Psoriasis Causes, Symptoms, Diagnosis, Treatment, Home Remedies

Psoriasis Causes, Symptoms, Diagnosis, Treatment, Home Remedies


What Is Psoriasis?


Psoriasis is a chronic (long-lasting) skin disease characterized by scaling and inflammation. Scaling occurs when cells in the outer layer of the skin reproduce faster than normal and pile up on the skin’s surface.

Some people have such mild psoriasis (small, faint dry skin patches) that they may not even suspect that they have a medical skin condition. Others have very severe psoriasis where virtually their entire body is fully covered with thick, red, scaly skin.

Psoriasis Causes, Symptoms, Diagnosis, Treatment, Home Remedies

Psoriasis affects between 1 and 2 percent of the United States population, or about 5.5 million people. Although the disease occurs in all age groups and about equally in men and women, it primarily affects adults. People with psoriasis may suffer discomfort, including pain and itching, restricted motion in their joints, and emotional distress.

In its most typical form, psoriasis results in patches of thick, red skin covered with silvery scales. These patches, which are sometimes referred to as plaques, usually itch and may burn. The skin at the joints may crack. Psoriasis most often occurs on the elbows, knees, scalp, lower back, face, palms, and soles of the feet but it can affect any skin site. The disease may also affect the fingernails, the toenails, and the soft tissues inside the mouth and genitalia. About 15 percent of people with psoriasis have joint inflammation that produces arthritis symptoms. This condition is called psoriatic arthritis. 

Psoriasis is considered an incurable, long-term (chronic) skin condition. It has a variable course, periodically improving and worsening. It is not unusual for psoriasis to spontaneously clear for years and stay in remission. Many people note a worsening of their symptoms in the colder winter months. 

What Causes Psoriasis?


Recent research indicates that psoriasis is likely a disorder of the immune system. This system includes a type of white blood cell, called a T cell, that normally helps protect the body against infection and disease. Scientists now think that, in psoriasis, an abnormal immune system causes activity by T cells in the skin. These T cells trigger the inflammation and excessive skin cell reproduction seen in people with psoriasis.

In about one-third of the cases, psoriasis is inherited. Researchers are studying large families affected by psoriasis to identify a gene or genes that cause the disease. (Genes govern every bodily function and determine the inherited traits passed from parent to child.)

People with psoriasis may notice that there are times when their skin worsens, then improves. Conditions that may cause flareups include changes in climate, infections, stress, and dry skin. Also, certain medicines, most notably beta-blockers, which are used to treat high blood pressure, and lithium or drugs used to treat depression, may trigger an outbreak or worsen the disease.

Certain factors may trigger psoriasis


Psoriasis Causes, Symptoms, Diagnosis, Treatment, Home Remedies
Psoriasis

Injury to the skin


Injury to the skin has been associated with plaque psoriasis. For example, a skin infection, skin inflammation, or even excessive scratching can trigger psoriasis.

Sunlight


Most people generally consider sunlight to be beneficial for their psoriasis. However, a small minority find that strong sunlight aggravates their symptoms. A bad sunburn may worsen psoriasis.

Streptococcal infections


Streptococcal sore throats may trigger a guttate psoriasis, a type of psoriasis that looks like small red drops on the skin.

HIV


Psoriasis typically worsens after an individual has been infected with HIV. However, psoriasis often becomes less active in advanced HIV infection.

Drugs


A number of medications have been shown to aggravate psoriasis. Some examples are as follows:
  • Lithium: Drug that may be used to treat depression
  • Beta-blockers: Drugs that may be used to treat high blood pressure
  • Antimalarials: Drugs used to treat malaria
  • NSAIDs: Drugs, such as ibuprofen (Motrin and Advil) or naproxen (Aleve), used to reduce inflammation

Emotional stress


Many people note an increase in their psoriasis when emotionally stressed.

Smoking


Cigarette smokers have an increased risk of chronic plaque psoriasis.

Alcohol


Alcohol is considered a risk factor for psoriasis, particularly in young to middle-aged males.

Hormone changes


The severity of psoriasis may fluctuate with hormonal changes. Disease frequency peaks during puberty and menopause. During pregnancy, psoriatic symptoms are more likely to improve, In contrast, flares occur in the postpartum period.

Several types of psoriasis exist


Plaque psoriasis


The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques itch or may be painful and can occur anywhere on your body, including your genitals and the soft tissue inside your mouth. You may have just a few plaques or many, and in severe cases, the skin around your joints may crack and bleed.

Nail psoriasis


Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails may become loose and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.

Scalp psoriasis


Psoriasis on the scalp appears as red, itchy areas with silvery-white scales. You may notice flakes of dead skin in your hair or on your shoulders, especially after scratching your scalp.

Psoriasis Causes, Symptoms, Diagnosis, Treatment, Home Remedies
Psoriasis

Guttate psoriasis


This primarily affects people younger than 30 and is usually triggered by a bacterial infection such as strep throat. It's marked by small, water-drop-shaped sores on your trunk, arms, legs and scalp. The sores are covered by a fine scale and aren't as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes, especially if you have ongoing respiratory infections.
Inverse psoriasis. Mainly affecting the skin in the armpits, in the groin, under the breasts and around the genitals, inverse psoriasis causes smooth patches of red, inflamed skin. It's more common in overweight people and is worsened by friction and sweating.

Pustular psoriasis


This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips. It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters dry within a day or two, but may reappear every few days or weeks. Generalized pustular psoriasis can also cause fever, chills, severe itching and fatigue.

Erythrodermic psoriasis


The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely. It may be triggered by severe sunburn, by corticosteroids and other medications, or by another type of psoriasis that's poorly controlled.

Psoriatic arthritis


In addition to inflamed, scaly skin, psoriatic arthritis causes pitted, discolored nails and the swollen, painful joints that are typical of arthritis. It can also lead to inflammatory eye conditions, such as conjunctivitis. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. Although the disease usually isn't as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.

Psoriasis Symptoms and Signs


Psoriasis Causes, Symptoms, Diagnosis, Treatment, Home Remedies
Psoriasis on leg

Psoriasis signs and symptoms can vary from person to person but may include one or more of the following:

  • Red patches of skin covered with silvery scales
  • Small scaling spots (commonly seen in children)
  • Dry, cracked skin that may bleed
  • Itching, burning or soreness
  • Thickened, pitted or ridged nails
  • Swollen and stiff joints
Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. Mild cases of psoriasis may be a nuisance; more-severe cases can be painful, disfiguring and disabling.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission. In most cases, however, the disease eventually returns.

Can psoriasis affect my joints?


Yes, psoriasis is associated with joint problems in about 10%-35% of patients. In fact, sometimes joint pains may be the only sign of the disorder with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and is treated with medications to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. In most cases, the skin symptoms occur before the onset of the arthritis.

Can psoriasis affect only my nails?


Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail symptoms accompany the skin and arthritis symptoms. Nails may have small pinpoint pits or large yellowish separations of the nail plate called "oil spots." Nail psoriasis is typically very difficult to treat. Treatment option are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

When to Seek Medical Care


You should see your doctor or health-care practitioner if you have symptoms of psoriasis, such as red raised patches of skin with silvery scales, and do not feel comfortable with how your skin looks or feels. Psoriasis is usually a mild inconvenience to most people. However, for others, it may be disabling or painful. The doctor can prescribe treatments that help. If symptoms are treated when they first appear, the condition will usually not progress.

Psoriasis Causes, Symptoms, Diagnosis, Treatment, Home Remedies
Psoriasis on head

When someone with psoriasis visits the doctor, he or she is usually concerned about raised, itchy, red areas on the skin that are scaly or peeling. The individual is typically self-conscious about the plaques or scaly areas and uses clothing to cover the affected skin to avoid being embarrassed in public.

Those with psoriasis commonly recognize that new areas of psoriasis occur within seven to 10 days after the skin has been injured. This has been called the Koebner reaction. Sometimes, the reverse occurs in which psoriasis clears after injury to the skin.

You should always see your doctor if you have psoriasis and develop significant joint pain, stiffness, or deformity. You may be in the reported 10% of individuals with psoriasis who develop psoriatic arthritis.

You also should always see your doctor if signs of infection develop. Common signs of infection are red streaks or pus from the red areas, fever with no other cause, or increased pain.

How Is Psoriasis Diagnosed?


Doctors usually diagnose psoriasis after a careful examination of the skin. However, diagnosis may be difficult because psoriasis can look like other skin diseases. A pathologist may assist with diagnosis by examining a small skin sample (biopsy) under a microscope.

There are several forms of psoriasis. The most common form is plaque psoriasis (its scientific name is psoriasis vulgaris). In plaque psoriasis, lesions have a reddened base covered by silvery scales. Other forms of psoriasis include

Guttate psoriasis


Small, drop-like lesions appear on the trunk, limbs, and scalp. Guttate psoriasis is most often triggered by bacterial infections (for example, Streptococcus).


Pustular psoriasis


Blisters of noninfectious pus appear on the skin. Attacks of pustular psoriasis may be triggered by medications, infections, emotional stress, or exposure to certain chemicals. Pustular psoriasis may affect either small or large areas of the body.


Inverse psoriasis


Large, dry, smooth, vividly red plaques occur in the folds of the skin near the genitals, under the breasts, or in the armpits. Inverse psoriasis is related to increased sensitivity to friction and sweating and may be painful or itchy. 


Erythrodermic psoriasis


Widespread reddening and scaling of the skin is often accompanied by itching or pain. Erythrodermic psoriasis may be precipitated by severe sunburn, use of oral steroids (such as cortisone), or a drug-related rash.

Treatments and drugs for Psoriasis


Doctors generally treat psoriasis in steps based on the severity of the disease, the extent of the areas involved, the type of psoriasis, or the patient’s responsiveness to initial treatments. This is sometimes called the “1-2-3” approach. In step 1, medicines are applied to the skin (topical treatment). Step 2 focuses on light treatments (phototherapy). Step 3 involves taking medicines internally, usually by mouth (systemic treatment).

Over time, affected skin can become resistant to treatment, especially when topical corticosteroids are used. Also, a treatment that works very well in one person may have little effect in another. Thus, doctors commonly use a trial-and-error approach to find a psoriasis treatment that works, and they may switch treatments periodically (for example, every 12 to 24 months) if resistance or adverse reactions occur. Psoriasis treatment depends on the location of lesions, their size, the amount of the skin affected, previous response to treatment, and patients’ perceptions about their skin condition and preferences for treatment. In addition, treatment is often tailored to the specific form of the disorder.

Topical Psoriasis Treatment for Psoriasis


Psoriasis Treatments applied directly to the skin are sometimes effective in clearing psoriasis. Doctors find that some patients respond well to sunlight, corticosteroid ointments, medicines derived from vitamin D3, vitamin A (retinoids), coal tar, or anthralin. Other topical measures, such as bath solutions and moisturizers, may be soothing but are seldom strong enough to clear lesions over the long term and may need to be combined with more potent remedies.

  • Sunlight - Daily, regular, short doses of sunlight that do not produce a sunburn clear psoriasis in many people.

  • Corticosteroids - Available in different strengths, corticosteroids (cortisone) are usually applied twice a day. Short-term psoriasis treatment is often effective in improving but not completely clearing the condition. If less than 10 percent of the skin is involved, some doctors will begin treatment with a high-potency corticosteroid ointment. High-potency steroids may also be used for treatment-resistant plaques, particularly those on the hands or feet. Long-term use or overuse of high-potency steroids can lead to worsening of the psoriasis, thinning of the skin, internal side effects, and resistance to the treatment’s benefits. Medium-potency corticosteroids may be used on the torso or limbs; low-potency preparations are used on delicate skin areas.


  • Calcipotriene - This drug is a synthetic form of vitamin D3. (It is not the same as vitamin D supplements.) Applying calcipotriene ointment (for example, Dovonex®) twice a day controls excessive production of skin cells. Because calcipotriene can irritate the skin, however, it is not recommended for the face or genitals. After 4 months of treatment, about 60 percent of patients have a good to excellent response. The safety of using the drug for cases affecting more than 20 percent of the skin is unknown, and using it on widespread areas of the skin may raise the amount of calcium in the body to unhealthy levels.


  • Coal tar - Coal tar may be applied directly to the skin, used in a bath solution, or used on the scalp as a shampoo. It is available in different strengths, but the most potent form may be irritating. It is sometimes combined with ultraviolet B (UVB) phototherapy. Compared with steroids, coal tar has fewer side effects, but it is messy and less effective and thus is not popular with many patients. Other drawbacks include its failure to provide long-term help for most patients, its strong odor, and its tendency to stain skin or clothing. 


  • Anthralin - Doctors sometimes use a 15- to 30-minute application of anthralin ointment, cream, or paste to treat chronic psoriasis lesions. However, this treatment often fails to adequately clear lesions, it may irritate the skin, and it stains skin and clothing brown or purple. In addition, anthralin is unsuitable for acute or actively inflamed eruptions. 


  • Topical retinoid - The retinoid tazarotene (Tazorac) is a fast-drying, clear gel that is applied to the surface of the skin. Although this preparation does not act as quickly as topical corticosteroids, it has fewer side effects. Because it is irritating to normal skin, it should be used with caution in skin folds. Women of childbearing age should use birth control when using tazarotene. 


  • Salicylic acid - Salicylic acid is used to remove scales, and is most effective when combined with topical steroids, anthralin, or coal tar. 


Bath solutions - People with psoriasis may find that bathing in water with an oil added, then applying a moisturizer, can soothe their skin. Scales can be removed and itching reduced by soaking for 15 minutes in water containing a tar solution, oiled oatmeal, Epsom salts, or Dead Sea salts. 


Moisturizers - When applied regularly over a long period, moisturizers have a cosmetic and soothing effect. Preparations that are thick and greasy usually work best because they hold water in the skin, reducing the scales and the itching.

Phototherapy


Ultraviolet (UV) light from the sun causes the activated T cells in the skin to die, a process called apoptosis. Apoptosis reduces inflammation and slows the overproduction of skin cells that causes scaling. Daily, short, nonburning exposure to sunlight clears or improves psoriasis in many people. Therefore, sunlight may be included among initial treatments for the disease. A more controlled form of artificial light treatment may be used in mild psoriasis (UVB phototherapy) or in more severe or extensive psoriasis (psoralen and ultraviolet A [PUVA] therapy). 

  • UVB phototherapy - Some artificial sources of UVB light are similar to sunlight. Newer sources, called narrow-band UVB, emit the part of the ultraviolet spectrum band that is most helpful for psoriasis. Some physicians will start with UVB treatments instead of topical agents. UVB phototherapy is also used to treat widespread psoriasis and lesions that resist topical treatment. This type of phototherapy is normally administered in a doctor’s office by using a light panel or light box, although some patients can use UVB light boxes at home with a doctor’s guidance. Generally at least three treatments a week for 2 or 3 months are needed. UVB phototherapy may be combined with other treatments as well. One combined therapy program, referred to as the Ingram regime, involves a coal tar bath, UVB phototherapy, and application of an anthralin-salicylic acid paste, which is left on the skin for 6 to 24 hours. A similar regime, the Goeckerman treatment, involves application of coal tar ointment and UVB phototherapy.

  • PUVA - This treatment combines oral or topical administration of a medicine called psoralen with exposure to ultraviolet A (UVA) light. Psoralen makes the body more sensitive to this light. PUVA is normally used when more than 10 percent of the skin is affected or when rapid clearing is required because the disease interferes with a person’s occupation (for example, when a model’s face or a carpenter’s hands are involved). Compared with UVB treatment, PUVA treatment taken two to three times a week clears psoriasis more consistently and in fewer treatments. However, it is associated with more short-term side effects, including nausea, headache, fatigue, burning, and itching. Long-term treatment is associated with an increased risk of squamous cell and melanoma skin cancers. PUVA can be combined with some oral medications (retinoids and hydroxyurea) to increase its effectiveness. Simultaneous use of drugs that suppress the immune system, such as cyclosporine, have little beneficial effect and increase the risk of cancer. In very rare cases, patients who must travel long distances for PUVA treatments may, with a physician’s close supervision, be taught to administer this treatment at home.

Systemic Treatment


For more severe forms of psoriasis, doctors sometimes prescribe medicines that are taken internally:

  • Methotrexate - This treatment, which can be taken by pill or injection, slows cell production by suppressing the immune system. Patients taking methotrexate must be closely monitored because it can cause liver damage and/or decrease the production of oxygen-carrying red blood cells, infection-fighting white blood cells, and clot-enhancing platelets. As a precaution, doctors do not prescribe the drug for people with long-term liver disease or anemia. Methotrexate should not be used by pregnant women, by women who are planning to get pregnant, or by their male partners. 


  • Cyclosporine - Taken orally, cyclosporine (Neoral®) acts by suppressing the immune system in a way that slows the rapid turnover of skin cells. It may provide quick relief of symptoms, but it is usually effective only during the course of treatment. The best candidates for this therapy are those with severe psoriasis who have not responded to or cannot tolerate other systemic therapies. Cyclosporine may impair kidney function or cause high blood pressure (hypertension), so patients must be carefully monitored by a doctor. Also, cyclosporine is not recommended for patients who have a weak immune system, those who have had substantial exposure to UVB or PUVA in the past, or those who are pregnant or breast-feeding. 


  • Hydroxyurea (Hydrea®) - Compared with methotrexate and cyclosporine, hydroxyurea is less toxic but also less effective. It is sometimes combined with PUVA or UVB. Possible side effects include anemia and a decrease in white blood cells and platelets. Like methotrexate and cyclosporine, hydroxyurea must be avoided by pregnant women or those who are planning to become pregnant. 


  • Retinoids - A retinoid, such as acitretin (Soriatane®), is a compound with vitamin A-like properties that may be prescribed for severe cases of psoriasis that do not respond to other therapies. Because this psoriasis treatment also may cause birth defects, women must protect themselves from pregnancy beginning 1 month before through 3 years after treatment. Most patients experience a recurrence of psoriasis after acitretin is discontinued. 


  • Antibiotics - Although not indicated in routine psoriasis treatment, antibiotics may be employed when an infection, such as Streptococcus, triggers the outbreak of psoriasis, as in certain cases of guttate psoriasis.

Is psoriasis curable?


No, psoriasis is not currently curable. However, it can go into remission and show no signs of disease. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

Can I transmit the gene for psoriasis to my children?


Yes, it is possible. Although psoriasis is not contagious from person to person, there is a known genetic tendency, and it may be inherited by the offspring of affected parents. Therefore family history is very helpful in making the diagnosis.

Lifestyle and home remedies for Psoriasis


Although self-help measures won't cure psoriasis, they may help improve the appearance and feel of damaged skin. These measures may benefit you:

Eat a healthy diet


Although there's no evidence that certain foods will either improve or aggravate psoriasis, it's important to eat a healthy diet, particularly when you have a chronic disease. A healthy diet includes eating a variety fruits and vegetables of all colors and whole grains. If you eat meat, focus on lean cuts and fish. If you think certain foods make your symptoms better or worse, keep a food diary to see what effect different foods have.

Take daily baths


Bathing daily helps remove scales and calm inflamed skin. Add bath oil, colloidal oatmeal, Epsom salts or Dead Sea salts to the water and soak for at least 15 minutes. Avoid hot water and harsh soaps, which can worsen symptoms; use lukewarm water and mild soaps that have added oils and fats.

Self-Care at Home


  • Do not use irritating cosmetics or soaps.
  • Avoid scratching that can cause bleeding or excessive irritation.
  • Cortisone creams can reduce the itching of mild psoriasis and are available without a prescription.
  • Some people use an ultraviolet B light unit at home under a doctor's supervision. A dermatologist may prescribe the unit and instruct the patient on home use, especially if it is difficult for the patient to get to the doctor's office for phototherapy treatment.

Use moisturizer


Blot your skin after bathing, then immediately apply a heavy, ointment-based moisturizer while your skin is still moist. For very dry skin, oils may be preferable — they have more staying power than creams or lotions do and are more effective at preventing water from evaporating from your skin. During cold, dry weather, you may need to apply a moisturizer several times a day.

Apply medicated cream or ointment. 


Apply an over-the-counter cream or ointment containing hydrocortisone or salicylic acid to reduce itching and scaling. If you have scalp psoriasis, try a medicated shampoo that contains coal tar. For best results, follow label directions.

Avoid psoriasis triggers, if possible


Find out what triggers, if any, worsen your psoriasis and take steps to prevent or avoid them. Infections, injuries to your skin, stress, smoking and intense sun exposure can all worsen psoriasis.

Avoid drinking alcohol


Alcohol consumption may decrease the effectiveness of some psoriasis treatments.

Cover the affected areas overnight


To help improve redness and scaling, apply an ointment-based moisturizer to your skin and wrap with plastic wrap overnight. In the morning, remove the covering and wash away the scales with a bath or a shower.
Expose your skin to small amounts of sunlight. A controlled amount of sunlight can significantly improve lesions, but too much sun can trigger or worsen outbreaks and increase the risk of skin cancer. If you sunbathe, it's best to try short sessions three or more times a week. Keep a record of when and how long you're in the sun to help avoid overexposure. And be sure to protect healthy skin with a broad-spectrum sunscreen with an SPF of at least 15. Apply sunscreen generously, and reapply every two hours — or more often if you're swimming or perspiring. Before beginning any sunbathing program, ask your doctor about the best way to use natural sunlight to treat your skin.