Psoriasis symptoms & treatments - Illnesses & conditions | NHS inform
Any chronic condition like psoriasis can be a source of stress. This can often turn into a vicious cycle because stress itself can worsen psoriasis symptoms. In addition to reducing stress whenever possible, consider incorporating stress-reducing practices such as yoga and meditation. Alcohol is a trigger for many people who have psoriasis. A study in found an increased risk of psoriasis among women who drank nonlight beer.
Turmeric has been found to help minimize psoriasis flare-ups. It can be taken in pill or supplement form, or sprinkled on your food. Talk to your doctor about the potential benefits for you. The FDA-approved dosage of turmeric is 1. Smoking may increase your risk of psoriasis. What works for one person may not work for another. Some treatment options may have negative side effects for preexisting conditions other than psoriasis. Remember that while these home remedies for psoriasis may help with mild cases, prescription therapy is required for more severe cases.
Talk to your doctor before seeking treatment on your own. Healthline and our partners may receive a portion of revenues if you make a purchase using a link above. Having psoriasis and dealing with flare-ups at work can be stressful. Here's how to remain professional and dress accordingly. Abnormal epidermal cell kinetics and abnormal activation of immune mechanisms are thought to be the major contributors, and treatment may affect one or both of these mechanisms. The primary lesion is a well-demarcated erythematous plaque with a silvery scale.
Characteristically, psoriasis is symmetrically distributed, with lesions frequently located on the ears, elbows, knees, umbilicus, gluteal cleft and genitalia Figure 1. The joints psoriatic arthritis , nails and scalp may also be affected. Common areas of distribution of psoriasis. The lesions are usually symmetrically distributed and are characteristically located on the ears, elbows, knees, umbilicus, gluteal cleft and genitalia.
Itching is the most common symptom, 4 and extensive scratching can often lead to superimposed lichen simplex chronicus. In some patients, burning and pain may be the only symptoms. Psoriasis can be classified into four types: The less common forms of psoriasis include pustular localized and generalized and erythrodermic variants. The most common form is plaque-type psoriasis Figure 2. The scale itself is variable, ranging from a thick, massive scale, as is generally seen on the scalp, to no scale at all, as is generally seen in intertriginous or partially treated areas.
Atopic dermatitis, irritant dermatitis, cutaneous T-cell lymphoma, pityriasis rubra pilaris, seborrheic dermatitis. Teardrop-shaped, pink to salmon, scaly plaques; usually on the trunk, with sparing of palms and soles. Erythematous papules or plaques studded with pustules; usually on palms or soles known as palmoplantar pustular psoriasis. Same as localized with a more general involvement; may be associated with systemic symptoms such as fever, malaise and diarrhea; patient may or may not have had preexisting psoriasis.
Severe, intense, generalized erythema and scaling covering entire body; often associated with systemic symptoms; may or may not have had preexisting psoriasis. Drug eruption, eczematous dermatitis, mycosis fungoides, pityriasis rubra pilaris. A primary lesion of plaque-type psoriasis. The typical lesion is a well-demarcated, thick, erythematous plaque with a silvery scale. Guttate psoriasis is characterized by numerous small, oval teardrop-shaped lesions that develop after an acute upper respiratory tract infection.
These lesions are often not as scaly or as red as the classic lesions of plaque-type psoriasis. Usually, guttate psoriasis must be differentiated from pityriasis rosea, another condition characterized by the sudden outbreak of red scaly lesions. Compared with pityriasis rosea, psoriatic lesions are thicker and scalier, and the lesions are not usually distributed along skin creases.
The diagnosis of psoriasis can usually be made on the basis of the clinical presentation; histologic confirmation is rarely needed. If the diagnosis is uncertain, a biopsy can be performed or consultation with a dermatologist can be obtained. Once the diagnosis of psoriasis is made, patient education about the disease should begin.
Points that should be emphasized about the disease initially include its noncontagious nature and the possibility of controlling but not curing it. Patients should also be assured that psoriasis is quite common. Exacerbating factors should be discussed, including stress, infection, trauma, xerosis and use of medications such as angiotensin-converting enzyme inhibitors, beta-adrenergic blockers, lithium and the antimalarial agent hydroxychloroquine Plaquenil.
The National Psoriasis Foundation is a widely used resource for patients Web site: An algorithm for the treatment of localized psoriasis is depicted in Figure 3. Localized psoriasis can be defined as disease that is limited to such a degree that topical therapy controls it. Generalized psoriasis may require oral medications, treatment with ultraviolet light or treatment at an outpatient or inpatient facility. Algorithm for the treatment of localized psoriasis. Treatment of localized psoriasis is initiated using topical corticosteroids, alone or in combination with coal tar or calcipotriene.
Patients with resistant lesions may benefit from the addition of anthralin or tazarotene. The treatment of psoriasis requires an understanding of the effect that psoriasis is having on the patient's quality of life, and that effect is extremely variable. Taking the individual patient's treatment needs into consideration can improve the overall outcome. Topical therapy, including corticosteroids, calcipotriene Dovonex , coal tar products, tazarotene Tazorac and anthralin Anthra-Derm , is the mainstay of treatment for localized disease Tables 2 and 3.
Immunobiologics in the treatment of psoriasis
While the use of emollients should be encouraged, they should be used selectively because many e. Low-potency corticosteroids classes 6 and 7 , such as desonide Desowen , aclometasone dipropionate Aclovate ; hydrocortisone agents Cortizone, Cortaid, etc. Medium-potency corticosteroids classes 3, 4 and 5 , such as triamcinolone acetonide Kenalog , hydrocortisone valerate Westcort , fluticasone propionate Cutivate , halcinonide Halog , mometasone furoate Elocon.
High-potency corticosteroids classes 1 and 2 , such as halobetasol propionate Ultravate , clobetasol propionate Temovate , diflorasone diacetate Psorcon , betamethasone dipropionate Diprolene , clobetasole propionate Cormax. Side effects increase with increased potency, duration of therapy and total dosage. For onycholysis, a topical corticosteroid in a solution vehicle may be used under the nail. Systemic therapy may be required to improve severe disease.
The thin skin of the genitalia is highly sensitive to the adverse effects atrophy of topical corticosteroids. A low-potency topical corticosteroid ointment is recommended. Topical calcipotriene, which is not associated with a risk of atrophy, may be used. The thick stratum corneum of palms and soles is a barrier to penetration of topical agents. A highest-potency topical corticosteroid is recommended.
Methotrexate Rheumatrex or acitretin Soriatane; a systemic retinoic acid analog may be needed. Topical corticosteroids are the most commonly prescribed treatment for psoriasis. Corticosteroids have well-recognized anti-inflammatory and antiproliferative effects, which are thought to be their primary mechanism of action in psoriasis.
In general, treatment is initiated with a medium-strength agent, and high-potency agents are reserved for the treatment of thick chronic plaques that are refractory to weaker steroids. Low-potency agents are used on the face, on areas where the skin tends to be thinner, and on the groin and axillary areas, where natural occlusion increases the potency of a low-potency agent to the equivalent of a higher potency agent. Use of high-potency agents in these areas increases the risk of side effects and therefore should be avoided.
Potential side effects from corticosteroids include cutaneous atrophy, telangiectasia and striae, acne eruption, glaucoma, hypothalamus-pituitary-adrenal axis suppression and, in children, growth retardation. The true incidence of corticosteroid-induced hypothalamus-pituitary-adrenal suppression is unknown, but it is of concern with prolonged use. Careful long-term follow-up of patients receiving topical corticosteroid therapy is highly recommended to detect potential complications.
Although corticosteroids are rapidly effective in the treatment of psoriasis, they are associated with a rapid flare-up of disease after discontinuation, and they have many potential side effects. Consequently, topical corticosteroids are frequently used in conjunction with another agent to maintain control.
Topical calcipotriene is often used in combination with topical corticosteroids to speed clearing of the lesions and maintain control after the initial phase of treatment is completed. Calcipotriene is a vitamin D 3 analog available in cream, ointment and solution formulations. It inhibits epidermal cell proliferation and enhances normal keratinization. This agent has a slow onset of action, and patients should be aware that the effects of calcipotriene may not be noticeable for up to six to eight weeks after the initiation of therapy.
Although calcipotriene monotherapy has been shown to be moderately effective in reducing the thickness, scaliness and erythema of psoriatic lesions, 8 maximal benefits are achieved when calcipotriene is used in combination with potent topical corticosteroids. This second phase helps prevent rebound from abrupt withdrawal of corticosteroids. When the lesions have remained flat and the intensity of their color has declined from bright red to pink, the maintenance phase begins, with use of calcipotriene alone and discontinuation of the weekend use of topical corticosteroids.
After appropriate control of the disease is maintained, topical therapy can be discontinued until a flare-up occurs. Use of emollients should be recommended, to reduce the scaly appearance of the lesions and to potentially reduce the amount of corticosteroid needed. The only cutaneous side effect of calcipotriene is local irritation, which occurs in approximately 15 percent of patients. Hypercalcemia is a potential side effect of this agent when the dosage exceeds g per week.
This effect does not usually occur with weekly use of g or less. Read more about the symptoms of psoriasis. The resulting build-up of skin cells is what creates the patches associated with psoriasis. Many people's psoriasis symptoms start or become worse because of a certain event, known as a "trigger".
In rare cases, a small sample of skin, called a biopsy , will be sent to the laboratory for examination under a microscope. This determines the exact type of psoriasis and rules out other skin disorders, such as seborrhoeic dermatitis, lichen planus , lichen simplex and pityriasis rosea. You may be referred to a dermatologist 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 rheumatologist 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. There's no cure for psoriasis, but a range of treatments can improve symptoms and the appearance of skin patches. In most cases, the first treatment used will be a topical treatment, such as vitamin D analogues or topical corticosteroids.
Polymyositis
Topical treatments are creams and ointments applied to the skin. If these aren't effective, or your condition is more severe, a treatment called phototherapy may be used. Phototherapy involves exposing your skin to certain types of ultraviolet light. In severe cases, where the above treatments are ineffective, systemic treatments may be used.
These are oral or injected medicines that work throughout the whole body. Read more about treating psoriasis. Although psoriasis is just a minor irritation for some people, it can have a significant impact on quality of life for those more severely affected. This is known as psoriatic arthritis. There are also support groups for people with psoriasis, such as The Psoriasis Association , where you can speak to other people with the condition.
Read more about living with psoriasis. Psoriasis typically causes patches of skin that are dry, red and covered in silver scales. Some people find their psoriasis causes itching or soreness. There are several different types of psoriasis. One type may change into another type, or become more severe. Most cases of psoriasis go through cycles, causing problems for a few weeks or months before easing or stopping. Its symptoms are dry, red skin lesions, known as plaques, which are covered in silver scales.
They normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body. The plaques can be itchy, sore or both. In severe cases, the skin around your joints may crack and bleed. This can occur on parts of your scalp or on the whole scalp. It causes red patches of skin covered in thick silvery-white scales. Some people find scalp psoriasis extremely itchy, while others have no discomfort. In extreme cases it can cause hair loss, although this is usually only temporary. In about half of all people with psoriasis, the condition affects the nails.
Psoriasis can cause your nails to develop tiny dents or pits, become discoloured, or grow abnormally. In severe cases, your nails may crumble. There's a good chance that guttate psoriasis will disappear completely after a few weeks, but some people go on to develop plaque psoriasis. This affects folds or creases in your skin, such as the armpits, groin, between the buttocks and under the breasts. It can cause large, smooth red patches in some or all of these areas. Inverse psoriasis is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather.
Pustular psoriasis is a rarer type of psoriasis that causes pus-filled blisters pustules to appear on your skin. Different types of pustular psoriasis affect different parts of the body. This causes pustules on a wide area of skin, which develop very quickly. The pus consists of white blood cells and is not a sign of infection.
The pustules may reappear every few days or weeks in cycles.
During the start of these cycles, von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue. This causes pustules to appear on the palms of your hands and the soles of your feet. The pustules gradually develop into circular brown, scaly spots, which then peel off. Pustules may reappear every few days or weeks.
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This causes pustules to appear on your fingers and toes. The pustules then burst, leaving bright red areas that may ooze or become scaly. These may lead to painful nail deformities. Erythrodermic psoriasis is a rare form of psoriasis that affects nearly all the skin on the body. This can cause intense itching or burning. Psoriasis occurs when skin cells are replaced more quickly than usual.
It's not known exactly why this happens, but research suggests it's caused by a problem with the immune system. Your body produces new skin cells in the deepest layer of skin. These skin cells gradually move up through the layers of skin until they reach the outermost level. Then they die and flake off.
As a result, cells that aren't fully mature build up rapidly on the surface of the skin, causing red, flaky, crusty patches covered with silvery scales. Your immune system is your body's defence against disease and it helps fight infection. One of the main types of cell used by the immune system is called a T-cell.
T-cells normally travel through the body to detect and fight invading germs such as bacteria, but in people with psoriasis they start to attack healthy skin cells by mistake. This causes the deepest layer of skin to produce new skin cells more quickly than usual, which in turn triggers the immune system to produce more T-cells. Psoriasis runs in families. However, the exact role that genetics plays in causing psoriasis is unclear. Research studies have shown many different genes are linked to the development of psoriasis. It's likely that different combinations of genes may make people more vulnerable to the condition.
However, having these genes doesn't necessarily mean you'll develop it.