What Is Psoriasis?

While psoriasis can affect any part of your body, plaques most often develop on the elbows, knees, scalp, back, palms, and feet. Like other autoinflammatory diseases, psoriasis occurs when your immune system — which normally attacks infectious germs — begins to attack healthy cells instead.

Types of Psoriasis

• Plaque psoriasis
• Guttate psoriasis
• Inverse psoriasis
• Pustular psoriasis
• Erythrodermic psoriasis
• Nail psoriasis

Plaque Psoriasis

Also called psoriasis vulgaris, plaque psoriasis is the most common form of the skin disease. It appears as raised, discolored plaques covered with a scaly buildup of dead skin cells, or scales. The itchy, sometimes painful plaques can crack and bleed. They commonly affect the scalp, knees, elbows, back, hands, and feet.

Guttate Psoriasis

Inverse Psoriasis

Also known as intertriginous psoriasis, inverse psoriasis causes red or otherwise discolored lesions in skin folds. The lesions may look smooth and shiny. They can occur on the armpits, under the breasts or buttocks, or around genitals or in areas near the genitals, like the upper thighs and groin. It’s common for people with inverse psoriasis to have another type of psoriasis somewhere else on their body at the same time.

Pustular Psoriasis

This causes white blisters of pus that surround red or otherwise discolored skin, often on the hands or feet. The pus consists of white blood cells. When pus-filled bumps cover the body, you may have bright red skin and feel ill or exhausted. You may have a fever, chills, severe itching, rapid pulse, loss of appetite, or muscle weakness.

Erythrodermic Psoriasis

This is a dangerous and rare form of the skin disease characterized by a widespread, fiery redness or other discoloration and exfoliation of the skin that causes severe itching and pain.

Nail Psoriasis

People with nail psoriasis may experience symptoms like pitting, abnormal nail growth, and discoloration in their fingernails and toenails. It could cause onycholysis, which is when nails separate from the nail bed, causing more of the nail to look white than usual. People with severe nail psoriasis may experience crumbling of the nails.

Signs and Symptoms of Psoriasis

Psoriasis plaques can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. The disease’s symptoms and appearance vary according to the type and severity of psoriasis.

• Discolored patches that are typically red with silver scales on lighter skin tones or purple with gray scales on darker skin tones; they may also appear as raised plaques of skin that are covered with scales
• Cyclic rashes that flare up for several weeks or months and then subside
• Dry or cracked skin that bleeds
• Burning, itching, or soreness near the affected areas
• Pitted or thickened fingernails or toenails

Causes and Risk Factors of Psoriasis

“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, a dermatologist in Maywood, Illinois, who specializes in psoriasis.

• Being overweight or having obesity

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• Celiac disease
• Smoking
• Heavy alcohol use

A psoriasis outbreak may be provoked by factors including:

Stress

“Psoriasis is very stress-dependent. It flares very easily when patients are under stress, and it tends to improve when they’re relaxed,” says Vesna Petronic-Rosic, MD, chair of the dermatology department at John H. Stroger, Jr. Hospital of Cook County in Chicago.

Cold Weather

Cold, dry weather can exacerbate psoriasis symptoms by sapping even more moisture from the skin. Heated indoor air doesn’t help because it’s also drying. Plus, staying inside all winter long lowers exposure to sunlight, which some people say improves their psoriasis.

Dry Skin

Anything that injures the skin, including excessively dry skin, can cause a psoriasis flare. The solution? Keep your skin moisturized.

Vaccinations

Beta-Blockers and Lithium

If you’re taking beta-blockers or lithium, be sure to mention this to your dermatologist when discussing your psoriasis treatment plan.

Upper Respiratory Infections

Smoking

Diet

Studies haven’t shown any beneficial effects of taking nutritional supplements for psoriasis, but avoiding certain foods may reduce inflammation and help with psoriasis.

Alcohol

Alcohol can cause inflammation, which is why it may be problematic for inflammatory conditions like psoriasis. It also causes dehydration, oxidative stress, and nutritional issues that can affect skin conditions.

How Is Psoriasis Diagnosed?

There aren’t any special tests to help doctors diagnose psoriasis. Typically, a dermatologist will examine your skin and ask about your family history. You’ll likely receive a diagnosis based on this physical exam.

Treatment and Medication Options for Psoriasis

While psoriasis is a chronic condition and there is no cure, some effective options exist to treat it. Talk to your doctor about the benefits, risks, and side effects of any therapies you use.

Medication Options

• Topicals Prescription and over-the-counter topical treatments can help minimize psoriasis symptoms. Each topical medication contains different active ingredients, such as salicylic acid, and can come in various formulations, including lotion, cream, shampoo, gel, spray, and ointment. Doctors often prescribe topical corticosteroids for mild psoriasis or moderate psoriasis. Some nonsteroidal creams also have approval from the U.S. Food and Drug Administration (FDA) to treat psoriasis, such as roflumilast (Zoryve) and tapinarof (Vtama).
• Biologics Biologic drugs are a type of systemic medication. They affect the entire body and alter the immune system. They’re typically administered via injection, but some are available as a tablet. Biologics include adalimumab (Humira), bimekizumab (Bimzelx), brodalumab (Siliq), etanercept (Enbrel), guselkumab (Tremfya), infliximab (Remicade), ixekizumab (Taltz), risankizumab (Skyrizi), secukinumab (Cosentyx), tildrakizumab (Ilumya), and ustekinumab (Stelara).
• Apremilast (Otezla) This medication comes as a pill and works by suppressing an enzyme that’s involved in inflammation.
• Oral Retinoids Doctors may prescribe this type of systemic therapy if you have severe psoriasis that doesn’t respond to other treatments.
• Methotrexate (Rheumatrex) This drug helps control inflammation.
• Deucravacitinib (Sotyktu) This is an oral tablet in the JAK inhibitor family that may be prescribed for moderate to severe plaque psoriasis.
• Cyclosporine (Gengraf or Neoral) This systemic treatment suppresses the immune system. It should only be taken for short periods.

Light Therapy

Light therapy, such as UVB phototherapy, involves exposing your skin to controlled amounts of natural or artificial ultraviolet light to help reduce symptoms of psoriasis. You may receive this treatment alone or along with other medication.

Disparities and Inequities in Psoriasis

Psoriasis is less common in people of color than in white people. However, the condition may present as more severe and more challenging to diagnose in people of color.

The appearance of psoriasis can differ depending on skin color. Psoriasis tends to be red or pink with silvery-white scales on light skin. On medium skin, psoriasis is more likely to be salmon-colored with silvery-white scales. On deep skin tones, psoriasis often looks violet with gray scales. Or, it may be very brown and hard to see.

Lifestyle Changes and Prevention of Psoriasis

• Taking daily baths
• Keeping skin moisturized
• Avoiding triggers whenever possible
• Trying not to scratch
• Getting a small amount of sunlight each day, with guidance from your healthcare provider on how much sun exposure is safe for you
• Eating a nutritious diet
• Exercising regularly
• Maintaining a healthy weight
• Limiting or avoiding alcohol
• Managing stress with mindfulness activities, like meditation and yoga

Psoriasis Prognosis

Psoriasis is considered a chronic, lifelong condition. There currently isn’t a cure, but there are treatments that can help keep your skin clear or nearly clear.

Complications of Psoriasis

• High blood pressure
• Obesity
• High cholesterol
• Diabetes
• Heart disease
• Liver disease
• Kidney disease
• Cancer
• Uveitis (an eye disease)
• Crohn’s disease
• Depression

“Over the past few years, we’ve seen that maybe psoriasis plays a more integral part in metabolic syndrome, a collection of symptoms that can lead to diabetes and heart disease,” says Erin Boh, MD, chairman and a professor of dermatology at the Tulane University School of Medicine in New Orleans.

Further, many conditions are closely related to, and sometimes mistaken for, psoriasis, including:

• Certain types of eczema, such as atopic dermatitis or seborrheic dermatitis
• Dandruff
• Ringworm
• Pityriasis rosea, a rash that usually starts as an oval spot on the chest, abdomen, back, or face

The Takeaway

• Psoriasis is an autoimmune disease that causes itchy, dry, and sometimes sore patches of discolored skin. There are various types of psoriasis.
• A combination of genetic and environmental factors, such as an inflammatory diet, stress, infections, cold weather, and certain medications, can trigger psoriasis.
• Psoriasis is linked to an increased risk of developing other health conditions, such as metabolic syndrome, diabetes, and heart disease.
• Diet and lifestyle changes may reduce flare-ups, although you may require additional support from your dermatologist or primary care doctor. Prescription treatments may include topical creams, biologics, or other medications.