatments include topical steroids applied to the cuticle, steroid injections at the cuticle, or oral medications.
Tips For Living With Scalp Psoriasis
Having short hair or a shaved head can help the effectiveness of ultraviolet light therapies and topical treatments . Itching on the scalp can be particularly bothersome and painful for many people.2 Your healthcare provider can advise you about strategies for dealing with scalp itching. Some people find it helpful to use an over-the-counter antihistamine and/or to use shampoo or conditioner containing menthol.3
Flare-ups of scalp psoriasis and dandruff-like flaking can have different causes for different people, but some common triggers are cold weather, dry air, and experiencing stress. Also, getting your hair cut or styled may cause further irritation to your scalp if the barber or hairdresser is not familiar with psoriasis. If your barber or hairdresser is not familiar with the condition , then it may help to explain that it is not contagious and it is not a fungal infection.
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What Is Scalp Psoriasis
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Plaque psoriasis is a chronic inflammatory autoimmune condition that affects the skin, causing patches of raised, red, inflamed, thickened skin called plaques to develop. Plaques are often covered in silvery scales and can cause itchiness and other types of discomfort. The scalp is one of the most common places on the body to be affected by plaque psoriasis. In fact, around half of people with the condition have symptoms located on the scalp1. As with psoriasis located in other areas, symptoms may come and go over time.
Plaque Psoriasis: Causes Picture Symptoms And Treatment
Plaque psoriasis is a common type of skin disease that affects many people across the globe. The type of skin disorder causes the skin cells to multiply ten times faster than normal. So, the condition can speed up the life cycle of skin cells leading to build up. It can result in bumpy red patches on the surface of the skin. In most cases, the skin cells form scales, which causes itching and pain. The chronic condition has no known cure. You can only opt for treatment to manage the skin cell growth. So, you can manage the symptoms with treatment. The skin disorder can appear anywhere. But, the excess skin cells develop on your lower back, knees, elbows, and scalp. The condition does not pass from one person to another. It does affect people from the same family.
The chronic skin problem can affect you in your early adulthood. In mild cases, the skin buildup only occurs in a few areas of the body. But, people suffering from the severe condition can experience skin problems in large parts of the body. So, the bumpy and scaly skin can cover several parts of the affected person. Remember, the condition has no permanent cure. It can heal and return throughout your life. Therefore, you need to know tips to manage the symptoms of the problem. With some lifestyle measures, the condition can trigger less severe signs. Read ahead to know more about the skin disorder.
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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 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.
Natural Skin Treatments For Plaque Psoriasis
Because its a chronic condition, many people with plaque psoriasis will try alternative and natural treatment methods. One method that has gained significant attention in the psoriasis community is the mud and salt of the Dead Sea.
Thousands of people a year invest in expensive Dead Sea skin treatments or vacations to attempt to heal their psoriasis. Although the scientific evidence is limited regarding the effectiveness of these treatments, many believe it can help treat plaque psoriasis.
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Signs/symptoms Associated With Plaque Psoriasis
In most cases, the condition can cause changes in your skin appearance. You can see the following signs on your skin:
- Pink plaque with well-defined edges on your skin
- Bleeding/cracking of affected skin
- Heavy silver-colored/white scales covering the plaque surface
- Plaque psoriasis can appear anywhere on your body. But, the common places affected by the skin disorder are:
Tablets Capsules And Injections
If your psoriasis is severe or other treatments have not worked, you may be prescribed systemic treatments by a specialist. Systemic treatments work throughout the entire body.
These medications can be very effective in treating psoriasis, but they all have potentially serious side effects. All the systemic treatments for psoriasis have benefits and risks. Before starting treatment, talk to your doctor about your treatment options and any risks associated with them.
If you’re planning for a baby, become pregnant or are thinking of breastfeeding, you should also speak to your doctor first before taking any new medicine to check it’s suitable for use during pregnancy or breastfeeding.
There are 2 main types of systemic treatment, called non-biological and biological .
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Who Gets Psoriasis
The prevalence of psoriasis worldwide is 0.5% to 11.4% in adults, and 0% to 1.4% in children .
- Psoriasis is at a higher prevalence with increasing distance from the equator .
- The prevalence of psoriasis in New Zealand has not yet been established. Studies have shown the prevalence of psoriasis in adults to be 2.3% to 6.6% in Australia, and 1.3% to 2.2% in the United Kingdom .
- Rates of psoriasis vary between ethnic groups. A small study suggests that Maori and Pacific Islander peoples may be overrepresented in New Zealand compared to New Zealand Europeans .
- While most cases of psoriasis present before age 35, psoriasis can develop at any age .
- Males and females are equally affected by psoriasis .
How You Find Out
Severity and body surface area are used together to calculate something called a Psoriasis Area and Severity Index score. It combines the severity and surface area for six regions of your body. Scores range from 0 to 72. A score of more than 10 generally translates to âmoderate-to-severe.â A score of more than 40 is rare.
Usually, the higher your PASI score, the lower your quality of life.
Your doctor may use one of three surveys to figure out how your psoriasis affects your quality of life:
Psoriasis Index of Quality of Life : This tool focuses on how psoriasis changes how you deal with the needs of daily life. Questions cover things like sleep, your social life, and emotions.
Psoriasis Life Stress Inventory : It’s a 15-item questionnaire that asks you how stressful various daily tasks are for you.
Psoriasis Disability Index : The PDI looks at how psoriasis affects your daily activities, including work, leisure time, and personal relationships.
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Diagnosing Plaque Psoriasis By Looking At The Skin
Most doctors and nurses can tell if a scaly or rough patch of skin is psoriasis. Sometimes a biopsy or a visit with a dermatologist is needed. During your visit, make sure to point out all of your abnormal patches of skin.
Tell your doctor about your symptoms and what seems to aggravate your skin. Possible triggers of psoriasis include:
- skin trauma
Systematic Treatment Using Oral/injected Medications
For severe plaque psoriasis, your doctor can adopt a different approach to manage the condition. In most cases, oral or injected drugs can provide relief. The treatment also known as systematic treatment is effective when other treatment options fail to offer relief. But, the treatment option has severe side effects. So, it is used only for a brief period. It is alternated with other forms of treatment to avoid lasting adverse effects. Here are the options available:
It is related to Vitamin A and is quite effective in managing severe plaque psoriasis. The group of drugs is prescribed when you fail to respond to other therapies.
It is an oral medication that can reduce the production of skin cells. The medication is also effective in suppressing inflammation occurring due to the skin disorder. The drugs can also slow down the progression of the condition in some people. But, it is not used for a long period due to its serious side effects.
It is the medication that has similar effects of methotrexate. Irrespective of its effectiveness, it is prescribed only for a short duration of time. The drugs suppress your immune system to manage skin disorder. Like other immunosuppressant drugs, it puts you at risk of health problems like infection, cancer, kidney problem, and high blood pressure. So, the drug is not an ideal choice for long-term therapy or higher doses.
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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.
Medical Treatment Topical Agents
The first line of treatment for psoriasis includes topical medications applied to your skin. The main topical treatments are corticosteroids , vitamin D-3 derivatives, coal tar, anthralin, and retinoids. These drugs may lose potency over time, so often they are rotated or combined. Ask your doctor before combining medications, as some drugs should not be combined.
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Patches Of Plaque Psoriasis
The most commonly affected parts of the body include the elbows, knees, and scalp. Most people with plaque psoriasis will develop patches in these areas. But some will also have psoriasis patches on other areas of the body.
The location of plaque psoriasis can change as patches heal. New patches may appear in different locations during future attacks. Plaque psoriasis affects everyone differently. No two people will experience the same symptoms.
Psoralen Plus Ultraviolet A
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 has not responded to other treatment.
Side effects 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 is not encouraged, as it can increase your risk of developing skin cancer.
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