It’s a sunny, 80-degree day. Everyone on the beach is wearing swim suits, tank tops, or shorts. You, on the other hand, are overheating in a long sleeved t-shirt. You are uncomfortable and a bit self-conscious, but it is the only way you can hide the latest flare-up of lesions on your arms and red, thick patches on your elbows due to a chronic skin condition called psoriasis. And if you have this disease, you are not alone as over 7.5 million Americans suffer from it, as well.

While psoriasis generally does not cause any life-threatening health complications and is not a contagious condition, it does result a great deal of discomfort and may cause many emotional complications.

Psoriasis is a non-contagious, long-term autoimmune disease that speeds up the life cycle of skin cells in the body. It manifests on the skin as thick, pink to red patches.

To better understand psoriasis, it is important to understand the skin’s life cycle. Under normal conditions, skin cells in the deeper layers grow and replace the surface skin cells. This process usually takes about a month, and although you do not notice it happening, your skin is constantly being replenished as the old skin sheds off.

If a person has psoriasis, that person’s autoimmune system may overreact and mistake his or her healthy skin cells for something foreign. Immune cells, known as T-cells, will attack these “foreign” healthy skin cells on both the surface and the deeper layers of the skin. This process causes the life cycle of the skin to speed up and take days instead of several weeks. Skin cells will start to build up too fast and form patches, called plaques, on the skin that are thick, rough, pink or red, and often dry, itchy, painful, or covered with scales.

Psoriasis can also become disabling for some people. Sometimes psoriasis will cause psoriatic arthritis – a condition that causes a patient’s joints to become swollen, tender, and painful. This same arthritis can sometimes cause dead skin cells to build up under the fingernails and toenails, causing nails to change color or even separate from the nail bed and fall off.

Psoriasis cannot be cured, but there may be periods of time when it goes into remission and does not show symptoms. In some people, it may even appear once and never flare up again. But in most cases, the disease will flare up on and off throughout that person’s life.

Even though psoriasis cannot be cured, it can be treated, and you and your doctor can often identify the triggers that cause your condition to flare up, and then take steps to eliminate those triggers from your life.

The exact cause of psoriasis is not known, but experts believe it is a response to a faulty immune system and suspect that it may run in families and is a genetic disorder. There are some triggers that can cause flare-ups in people once they have the disease. Triggers may vary from person to person, but some common triggers are:

• Infections such as strep-throat, thrush, or the common cold
• Diseases that weaken immune system like HIV/AIDS
• High amount of stress
• Smoking
• Heavy alcohol consumption
• Medications – including lithium prescribed for bipolar disorder; beta-blockers prescribed for high blood pressure or heart issues; and anti-malarial drugs
• Injury or irritation to the skin from things like burns, cuts, or bug bites
• Cold, dry weather that deprives the skin of moisture
• No exposure or very little exposure to sunlight and UVB rays
• Too much exposure to sunlight or UVB rays, or sunburn

There are also factors that increase someone’s risk of developing psoriasis:

• A family history of psoriasis
• A weakened immune system, for example from HIV
• Living in a cold, dry climate
• Smoking

While you cannot control things like genetics or the climate where you live, you can gain some control over psoriasis by reducing your exposure to the triggers that seem to cause flare-ups. Work with your physician to determine which factors are present when flare-ups occur.
 

Identifying Psoriasis

A doctor can usually identify psoriasis based on a description of your symptoms and by observing the rash. Occasionally, a doctor may take a skin biopsy to determine if you have a specific type of psoriasis or to rule out any other causes, such as a fungal infection.

While it is possible for psoriasis to appear anywhere on the body – including the scalp, palms, soles of the feet, mouth, torso, and the skin covering the joints – psoriasis most commonly appears on the knees and elbows. There are five main types of psoriasis, but plaque psoriasis is the most common form, accounting for 80 percent of all cases.

Types of Psoriasis

Plaque Psoriasis:

• Most common form of psoriasis
• Often on elbows or knees, but may occur anywhere on the body including mouth, nails, scalp
• Dry, raised, red skin plaques covered with silvery scales
• May itch or cause pain
• Skin around joints may crack or bleed

Guttate Psoriasis:

• More common in people under age 30
• Triggered by bacterial infection, such as strep throat
• Also triggered by anti-malarial drugs or beta blockers
• Drop-shaped sores on trunk, arms, legs, or scalp

Inverse Psoriasis:

• Less common in general population; more common in overweight people
• Affects skin in areas prone to friction and sweating; mainly in the armpits, groin, around the genitals, and under the breasts
• Sores present as smooth patches of inflamed, often shiny, red skin

Pustular Psoriasis:

• Less common
• Mainly affects skin on fingertips, feet, or hands
• Presents as red, tender skin; white, pus-filled blisters develop
• Blisters may reappear as often as every few days or weeks
• Can be triggered by overexposure to UV light, pregnancy, hormone changes, steroids, other internal medications, infections, stress
• Often accompanied by fever, chills, itching, fatigue

Erythrodermic Psoriasis:

• Least common form
• Can cover the entire body with a red, itchy, burning rash; skin scales may peel off in sheets as opposed to flakes
• Triggered by severe sunburn; certain medications like lithium or anti-malarial drugs; or sometimes by a withdrawal reaction to other psoriasis treatments, such as cortisone

Though psoriasis is incurable, most of the symptoms can be treated with proper medications. Treatments aim to reduce new formation of scales by slowing skin cell production, decreasing inflammation, stopping itching, and smoothing skin.

A doctor may recommend various treatments depending on sex, age, severity, and other existing health conditions. Generally, mild treatments, like topical creams or UV light therapy, are recommended before applying stronger treatments that may have harsher side effects.

Common topical treatments include:

• Steroid Creams: reduce slow cell turnover by suppressing the immune system; this reduces inflammation and itching
• Synthetic Forms of Vitamin D: slow down the growth of skin cells
• Moisturizers, Oils, or Lotions: to relieve dry skin and reduce itching and scaling
• Coal-Tar in the Form of Lotions, Shampoos, or Soaps: used mainly for scalp psoriasis; relieves itching, inflammation, and flaking

Severe cases of psoriasis require internal medications or other forms of treatment. These treatments are listed below.

• Ultraviolet (UV) Light: decreases the inflammation of the skin and reduces the development of skin cells; sunlight or artificial light may be used.
• UVB Phototherapy: Controlled doses of UVB light are used to target very specific patches of skin that do not respond to topical treatments; this therapy has side effects, but they are short-term.
• Photochemotherapy (PUVA): treatment that combines a medicine called "psoralen" with exposure to a special form of ultraviolet light; PUVA treatment has many potential side effects, including cancer, so it is generally administered only to older psoriasis patients, to patients with severe psoriasis, or to patients who do not respond to conventional treatment.
• Retinoid Gel or Pills: vitamin A derivatives given together with UVA and PUVA to slow down the growth and shedding of the skin cells; retinoids have side effects such as skin irritation and increased sensitivity to sunlight, and should not be used by anyone who is pregnant.
• Cyclosporine or Methotrexate: Both of these drugs are taken orally or via injection and suppress the immune system, slowing down the growth of certain immune cells responsible for psoriasis. Both of these treatments carry the risk of some serious side effects such as liver or kidney damage, so it is important to have a doctor monitor the effects of the drugs.
• Biological Therapies: Newer biological drugs, which are given through an IV, block communication between certain immune cells to halt the effects of psoriasis; this therapy is only used in serious cases and can interfere with the patient’s immune system or cause life-threatening infections

UV or UVB therapies are sometimes combined with coal tar or retinoid treatments as well.
 

Genetics and the immune system seem to be the causes of psoriasis; so contracting the disease is not something a person can control. Once contracted, psoriasis cannot be cured and will linger in your body throughout your life. However, psoriasis can successfully be identified, managed, and treated. With the proper care, discomforts such as itching, flaking, or pain can be reduced or resolved. Pinpointing your triggers and eliminating them from your life can often keep this disease in remission indefinitely.