Psoriasis

What is psoriasis?

Psoriasis is a chronic, autoimmune condition that presents with thickened, red, scaly areas of the skin classically on the scalp, elbows, knees, lower back, buttocks, hands, feet, and nails. In more advanced cases it can spread to affect all areas of the body. It can present at any age, but on average tends to present for the first time between the ages of 20-30 and then again between 50-60. Once psoriasis develops, it is a chronic condition which requires active therapy to keep the condition clear. There can be periods of flares when the condition worsens. Some triggers for psoriasis flares include upper respiratory infections, strep throat, stress, sunburn, injury to the skin, medications, etc. Approximately 20-30% of psoriasis patients also develop psoriatic arthritis which causes redness, inflammation, swelling, and pain of the joints, typically in the fingers, toes, ankles, and lower back. Current research has shown that psoriasis also increases one’s risk for diabetes, high blood pressure, elevated cholesterol and triglycerides, heart attack, stroke, lymphoma/leukemia, and depression. Given these risk factors it is important that patients with psoriasis see their primary care physician for an annual exam.

What are the different types of psoriasis?

Plaque-Type Psoriasis

This is the most common type of psoriasis presenting as red, thickened, and scaly plaques appear symmetrically on the scalp, elbows, knees, hands, feet, lower back, and genitalia. Plaques can last for months or years unless treated.

Guttate Psoriasis

This type of psoriasis presents with small, scaly, red bumps scattered over the entire body often times following an upper respiratory infection such as Strep throat. It is most commonly seen in children and adolescents, however it can also present in adults.

Inverse Psoriasis

This form of psoriasis presents within the folds of the body such as behind the ears, armpits, under the breasts, groin, and gluteal cleft of the buttocks. The patches often appear to be red and shiny.

Nail Psoriasis

Psoriatic nails typically present with pitting, brittleness, thickening, white or yellow-brown spots, or lifting of the nail off the nail bed. Patients with nail involvement are known to have a higher risk for psoriatic arthritis.

Other Variants

There are other less common presentations of psoriasis including pustular psoriasis, acrodermatitis continua of Hallopeau, and pustulosis of the palms and soles.

What causes psoriasis?

Psoriasis involves a complex interplay between genetics and various environmental and systemic factors. Depending on the study, it is estimated that 35% to 90% of patients have reported a family history of psoriasis. Various factors have been found to worsen or trigger psoriasis in those who are genetically predisposed including infections (especially Streptococcal), HIV, pregnancy, low calcium or Vitamin D, psychological stress, medications, obesity, alcohol consumption, and smoking.

How is psoriasis treated?

There are many different therapies for psoriasis than ever before. They are tailored to the patient based on age, sex, location on the body, severity, impact on quality of life, and presence of psoriatic arthritis.

Topical Products: steroids, vitamin D analogues, calcineurin inhibitors, anthralin, coal tar and retinoids
Narrow-Band Ultraviolet B Therapy
Systemic Medications: methotrexate, cyclosporine, acitretin and apremilast (Otezla)
Biologics: etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), ustekinumab (Stelara), secukinumab (Cosentyx), ixekizumab (Taltz), brodalumab (Siliq) and golimumab (Simponi)