Psoriasis_A close up image of psoriasis plaques

What is psoriasis?

Although not contagious or infectious, this autoimmune disease can be associated with various other health conditions
September 18, 2019

Psoriasis affects nearly 125 million people worldwide. Associated with itchy, scaly patches on the skin, psoriasis is not contagious, but unfortunately has no cure. It is an autoimmune disease that causes the immune system to attack the skin. As a response, the skin is triggered into excessive thickening and inflammation. However, Grady Hogue, MD, family medicine physician at Texas A&M Family Care and clinical assistant professor at the Texas A&M College of Medicine, says people suffering from psoriasis have many options to manage this condition.

What are the symptoms of psoriasis?

“The most common type of psoriasis is ‘chronic plaque psoriasis,’ which initially presents in either late teens or adults in their 50s,” Hogue explained. “Furthermore, about 30 percent of patients have a first degree relative with psoriasis, which confirms a hereditary association.”

Approximately 80 to 90 percent of people with psoriasis get this type of psoriasis. These plaques can appear anywhere on the body, but they are most often found on the knees, elbows, lower back and the scalp. These plaques are thickened red skin with silver to white scales overlying the redness. Often, these patches itch and can even impact the joints, in the case of the related condition psoriatic arthritis.

The other less common types of psoriasis are guttate, inverse, pustular, erythrodermic and nail. Often the diagnosis is self-evident to the medical provider, but a skin biopsy may be needed to eliminate other conditions.

“If you notice any unexplained rash or skin-related issue, contact your primary care provider,” Hogue said. “Often, including cases of psoriasis, skin issues are actually manifestations of greater underlying conditions.”

 What are common triggers for psoriasis?

Psoriasis triggers are often everyday things that can be hard to avoid—like the weather and humidity. Yet, sometimes they can also be lifestyle-related, like stress and alcohol.

“We know smoking is known to worsen psoriasis,” Hogue said. “We also know certain drugs are associated with psoriasis, including NSAIDs, anti-malarial medications and a type of blood pressure medication called a beta blocker.”

Other common triggers for psoriasis are viral and bacterial infections, skin injuries like sunburns, allergies and even pregnancy.

How do you treat psoriasis?

“If it is minor, psoriasis is treated with a topical steroid applied directly to the skin,” Hogue explained. “However, if the psoriasis is more severe, other combinations of moisturizing creams, steroids and retinoids are available.”

Frequently, the disease is best managed by a combination of these topical treatments. Hogue notes continued steroid usage can lead to thinning of the skin and acne, so steroids should only be used in short two- to four-week time periods.

For cases where the topical medications are ineffective, where 20 percent of the body surface is involved or for psoriatic arthritis, the use of ‘‘biological” treatments—taken orally or injected—can attack the specific disease process that creates the plaques. If you take these stronger treatments, your provider should frequently monitor your liver and kidney function.

If someone is on ”biological” medications for psoriasis as prescribed by their dermatologist or rheumatologist, they should continue to follow up with their primary care provider for their routine health screenings. “Psoriasis can be more than a skin issue,” Hogue reiterated. “Psoriasis is increasingly noted to be a multi-system inflammatory condition associated with diabetes, liver and lung conditions, cancer and psychiatric disease. Your primary care provider can be on the lookout for those related conditions.”

What is psoriatic arthritis? Does psoriasis cause joint problems?

“If your joints begin to hurt or nails become pitted or thickened and crumbling, you may have psoriatic arthritis,” Hogue said. “Psoriatic arthritis occurs when inflammation in the joints causes swelling, pain and stiffness.” Common symptoms are fatigue, stiffness and swollen fingers or toes.

Approximately 30 percent of people with arthritis develop psoriatic arthritis, and it often develops 10 years after the initial psoriasis flare. If you have psoriatic arthritis, your primary care provider may suggest you see a rheumatologist, as it can cause permanent joint damage if left untreated.

What are some health conditions associated with psoriasis?

According to the National Psoriasis Foundation, people with psoriatic arthritis are at higher risk of cardiovascular conditions; they are 58 percent more likely to have a major cardiac event and 43 percent more likely to have a stroke than people in the general population.

Another health condition commonly associated with psoriasis is kidney disease. People with severe psoriasis are twice as likely to develop chronic kidney disease and are at greater risk for developing liver disease, certain cancers like lymphoma and skin cancer and osteoporosis.

“Besides the itching, psoriasis can be a cosmetic and self-esteem issue for many people,” Hogue said. “Many people struggle with their appearance when they have a psoriasis flare up. When the plaques get bad enough to impact your mental health, your provider can prescribe some medications to alleviate the symptoms as well as discuss some options for coping.”

— Mary Leigh Meyer

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