Psoriasis: Types, Symptoms, Causes & Treatment

Psoriasis is a chronic autoimmune skin condition that causes the rapid buildup of skin cells. It results in thick, red patches of skin covered with silvery scales. Psoriasis can affect any body part, but it most commonly appears on the elbows, knees, scalp, and lower back. According to the World Health Organization (WHO), psoriasis affects approximately 2-3% of the global population. Psoriasis can occur in people of all ages, but it most commonly appears in adults between 15 and 35. Psoriasis can affect men and women equally. The incidence and prevalence of psoriasis in India are also substantial; around 1-2% of the Indian population is affected. It affects people of all ethnic backgrounds, including rural and urban dwellers.

Psoriasis is a complex skin condition that can manifest in different forms. The following are the various types of psoriasis:

• Plaque psoriasis: Plaque psoriasis is the most common type, accounting for about 80% of cases. It appears as raised, red patches of skin covered with thick, silvery-white scales. Plaque psoriasis can affect any body part, but it most commonly affects the elbows, knees, scalp, and lower back area.
• Guttate psoriasis: This type often develops after a bacterial or viral infection, such as strep throat. It generally appears as small, drop-like lesions on the skin. Guttate psoriasis usually appears on the trunk, arms, legs, and scalp. It is more common in children and young adults.
• Inverse psoriasis: Unlike other types of psoriasis, inverse psoriasis is present in skin folds such as armpits, groins, and under the breast area. It appears as smooth, red patches without scales. Friction and sweat may aggravate inverse psoriasis.
• Pustular psoriasis: A pus-filled blister with red, inflamed skin is the characteristic feature of pustular psoriasis. It can affect specific or entire areas of the body. Sometimes, a person with pustular psoriasis may have other systemic symptoms like fever and chills.
• Erythrodermic psoriasis: Erythrodermic psoriasis is a severe and rarely occurring psoriasis that affects the whole body. It causes widespread redness, scaling, and skin shedding, which is life-threatening and requires immediate medical attention.
• Nail psoriasis: Psoriasis can also affect the nails, resulting in numerous changes such as pitting, discoloration, thickening, and separation from the nail bed. Nail psoriasis can be challenging to treat and may lead to functional impairment of the nails.
• Scalp psoriasis: This psoriasis affects the scalp, causing redness, scaling, and itching. It can extend beyond the hairline onto the forehead, neck, and ears. Though scalp psoriasis can appear similar to dandruff, it requires a different approach to treatment.

Psoriasis is a chronic and often misunderstood skin condition that can significantly impact a person's quality of life. The symptoms of psoriasis can be distressing and vary in severity from mild to severe. The following are some common manifestations of psoriasis:

• Red, raised patches of skin: Psoriasis typically manifests as red, elevated patches of skin known as plaques. These plaques can appear on various body areas, including the elbows, knees, scalp, lower back, and buttocks. The affected skin may be inflamed, itchy, and painful.
• Silvery-white scales: A distinctive feature of psoriasis plaque is a silvery-white covering of scales. In addition to being thick and dry, the scales tend to flake easily, causing the skin to flake. The shedding of scales may occur on clothing or bedding.
• Dry, cracked, and bleeding skin: Psoriasis can cause the skin to become dry, rough, and prone to cracking. The affected areas may be more susceptible to injury, and scratching or picking at the plaques can lead to bleeding and further skin damage.
• Nail changes: Psoriasis can cause thickening, discoloring, pitting, and ridges on the nails, and in severe cases, the nail may crumble, separate or loosen from the nail bed, accompanied by discomfort or pain.
• Itching and discomfort: Psoriasis plaques can be intensely itchy, causing significant displeasure and distress. The constant urge to scratch the affected areas can worsen the symptoms, potentially leading to skin infections.
• Joint pain and swelling: Psoriasis can also affect the joints, resulting in a condition known as psoriatic arthritis. Joint pain, stiffness, and swelling may affect various joints, particularly in the fingers, toes, wrists, knees, or ankles. Psoriatic arthritis can cause joint deformities and restrict movement.
• Emotional distress: Having psoriasis can be highly distressing to the patient, as the visible nature of the lesions can cause feelings of embarrassment, low self-esteem, and self-consciousness. Therefore, it is vital to address the psychological aspects of psoriasis and seek support if needed.

Psoriasis is a complex and chronic autoimmune disease that affects the skin. While the exact cause of psoriasis is still not fully understood, extensive research has shed light on several contributing factors. These factors may include:

• Genetics: Family history plays a significant role in psoriasis. Individuals with a family history of psoriasis have a higher risk of developing the condition. Certain genetic variations, such as variations in specific genes related to the immune system, have been linked to an increased susceptibility to psoriasis.
• Immune system dysfunction: Psoriasis is an immune-mediated disease. In this condition, the body's immune system mistakenly targets and attacks healthy skin cells, which triggers a cascade of inflammatory responses and an accelerated production of skin cells, leading to the characteristic symptoms of psoriasis.
• Environmental stimulus: Various environmental factors can trigger or exacerbate psoriasis in individuals predisposed to the condition. These triggers include infections (streptococcal infections), which can cause an immune response that triggers or worsens psoriasis. Other triggers include certain medications (such as beta-blockers, lithium, and antimalarials), injury to the skin, emotional stress, smoking, and excessive alcohol consumption.
• Koebner phenomenon: The Koebner phenomenon is a unique characteristic of psoriasis, where new psoriatic lesions develop at skin injury or trauma sites. Even minor skin trauma, such as scratches, cuts, or sunburn, can induce the development of new psoriatic plaques.
• Hormonal factors: Hormonal changes can have an impact on psoriasis. Fluctuations in hormone levels during puberty, pregnancy, and menopause can influence the severity and course of the disease. Some women may experience improvements in their psoriasis symptoms during pregnancy, while others may experience flare-ups.
• Lifestyle habits: Unhealthy lifestyle choices, including a poor diet, lack of exercise, and chronic stress, can contribute to the development and exacerbation of psoriasis. Obesity is also associated with a higher risk of developing psoriasis, making the condition more challenging to manage.

Preventing psoriasis is challenging due to its genetic and immune system factors. However, some preventive measures can help reduce the frequency and severity of flare-ups and improve skin health. The following are some strategies to consider:

• Maintain a healthy lifestyle: Follow a balanced diet, exercise regularly, manage stress, and prioritize sufficient sleep. Eating antioxidants and a nutrient-rich diet with fruits, vegetables, whole grains, and lean proteins supports overall immune system health.
• Avoid triggers: Identify and avoid stimuli that worsen your psoriasis. Common trigger factors include stress, certain medications, skin injuries, infections, excessive alcohol consumption, and smoking. You may lessen the likelihood of flare-ups by minimizing exposure to these triggers.
• Practice a good skincare routine: Keep your skin clean and well-moisturized. Use mild, fragrance-free cleansers and moisturizers suitable for sensitive skin. Avoid harsh soaps, hot water, and abrasive scrubbing, as they can dry out the skin and exacerbate symptoms.
• Use skin protection: Shield your skin from excessive sun exposure, as sunburn can trigger psoriasis flare-ups. Apply broad-spectrum sunscreen with a high SPF, wear protective clothing (like hats, scarves, and umbrellas), and seek shade during peak sun hours.
• Manage your stress: Practice effective stress-management techniques, such as yoga, meditation, deep breathing exercises, or engaging in hobbies. Seeking support from a therapist or counselor can also be beneficial in managing stress levels.
• Avoid skin injuries: Take precautions to prevent injuries or trauma that can lead to new psoriatic plaques. Therefore, be mindful when handling sharp objects and wear protective gear during physical activities.
• Quit smoking: Quitting smoking is crucial. As it not only increases the risk of developing psoriasis but also worsens symptoms. Seek support from healthcare professionals or smoking cessation programs to assist you in the quitting process.

Dermatologists use various methods to diagnose psoriasis by evaluating your skin, nails, and medical history. These methods help distinguish psoriasis from other skin conditions. The following are the diagnostic methods for psoriasis:

• Physical examination: During a physical assessment, the dermatologist carefully examines your skin, scalp, and nails for the characteristic signs of psoriasis. They look for red and inflamed patches with thick, silvery scales and nail changes. The doctor evaluates the psoriatic lesions' size, shape, color, and distribution to make a preliminary diagnosis.
• Medical history: The doctor will discuss your symptoms in detail and inquire about any triggers or factors that worsen or improve your psoriasis. They will ask about your family history of psoriasis or other autoimmune disorders, as genetics can play a role in its development. Providing a comprehensive medical history helps in confirming the diagnosis.
• Skin biopsy: Occasionally, dermatologists may recommend a skin biopsy to confirm the diagnosis. It involves taking a tiny skin sample and examining it under a microscope. This procedure helps exclude other skin conditions and shows the cellular changes in the skin, confirming the diagnosis of psoriasis. 
• Koebner phenomenon: The dermatologist may check for the Koebner phenomenon, which refers to the development of new psoriatic lesions at the site of skin injury or trauma. This observation can further support the diagnosis of psoriasis.
• Nail examination: If you have nail involvement, the doctor will thoroughly examine your nails for characteristic changes such as pitting, thickening, discoloration, or separation. Nail involvement is a common psoriasis manifestation and can provide additional evidence for diagnosis.

The stages of psoriasis can help classify the severity and extent of psoriasis lesions on the body. The progression of psoriasis can vary from person to person. Some individuals may experience stable, mild symptoms over an extended period, while others may have fluctuating or more severe symptoms.

The following are the stages of psoriasis:

• Mild psoriasis: In the early stage of psoriasis, the symptoms are generally limited to small, localized areas of the body. The affected skin may have slightly raised, red patches with a silvery scale. Mild psoriasis is often manageable with topical treatments.
• Moderate psoriasis: At this stage, the symptoms become more widespread and may cover larger body areas, such as the elbows, knees, scalp, and lower back. The patches are thicker and may merge, forming larger plaques. Treatment options may include a combination of topical treatments, phototherapy, or oral medications.
• Severe psoriasis: An individual with severe psoriasis can suffer from extensive body involvement, including the trunk, limbs, and face. The plaques are thicker, and scaling is more pronounced. Severe psoriasis can significantly impact a person's quality of life and may require more aggressive treatment approaches, such as systemic medications or biological therapies.
• Remission: Remission is a stage where psoriasis symptoms subside or entirely disappear. During this phase, the skin appears normal without any active psoriasis patches. However, the disease can flare-ups after the periods of remission.

The treatment options for psoriasis are:

• Topical treatments: These medications are applied directly to the skin affected by psoriasis. Doctors commonly prescribe corticosteroids to reduce inflammation and itching. Vitamin D analogs, such as calcipotriene, help slow down the growth of skin cells. Retinoids, such as tazarotene, normalize skin cell turnover. Calcineurin inhibitors, like tacrolimus and pimecrolimus, reduce inflammation and itching. Salicylic acid preparations help remove scales and promote the effectiveness of other treatments.
• Phototherapy: This therapy involves exposing the skin to specific wavelengths of ultraviolet (UV) light to slow down the rapid skin cell growth in psoriasis. There are different types of phototherapy, including UVB therapy, PUVA therapy (which involves combining psoralen medication with UVA light), and targeted phototherapy using lasers or light-emitting devices.
• Systemic medications: These medicines are taken orally or by injection and work throughout the body to modulate the immune system and reduce inflammation. Methotrexate is an immunosuppressant that can slow down skin cell growth. Cyclosporine suppresses the immune system's response to inflammation. Retinoids, such as acitretin, help normalize skin cell turnover. Immunomodulators, such as apremilast, target specific molecules involved in inflammation.
• Biologic therapies: Biologic drugs are a newer class of medications that selectively target specific proteins in the immune system involved in psoriasis. Doctors typically administer these drugs by injection or infusion. Examples include tumor necrosis factor (TNF)-alpha inhibitors (adalimumab, etanercept, infliximab), interleukin (IL)-17 inhibitors (secukinumab, ixekizumab), IL-23 inhibitors (guselkumab, tildrakizumab), and phosphodiesterase-4 (PDE4) inhibitors (apremilast).
• Oral retinoids: Doctors recommend oral retinoids, derived from vitamin A, for severe psoriasis cases that do not respond to other treatments. Acitretin is the most commonly used oral retinoid. It works by slowing down the growth of skin cells and reducing inflammation. It is important to note that oral retinoids have potential side effects and require careful monitoring.
• Combination therapy: In some cases, dermatologists may combine various treatments for psoriasis symptoms. These may involve topical treatments in combination with phototherapy, systemic medications, or biologic therapies. Combining treatments can often provide more effective results than a single treatment alone.

The recovery period from psoriasis varies from person to person. It depends on several factors, which include:

• The severity of the condition
• The chosen treatment approach
• The patient's response to treatment

Some cardinal aspects of the road to recovery are:

• Treatment plan: Following a personalized treatment plan is crucial for betterment. The treatment modalities may involve a combination of topical treatments, phototherapy, systemic medications, or biologic therapies, depending on the severity and extent of psoriasis. It is essential to adhere to the prescribed treatment regimen and use the medicines as directed by the healthcare provider.
• Lifestyle modifications: Certain lifestyle changes can help manage psoriasis symptoms and promote overall well-being. These may include consuming a healthy diet, managing stress levels, regular exercising, avoiding triggers (such as certain foods or environmental factors), and practicing a good skincare routine, including moisturizing the skin.
• Regular follow-up visits: Attend follow-up visits with a dermatologist or healthcare provider for betterment. These visits allow monitoring of treatment progress, adjustment of medications if needed, and addressing any concerns or side effects. It is crucial to communicate openly with the healthcare provider about the effectiveness of the treatment and any challenges faced during the recovery process.
• Patient education: Learning about psoriasis and its treatment options empowers individuals to make informed decisions and actively engage in their care. Educating yourself about the condition, its triggers, and treatment options allows individuals to take action. Information and support by resources such as patient education materials, support groups, and online forums are of great help.
• Psychological support: An individual with psoriasis may suffer significant emotional stress and feel isolated. Getting psychological support, including counseling or joining a support group, can be helpful in managing the emotional challenges associated with the disease. It is crucial to address any feelings of anxiety, depression, or social isolation that may arise.
• Patience and persistence: Achieving optimal control of psoriasis may take time and patience. It is important to remain persistent and committed to the treatment plan, as consistent management can lead to significant improvement. Some treatments may take several weeks or months to show full effectiveness, so it is crucial to be patient during treatment. Therefore, work closely with the healthcare provider.

What is psoriasis?
Psoriasis is a chronic autoimmune skin condition that causes the rapid buildup of skin cells, leading to the development of thick, red, and scaly patches on the skin.

What causes psoriasis?
The exact cause of psoriasis is still unknown. But a combination of genetic, immune system, and environmental factors are contributing agents in psoriasis development.

Is psoriasis contagious?
Psoriasis is not a contagious condition, therefore, cannot be spread from person to person.

What are the common symptoms of psoriasis?
Common symptoms of psoriasis include red, inflamed patches of skin, silver-white scales, itching, and sometimes pain or burning sensation.

Are there different types of psoriasis?
There are various types of psoriasis, including plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis.

Can psoriasis affect nails and joints?
Psoriasis can affect nails, causing pitting, discoloration, and separation from the nail bed. It can also cause joint inflammation, known as psoriatic arthritis.

How is psoriasis diagnosed?
Doctors carry a diagnosis of psoriasis through a physical examination of the skin and nails and medical history. Sometimes, a healthcare provider may recommend a skin biopsy to confirm the diagnosis.

Are there any triggers for psoriasis flare-ups?
Various factors can trigger psoriasis flare-ups, including stress, infections, certain medications, injury to the skin, and changes in weather or climate.

Is there a cure for psoriasis?
There is no known cure for psoriasis. However, various treatment options help manage the symptoms and control flare-ups.

What are the treatment options for psoriasis?
Treatment options for psoriasis include topical medications, phototherapy, systemic medicines, and biologic therapies. The choice of treatment depends on the severity and type of psoriasis.

Can psoriasis be managed with lifestyle changes?
Certain lifestyle modifications can help manage psoriasis. These include maintaining a healthy diet, managing stress, avoiding triggers, and moisturizing the skin.

Can psoriasis be treated during pregnancy?
A healthcare provider should carefully evaluate psoriasis treatment during pregnancy, as some medications could pose dangers during pregnancy or breastfeeding.

Can psoriasis increase the risk of other health conditions?
Psoriasis may increase the risk of developing other health conditions, such as cardiovascular disease, diabetes, obesity, and certain autoimmune disorders.

What is phototherapy for psoriasis?
Phototherapy involves exposing the affected skin to ultraviolet (UV) light by natural sunlight or specialized light therapy equipment. This treatment may help reduce inflammation and slow down the excessive growth of skin cells.

What are topical medications used for psoriasis?
Topical medications for psoriasis include creams, ointments, gels, and lotions that are applied directly to the affected skin to reduce inflammation and control symptoms.

Are there any natural remedies for psoriasis?
Although there is no definitive cure for psoriasis, some individuals may find relief with natural remedies such as aloe vera, apple cider vinegar, fish oil supplements, and oatmeal baths. However, consult with your healthcare provider before trying these natural remedies.

What is the role of diet in psoriasis management?
While there is no specific psoriasis diet, maintaining a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health and reduce inflammation. Some individuals find that certain dietary modifications, such as limiting processed foods and alcohol consumption, can help manage symptoms.

Is stress a trigger factor for psoriasis?
Stress can be a trigger factor for psoriasis flare-ups in some individuals. Adopting stress management techniques such as exercise, meditation, and therapy can reduce the impact of stress on psoriasis.

Can psoriasis affect mental health?
Having psoriasis can significantly impact on person's mental health and emotional well-being. It may lead to feelings of embarrassment, self-consciousness, and depression. Seeking support from healthcare providers and support groups can be beneficial.

What is the role of smoking in psoriasis?
Smoking can worsen psoriasis and increase the risk of developing more severe forms of the condition. Quitting smoking can have a positive impact on psoriasis symptoms.

Is there a connection between psoriasis and obesity?
There is a link between psoriasis and obesity, as excess body weight and inflammation can exacerbate psoriasis symptoms. Weight management through a healthy lifestyle can be beneficial in reducing the risk.

What is the best way to moisturize the skin with psoriasis?
Regularly moisturizing the skin with recommended moisturizers can help soothe and hydrate psoriasis-affected areas. It is essential to choose products that are gentle, non-irritating, and fragrance-free.

Can medications trigger psoriasis?
Certain medications, such as beta-blockers, lithium, antimalarials, and nonsteroidal anti-inflammatory drugs (NSAIDs), can trigger or worsen psoriasis symptoms. Therefore, discuss medication use with a healthcare provider.

Can psoriasis affect children?
Psoriasis can affect anyone, including children, although it is less common than in adults. Pediatric psoriasis may require specialized care and treatment based on the child's age and needs.

Is there a link between psoriasis and skin cancer?
Individuals with psoriasis may have a slightly increased risk of developing certain types of skin cancer, such as squamous cell carcinoma. Regular skin examination and sun protection are crucial to reduce such risks.

What is the impact of psoriasis on quality of life?
Psoriasis can significantly impact a person's quality of life, affecting their self-esteem, social interactions, and overall well-being. Seeking emotional support and counseling can be beneficial.

Can infections trigger psoriasis?
Certain infections, such as strep throat or respiratory infections, can trigger or worsen psoriasis symptoms in some individuals. Prompt treatment of these infections is essential.

What is the role of genetics in psoriasis?
Genetics plays a role in psoriasis, as the condition can run in families. A family history of this condition may increase your risk of developing psoriasis.

Can psoriasis affect the scalp?
Scalp psoriasis is a common psoriasis type that affects the scalp. It can cause red, itchy, and scaly patches on the scalp. Doctors recommend special shampoos, topical treatments, or phototherapy for scalp psoriasis.

Is there a cure for psoriasis in alternative medicine?
Alternative medicine approaches are likely to provide some relief and help manage symptoms; however, there is currently no cure for psoriasis, so you should speak with your healthcare provider before using alternative medicine.

Can cold weather trigger psoriasis?
During colder temperatures, some people can experience worsening symptoms of psoriasis, such as dryness and skin irritation. Proper skin care and moisturization are essential during the colder months.

Is there a link between psoriasis and other autoimmune diseases?
Psoriasis is associated with an increased risk of developing other autoimmune diseases, such as rheumatoid arthritis, Crohn's disease, and lupus.

Can psoriasis affect the genitals?
Psoriasis can affect the genital area, causing discomfort and irritation. Managing genital psoriasis requires specialized treatments and good hygiene practices. 

What is the role of stress management in psoriasis treatment?
Managing stress through stress-reduction techniques, like relaxation exercises, therapy, and self-care, can help reduce the frequency and severity of psoriasis flare-ups.

Are there any support groups or communities for people with psoriasis?
There are numerous support groups and online communities where individuals with psoriasis can connect, share experiences, and gain support from others going through similar challenges.

Can psoriasis affect the eyes?
Sometimes, psoriasis can affect the eyes, leading to redness, dryness, and discomfort. Prompt evaluation and treatment by an eye specialist are crucial if eye symptoms occur.

Is there a link between psoriasis and heart disease?
Individuals with psoriasis may have an increased risk of heart disease and cardiovascular conditions. Regular cardiovascular screenings and a heart-healthy lifestyle are essential for healthy overall well-being.

Can certain foods trigger psoriasis?
While certain foods may trigger psoriasis flare-ups in some individuals, the impact of diet on psoriasis varies. Doctors recommend monitoring and identifying any potential trigger foods on an individual basis.

Can psoriasis be treated with over-the-counter creams?
Over-the-counter creams might work for mild psoriasis, but you should consult a healthcare provider for a proper diagnosis and treatment plan.

Can hormonal changes trigger psoriasis?
Hormonal changes, such as those occurring during puberty, pregnancy, or menopause, can influence psoriasis symptoms in some individuals. Close monitoring and proper management are crucial in these periods.

Can psoriasis affect self-esteem and body image?
Psoriasis can significantly impact self-esteem and body image because of visible skin changes. Therefore, seeking emotional support and practicing self-acceptance is essential for overall well-being.

Is it possible for psoriasis to go into remission?
Psoriasis can go into periods of remission, during which symptoms may be minimal or absent. However, regular monitoring and proper management are crucial to prevent flare-ups.