Psoriasis

Table of Contents

1. An Introduction To Psoriasis
2. What Causes Psoriasis?
3. The Different Types Of Psoriasis
4. How To Treat Psoriasis
5. The Psoriasis Blacklist: Ingredients To Avoid
6. Conclusion
7. References

An Introduction To Psoriasis

Psoriasis is a skin condition that leads to red, scaly patches on the skin that can be itchy and painful, sometimes causing significant physical discomfort and emotional distress to those who live with it. The exact cause of psoriasis is not known, but like many other skin conditions, is believed to be a combination of genetic and environmental factors. Psoriasis is not contagious and cannot be spread through contact with an infected person. It affects around 1.1 million people in the U.K., or 1.7% of the population according to researchers at The University of Manchester [1] and can start at any age, but typically develops in young adults or those aged between 50 and 60 years old. It can affect both men and women.

In this article, the various types of psoriasis will be explored, each with a unique set of symptoms and manifestations, from the most common plaque psoriasis to the less prevalent pustular type. Causes and triggers will be discussed in detail, along with methods to help manage the condition including a suitable skincare routine, potential triggers to avoid and prescription medication.

What Causes Psoriasis?

Much like other skin conditions such as acne and rosacea, the exact cause of psoriasis is unknown, but it’s believed to be related to the immune system that attacks healthy skin cells in people with psoriasis by mistake. This is due to an overactive immune response where T-cells, a type of white blood cell, mistakenly attack healthy skin cells which then triggers an increased production of skin cells, leading to the characteristic symptoms of psoriasis such as dry, scaly patches that may be sore. For many, symptoms start after a trigger event, for instance an infection or injury to the skin, certain medications or illnesses.

There is some evidence to suggest psoriasis runs in families, and studies have shown that approximately 40% of patients with psoriasis or psoriatic arthritis have a family history of the condition [2]. Furthermore, if both parents have psoriasis, the risk of their children developing the condition is 75%, whereas if one parent has psoriasis, this falls to 15% [3].

What Are The Different Types Of Psoriasis?

Psoriasis is a complex skin condition that can present in several different forms. Each type of psoriasis has unique characteristics and may require different treatment approaches. Here are the main types of psoriasis:

Plaque Psoriasis (Psoriasis Vulgaris). This is the most common form of psoriasis, affecting about 80-90% of people with the condition. It is characterized by raised, red patches covered with a buildup of dead skin cells, known as plaques. On darker skin, the patches can appear purple or brown, and the scales may look grey. These plaques are often itchy and painful, and they can occur anywhere on the body, but they are most common on the scalp, knees, elbows and lower back.

Guttate Psoriasis. This type of psoriasis often starts in childhood or young adulthood and appears as small, dot-like lesions. Guttate psoriasis often comes on suddenly, often following a strep infection. It can appear on the chest, arms, legs and scalp, and typically disappears on its own after a few weeks.

Inverse Psoriasis (Intertriginous Psoriasis or Flexural Psoriasis). This type of psoriasis causes smooth, red patches in the skin folds, such as under the breasts, in the armpits, or around the genitals and buttocks. It is often exacerbated by friction and sweating.

Pustular Psoriasis. This is a rare form of psoriasis that causes small, red, pus-filled blisters on different parts of the skin. Pustular psoriasis can be localized to certain areas of the body, like the hands and feet, or it can cover most of the body in a condition known as generalized pustular psoriasis.

Erythrodermic Psoriasis. This is the least common type of psoriasis, affecting around 2% of people with the condition [4]. It’s very serious and leads to widespread, fiery redness over most of the body and can cause severe itching and pain. It can cause the skin to come off in sheets and is life-threatening, so immediate medical attention is necessary.

Nail Psoriasis. This type affects the fingernails and toenails, causing pitting, abnormal nail growth, and discoloration. In some cases, the nails might loosen and separate from the nail bed.

Verywell / Emily Roberts

In addition to skin symptoms, about 30% of people with psoriasis also develop joint inflammation that produces symptoms of arthritis. This can cause swelling, stiffness, and pain in the affected joints.

Each type of psoriasis can vary in severity from mild to severe, and the course of the disease can also vary, with periods of worsening symptoms (flares) and periods of remission.

Skin Conditions Often Confused With Psoriasis

Eczema vs Psoriasis

Both of these skin conditions can lead to red, itchy patches but there are some important differences. Psoriasis occurs when the body makes new skin cells too fast, resulting in scaly patches, whereas eczema can be caused by a wide range of factors including stress, weather and allergies, resulting in red and inflamed areas of the skin. Treatments can be similar, with both conditions often responding well to topical steroids.

Seborrheic Dermatitis vs Psoriasis

Seborrheic dermatitis can cause flaky, dandruff-like scales and red skin, which can be mistaken for psoriasis. However, seborrheic dermatitis typically affects areas of the body with a lot of oil glands, like the scalp and face, while psoriasis can occur anywhere on the body.

Candidal Intertrigo vs Psoriasis

This is a yeast infection that occurs in skin folds, causing redness and discomfort. It can be mistaken for inverse psoriasis, which also affects skin folds. However, candidal intertrigo typically responds to anti-fungal treatment, while inverse psoriasis does not.

How To Effectively Treat Psoriasis

There are a number of ingredients and treatments that can help improve symptoms of psoriasis, some of which can be found over-the-counter and others need to be prescribed by a GP or dermatologist. The following have all be shown to have some level of beneficial properties in the treatment of psoriasis, however, it is important to note that the choice of treatment depends on the individual's specific condition, the severity of psoriasis, and the response to previous treatments. It’s important to consult with a healthcare professional to determine the most appropriate treatment plan for each person.

Anthralin. This medication helps slow skin cell growth and remove scales, making the skin smoother. A study conducted in 2000 showed a high response rate for plaque psoriasis in 70 patients [5].

Calcineurin Inhibitors. These drugs reduce inflammation and plaque buildup. Their efficacy is similar to corticosteroids, but they do not induce skin atrophy (the thinning of skin) [6].

Coal Tar. This is a thick, black byproduct of coal processing that has been used for many years for a variety of skin conditions and can help reduce scaling, itching, and inflammation. A 1989 study found a coal tar gel to be more effective at treating psoriasis than a topical corticosteroid [7]. However, there are concerns around coal tar as it contains carcinogens that may increase the risk of cancer.

Loganin. This is a pharmaceutically active ingredient derived from Cornus officinalis. It has multiple biological activities, including immunomodulation, antioxidation, and anti-inflammation. It has been suggested that loganin could manage psoriasis by preventing certain types of immune responses [8].

Phototherapy. This is considered an effective and safe treatment for psoriasis, particularly for moderate-to-severe cases. It involves the use of ultraviolet (UV) light, such as narrowband ultraviolet B (NB-UVB) and psoralen combined with ultraviolet A (PUVA), to reduce inflammation and slow down the growth of skin cells [9].

Psoralin. This is a natural biologically active food supplement made from local medicinal herbal ingredients. It has been recommended for the treatment of patients with psoriasis and has been found to have no side effects [10].

Salicylic Acid. This popular skincare ingredient is a beta hydroxy acid that helps to exfoliate the skin and reduce scaling. Several studies have demonstrated it’s effectiveness in treating psoriasis [11, 12].

Topical Corticosteroids. These are powerful anti-inflammatory drugs that can quickly reduce inflammation and relieve itching. They come in different strengths, and high-potency corticosteroids are often used for psoriasis [13].

Topical Retinoids. These are vitamin A derivatives that can normalize DNA activity in skin cells and decrease inflammation. Tazarotene (Tazorac) is an example of a topical retinoid used for psoriasis.

The Psoriasis Blacklist: What To Avoid If You Have Psoriasis

If you have psoriasis, certain ingredients found in skincare products, foods, and medications may potentially trigger or worsen your symptoms. Here are some ingredients to be cautious of.

Fragrances and Dyes. Many skincare products contain artificial fragrances and dyes that can irritate the skin and potentially trigger a psoriasis flare-up. It's often recommended to use fragrance-free and dye-free products.

Alcohol. Alcohol can dry out the skin and trigger psoriasis flares. It's often found in many skincare products, including lotions and toners. Additionally, consuming alcohol may also worsen psoriasis symptoms [14].

Certain Foods. According to a 2018 study, dietary interventions can be used to reduce the severity of psoriasis [15]. A survey of 1,206 psoriasis patients, conducted in 2017, found that symptoms improved after reducing a variety of foods including red meat, pork, high-sugar foods, dairy products, gluten and others [16]. It’s important to speak to a dietician or healthcare provider about any dietary changes that could improve symptoms.

Beta Blockers. These medications are known to potentially trigger psoriasis flare-ups in some individuals [17].

Lithium. This medication is sometimes used to treat bipolar disorder, but has been associated with various skin reactions including psoriasis [18].

Stress. Studies have shown a significant correlation between stress and the severity of psoriasis, so it’s important to find methods and techniques to help manage this [19, 20].

Conclusion

In conclusion, psoriasis is a common skin condition that affects millions of people worldwide and results in red, scaly patches that can be sore. It presents in various forms, each with unique characteristics, and can significantly impact an individual's quality of life. While the exact cause remains elusive, it is clear that a combination of genetic predisposition and environmental factors play a crucial role in its onset.

Although there is no cure, symptoms can be managed and flare-ups reduced by using suitable skincare products, maintaining a healthy lifestyle and avoiding certain triggers. There are also a variety of treatments such as corticosteroids that can help to improve symptoms, and it’s important to consult with a dermatologist or healthcare professional if you have any concerns about psoriasis, as early diagnosis and treatment can help to prevent complications and improve quality of life.

Living with psoriasis can be challenging, but with the right knowledge and resources, individuals can effectively manage their symptoms and lead fulfilling lives.

References

[1] New figures show Psoriasis affects around 1.1 million people in UK. (n.d.). New figures show Psoriasis affects around 1.1 million people in UK. [online] Available at: https://www.manchester.ac.uk/discover/news/new-figures-show-psoriasis-affects-around-11-million-people-in-uk/.

[2] Solmaz, D., Bakirci, S., Kimyon, G., Gunal, E.K., Dogru, A., Bayindir, O., Dalkilic, E., Ozisler, C., Can, M., Akar, S., Cetin, G.Y., Yavuz, S., Kilic, L., Tarhan, E.F., Kucuksahin, O., Omma, A., Gonullu, E., Yildiz, F., Ersozlu, E.D. and Cinar, M. (2019). Impact of Having Family History of Psoriasis or Psoriatic Arthritis on Psoriatic Disease. Arthritis Care & Research, 72(1), pp.63–68. doi:https://doi.org/10.1002/acr.23836.

[3] Psoriasis and Psoriatic Arthritis Alliance (PAPAA). (2019). What are the risks of my children developing psoriasis? [online] Available at: https://www.papaa.org/learn-about-psoriasis-and-psoriatic-arthritis/fertility-and-pregnancy/heredity/.

[4] Boyd, A.S. and Menter, A. (1989). Erythrodermic psoriasis. Precipitating factors, course, and prognosis in 50 patients. Journal of the American Academy of Dermatology, [online] 21(5 Pt 1), pp.985–991. Available at: https://pubmed.ncbi.nlm.nih.gov/2530253/.

[5] Yamamoto, T., Matsuuchi, M., Irimajiri, J., Otoyama, K. and Nishioka, K. (2000). Topical Anthralin for Psoriasis Vulgaris: Evaluation of 70 Japanese Patients. The Journal of Dermatology, 27(7), pp.482–485. doi:https://doi.org/10.1111/j.1346-8138.2000.tb02212.x.

[6] Wen, X., Wei, Z., & Liu, Y. (2011). Calcineurin inhibitors in the treatment of psoriasis. International Journal of Dermatology and Venereology, 37, 346-348.

[7] Langner, A., Wolska, H. and Fraczykowska, M. (1989). Effectiveness of a new coal tar preparation in the treatment of chronic plaque-type psoriasis. The British Journal of Clinical Practice, [online] 43(4), pp.148–150. Available at: https://pubmed.ncbi.nlm.nih.gov/2590625/ [Accessed 6 Dec. 2023].

[8] Chen, X., Deng, Q., Li, X., Xian, L., Xian, D. and Zhong, J. (2023). Natural Plant Extract – Loganin: A Hypothesis for Psoriasis Treatment Through Inhibiting Oxidative Stress and Equilibrating Immunity via Regulation of Macrophage Polarization. Clinical, Cosmetic and Investigational Dermatology, [online] Volume 16, pp.407–417. doi:https://doi.org/10.2147/ccid.s396173.

[9] Yazkova, O.S., & Anpilogova, E.M. (2022). Phototherapy for psoriasis. Russian Journal of Skin and Venereal Diseases.

[10] (2022). PSORIAZ KASALLIGINING TURLI BOSQICHLARIDA KUZATILADIGAN OBSERVED CHANGES IN DIFFERENT STAGES OF PSORIASIS DISEASE.

[11] Goruntla, N., Arakala, G., Nelluri, G., Mounika, K., Pujari, S., & Byalla, M. (2018). Comparison of efficacy, safety, and cost-effectiveness of topical salicylic acid 6% versus clobetasol propionate 0.05% in the treatment of limited chronic plaque psoriasis. Journal of Health Research and Reviews, 5, 86 - 92.

[12] Kircik, L. (2011). Salicylic Acid 6% in an ammonium lactate emollient foam vehicle in the treatment of mild-to-moderate scalp psoriasis. Journal of drugs in dermatology: JDD, [online] 10(3), pp.270–273. Available at: https://pubmed.ncbi.nlm.nih.gov/21369643/.

[13] Mason, A.R., Mason, J., Cork, M., Dooley, G. and Hancock, H. (2013). Topical treatments for chronic plaque psoriasis. The Cochrane database of systematic reviews, [online] (3), p.CD005028. doi:https://doi.org/10.1002/14651858.CD005028.pub3.

[14] Qureshi, A.A., Dominguez, P.L., Choi, H.K., Han, J. and Curhan, G. (2010). Alcohol Intake and Risk of Incident Psoriasis in US Women. Archives of Dermatology, 146(12), p.1364. doi:https://doi.org/10.1001/archdermatol.2010.204.

[15] Ford, A.R., Siegel, M., Bagel, J., Cordoro, K.M., Garg, A., Gottlieb, A., Green, L.J., Gudjonsson, J.E., Koo, J., Lebwohl, M., Liao, W., Mandelin, A.M., Markenson, J.A., Mehta, N., Merola, J.F., Prussick, R., Ryan, C., Schwartzman, S., Siegel, E.L. and Voorhees, A.S.V. (2018). Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review. JAMA Dermatology, [online] 154(8), pp.934–950. doi:https://doi.org/10.1001/jamadermatol.2018.1412.

[16] Afifi, L., Danesh, M.J., Lee, K.M., Beroukhim, K., Farahnik, B., Ahn, R.S., Yan, D., Singh, R.K., Nakamura, M., Koo, J. and Liao, W. (2017). Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey. Dermatology and Therapy, 7(2), pp.227–242. doi:https://doi.org/10.1007/s13555-017-0183-4.

[17] Awad, V.M., Sakhamuru, S., Kambampati, S., Wasim, S. and Malik, B.H. (2020). Mechanisms of Beta-Blocker Induced Psoriasis, and Psoriasis De Novo at the Cellular Level. Cureus, [online] 12(7). doi:https://doi.org/10.7759/cureus.8964.

[18] Jafferany, M. (2008). Lithium and Psoriasis. The Primary Care Companion to The Journal of Clinical Psychiatry, 10(06), pp.435–439. doi:https://doi.org/10.4088/pcc.v10n0602.

[19] Kowalewska, B., Krajewska-Kułak, E. and Sobolewski, M. (2022). The Impact of Stress-Coping Strategies and the Severity of Psoriasis on Self-Esteem, Illness Acceptance and Life Satisfaction. Dermatology and Therapy, 12(2), pp.529–543. doi:https://doi.org/10.1007/s13555-021-00669-8.

[20] Wintermann, G.-B., Bierling, A.L., Peters, E.M.J., Abraham, S., Beissert, S. and Weidner, K. (2022). Childhood Trauma and Psychosocial Stress Affect Treatment Outcome in Patients With Psoriasis Starting a New Treatment Episode. Frontiers in Psychiatry, 13. doi:https://doi.org/10.3389/fpsyt.2022.848708.