Psoriasis is a chronic, immune-mediated inflammatory disease characterized by red, silvery, scaly plaques on the skin. It can also present with nail changes and arthritis. Psoriasis persists throughout a person’s lifetime and can be exacerbated by stress, infection, medications and other illnesses. Plaques are typically located over the scalp, elbows and knees but can be generalized. Sites of injury are more likely to develop plaques.
Psoriasis is found in about 2% of the population with peaks at 15-25 years and 50-60 years of age. Psoriasis is categorized by dermatologists according to age of onset (early vs late onset), location of symptoms (localized to scalp, palms/soles of feet, generalized), size of plaques and nail involvement.
There are many variants of psoriasis, some of which include:
Chronic plaque psoriasis: the most common type and can be mild to severe depending on degree of total body surface area affected. Lesions are typically pruritic with associated post inflammatory hyper or hypopigmentation. Scarring is not common.
Inverse psoriasis: occurs in the intertriginous areas (underarms, groin, under breasts). These lesions appear shiny and can be superinfected with a fungal infection.
Psoriatic arthritis: characterized by typical psoriatic plaques along with arthritis. This is more common in patients with nail and scalp involvement.
Guttate psoriasis: more common in children and usually presents few weeks after an upper respiratory or streptococcal infection. Characterized by generalized eruption of oval scaly papules.
Nail psoriasis: associated with nail pits, “oil spots”, friability, thickening and splinter hemorrhages.
Patients with severe psoriasis are at an increased risk of cardiovascular disease, metabolic syndrome, hypertension, diabetes, high cholesterol, fatty liver and mood disorders. If you have psoriasis, regular follow up with your primary care physician is important to screen for these conditions.
Treatment for mild to moderate localized psoriasis consists of of topical steroids, vitamin D analogs, retinoids, and combination therapy. For generalized psoriasis, ultraviolet light and systemic therapies with medications such as methotrexate, mycophenolate mofetil and tacrolimus is recommended. This stage of therapy is typically managed a dermatologist.