Psoriasis is a chronic skin condition characterized by thick scaly plaques on the elbows, knees, and scalp. While never contagious, the condition can lead to significant psychosocial stress surrounding one’s own appearance and flakiness. Some studies suggest that the impact of psoriasis on a patient’s mood can rival even terminal illness. Good news is that dermatologic care for patients afflicted by psoriasis has vastly improved over the last 5 years.
Psoriasis is a result of skin turn-over in 7 days instead of the normal 30 day period. We have no idea why that happens although the tendency is strongly inherited. With this fast rate of cycling, the skin ends up retaining heaped-up scale known as a psoriatic plaque. Psoriasis typically runs in cycles, worse in the winter because of dryness and wind chapping and better in the summer because of ultraviolet light exposure which can actually suppress a psoriatic flare. Plaques are uncomfortable, but less commonly itch.
There are 3 less common variants of psoriasis that serve mention because they often throw clinicians off the trail of a correct diagnosis:
Guttate psoriasis – Small “rain drop” plaque lesions are found throughout the body. Often triggered by strep throat.
Inverse psoriasis – Inverse because these wet, red plaques affect intertriginous areas of the skin (areas that rub together like armpits, groin, and between buttocks) instead of the usual knees and elbows for which psoriasis is known.
Pustular psoriasis – Most commonly found on the hands and feet, this subtype of psoriasis appears just like it sounds…small pus-filled blisters on a red base.
The most significant morbidity associated with all types of psoriasis is not its appearance, but rather the associated arthritis that can be seen in 1/3 of patients who carry this diagnosis. Psoriatic arthritis is debilitating, because it stems from inflammation inside the joint that can destroy protective cartilage and restrict walking.
Although there is no cure for psoriasis, recent advancements in our understanding of the immunology behind this condition has led to the development of selective immuno-modulators. Unlike older immunosuppressives (like prednisone) that blunt the body’s entire immune system, these newer agents target only those arms of the immune system that are responsible for psoriatic flares. The goal of treatment is to slow the skin cell turnover that leads to plaque formation and inflammation.
If you believe you may suffer from psoriasis, come on in and let’s have a look. In the meantime, try and avoid important psoriatic triggers like stress and tobacco and always keep your skin hydrated with thick moisturizers.