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Psoriasis Basics
What is psoriasis?
Psoriasis is a long-lasting skin disorder that causes red, scaly patches on the limbs, trunk, scalp, and other parts of the body. It is not contagious.
The rash of psoriasis goes through cycles of improving and worsening. At times it can be disfiguring, uncomfortable, and even painful.
The scaling and unpleasant appearance of psoriasis lesions (especially if left untreated) can cause embarrassment and be a significant source of anxiety or depression. Psoriasis can also interfere with sleep and make everyday tasks difficult.
Types of psoriasis
There are five types of psoriasis, each defined by the type of skin lesions that appear.
Plaque psoriasis—appears as thickened, red scaly lesions called plaques. This is the most common type of psoriasis.
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Guttate psoriasis— appears as small, drop-shaped spots on the trunk, limbs, and scalp. This is often triggered by bacterial infections, such as strep throat.
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Inverse psoriasis— appears as smooth, red patches in the folds of skin near the genitals, breasts, or armpits.
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Erythrodermic psoriasis - appears as a scaly, red, peeling rash that afflicts the entire body. Also uncommon.
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Pustular psoriasis— appears as pus-filled blisters that can be widespread or localized to the hands or feet. This is an uncommon form. (see below)
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Most people have just one type of psoriasis at a time, but it is possible to have two types simultaneously. And a person with one type of psoriasis (typically plaque psoriasis) may later develop a different type.
Psoriasis can occur anywhere on the body. However, people tend to have areas that are more prone to developing lesions than others. Some places are particularly challenging to treat, including the scalp, face, hands, feet, and nails.
Psoriasis severity
Each psoriasis outbreak can vary in severity. A mild outbreak, with small dandruff-like scales limited to one spot, could be followed by a severe outbreak with large thick plagues covering multiple parts of the body.
There are several ways to measure psoriasis severity. One simple approach is to measure the amount of the body covered by psoriasis. This is described as the percentage of body surface area. The area beneath one hand, including fingers and thumb, is equal to 1 percent of your body surface area. If all of your psoriasis lesions can be covered by two hands, about 2 percent of your body is affected.
- Mild psoriasis = up to 3% of the body affected
- Moderate psoriasis = 3% to 10% of the body affected
- Severe psoriasis = more than 10% of the body affected
Severity is also influenced by the type of psoriasis, the impact the illness has on a person’s quality of life, and a person’s susceptibility to side effects from treatment. Psoriasis is generally considered severe if it covers the palms and soles because of its impact on a person’s ability to walk and perform day-to-day tasks.
Very rarely people with psoriasis will also develop psoriatic arthritis. Symptoms of psoriatic arthritis include stiffness, pain, and swelling of the tendons and joints, as well as morning stiffness and generalized fatigue.
What causes psoriasis?
Normal skin cells (keratinocytes) start growing in the deepest layers of the skin (epidermis) and rise to the surface as they mature. The mature cells at the surface eventually fall off from everyday wear and tear and are replaced by newer cells below. This process usually takes about a month.
In skin affected by psoriasis, this process is accelerated and takes just a week or more. The skin cells multiply quickly and accumulate on the surface in silvery scales.
This rapid growth is the result of a problem with the immune system.
Under normal circumstances, the immune system’s T cells patrol the body looking for bacteria or other foreign substances. The T cells’ attack on such invaders is called the immune response. People with psoriasis have overactive T cells that trigger an increased production of skin cells.
Many of the treatments for psoriasis are aimed at controlling the immune response.
What are the treatment options for psoriasis?
Although there is currently no cure for psoriasis, there are multiple treatments available that can usually lead to a clearing of symptoms. The goal of treatment is to stop the skin cell overgrowth that leads to plaque formation and inflammation.
Treatment options include topical medications, oral medications, phototherapy, lasers, and a new class of medications called “biologics.”
Your doctor will recommend one or more of these treatments depending on the following factors:
- Type of psoriasis
- Location (scalp, trunk, hands feet, etc.)
- Severity of psoriasis
- Results of previous treatments
- Ease or convenience of a treatment
- Possible side effects
Since some treatments work better for some patients than others, be prepared to try more than one treatment.
Topical medications: over-the-counter
For mild to moderate psoriasis, some people may find sufficient relief from one or more of the following creams or ointments applied directly to the lesion:
- Moisturizers—While moisturizers won’t actually heal lesions or plaques, they can reduce the itching and scaling. For psoriasis, the greasier the better, so choose ointments over lighter creams and lotions.
- Coal tar—One of the oldest known treatments for psoriasis, coal tar is available without a prescription as a shampoo, gel, and cream. Coal tar reduces inflammation, slows the growth of skin cells, and relieves itching and irritation. It can be messy to apply and has a strong odor.
- Salicylic acid—This medication is available in shampoos, creams, lotions, pads, paste, and soap. It works as a peeling agent, removing scales from the skin, and it’s often combined with other topical treatments.
Topical medications: prescription
- Anthralin (Micanol)—An established, safe treatment for psoriasis (especially of the scalp), anthralin slows down skin cell growth and reduces inflammation. The medication may stain clothing and non-affected skin.
- Calcipotriene (Dovonex, Taclonex)—This synthetic form of vitamin D slows skin cell growth, flattens psoriasis lesions, and removes scales. While it doesn’t address inflammation specifically, most patients notice a reduction of skin redness.
- Corticosteroids (“topical steroids”)—Corticosteroids slow skin cell growth and relieve itching by suppressing the immune system. They work quickly and are easy to use. They may be used alone for mild psoriasis or combined with other therapies for severe lesions. Side effects include thinning of the skin, stretch marks, and reduced immune function, so prolonged use should be avoided.
- Topical retinoids (Tazorac)—Retinoids are a class of medications derived from vitamin A that are used for a variety of skin conditions. Some retinoids, such as Tazorac, have been formulated for application to the skin. (Oral retinoids, such as Soriatane, are taken by mouth.) Tazorac is FDA-approved for the treatment of psoriasis and helps slow the growth of quickly multiplying skin cells.
- Calcineurin inhibitors (Elidel, Protopic)—These medications, typically used for atopic dermatitis (eczema), may be prescribed in some cases of psoriasis.
Many other treatments for psoriasis are available, if your doctor can not control you with topical medications.
What triggers psoriasis?
Although the cause of a particular outbreak may not be known, some common psoriasis triggers have been identified, including:
- Stress
- Infection, such as strep throat or staphylococcus
- Medications, including lithium, beta blockers, and anti-malarial drugs
- Skin injury, including bruises, chafing from tight clothing, shaving, tattoos, vaccinations, or sunburn
- Other skin conditions, such as scabies, blisters, boils, and dermatitis
- Weather that dries the skin, such as cold winter days and indoor heating or cooling
- Hormones, such as the surges that occur after puberty and during pregnancy
- Smoking and excessive drinking
What about psoriasis self-care and prevention?
These steps can ease the discomfort of psoriasis and help minimize flare-ups:
Identify and avoid triggers. If you’re not sure exactly what your triggers are, consider keeping a diary for a couple months.
Limit alcohol consumption. Because heavy drinking can trigger psoriasis and interfere with certain medications (methotrexate and others), use alcohol in moderation, or avoid it altogether.
Take care of your skin.
- Moisturizers help lock in your skin’s own moisture. Use them regularly, particularly after bathing.
- Avoid scratching itchy skin. Cold compresses, topical steroids, menthol-based ointments, and oatmeal baths can curb the itch.
- Bathe in warm (not hot) water, keep showers or baths short, and use fragrance-free cleansers. Gently pat-dry skin instead of rubbing it.
- Do not pick at lesions.
- Protect your skin from the sun during PUVA therapy or if you’re taking retinoids (Soriatane or Tazorac).
- Choose cotton clothing over synthetic materials, which can irritate or overheat the skin.
- Protect your skin in the winter. Step up moisturizing efforts and use a humidifier.
Take care of your whole self. To keep your immune system calm and less likely to trigger skin cell overgrowth, follow the basics of good health. Get enough sleep, eat a balanced diet, and drink plenty of water. And avoid cigarette smoking, which can be a psoriasis trigger and overall health hazard.
Reduce stress. Stress is a trigger for many people with psoriasis. While there’s no way to eliminate stress altogether, there are many ways to manage it, such as meditation, counseling, or exercise. For managing the stress of psoriasis itself, consider joining a support group.
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This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.
Be sure to follow specific instructions given to you by your physician or health care professional.
Sources: National Psoriasis Foundation, American Academy of Dermatology
Additional Resources
- Disease Types
- Treatment Summary
- Medications: Topical
- Medications: Oral
- Procedures
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