Psoriasis and Psoriatic Arthritis

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If you have psoriasis, you are not alone. Millions of people have this chronic condition. Some people who have psoriasis develop psoriatic arthritis. Learning about these conditions can help you manage your disease and improve your quality of life.

What is Psoriasis?

Typically, new skin cells form over several weeks. In psoriasis, new cells are made too quickly and build up into raised pink patches (known as plaques) with silver-white coating (known as scale) on your skin.

Psoriasis is not contagious. It cannot be spread from person to person.

You cannot catch psoriasis from someone else or from touching someone’s psoriasis.

What Does Psoriasis Look Like?

There are different types of psoriasis. Each type appears differently on the skin.

Plaque psoriasis

  • This is the most common form of psoriasis, appearing in 80-90 percent of patients.
  • Raised red round or oval patches appear on the skin. These patches can be covered by silver-white coating.
  • While patients usually only have a few plaques, some patients may have plaques covering their entire body.
  • Plaques can occur anywhere on the skin but are most common on the scalp, trunk, buttocks, elbows and knees.


Plaque psoriasis

Guttate psoriasis

  • This type occurs in about 2 percent of psoriasis patients.
  • Small reddish bumps (papules and plaques) appear on the skin. They usually occur on the trunk, arms and legs but also may appear on the scalp, face and ears.
  • If you have plaque psoriasis and develop guttate psoriasis, it may mean your psoriasis is worsening.
  • This form of psoriasis is most common in individuals under 30.
  • The onset of this condition is often associated with an infection, most commonly strep throat.
  • The disease may take a few weeks to a few months to clear, although it may last longer in some patients.
  • Some patients with guttate psoriasis go on to develop plaque psoriasis.

Pustular psoriasis

  • This is an uncommon form of psoriasis that mostly occurs in adults.
  • Skin becomes red, swollen and dotted with pus-filled bumps (pustules). These pustules are associated with inflammation, rather than infection.
  • The condition usually occurs on the palms of the hands and soles of the feet, but it may appear all over the body.
  • Fever and flu-like symptoms can occur if pustular psoriasis appears all over the body.

Inverse psoriasis

  • This type of psoriasis develops in the folds of the skin, such as the armpits, the groin, under the breasts and in the crease of the buttocks.
  • Smooth red patches that look raw appear on the skin.
  • There is typically minimal scale with this type of psoriasis.
  • The condition may get worse from sweating or rubbing the skin.
  • Because this condition typically occurs in areas of thin skin, your dermatologist will prescribe treatments that are safe for those areas.

Erythrodermic psoriasis

  • This is the least common form of psoriasis.
  • The skin looks like it is burned, with severe redness and shedding occurring over much of the body.
  • Varying degrees of scale can be present.
  • Fever and flu-like symptoms are common.
  • Increased heart rate may occur.
  • Some patients with this condition may need hospital treatment.

Nail psoriasis

  • This condition affects the fingernails and toenails, causing tiny holes that may cause nails to loosen, thickenand eventually crumble.
  • Although patients may experience nail psoriasis without other parts of the body being affected, it is most common in patients with other forms of psoriasis. It can accompany all psoriasis types.
  • This disease is often misdiagnosed as a fungal nail infection. In some cases, the two conditions may occur together.
  • Nail psoriasis may be a sign of psoriatic arthritis.


Caption: Nail psoriasis

How Did I Get Psoriasis?

Scientists have learned that a person’s immune system and genes play important roles in developing psoriasis. It seems that many genes can increase your likelihood of developing psoriasis.

While some psoriasis patients may have a blood relative who has the disease, scientists have learned that not everyone who inherits genes for psoriasis gets the condition. Conversely, many patients without any family history of psoriasis develop the disease. 

For psoriasis to appear, it seems that you must inherit the right mix of genes and be exposed to a trigger.

The most common triggers are infections. Further research is needed to identify which specific genes cause psoriasis.

Although psoriasis can occur at any age, most people initially develop the disease between the ages of 15 and 30.
Many patients see their symptoms improve as they get older. Psoriasis affects men and women equally, and it
occurs in all races.

What Triggers Psoriasis?

Different people have different triggers. Common triggers include stress, strep throat, a bad sunburn or a trauma to
the skin. For some people, psoriasis flares about 10 to 14 days after they injure their skin. Smoking and obesity
also can be triggers for certain types of psoriasis. Some medications can trigger psoriasis, including lithium, interferon and beta blockers, as well as some drugs taken to prevent malaria.

What Is Psoriatic Arthritis?

Psoriatic arthritis is a type of arthritis that can occur in psoriasis patients. It also affects some people who do not have psoriasis. The first sign is often swollen, stiff and sometimes painful joints when waking up. If you experience this, contact your dermatologist right away.

Like psoriasis, psoriatic arthritis is a lifelong condition. If psoriatic arthritis worsens, the affected joints can weaken. This is why it is so important to tell a dermatologist about joint problems. Treatment for psoriatic arthritis may include physical therapy, arthritis-friendly exercise and medicine. There are medicines that can prevent psoriatic arthritis from worsening. Some medications used to treat psoriasis may also be used for psoriatic arthritis.

How Are Psoriasis and Psoriatic Arthritis Diagnosed?

Dermatologists diagnose psoriasis by examining your skin, nails and scalp. Occasionally, a dermatologist may need to perform a biopsy to make the diagnosis, which involves removing a small piece of skin or nail that is sent to a lab to be examined under a microscope.

To find out if you have psoriatic arthritis, your dermatologist will ask you questions about fatigue, pain, stiffness and tenderness in your joints and tendons, and swelling of your fingers. He or she also will examine your joints and may send you for medical tests.

Does Psoriasis Just Affect My Skin?

Research has shown that excessive inflammation is a feature of psoriasis and psoriatic arthritis. Having psoriasis increases your risk for other health conditions such as arthritis, diabetes, high blood pressure, obesity, high cholesterol and heart disease, including heart attack and stroke. As a result, it is important for you to monitor your health closely for signs of these diseases, especially if you have severe psoriasis. Talking with both your dermatologist and your primary care doctor can help ensure that signs of these other conditions are caught early and treated properly.

How Is Psoriasis Treated?

Once psoriasis appears, it usually does not go away on its own. Treatment can clear plaques and reduce symptoms in many people, but it does not cure the disease.


Psoriasis on the elbow

Because psoriasis can be stubborn, finding the right treatment can take time. Your dermatologist may recommend more than one type of treatment or use a combination of treatments to get the best results.

Also, some treatments may stop working, so other treatments may be needed.

It is important to remember that no matter what treatment you and your dermatologist choose, you should use it exactly as prescribed. Many psoriasis treatments can produce unwanted side effects. You and your dermatologist will discuss the benefits and risks of possible treatments to determine what is best for you.

Types of treatment for psoriasis include:

Topical Medications

Topical medications, such as creams, ointments, lotions or salves, are applied to the skin. There are many different types of topical medications that can help control mild to moderate psoriasis by decreasing the rate at which skin cells grow and reducing inflammation.

Laser/Light Therapy

Under a dermatologist’s care, light therapy can provide safe and effective treatment for psoriasis. Because too much ultraviolet light can make psoriasis worse and the wrong type of UV light can increase your risk for skin cancer, it is important to see a dermatologist for treatment. Never try to self-treat your psoriasis by using an indoor tanning bed or by seeking the sun outdoors. Overexposure to UV light can increase your risk for skin cancer.

Talk with your dermatologist about this treatment option, since light therapy is not appropriate for everyone.

Traditional Systemic (Non-Biologic) Medications

Systemic medications work throughout the body. These medications are used to treat moderate to severe psoriasis. Systemic medications are most commonly taken orally, but they can be injected via a shot or infused through an IV. Some of these medications can only be used for a limited time, and they may be combined and rotated to minimize side effects. All systemic medications have potential side effects, so it is important to discuss the benefits and risks of these treatments with your dermatologist.

Biologics

If you have moderate to severe psoriasis and other treatments have not been successful, a biologic may be an effective treatment option. Some biologics may help slow down the joint damage caused by psoriatic arthritis.

Biologics can be injected via a shot or infused through an IV. Some shots can be self-injected at home by the patient. To receive an infusion, patients must go to a dermatologist’s office, psoriasis treatment center or hospital for treatment.

All biologics have potential side effects, so it is important to discuss the benefits and risks of these treatments with your dermatologist.

How Can I Manage My Psoriasis?

Psoriasis is a long-lasting disease. Here are some things you can do that will help you take control:

  • Learn as much as you can about psoriasis. Learning about psoriasis and the treatment options available
    will help you make informed decisions. Visit aad.org/psoriasis and psoriasis.org, the website of
    National Psoriasis Foundation.
  • Take good care of yourself. Eat a healthy diet, exercise, do not smoke and drink alcohol only in moderation. Smoking, heavy drinking and being overweight make psoriasis worse, and they also can make treatment less effective.
  • Be careful about the sun. Overexposure to the sun or the UV light from indoor tanning beds can cause sunburn, which can make existing psoriasis worse and increase the number of psoriasis plaques on your skin. Protect your skin from the sun by seeking shade, wearing protective clothing and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. Talk with your dermatologist about selecting a sunscreen that is right for your skin.
  • Be aware of your joints. If your joints feel stiff and sore, especially when you wake up, talk with your dermatologist.
  • Pay attention to your mood. If you feel depressed, you may want to join a psoriasis support group or see a mental health professional. Talking with other patients about living with psoriasis can make you feel less alone.
  • Talk with your dermatologist before you stop taking medicine for psoriasis. Stopping a medicine for psoriasis can have serious consequences.
  • Tell your dermatologist about your personal and family medical history, as well as the medications you are taking. This will affect how your psoriasis is managed.

Taking an active role in managing your psoriasis or psoriatic arthritis can make a big difference in improving your health, reducing the appearance of psoriasis plaques and the pain of psoriatic arthritis, and improving your overall quality of life. Your dermatologist can be your partner in helping you find the treatments that work best for you.

A board-certified dermatologist is a medical doctor who specializes in the diagnosis and medical, surgical and cosmetic treatment of skin, hair and nail conditions. To learn more about psoriasis or to find a board-certified dermatologist in your area, visit aad.org/psoriasis or call toll-free (888) 462-DERM (3376).

All content solely developed by the American Academy of Dermatology.

Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

American Academy of Dermatology

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AAD Member Resource Center: 866.503.SKIN (7546)

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