Everything You Need to Know About Psoriasis & Psoriatic Arthritis

What is Psoriasis?

Psoriasis is a skin and systemic autoimmune disease in which skin cells build up and form itchy, scaly patches. These scaly patches are most often found in the elbows, knees, scalp and trunk. There are 7 different types of psoriasis of varying degrees, including psoriatic arthritis which is a type of psoriasis that can affect your joints. 

Scientists are unsure the exact cause of psoriasis however it is believed that genetics and environmental factors play a role. Since psoriasis tends to run in families, if one of your parents, siblings or grandparents has it, you're more likely to develop it as well. It's also believed that people with certain genes are more likely to develop psoriasis than others. 

There are also certain factors that can trigger the onset of psoriasis in those at high risk for the disease.

These risk factors may include: 

• Stress
• Certain prescription medications
• Cold, dry weather
• Tobacco and excessive alcohol use
• Infections like strep throat
• Skin damage from things like cuts, sunburns, vaccines, bug bites, etc. 

Types of Psoriasis

There are seven different types of psoriasis with plaque psoriasis being the most common and Guttate psoriasis being the second most common.

The following are the different types of psoriasis: 

• Plaque Psoriasis
• Guttate Psoriasis
• Nail Psoriasis
• Inverse Psoriasis
• Pustular Psoriasis
• Erythrodermic Psoriasis
• Psoriatic Arthritis

Who is affected by Psoriasis?

Men, women and children of all ages and races are affected by Psoriasis, however it is most often diagnosed between the ages of 15 and 25. It is believed that up to 2% of the United States population and up to 3% of people worldwide are living with some form of Psoriasis. 

An estimated 125 million people have some form of psoriasis worldwide, with Caucasian people having the highest incidences. While men and women are diagnosed with Psoriasis at fairly equivalent rates, women tend to be diagnosed when they are younger, with males being diagnosed when they are older. Males tend to have slightly more severe cases of psoriasis than women do. 

Symptoms of Psoriasis

Psoriasis symptoms can vary based on the type of psoriasis you have.

The most common symptom is dry, flaky, silvery-white patches of skin most commonly found on the elbows, knees, scalp, trunk and back. The skin may also get dry enough that it cracks and bleeds. These symptoms are most often seen in plaque psoriasis, the most common type of psoriasis.

With psoriatic arthritis, symptoms may include all of the above, as well as arthritis which causes pain, swelling and stiffness in the joints, plus pain in the ligaments and tendons that attach to the bone. Psoriasis may also increase your risk of cardiovascular issues like heart attack and stroke.

The second most common type of psoriasis, called guttate psoriasis, presents with small red patches on the skin. While anyone of any age can get guttate psoriasis, it's most commonly seen in childhood or adolescence after a strep infection. Guttate psoriasis is the only type of psoriasis that is not chronic (long lasting) and it usually clears up in a few weeks though in some cases guttate psoriasis may turn into plaque psoriasis which is a chronic, life-long condition. 

Nail psoriasis affects over 50% of people with psoriasis and up to 86% of people with psoriatic arthritis. Symptoms of nail psoriasis include discoloration that may look yellow, red, pink or brown, nail pitting which is pin sized depressions in the nails and changes in nail structure including grooves in the nails called "Beau's lines" as well as peeling of the nail bed. 

Approximately 20-30 percent of people with living with psoriasis will develop a second type of psoriasis called inverse psoriasis. Inverse psoriasis is more common in people who are overweight or have excess skin folds and is often seen in the armpits, groin or under the breasts. Inverse psoriasis causes skin lesions that are often smooth and shiny and may be red, purple or brown in color. 

Another type of psoriasis is called pustular psoriasis, aptly named for the pus filled bumps it causes. This type of psoriasis can be widespread, causing red, scaly bumps that can often be dangerous if left untreated. Pustular psoriasis may also cause fever, chills, dehydration, muscle weakness and a rapid pulse. Approximately 3% of people with plaque psoriasis will develop pustular psoriasis, though it's rarely seen in children. 

The rarest form of psoriasis is erythrodermic psoriasis which causes a widespread red rash to form over most of the body. Erythrodermic psoriasis is aggressive and inflammatory and can be dangerous if left untreated as it may affect your ability to regulate your body temperature and fluid balance. Nail changes are common with erythrodermic psoriasis. Approximately 1-2% of people with psoriasis have erythrodermic psoriasis. 

Diagnosing Psoriasis

If your dermatologist suspects you have psoriasis they will exam your skin, nails and scalp to look for signs of the disease. They will also take an oral history from you asking about your symptoms such as dry itchy skin, yellowing nails or nail pain, if you've recently had any type of infection and if you have any blood relatives who have psoriasis. Your dermatologist may also ask about any joint pain, stiffness and swelling, especially upon waking up. 

In most cases your dermatologist can make a diagnosis just by looking at your skin, however they will sometimes perform a skin biopsy, sometimes referred to as a "punch biopsy" to rule out similar skin conditions such as eczema. There are no blood tests to confirm the diagnosis of psoriasis. 

What to Expect After Diagnosis

Treatment for psoriasis varies widely based on they type of psoriasis you're diagnosed with as well as the severity of your specific case. There are 3 main types of treatments for psoriasis - topical (creams and ointments applied directly to the rash), phototherapy (ultraviolet light treatments) and systemic (oral and/or injectable medications). 

Topical treatments are typically the first line of treatment for mild to moderate psoriasis and is often combined with phototherapy. 

Psoriasis Comorbidities

What is a comorbidity?

A comorbidity is when a person has two or more long-term chronic illnesses at the same time. Psoriasis has several common comorbidities including but not limited to cardiovascular disease, depression and inflammatory bowel disease, specifically Crohn's disease. People with Crohn's disease are 7 times more likely to develop psoriasis and people with psoriasis are 3 times more likely to develop Crohn's disease than the general population. Having Psoriasis also puts a person at higher risk of developing other autoimmune diseases including Systemic Lupus and Sjögren's Syndrome. 

People with all forms of psoriasis are also at a higher risk of all types of lymphoma, especially a type of lymphoma called cutaneous T-cell lymphoma (CTCL).

Psoriasis FAQ's

When is Psoriasis Awareness Month? 

Psoriasis Awareness Month is celebrated in August. 

Is Psoriasis contagious? 

No, Psoriasis is an autoimmune disease and is not contagious at all.