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Who is at risk?
Psoriasis can develop at any age, although it is typically seen in adults. One form of psoriasis called guttate psoriasis tends to occur in childhood and early adulthood. Psoriasis occurs equally among men and women.
What causes it?
Psoriasis has a genetic basis and about one-third of people with psoriasis have at least one family member with the disease. While the exact cause of psoriasis has not yet been determined, researchers believe it involves a combination of genetic, environmental and immune factors.
Psoriasis develops when there is a malfunctioning of the immune system which causes inflammation.
White blood cells (T cells) in the immune system are triggered and this causes inflammation to occur, which then causes skin cells to rise to the surface and shed at 10 times the normal rate.
Psoriasis has a broad impact on patients that extends beyond the cosmetic or physical aspects. It can negatively affect a person’s quality of life due to physical pain and discomfort.
Psoriatic lesions can be itchy, painful and bleed, making it difficult to sleep, dress or engage in various daily activities. If there is joint involvement, the pain can also make it challenging for the individual to function physically.
People with psoriasis have an increased risk of depression, anxiety and suicide.
The aim of treatment is ultimately to reach an appropriate quality of life.
- The most common form is plaque psoriasis, which affects approximately 90% of patients.
- Up to 30% of patients with psoriasis have or will have arthritis. Having psoriasis may increase the risk of developing other chronic systemic diseases, including heart attack and stroke, diabetes, cancer, and liver disease
Diagnosis of psoriasis involves taking a careful history and conducting a physical examination.
Psoriasis can take on a variety of forms, which include plaque, guttate, pustular, inverse and erythrodermic. Some of these types may evolve from plaque psoriasis.
Plaque psoriasis is the most common form and it occurs in about 90% of patients. It usually begins with red scaly patches. The symptoms can range from mild to severe, covering very small or extensive areas of the body.
Guttate psoriasis is typically of abrupt onset, appearing in a few weeks, being often quite extensive. It is marked by lesions that are small and “drop-like”, which often appear on the trunk (i.e. lower back), arms, legs or scalp. It makes up about 10% of psoriasis cases and is the second most common form. It often develops following an upper respiratory infection, often strep throat, which acts as the trigger. Guttate psoriasis can resolve on its own without treatment, and the individual may never develop psoriasis again. Or it can become recurrent throughout life. Sometimes, it can become severe, persistent and require treatment.
Pustular psoriasis is characterized by pustules (pus-filled bumps) and can sometimes be disabling and life-threatening. It can be limited to certain areas of the body (localized) or widespread (generalized). If localized, the pustules are usually confined to the palms and soles of the feet. Scales gradually form as pustular lesions dry out.
Inverse psoriasis occurs in skin folds (also called “flexures”) where there tends to be pressure, friction and/or moisture or perspiration, such as between buttocks, the genitals, under breasts and armpits. These lesions are smooth and red as opposed to raised and scaling.
Erythrodermic psoriasis is a rare but serious form of disease marked primarily by widespread redness and inflammation that resembles sunburn. It can result from severe sunburn, using certain medications (i.e. oral corticosteroids, lithium) or suddenly stopping psoriasis treatment. It can also stem from poorly controlled psoriasis. It can be life-threatening and usually requires hospitalization since the skin loses its ability to perform vital functions, such as controlling body temperature and protecting against infectious organisms (i.e. bacteria).
A Note About Psoriatic Arthritis
In addition to its obvious effects on the skin, psoriasis can also affect other body tissues. Some patients with psoriasis can develop a kind of arthritis called Psoriatic Arthritis. This may be considered a disease in its own right, may be severe and involves inflammation, stiffness and pain within joints (arthritis) in addition to skin plaques. The skin plaques and joint pain do not coincide, so a flare-up may consist of joint pain in the absence of visible lesions or vice-versa. Typically, the arthritic component develops about a decade after the skin plaques.
Psoriasis may be permanent or episodic, meaning that it can flare up then subside and disappear altogether for a while before another episode occurs.
Triggers or precipitating factors may cause a flare-up in disease or even lead to the development of psoriasis. These factors include emotional stress, local injury to skin, systemic infections, and the use of certain medications.
Infection such as upper respiratory bacteria or viruses can cause someone to develop psoriasis or case psoriasis to worsen.
Skin injury or any break in the skin can cause psoriasis to spread or lead to the development of new lesions. This can include a razor nick or burn, an insect bite, cut, abrasion, sunburn, needle puncture (from vaccination), blister or bruise.
Medications such as lithium (an antidepressant), beta-blockers (commonly prescribed for high blood pressure) and, rarely, anti-malarial drugs can also predispose one to a flare-up or cause psoriasis to first appear. Oral corticosteroids can worsen psoriasis symptoms with overuse or if treatment is stopped abruptly.
Stress is a factor in a number of health conditions and seems to be a trigger for psoriasis as well. It can also worsen symptoms. Living with psoriasis also contributes to stress, which in turn, can negatively affect the skin condition.
Weather is another factor that can cause psoriasis to improve or worsen. In particular, the dry cold winter season seems to adversely impact on psoriasis because it dries and irritates the skin.
Smoking and being overweight have been shown to increase the risk of developing psoriasis and its severity.