Psoriasis quick guide

Psoriasis is known for symptoms you see on the skin, but this condition runs deeper than that. It is an autoimmune disease that occurs when the immune system starts attacking healthy cells — usually skin cells — instead of targeting foreign bodies like bacteria and viruses.

This process causes skin cells to develop and shed rapidly in affected areas. Normal skin cells take around 28 days to grow and shed. However, skin cells affected by psoriasis can mature in just three or four days. Dead cells accumulate on the skin surface to form legions (patches).

Legions can occur on different parts of the body including the face, scalp, hands and feet, groin, skin folds and nails. They can be very dry, cracked and itchy but scratching can cause them to bleed. They vary from mild patches in a few spots to severe cases that cover most of the body.

Psoriasis affects around 1.6 million Australians. Although it can begin at any age, psoriasis is more common among adults than children and affects men and women equally.

Psoriasis can be unpredictable and frustrating for sufferers, as it comes and goes in cycles of remissions and flare-ups over a lifetime. Every person with psoriasis has their own unique set of triggers that can set off a flare or worsen symptoms. These triggers include stress, certain medications and skin injury.

It is important to know that psoriasis is not contagious. You can’t catch it by touching someone else’s skin plaques.

The exact cause of psoriasis is not known, but several factors are known to play a role.

Some people are genetically predisposed to autoimmune conditions such as psoriasis, rheumatoid arthritis or lupus. However, the specific genes (or gene combinations) associated with psoriatic disease are yet to be identified conclusively. We do know the genes related to autoimmune conditions can remain dormant in some people, skip generations or lead to different autoimmune conditions within the same family.

While autoimmune conditions can be present at birth, most can appear at any age following exposure to an internal or external trigger. Psoriasis triggers can include, but are not limited to:

• Stress
• Injury to the skin
• Infections, such as streptococcal tonsillitis or HIV
• Certain medications, such as lithium
• Cold weather

Other factors, such as smoking heavy alcohol consumption or obesity, can also increase your risk of developing psoriasis or other autoimmune conditions. Hormonal changes (such as pregnancy) can trigger flares of existing psoriasis.

Following a trigger, it is believed that T-cells, a type of white blood cell designed to fight off viral and bacterial invaders, begin to attack healthy skin cells by mistake. This process leads to an overproduction of healthy skin cells. New skin cells move to the outermost layer of skin in days rather than weeks, resulting in scaly patches of skin build-up.

In most people with psoriasis, the disease goes through cycles, flaring for a few weeks or months, then subsiding for a time.

Psoriasis symptoms can vary from person to person and depend on the kind of psoriasis you have. Some people may have a few patches near their scalp or elbow; others can have patches that cover much of their body. It is possible to have more than one form of psoriasis at the same time.

Here’s a look at the most common symptoms of psoriasis to be aware of.

Silver, scaly patches

What sets psoriasis apart from typical rashes are the thick white or silvery patches that are the classic tell-tale marker of a type of psoriasis called plaque psoriasis. These plaques usually show up on the elbows, knees and scalp, but they can appear anywhere on the body. Plaque psoriasis occurs in 90 per cent of people affected by the condition.

An itching or burning feeling on the skin

Although psoriasis patches aren’t usually irritating, some people do report itchiness. People who have psoriasis of the scalp can report it as feeling very itchy or dry. The itching and pain can interfere with basic daily activities including self-care, sleep and even walking.

Dry, cracked skin

The skin of a psoriasis patch tends to be very dry, which is why bland but powerful lotions or creams can help. Psoriasis patches on the skin can crack and bleed, which can cause pain for some patients. People with painful plaques on the hands and feet may have difficulty with exercise, performing certain occupations or doing household chores.

Small, red dots or lesions

This type of psoriasis looks very different from the silver plaques. Called guttate psoriasis, it may be set off by having a strep infection. It’s the second-most common type of psoriasis after plaque psoriasis.

Red patches of skin

This type of psoriasis is known as inverse psoriasis. These flat, red, shiny skin patches usually have well-defined edges. They usually occur in folds of the body, such as in the elbows, knees or groin.

If they occur in your armpit, you may mistake them for irritation or even an allergic reaction to your deodorant. If these red lesions occur in your groin, you might think you have jock itch or an STD.

Patches on the scalp

People with milder cases of psoriasis located only on the scalp could mistake their symptoms for dandruff. The main difference in the appearance between dandruff and psoriasis patches is that dandruff is usually white, dry flakes, whereas psoriasis patches have a red or silvery sheen. Scalp psoriasis can make the skin crack or bleed and may lead to hair loss.

Blistery pustules on the body

Pustular psoriasis is less common than plaque psoriasis, but its symptoms can come on much stronger. Larger areas of the body are affected, and instead of scaly patches, patients will have flares of pus-filled blisters. Palmar plantar psoriasis occurs on the hands and feet. Generalised pustular psoriasis is rare but can be life-threatening if not treated quickly as it affects vital functions.

Shedded layers of skin

Erythrodermic psoriasis is another rare form of the disease. Symptoms include intense redness and shedding of skin layers in large sheets. It often affects nearly the whole body and can also be life-threatening as it disrupts the body’s normal temperature and fluid balance.

Discoloured, pitted nails

Dermatologists don’t just check the skin if they suspect a patient might have signs of psoriasis — they look at the nails for yellow or red discolouration too. Nail symptoms include pitting in the nail and the nail plate lifting off the nail bed. That can cause pain if debris gets caught in the space underneath. Nail symptoms usually accompany body psoriasis, but they can develop in isolation too.

Fatigue

Fatigue is often overlooked as a symptom of skin diseases despite patients frequently reporting it. While fatigue is common in the general population and has many causes, psoriatic fatigue can be due to:

• Active inflammation, especially when physical psoriasis symptoms flare up.
• Chronic pain.
• Itchy or irritated skin.
• Certain medications, such as methotrexate or strong pain killers.
• Co-occurring medical conditions, such as psoriatic arthritis, thyroid conditions or diabetes.
• Lifestyle factors including stress or poor diet.

There is currently no cure for psoriasis but it can be well-managed. In many cases, treatment can also reduce the size and severity of skin lesions or clear them up altogether. Treating your psoriasis holistically will likely include treating your skin, your immune system and your general health (including your mental health).

The treatments you use may depend on how serious your psoriasis symptoms are (mild, moderate or severe) and where they’re located. Common medical treatments for psoriasis include:

• Topical creams and haircare products
• Combination vitamin D and cortisone products
• Light therapy
• Retinoids
• Medications to suppress your immune system

You can also consider modifying your diet, physical activities and other aspects of your lifestyle to improve your overall health. Managing your stress levels and making time to do the things you enjoy can also be very beneficial.

(See our Psoriasis treatments section for more information on ways to manage your psoriasis.)

Although psoriasis is mostly associated with the skin, people with the condition are also at risk of developing comorbidities (other related conditions), however, that does not mean everyone with psoriasis will develop them.

Many factors can contribute to the onset of comorbidities, including having other autoimmune conditions or conditions that share similar risk factors. Some psoriasis treatments also increase the risk of comorbidities.

The most common comorbidities associated with psoriasis include:

• Other autoimmune conditions (such as psoriatic arthritis and inflammatory bowel disease)
• Metabolic disorders (such as obesity and diabetes)
• Cardiovascular diseases

(See our Psoriasis comorbidities section for more information on conditions liked to psoriasis.)

Unlike many other autoimmune diseases, psoriasis can be very visible, especially when it occurs on the face and hands. Legions are often red, scaly and cracked or bleeding. As dead skin sheds, it can leave scatterings of dandruff-like flakes around the affected person. It is, therefore, no surprise that people with the condition can experience social stigma, poor self-esteem, depression and anxiety about forming close relationships.

It can also be hard to cope with other symptoms of autoimmune disease such as pain and fatigue. If you are struggling to deal with the mental or emotional effects of psoriasis, you can reach out for help via:

• Supportive friends or family
• Your GP
• A mental health practitioner
• A psoriasis patient organisation, such as Psoriasis Australia (facebook.com/psoriasisaust) or email [email protected].
• A psoriasis support group in your area or online.

If this content has raised feelings that concern you, visit the Lifeline website or call 13 11 14.

Living with psoriasis?
There are now many treatments available to help you live well.

Here are six things you can ask your doctor today:

1. What other psoriasis treatments can I try?
2. Do I need to see a dermatologist?
3. I’m experiencing new symptoms. Could they be related to my psoriasis?
4. Can you refer me to allied health professionals, such as physiotherapists and dietitians, to help me mange my symptoms?
5. I’m struggling to cope with the stress and stigma of having psoriasis. Is there someone I can talk to about this?
6. Can you suggest any psoriasis peer support groups I could contact?

Start the conversation today!