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.
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|
Psoriasis Creams And Shampoos
Topical treatments are creams or ointments that you apply directly to the skin. If you have mild psoriasis, a topical treatment may be all you need. For moderate to severe psoriasis, topical treatments can be used in combination with other medications .
There are some remedies you can try at home for mild psoriasis or in combination with prescription medicines. Below are some examples:
Moisturizers relieve dry, itchy, red skin and can be helpful for everyone with psoriasis.
is a low-dose, over-the-counter steroid that decreases itching and inflammation. Its great for very mild psoriasis affecting a small area.
Products with salicylic acid can soften and remove the scale seen in plaque psoriasis.
Coal tar-containing products relieve symptoms and slow the rapid growth of skin cells.
Products with calamine, camphor, or menthol can help itching.
Topical psoriasis treatments that require a prescription include:
Corticosteroids: These medications reduce inflammation, redness, and itching. There are many topical steroids, but two common ones are and .
Vitamin D analogues : These decrease skin growth, which helps control psoriasis. They may be used in combination with steroids. Examples are and .
Calcineurin inhibitors : These medications are used for sensitive areas like the face. They include and . Both of these medications are considered off label for psoriasis treatment.
Keratolytics: These decrease skin growth and break down thick plaques. Examples are and .
Also Check: How To Stop Guttate Psoriasis Spreading
How A Dermatologist Can Help
With so many products, it can be difficult to know what to use. If you dont see the results you like with OTC treatment for psoriasis, you may want to see dermatologist. Dermatologists are the skin disease experts. They know how to tailor psoriasis treatment to the type of psoriasis you have. Sometimes, this requires combining treatments. You may also need one treatment plan to gain control over your psoriasis and another to maintain the results.
ReferencesMenter A, Korman NJ, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3: Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009 60:64359.
Paghdal KV, Schwartz RA. Coal tar: Back to the future. J Am Acad Dermatol. 2009 Aug 61:294-302.
All content solely developed by the American Academy of Dermatology
The American Academy of Dermatology gratefully acknowledges the support from Amgen and .
Treatments For Nail Psoriasis
The same treatments you get for skin psoriasis can also treat your nail psoriasis. Because your nails grow slowly, it can take time before you see any improvements in the newly grown parts of your nail.
The treatments for nail psoriasis include:
- Ultraviolet light is used to treat skin psoriasis and may also be useful in nail psoriasis. The treatments usually take place in a doctors office or a clinic.
- Medicines that work throughout your body. Your doctor may call these systemic medications. Some examples are:
If your nails are thick, the medicine you apply may have a hard time getting inside. Gels or ointments that contain urea can help thin them.
Your doctor may also prescribe a nail lacquer that hydrates and strengthens your nails. You apply it every day in the same way you put on nail polish.
- Corticosteroid injections. These are put under your nail surface every 2-9 months. Your doctor will numb the area or use a nerve block to reduce pain.
Also Check: Difference Between Eczema And Psoriasis On Hands
How Do You Pick The Best Treatment Option
Once you are diagnosed with psoriasis, your healthcare provider will help you decide the best treatment for you. Your primary care provider can usually treat mild psoriasis. In some cases, you might need to see a specialist called a dermatologist.
Psoriasis is different for everyone, but treatment generally proceeds as follows:
If you have mild psoriasis involving a small area of your body, you can try a topical treatment or targeted phototherapy first. If that doesnt work, systemic treatment with an oral medication or biologic is the next step.
If you have moderate or severe psoriasis involving a larger area of the body or a sensitive area like the palms or soles a systemic treatment with or without phototherapy is recommended as first-line treatment.
Systemic treatment is also needed if you have both psoriasis and psoriatic arthritis.
Finding the right treatment isnt always easy. Its not easy to predict how someone will respond to treatment, and sometimes you have to try a few medications before you find one that works for you. You may even need more than one medication, too. This process can be frustrating, but your healthcare provider can guide you through the process.
If you have already been diagnosed with psoriasis and need prescription refills, it may help to know that there are several services that can provide a consultation and prescription online.
Treatment Of Associated Conditions
Health conditions associated with psoriasis include psoriatic arthritis, sleep disturbance, and depression. Treatment for these may help skin disease.
Due to the association between psoriasis and metabolic syndrome, weight loss, smokingcessation, moderation of alcohol intake, and blood pressure control may also lead to improvements in skin disease .
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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:
How To Prevent And Treat Your Stress To Cure Psoriasis
There are many ways to prevent and treat stress. Some people may find those different methods work for them, but these are some general tips that can help:
1) Identify healthy coping mechanisms and stick to them. This could involve things like exercise, journaling, or deep breathing exercises.
2) Avoid any type of self-judgement. Accepting that everyone has stress and its normal to feel overwhelmed sometimes can be helpful.
3) Try to maintain a positive outlook and practice gratitude. Focusing on the good things in life can help to offset negative thoughts.
4) Seek professional help if the stress is becoming too much to handle on your own. There is no shame in seeking help, and a professional. can provide you with the tools you need to manage your stress.
If you are struggling with psoriasis and stress, it is important to seek help. There are many resources available to you, and a professional can help you find the best way to manage both conditions. Stress can make psoriasis worse, so it is important to take the time to reduce the stressors in your life.
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What Is Psoriasis Its More Than Skin Deep
Psoriasis is a chronic autoimmune disease in which the cells of your skin are replaced at an unusually fast rate.
- Skin cells are quickly replaced every few days, instead of every 3 to 4 weeks.
- Due to this rapid turnover, extra skins cells cause raised silvery plaques that can be flaky, red, and itchy.
- Psoriasis tends to occur in adults most frequently, and the symptoms may come and go.
There is no cure for psoriasis, but advanced medications allow roughly 80% to 90% of patients to have successful treatment to lessen symptoms and improve the appearance of the plaques.
What Is The Treatment For Psoriasis
The goal of psoriasis treatment is to stop the skin cells from growing rapidly and to remove the scales.
There are several treatment options for psoriasis. The type of treatment done for you depends on how severe is psoriasis, and how responsive it has been to a previous treatment.
The different types of treatments done for psoriasis include:
Topical therapy: This includes the topical application of certain medications.
- These are the most commonly prescribed medicines for the treatment of mild to moderate psoriasis.
- Corticosteroids may be available in the form of creams, ointments, gels, lotions, foams, shampoos, and sprays.
- Examples of corticosteroids include hydrocortisone, triamcinolone, and clobetasol.
Vitamin D analogues:
- Tazarotene is a type of retinoid that is available in the form of a cream or gel.
- It can be applied one or two times a day.
- They help in reducing the inflammation and buildup of plaque.
- Examples include pimecrolimus and tacrolimus.
- It helps in reducing itching, scaling, and inflammation.
- Salicylic acid present in shampoos and scalp solutions reduces the scaling of the scalp psoriasis.
It is a tar product in the form of a cream.
- It is used to slow skin cell growth. It also removes the scales to make the skin smoother.
- Daily exposure to sunlight for a brief time is known as heliotherapy. This may help in improving psoriasis.
Also Check: Doctors Who Specialize In Psoriasis
What Else Should I Ask My Healthcare Provider
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.
Treatments For Plaque Psoriasis
There are a variety of plaque psoriasis treatments. Some people use over-the-counter products, while others get one or more treatments prescribed by a doctor or dermatologist. These include:
Topicals work on the skin surface and are often the first treatment when someone is diagnosed. They can come in gels, ointments or creams that are prescribed by your doctor or bought over the counter.
Oral treatments are medicines you take by mouth. They work within the body by suppressing all or part of the immune system.
Biologics target specific parts of the immune system. They attach to proteins involved with inflammation. Biologics work within the body and theyre typically given by injection.
Also Check: What Is Psoriasis Autoimmune Disease
How Psoriasis Is Diagnosed
A GP can often diagnose psoriasis based on the appearance of your skin.
In rare cases, a small sample of skin called a biopsy will be sent to the laboratory for examination under a microscope.
You may be referred to a specialist in diagnosing and treating skin conditions if your doctor is uncertain about your diagnosis, or if your condition is severe.
If your doctor suspects you have psoriatic arthritis, which is sometimes a complication of psoriasis, you may be referred to a doctor who specialises in arthritis .
You may have blood tests to rule out other conditions, such as rheumatoid arthritis, and X-rays of the affected joints may be taken.
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.
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Is Psoriasis The Same As Eczema
Psoriasis and eczema are two different skin conditions. They differ in where the disease appears on the body, how much it itches and how it looks. Eczema tends to appear more often behind the knees and inside the elbows. Eczema also causes more intense itching than psoriasis. Many people, especially children, can get both eczema and psoriasis.
What Can Trigger A Flare Up
There is nothing you can or could have done to get psoriasis but there are some things that may trigger a flare-up.
Skin injury and irritation or any break in the skin can lead to psoriasis. A break in the skin can be characterized as a razor burn, an insect bite, cut, abrasion, sunburn, needle puncture, blister or bruise. Frequent rubbing and/or scratching of the skin can irritate the psoriasis as well.
Weather is another factor that can cause psoriasis to improve or worsen. Moderate sun exposure can be helpful to relieve some psoriasis symptoms, but an overly hot and humid environment can make symptoms worse. The dry cold winter season tends to make the psoriasis worse because it becomes very dry and irritates the skin.
Stress is a factor in a number of health conditions and can be a trigger for psoriasis as well. Stress and tension seem to make psoriasis worse. Living with psoriasis also contributes to stress.
Some medications can make psoriasis worse, such as certain treatments for rheumatoid and osteoarthritis, including some anti-inflammatory medications. Medications such as lithium which is used as an antidepressant can cause a flare-up to appear.
A healthy diet is very important for everyone, especially people with psoriasis. Some foods may cause a flare-up, but it is important to avoid them after the flare-up. For some people, excessive alcohol consumption causes flare-ups.
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How Is It Treated
Psoriasis treatment ranges anywhere from a topical treatment, to a pill, to injections, to light therapy. The dermatologist will give you a treatment plan that is suited best for you, your type of psoriasis, what skin areas are affected, and the diseases effect on your overall health. The goal of treatment is to reduce the amount of inflammation and to control the amount of skin shedding.
Moisturizing creams loosen scales and help control itching. Special diets have not been successful in treating psoriasis, except in isolated cases increasing fish in the diet and/or taking fish oil capsules may benefit some patients with psoriasis.
There still isnt a cure for psoriasis, but there are still options that can help make your skin as clear as possible.
Narrowband Ultraviolet B Phototherapy
For adults with generalized plaque psoriasis, the recommended NB-UVB phototherapy starting dose should be based on the minimal erythema dose or it should be determined based on a fixed-dose or skin-phototype protocol.
For adults with generalized plaque psoriasis, a treatment phase of thrice-weekly dosing of NB-UVB phototherapy is recommended.
For adults with psoriasis, treatment with short-term psoralen plus ultraviolet A monotherapy is more effective than NB-UVB.
Owing to its increased safety, higher convenience, and lower cost, NB-UVB is preferred over PUVA monotherapy for psoriasis in adults, even though it is less effective.
In adults with generalized plaque psoriasis, NB-UVB is recommended over broadband ultraviolet B monotherapy.
Treatment with NB-UVB monotherapy is recommended for guttate psoriasis patients, regardless of their age.
For appropriate patients with generalized plaque psoriasis, home-based NB-UVB phototherapy is recommended as an alternative to in-office NB-UVB phototherapy.
Treatment with NB-UVB phototherapy is recommended for pregnant patients who have guttate psoriasis or generalized plaque psoriasis.
As a measure to possibly improve efficacy, NB-UVB phototherapy can be safely augmented with concomitant topical therapy using retinoids, vitamin D analogues, and corticosteroids.
Oral retinoids can be combined with NB-UVB phototherapy in appropriate patients with generalized plaque psoriasis if they have not responded adequately to monotherapy.
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