The Facts About Psoriasis

Psoriasis, an inflammatory skin condition that causes flaky skin patches and scales, affects more than 3 percent of American adults, or about 7.5 million people, according to the National Psoriasis Foundation.

There are five different types of psoriasis:

1. Erythrodermic psoriasis
2. Inverse psoriasis
3. Guttate psoriasis
4. Plaque psoriasis
5. Pustular psoriasis

You can have more than one type of psoriasis at a time. The condition can affect any part of the body but is commonly seen on the genitals, scalp, hands, feet, nails, face, elbows, knees and skinfolds.

Psoriasis affects men and women of all ages equally but most often develops in adults ages 20 to 30 and 50 to 60.

Scientists don't know exactly what causes psoriasis, but it's thought to be related to a problem with the immune system. In people who have psoriasis, the immune system attacks healthy skin cells by mistake, which triggers the body to produce more skin cells.

Skin cells are normally made and replaced every three to four weeks. In a person with psoriasis, though, this process happens every three to seven days, which means skin cells build up and cause patches and scales. Triggers for psoriasis can initiate or worsen the condition. These triggers include:

• Stress
• Hormonal changes
• Illness
• Smoking
• Excessive alcohol
• Skin injury
• Immune disorder
• Certain medications

The main symptom of psoriasis is flaky, dry and scaly skin patches. These patches might appear pink, red, purple or dark brown, and the scales can be white, gray or silvery.

The skin plaques can be itchy, sore or both, and they may crack and bleed. Depending on the location of psoriasis, it can also cause complications such as hair loss or nail loss. One in 3 people with psoriasis also develop psoriatic arthritis.

Psoriatic arthritis affects about 30 percent of people with psoriasis. It can develop anytime, but most commonly occurs about a decade after psoriasis symptoms appear, and usually in people ages 30 to 50.

It causes chronic inflammation in the joints and entheses, the places where tendons and ligaments connect to bone, and also affects the skin.

Symptoms of psoriatic arthritis include:

• Fatigue
• Joint pain
• Joint swelling (in particular, swollen fingers and toes that can look like sausages)
• Morning joint stiffness
• Nail changes, such as thickening, ridging, crumbling, color or nail loss
• Problems such as Achilles tendinitis or plantar fasciitis due to inflammation of the entheses
• Redness and pain in the eye
• Reduced range of motion
• Skin plaques (the same as in psoriasis)

If you are diagnosed with psoriatic arthritis, you need to see a rheumatologist. This specialist is trained in the diagnosis and treatment of diseases that affect bones, ligaments, joints, muscles and tendons, and can coordinate your care and offer advice on treatment.

There is no singular test for psoriasis, but your healthcare provider can make a clinical diagnosis. A dermatologist—a specialist trained in the diagnosis and treatment of conditions that affect the hair, nails and skin—usually makes the diagnosis by examining your body for any areas of psoriasis.

They also take a history of symptoms and joint problems, and a family history, and ask about any recent lifestyle changes that could be potential triggers. Sometimes, a small skin biopsy may be sent to a laboratory for examination, but this is very rare.

The most significant risk factor for developing psoriasis is a family history of the condition. About 1 in 3 people with psoriasis have a relative who has it. You have a 10 percent chance of developing psoriasis if one parent has it and a 50 percent chance if both parents have it. However, the exact role genetics plays in psoriasis is unclear, and you may not get it even if it runs in your family.

Treatment for psoriasis falls into three main categories:

1. Phototherapy. This is the use of artificial ultraviolet light therapy on your skin.
2. Systemic medications. These can be taken orally or injected and work throughout the body. Medications include methotrexate, ciclosporin, acitretin, apremilast and dimethyl fumarate.
3. Topical treatments. Steroid creams, emollients, vitamin D analog creams, calcineurin inhibitor creams, coal tar oil and dithranol can be applied to your skin.

Some people also turn to complementary or integrative medicine to help manage symptoms of psoriasis.

People with psoriasis can have problems with self-confidence and body image. Getting naked when you have psoriasis might make you feel uncomfortable, especially if you have genital psoriasis.

A lot of misinformation claims psoriasis is contagious. It isn't. There's also misinformation that it's a sexually transmitted disease (STD). It is not.

Communicating with your partner about your psoriasis before sex can help make it less of a challenge and a more pleasurable experience. Sharing your concerns may also bring you closer together, building trust and intimacy. You also need to find lubricants and condoms that don't irritate your skin and make your psoriasis worse, so you can avoid flare-ups after sex.

Up to two-thirds of people with psoriasis experience genital psoriasis. It can appear on the vulva, penis, anus, scrotum, pubis and thighs, and between the buttocks. Often, genital psoriasis does not have the same scaly plaque appearance as psoriasis in other areas. It tends to look red and shiny without the scales on top.

Genital psoriasis can be challenging to treat and control, but your doctor can guide you on the best treatments for the condition and how to use them around these delicate areas.

Psoriasis causes systemic inflammation, and research suggests it could impair male fertility. A 2017 study published in the journal Dermatology found participants with psoriasis had a significant decrease in testosterone and sex hormone-binding globulin.

Researchers concluded that psoriasis might impair male fertility due to the impact of systemic inflammation on hormones. But psoriasis can be triggered by myriad factors, such as stress, smoking, illness and medications, that might also impact fertility.

Psoriasis is an autoimmune disease, which means the immune system becomes overactive and attacks normal tissues in the body. Many people with autoimmune conditions experience one or more food intolerances or sensitivities, and some people with psoriasis find specific foods can be a trigger. It is advisable to keep a "food and symptom diary" and to cut out any foods you recognize as triggers for your symptoms.

There is no one diet to cure autoimmune diseases. However, nutrition is a vital part of reaching optimal health. The Mediterranean diet is often recommended for people with an autoimmune disease, as it is packed with whole foods and good fats and is recognized to be anti-inflammatory and nutrient-dense.

What causes psoriasis?

The cause of psoriasis remains unclear, but you are most likely to develop psoriasis if it runs in your family. Triggers that can initiate or worsen psoriasis include stress, hormonal changes, illness, smoking, excessive alcohol, skin injury, immune disorder and certain medications.

Is psoriasis contagious?

No, psoriasis is not contagious. You cannot spread it from person to person. It is also not classified as a sexually transmitted disease or infection (STD/STI).

Can psoriasis be cured?

There is no cure for psoriasis, but effective treatments can help keep it under control. Research is constantly advancing, and many people can get clear skin using prescribed medicines.