What Is Psoriasis Symptoms Causes Diagnosis Treatment And Prevention
Psoriasis is an autoimmune disease that causes plaques, which are itchy or sore patches of thick, dry, discolored skin.
While any part of your body can be affected, psoriasis plaques most often develop on the elbows, knees, scalp, back, face, palms, and feet.
Like other autoinflammatory diseases, psoriasis occurs when your immune system which normally attacks infectious germs begins to attack healthy cells instead.
Avoid Any Factors That Aggravate Psoriasis
In most people who have psoriasis, there is no apparent reason why a flare-up happens at any given time. However, in some people, psoriasis is more likely to flare up in certain situations. These include the following:
There is no evidence that any particular foods or diets are any better or worse for psoriasis than any other.
Causes And Risk Factors Of Psoriasis
Psoriasis, in general, is a genetic condition passed down through families. “It’s likely that multiple genes need to be affected to allow psoriasis to occur and that it’s frequently triggered by an external event, such as an infection,” says James W. Swan, MD, professor of dermatology at the Loyola University Stritch School of Medicine in Maywood, Illinois.
Certain risk factors, such as a family history or being obese, may increase your odds of developing psoriasis.
According to the National Psoriasis Foundation , at least 10 percent of people inherit genes that could lead to psoriasis, but only 3 percent or less actually develop the disease. For this reason, it is believed that the disease is caused by a combination of genetics and external factors or triggers.
A psoriasis outbreak may be provoked by:
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Psoriasis With Darker Skin
You can get psoriasis with all different skin colors, but it tends to look different on darker skin.
In African Americans, psoriasis is typically purplish in color with scaling that looks gray. In very dark skin, the psoriasis may also be dark brown and so harder to see.
Slightly lighter Hispanic skin tends to produce a dark pinkish-colored psoriasis and with a scale that looks silvery-white.
In addition, after psoriasis clears on these skin types, patches that are lighter or darker than the surrounding skin may remain for some time .
These are not scars, and they will clear after some time, though it can take from a few months to a year or longer. Your skin doctor may be able to treat them so they clear more quickly. Ask about this if the appearance of the patches bothers you.
Jeffrey M. Weinberg, MD, director of the Clinical Research Center, St. Luke’s-Roosevelt Hospital Center, New York City assistant clinical professor of dermatology, Columbia University College of Physicians and Surgeons consultant for Amgen and Genentech.
National Institute of Arthritis and Musculoskeletal and Skin Diseases.
American Academy of Dermatology.
Clinical Characteristics And Treatment History At Enrollment
The overall mean psoriasis disease duration was 14.9 ± 13.5 years, with significant differences observed between patients with and those without scalp psoriasis and between patients with and those without nail psoriasis. Patients with psoriasis in 1 CTT area were significantly more likely to have other CTT areas than those without the respective CTT area. Patients with scalp or nail psoriasis were also significantly more likely to have a history of guttate, erythrodermic, and inverse/intertriginous psoriasis morphology, and those with palmoplantar psoriasis were significantly more likely to have a history of erythrodermic, pustular, and inverse/intertriginous psoriasis morphology than patients without the respective CTT area .
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How Many People Have Psoriasis
Psoriasis is a fairly common skin condition and is estimated to affect approximately 1%-3% of the U.S. population. It currently affects roughly 7.5 million to 8.5 million people in the U.S. It is seen worldwide in about 125 million people. Interestingly, African Americans have about half the rate of psoriasis as Caucasians.
Patient Demographics At Enrollment
The overall mean age was 49.6 ± 14.7 years 51.5% of patients were male, 80.2% were white, and 50.5% were obese .1). Patients with scalp psoriasis were younger than those without , whereas those with palmoplantar psoriasis were older than those without . A higher proportion of patients with nail psoriasis were male compared with those without.
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Other Treatments For Psoriasis
If you have severe psoriasis then you may need hospital-based treatment. Light therapy is one type of treatment that can be used. This may involve treatment with ultraviolet B light. Another type of phototherapy is called PUVA – psoralen and ultraviolet light in the A band. This involves taking tablets which enhance the effects of UV light on the skin. You then attend hospital for regular sessions under a special light which emits ultraviolet A .
Sometimes people with severe psoriasis are given intense courses of treatment, using the creams or ointments described above, but in higher strengths and with special dressings.
If psoriasis is severe and is not helped by the treatments listed above then a powerful medicine which can suppress inflammation is sometimes used. For example, methotrexate, ciclosporin, acitretin, etanercept, infliximab, efalizumab, secukinumab, ustekinumab and adalimumab. There is some risk of serious side-effects with these medicines, so they are only used on the advice of a specialist.
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.
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Psoriasis Comorbidities: Overactivity Of Sympathetic Nervous System
The more common comorbidities include psoriatic arthritis and anxiety/depression disorder . More recently, psoriasis has also been reported to be associated with metabolic disorders including obesity, dyslipidaemia and diabetes . Moreover, an increased mortality from cardiovascular disease in patients with severe psoriasis has been documented, and psoriasis may confer an independent risk of myocardial infarction especially in young patients .
3.4.1. Psoriasis & metabolic syndrome
Recent studies of epinephrine stimulation at the 2 adrenergic receptor reveal important potential long-term beneficial effects in the metabolic syndrome . The association between psoriasis and metabolic disorders such as obesity, dyslipidemia, and type 2 diabetes has shown that severe psoriasis might be associated with increased mortality rate due to cardiovascular disorders .
3.4.2. Psoriasis & cardiovascular disease
The study by Gelfand et al. in 2006 indicated that patients with psoriasis are more likely than the general population to have diabetes, high cholesterol, and other traditional risk factors for heart disease . Recent studies suggest that psoriasis, particularly if severe, may be an independent risk factor for atherosclerosis, myocardial infarction , and stroke. Mehta et al. in 2010 conducted a cohort study using the General Practice Research Database to determine if severe psoriasis patients have an increased risk of cardiovascular mortality .
3.4.3. Shared risk factors
Comorbidities In Patients With Psoriasis
As we learn more about psoriasis, we begin to recognize the different ways it can cause and worsen other conditions. Although some psoriasis comorbidities can be attributed to poor diet and obesity, a 2021 study from The Journal of Dermatology suggests there are comorbidities that are not necessarily linked to these factors. Health care professionals need to make their patients aware of these comorbidities to help them manage their condition and better maintain their quality of life.
The researchers examined a wide range of studies to try and find common correlations between psoriasis and other health conditions. What are some comorbidities associated with psoriasis, and how at risk are these patients?
One of the more frequently observed and significant associations was cardiovascular disease. This was in large part due to patients with psoriasis being seen as more likely to have a number of cardiovascular disease risk factors at increased and aggravated incidence.
While managing a patients diet and exercise regimen can be helpful for preventing cardiovascular events, the researchers proposed that the inflammation in patients with psoriasis can potentially induce pro-inflammatory cytokines. These cytokines can lead to a number of dysfunctional elements in the body that can cause cardiovascular disease.
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What Are The Signs And Symptoms Of Psoriasis
Dry, thick, and raised patches on the skin are the most common sign of psoriasis. These patches are often covered with a silvery-white coating called scale, and they tend to itch.
While patches of thickened, dry skin are common, psoriasis can cause many signs and symptoms. What you see and feel tends to vary with the:
Type of psoriasis you have
Places psoriasis appears on your body
Amount of psoriasis you have
Patients With Psoriasis Have 2
In the United States, patients with psoriasis have a 2-fold higher risk for mortality compared with individuals without psoriasis, a study in the Journal of the American Academy of Dermatology suggests. The risk for mortality in these patients appears to be partially mediated by the higher prevalence of infectious, cardiovascular, and neoplastic disorders that are frequently observed in patients with psoriasis.
The ongoing, cross-sectional National Health and Nutrition Examination Survey was used to identify patients aged > 10 years with self-reported psoriasis and control patients without psoriasis . Only individuals who participated in the NHANES between 2003 and 2006, as well as 2009 and 2010, were included in the retrospective study.
Medical history questionnaires were used to assess participants comorbidities, including history of cancer, cardiovascular disease, chronic kidney disease, and diabetes mellitus. Data linked from national databases were examined to identify associated mortality rates.
Limitations of the analysis include its retrospective nature, as well as the self-reported nature of some of the data.
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What You Need To Know About Psoriasis Patients With Psoriasis Frequently Have
Is Your Stomach to Blame?
Who would have thought that a severe psoriasis outbreak could start because of something going wrong inside of your stomach and intestines? Yet, new research developed by psoriasis expert Edgard Cayce shows a distinct link between a leaky gut and a scaly psoriatic episode. According to Cayce, the primary source of psoriasis can be found in the intestinal tract, where toxins are leached into the body. This causes the immune system to react by thickening the skin. At the same time, the skin tries to purge the toxins through its layers, which can cause scabs and sores to form.
Could Arthritis Be the Cuplrit?
The intestines arent the only link to psoriasis found by researchers arthritis seems to also contribute to it. As many as one-third of all psoriasis patients eventually develop some form of psoriatic arthritis. Unlike normal forms of arthritis, those with psoriatic arthritis do not exhibit a rheumatoid factor when their blood is tested. This indicates that the arthritic condition comes solely from either the psoriasis itself or the underlying cause of the skin affliction.
Could a Virus Be the Cause?
Arthritis has been linked to certain virus and so have other auto-immune disorders. This leads some researchers to think that psoriasis too may start with a virus, which is what kicks the immune system into overdrive.
What If Those Psoriasis Treatments Dont Work
If psoriasis doesnt improve, your healthcare provider may recommend these treatments:
- Light therapy: UV light at specific wavelengths can decrease skin inflammation and help slow skin cell production.
- PUVA: This treatment combines a medication called psoralen with exposure to a special form of UV light.
- Methotrexate: Providers sometimes recommend this medication for severe cases. It may cause liver disease. If you take it, your provider will monitor you with blood tests. You may need periodic liver biopsies to check your liver health.
- Retinoids: These vitamin A-related drugs can cause side effects, including birth defects.
- Cyclosporine: This medicine can help severe psoriasis. But it may cause high blood pressure and kidney damage.
- Immune therapies: Newer immune therapy medications work by blocking the bodys immune system so it cant jumpstart an autoimmune disease such as psoriasis.
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Disease Activity And Patient
Patients had an overall mean Investigator’s Global Assessment score of 2.9 ± 0.8, body surface area involvement of 15.5 ± 16.6%, and Psoriasis Area and Severity Index score of 9.1 ± 8.1 the majority of patients had moderate to severe disease as assessed by IGA 3 and BSA 3% , and 34.1% had a PASI score > 10 . In multivariable-adjusted models, patients with scalp psoriasis had a higher mean IGA score , BSA involvement , and PASI score than those without scalp psoriasis . Patients with nail psoriasis had higher mean BSA involvement and PASI score but a lower mean IGA score than those without nail psoriasis . Conversely, patients with palmoplantar psoriasis had a higher mean IGA score but lower mean BSA involvement and PASI score than those without palmoplantar psoriasis .
Yes Although Its Not Common
The short answer: People do get psoriatic arthritis without psoriasis although its pretty rare and most often they will have a first-degree relative with skin psoriasis, says Rebecca Haberman, MD, a rheumatologist at NYU Langone in New York City.
Psoriatic arthritis is a type of inflammatory arthritis that often attacks the joints, causing swelling, stiffness, redness, and pain. In most cases, PsA occurs along with cutaneous psoriasis , or skin and nail inflammation. Your organs can also be affected by out-of-control inflammation, including your heart.
Its hard to define the percentage of patients who have PsA without PsO, because in a lot of these patients, the psoriasis can show up after the joint disease or its just not seen, says Dr. Haberman. In our cohort of PsA patients, 99.1 percent have skin involvement.
Psoriasis is often located in hidden areas, like the umbilicus and gluteal fold that are not routinely checked when a patient sees their primary care provider for a sore foot, says Susan M. Goodman, MD, a rheumatologist at Hospital for Special Surgery in New York City. The hope is that better epidemiologic studies will ensure that PsA patients dont have hidden disease.
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Are Psoriasis Shampoos Available
Coal tar shampoos are very useful in controlling psoriasis of the scalp. Using the shampoo daily can be very beneficial adjunctive therapy. There are a variety of over-the-counter shampoos available without a prescription. There is no evidence that one shampoo is superior to another. Generally, the selection of a tar shampoo is simply a matter of personal preference.
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.
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Pustular Psoriasis: In A Population Survey Of Psoriasis Pustular Lesions Were Reported At Any Time During The Course Of Psoriasis By About 20% Of Patients
Generalized pustular psoriasis : Patients with generalized pustular psoriasis may have preexisting plaque psoriasis or develop it after pustular episodes. Acute episodes may be triggered in patients with plaque psoriasis by irritating topical therapy or abrupt corticosteroid withdrawal . At the onset of an attack of acute GPP the skin becomes very red and tender. There may be fever and systemic symptoms such as anorexia and nausea. Within hours, myriads of pinhead-sized pustules appear, studding the erythematous background . Pustules may become confluent, producing lakes of pus. Subsequently, the pustules dry out, and the skin peels off, leaving a glazed, smooth erythematous surface on which new crops of pustules may appear . GPP should be distinguished from acute generalized exanthematic pustulosis, a self-limiting febrile drug reaction usually resolving in 2 weeks after withdrawal of the suspected agent, characterized by pinpoint nonfollicular pustules on erythematous patches mainly involving folds. Single necrotic cells in the epidermis, eosinophils, and vasculitic changes in the dermis are peculiar pathologic features .
Early phase of generalized pustular psoriasis with edematous plaques and pustules.
Localized pustular psoriasis : Besides so-called psoriasis with pustules , 2 main clinical varieties are reported as localized pustular psoriasis: acrodermatitis continua of Hallopeau and palmoplantar pustulosis.
Skins Immunity Function: Keratinocytes As Immune Sentinels
Keratinocytes can sense pathogens and mediate immune responses to discriminate between harmless commensal organisms and harmful pathogens. Keratinocytes are continuously in contact with external stimuli and have the capacity to produce several soluble mediators. Pathogen-associated molecular patterns are recognized, among others, by Toll-like receptors . Epidermal keratinocytes express several TLRs, located either on the cell surface or in endosomes . Keratinocytes are also an important source of chemokines and express chemokine receptors, and therefore can modulate an immune response by attracting different cell types into the skin.
3.3.1. Keratinocytes as a secretory organ of cytokines
Keratinocytes produce a wide array of cytokines, including tumor necrosis factor and interleukin 1 , IL-1, and IL-6. Disruption of the permeability barrier increases the expression of these cytokines . Studies in mice deficient in these cytokines or their receptors have shown delays in permeability barrier recovery after acute disruption, suggesting that the increased cytokine production facilitates barrier repair . Cytokines are well known to stimulate lipid synthesis and metabolism, and one could anticipate that an increase in epidermal lipids induced by cytokines could facilitate lamellar body formation and permeability barrier recovery .
3.3.2. Sympathetic regulation of innate immunity
3.3.3. Psoriasis & immune system
3.3.4. Psoriasis & the innate immune system
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