Psoriasis

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Images of Psoriasis

Overview

Psoriasis is a non-contagious, lifelong skin problem with thickened, red, and often scaly skin. It is very likely to be hereditary (run in families) and seems to be caused by errors in how the immune system works. Certain substances and situations (triggers) may cause psoriasis to flare or worsen. Triggers include injury to the skin, HIV/AIDS infection, certain drugs, emotional stress, smoking, and alcohol consumption. Psoriasis may also be triggered by infection with a type of bacteria called Streptococcus.

Who's at risk?

Psoriasis is common, and it is estimated that 1–2% of the US population has this condition. Psoriasis can develop at any age, but it is not common in infants. About 10–15% of those affected start showing signs of the disease before age 10. About 10–30% of people with psoriasis also develop arthritis.

Psoriasis is about 3 times more common in whites compared with African Americans, and it often runs in families. Psoriasis affects males and females fairly equally, with females tending to start showing signs at a younger age than males.

Signs and Symptoms

Psoriasis usually affects the elbows, knees, buttocks, scalp, and genitals; areas of rubbing or friction are particularly likely to develop lesions.

Red or salmon-red, raised areas often have silvery-white or grayish-white scale. Moist areas (such as body folds) may not be scaly.

People with related arthritis may have swelling and pain in the joints (often fingers or toes) or tendons.

The nails may be affected in psoriasis, causing pitting, "oil spots" (yellowish-brown discoloration of nail plate), and lifting of the nail plate from the nail bed (onycholysis).

Psoriasis can be graded as:

  • Mild – Few, scattered, small areas of involvement
  • Moderate – More widespread disease affecting larger areas, sometimes affecting the joints
  • Severe – Most of the skin surface is affected, sometimes affecting the joints

Self-Care Guidelines

For mild and moderate psoriasis:

  • Have your child bathe daily to help remove scale and moisten the skin. Avoid harsh soaps; soap-substitutes are milder for your skin.
  • Apply moisturizers to all scaly psoriasis patches after any water exposure or bathing. Heavier, oilier moisturizers help to retain water in the skin better than lighter moisturizers.
  • Apply hydrocortisone cream (0.5 or 1%), available over the counter, to help reduce itch and redness.
  • Use coal tar products, available over the counter as a shampoo, oil, gel, or cream. This is an old form of therapy, which can help, but it has a mild odor.
  • Use products with salicylic acid (shampoos, cleansers, and ointments) to help with removal of heavy scale.
  • Be sure your child follows a healthy diet and stays at the right weight. (Being overweight may make psoriasis worse.)

Small doses of natural sunlight may be helpful, such as 10–15 minutes 2 or 3 times a week. Avoid too much sun, however, and protect your child's healthy skin from sun exposure.

When to Seek Medical Care

See your child's doctor for evaluation if he or she has severe psoriasis or if self-care measures are not helpful. Also, see your child's doctor if his or her psoriasis worsened or appeared after a sore throat; psoriasis can be triggered by a strep infection.

Treatments Your Physician May Prescribe

Unfortunately, there is no cure for psoriasis, but multiple treatments are very helpful at controlling it.

For disease that affects only the skin (localized disease), topical treatments may be prescribed:

  • Mid-to-high-potency topical steroids for the body or scalp and low-strength topical steroids for the face and skin fold areas as needed. Stretch marks and thinning of the skin can result from overuse of topical steroids, particularly in skin fold areas.
  • Vitamin D creams may be prescribed and are sometimes combined with topical steroids.
  • Vitamin A-based creams may be prescribed, sometimes in combination with topical steroids.
  • Calcineurin inhibitors (tacrolimus, pimecrolimus) may be prescribed.
  • Tar-based therapies are sometimes used. These therapies may have a foul odor and cause irritation in some people.
  • Anthralin creams may be prescribed, but these may stain skin and cause irritation.
  • For the scalp, oils, gels, foams, or solutions, some of which include topical steroids, are used in combination with tar or salicylic acid shampoos.

For more extensive disease:

  • Ultraviolet light therapy (phototherapy) may be considered.
  • Oral medications may be used, including acitretin (made from Vitamin A), methotrexate, mycophenolate mofetil, cyclosporin A, and tacrolimus. These medications require close monitoring and may have potentially serious side effects.
  • Newer medications that affect the immune system may be injected at home, and other injected (intravenous) medications given in a medical facility are also available. Medications include etanercept, infliximab, adalimumab, alefacept, and felvizumab. These are very costly and may have serious side effects.

Trusted Links

National Psoriasis FoundationClinical Information and Differential Diagnosis of Psoriasis

References

Bolognia, Jean L., ed. Dermatology, pp.125-146. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.407, 1393-1394. New York: McGraw-Hill, 2003.