Common Skin Conditions: Psoriasis

Common Skin Conditions: Psoriasis

Psoriasis is a chronic skin disease that affects about 2% of the Canadian population. The cause is unknown but we do know that it is not contagious.

Psoriasis results from an overproduction of skin cells in the epidermis, the outer layer of the skin. Normally, it takes about a month for the cells of the epidermis to mature and be shed from the surface. In psoriasis this maturation occurs in a week or less. Lesions of psoriasis appear as red patches covered with thick, silvery scales. Psoriasis may be limited to a small area or cover large portions of the body. The scalp, elbows, knees, arms and legs are the most commonly affected sites. The nails may also be deformed.

Psoriasis occurs in both men and women with equal frequency and may begin at any age. It is often the first diagnosed during the teenage years or early adulthood. Heredity seems to play a role since many patients with psoriasis have other family members with the disease.

Many things may aggravate psoriasis or cause flare-ups. Patches of psoriasis may develop at sites of such minor injuries as cuts, scratches, minor abrasions, and sever sunburn. Psoriasis can also be triggered by infections-for example, strep throat and by certain drugs, including lithium, propranolol and chloroquine. Emotional stress can make psoriasis worse.

People who live in cold-weather climates frequently have flare-ups of psoriasis in winter when they are unable to benefit from moderate exposure to sunlight, which usually helps control psoriasis.

One with psoriasis must understand that he or she has a chronic disease (like diabetes or arthritis) that has a tendency to flare up and then subside. However, in most cases, remission can be obtained with proper therapy. The should be under the care of the dermatologist, who can tailor treatment to her individual case; no one form of therapy is ideal for everyone. Many advances have been made in treatment of psoriasis, and the dermatologist should be able to keep her disease under adequate control if they faithfully follow the prescribed treatment regimen. And remember that one can always obtain more information on psoriasis by writing to the Canadian or American Academy.

Psoriasis can vary in presentation and severity. The majority of patients (approximately 80 to 90 percent) present with relatively mild disease with only limited involvement of the skin, which can be controlled with topical creams. It is important to recognize that even though psoriasis might involve only limited areas of the body it can still pose a significant burden on patients’ lives. This fact was emphasized recently when a major conclusion of a consensus meeting of the American Academy of Dermatology stated that is important for doctors to not only rely on the amount or area of patients psoriasis when determining the severity of the disease and treatment, but also to take into account the effect the disease has on the patient’s quality of life. Approximately 15 to 30 percent of psoriasis patients experience arthritis or joint inflammation, which can range in severity from mild to disabling. When severe, psoriatic arthritis can limit a person’s ability to walk to work.

Psoriasis can be intensely itchy and can burn. The disease can cause patients great discomfort, pain and emotional distress. Depending on severity, psoriasis can affect relationships and the ability to work or enjoy leisure activities. For example, parents with tender lesions on their hands might find it difficult to care for their babies; patients with painful pastules on their hands or feet can find themselves unable to work with their hands or walk; and food handlers are constantly faced with the question: “Is it contagious?” Teens are often embarrassed by their blemished skin and are unwilling to wear shorts in gym class or during summer. These limitations can affect both their psychosocial development and ability to enjoy normal healthy activities. In short, psoriasis can have a profound negative physical and psychological impact on patients and their families.

Patients who have more limited disease, however, might not experience much discomfort, nor be emotionally distressed by its appearance. There are even patients with extensive areas of their bodies involved who are not physically or emotionally affected to any great degree.

Signs + Symptoms

Psoriasis most commonly appears as red, raised, dry scaly areas of the skin. In addition, nail changes such as deformity and crumbling of the nail plate can occur. Arthritis can also be present with joint swelling, tenderness and stiffness.

The physical appearance and symptoms of psoriasis vary depending on the type of psoriasis and the severity of the disease. The appearance can so vary from person to person and psoriasis lesion can differ in size from several millimeters to several centimeters.

A lesion that is less than 1 cm in diameter (and is raised above the surface of the skin), is called a papule, and a raised lesion that is greater than 1 cm in diameter is called a plaque. Some people can also have pastules present on the palms and soles or on other areas of the body. Psoriasis can be localized involving the elbows and knees, or widespread, covering the entire body.

Types of Psoriasis

There are five different types of psoriasis:

  1. Plaque-type psoriasis
  2. Guttate psoriasis
  3. Inverse psoriasis
  4. Erythrodermic psoriasis
  5. Pustular psoriasis

Each type has its own unique characteristics; some types can occur alone or coincide with other forms. Therapy can differ for each.

Plaque Type Psoriasis

The most common form of psoriasis is known as plaque-type psoriasis (or psoriasis vulgaris). As previously explained, the term “plaque” is used to describe a raised area of skin that is greater than 1 cm in diameter. By definition, many of the areas affected are greater than 1.0 cm in diameter.  Smaller papules may join to form a larger plaque. The affected area is usually raised, red and scaling. The lesions are usually well defined, meaning that the border between involved skin and uninvolved skin is remarkably sharp. The lesions of psoriasis are normally round to oval in shape. Scales can appear as silvery-white and powdery, and in some cases can be quite thick, even resembling an oyster shell (ostraceous). Scales can flake or peel off in thin transparent sheets. Plaque-type psoriasis occurs in 80 to 90 percent of all cases and tends to persist for long periods of time. It affects mostly elbows, knees, scalp and lower back. It can, however, involve any part of the body.

The condition commonly appears in a symmetrical pattern (eg. If the right elbow is affected the left elbow might also be affected) and can also involve the scalp. When the scalp is of the most frusterating and difficult areas to treat.

To learn more about psoriasis and you live Maple Ridge, contact us today!  Dermatologie is located in downtown Maple Ridge, BC and are one of the sole providers of UVB Phototherapy for psoriasis in the lower mainland.