Today is World Psoriasis Day

Psoriasis

A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis.

What exactly is psoriasis?

Let’s start with what it’s not. It’s not contagious and it’s not just a skin disease. Psoriasis is a chronic skin condition. The exact cause is unknown; however, researchers believe that psoriasis has hereditary and environmental components and is mediated by the immune system.

Normally, skin cells that are formed in the deepest layers of your skin make their way to the surface. They mature, are sloughed off the body’s surface, and replaced with new skin cells from below. This cycle takes approximately a month.

In people with psoriasis, however, once the immune system is accidentally activated, an abnormally rapid skin cell cycle occurs. This means the cells move from the deepest layers of your skin to the surface in about four days. Since the cells move to the surface so quickly, they don’t have time to properly mature. Instead, they accumulate on the skin's surface, forming raised, red patches or “lesions.”

Psoriasis symptoms

While plaque psoriasis is the most common type of psoriasis, the disease appears in a variety of forms that can occur on different parts of the body. Each has a unique set of symptoms.

Plaque psoriasis (psoriasis vulgaris)

Plaque Psoriasis is the most common form of psoriasis and affects 90% of people with the disease. Psoriasis vulgaris appears as dry, slightly elevated, red patches, known as plaques, which are covered with a layer of silvery white scales. They tend to start out as small bumps that grow together and are typically found on the elbows, knees, scalp and buttocks.

If you have plaque psoriasis, you may also experience changes to your toenails and fingernails – in fact, this occurs in about half of people with psoriasis. There are four changes to be aware of: pitting, thickening, discoloration and loosening of the nail from the nail bed.

Although the cause of plaque psoriasis is unknown, it is believed that hereditary factors, environmental factors and the immune system all play important roles.

There are a variety of treatments for plaque psoriasis. Some are available over the counter at your local drugstore; others are available only by prescription. Unfortunately, no one treatment works for everyone. The best approach is to talk to your dermatologist about your treatment options, and then you and your dermatologist can decide together which one may be right for you.

Guttate psoriasis

Guttate psoriasis appears as small, pinkish dots that can spread to cover large areas of the upper body, legs and arms. This type of psoriasis commonly appears in adolescence. It often occurs suddenly and sometimes in response to a respiratory infection such as a streptococcal infection (“strep throat”).

Inverse psoriasis

This form of psoriasis appears in the folds of the skin as smooth, red, dry patches without the scale found in plaque psoriasis. It may also be accompanied by itching. Inverse psoriasis may appear in the genital area as well as under the breasts and in the armpits.

Pustular psoriasis

Pustular psoriasis appears as small, white, fluid-filled blisters (pustules) surrounded by swollen, reddish skin. It tends to appear primarily on the palms and soles of the feet. While these localized lesions are difficult to treat, they pose no real threat to the body. However, pustular psoriasis that covers the entire body can result in fever, fluid imbalances and infection. The majority of people with the more generalized form of this psoriasis need to be hospitalized.

Palmo-plantar pustulosis

One type of pustular psoriasis is known as palmo-plantar pustulosis. Small pustules form on the palms of the hands and the soles of the feet. The pustules appear within the plaques and eventually turn a brownish colour, peel and develop a crusty surface.

Once established, it may last for decades. Significant morbidity can impair dexterity or mobility, and cause pain, pruritus and embarrassment

Erythrodermic psoriasis

This form of psoriasis occurs sporadically, often covering almost the entire body. The skin appears bright red with extensive scaling. It can be quite painful and severe itching may also be present.

Because symptoms are widespread over the body, this form can be extremely serious. If you have a flare-up of this type of psoriasis, you should see your doctor immediately. The resulting protein, fluid loss, and decrease in body temperature can lead to severe, life-threatening illness and may require hospitalization

Scalp psoriasis

Plaque psoriasis of the scalp is one of the more common forms of the disease, affecting at least half of all people who have psoriasis. Plaques appear on the scalp and may spread to the ears, forehead and the back of the neck. Hair loss may result in severe cases where the entire scalp is covered. Plaque psoriasis of the scalp can occur without the appearance of plaques on the rest of the body.

Nail psoriasis

Psoriasis affects the fingernails in approximately 50% of people with psoriasis, and approximately 35% in the toenails. Nail changes vary, but the most common are

• Severe thickening of the nail
• Shallow or deep holes (pits) in the nail
• Nail discoloration, such as yellow-brown
• Nail separation from the nail bed

Psoriatic arthritis: a related condition

Seven to 42% of people with psoriasis have psoriatic arthritis, an inflammatory disease that affects both the skin and the joints. Skin symptoms usually appear before the joint symptoms which typically affect the tendons and ligaments surrounding the bones of the knees, lower back, fingers, toes or a number of other joints. The "hinge" joints of the hands and feet may also become swollen and stiff, taking on a sausage-like appearance, resulting in tendonitis.

While the skin symptoms and the joint symptoms frequently appear at different times, often years apart, psoriasis is usually diagnosed first. The skin lesions have a distinct, raised border and are bright red and covered in a silvery white scale. Other symptoms may include pitting and ridges in the fingernails and toenails. Both dermatologists and rheumatologists (doctors who specialize in joint disease) treat psoriatic arthritis; however, each focuses on different aspects of the disease. Dermatologists focus primarily on evaluating and treating disorders of the skin, nails and hair. Rheumatologists specialize in treating patients with arthritis.

Causes of psoriasis

Over time, our understanding of psoriasis has changed. Long considered a skin disease, increasing attention and scientific information has indicated that psoriasis has genetic and environmental components and is mediated by the immune system. Researchers believe that the disease may occur when your immune system (your natural protection against bacteria, viruses, and other foreign invaders) is accidentally activated, triggering an acceleration of the normal skin cell cycle. This in turn causes an accumulation of skin cells on the surface of the skin.

While no one knows what triggers this response, heredity plays a part in it. If you have one parent with psoriasis, you have a 25% chance of getting it too. If both your parents have it, your chances are more than 50%.

On the other hand, some people with no detectable family history have psoriasis. There are various environmental factors, such as stress, injury to the skin, etc. that can trigger psoriasis. For this reason, it is believed that both genetic and non-genetic factors may cause the disease.

Diagnosing psoriasis

The classic symptoms of psoriasis are thick, raised red patches of skin covered with a dry, silvery white build-up of scales. The patches can appear anywhere on the body. While a doctor can diagnose psoriasis, it is typically done by a dermatologist – a physician who specializes in diagnosing and treating conditions that affect the skin.

Psoriasis can have a large impact on your quality of life. Knowing how various areas of your life and daily routine have changed since you began experiencing symptoms may be helpful for your doctor to determine the severity of your psoriasis.

Who gets psoriasis?

If you have psoriasis, you’re not alone. Research indicates that up to 10 million people in North America have psoriasis (1-3% of the population). It affects men and women at equal rates, affects all age groups, and is most common in people of European ancestry.

I suffer from Palmo-plantar pustulosis, mainly on my feet. At first I thought I had chronic athlete’s foot but when it spread to my hands, I went to see a dermatologist.  I guess I am one of the fortunate ones that do not have it all over my body.  With the correct treatment I keep it under control and the main discomfort is wearing socks all the time due to the paraffin base ointment that I need to apply.

You can visit psoriasis.org for more information.

When we visit with Congressional offices, we are told again and again about the historic doubling of biomedical research funding that has occurred in the last decade. But for the as many as 7.5 million Americans with psoriasis, this doubling of funding at NIH is a cruel joke, because psoriasis research has actually been decimated during this time. People with psoriasis, and their loved ones, must step up and make their voices heard to get this reversed, or this incurable and often debilitating disease will continue to devastate lives for generations to come.

Michael Paranzino