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PSORIASIS FAQ

What is psoriasis skin disease?
Psoriasis is a common, chronic inflammatory skin condition. The symptoms of psoriasis can either be permanent or relapsing (appearance of symptoms after a period of improvement). Some forms of psoriasis may develop into other forms of psoriasis over time.
What are the different types of psoriasis?
Psoriasis is subdivided into multiple forms known as plaque psoriasis, guttate psoriasis, pustular psoriasis, inverse psoriasis and erthyrodermic psoriasis. People can suffer from morethan one type of psoriasis.

  • Plaque psoriasis is the most common form of psoriasis (i.e. 90% of people with psoriasis suffer from plaque psoriasis).
  • Guttate psoriasis is the second most common form of psoriasis. This form of psoriasis develops after an upper respiratory infection like Strep throat and causes an abrupt onset of symptoms.
  • Pustular psoriasis is a form of psoriasis that is characterized by the presence of pustules or small bumps filled with pus.
  • Inverse psoriasis is a form of psoriasis that is characterized by the presence of smooth and red lesions instead of raised and scaling lesions that are characteristic of plaque psoriasis.This form of psoriasis affects the skin folds or flexures.
  • Erthyrodermic psoriasis is a rare form of psoriasis which is characterized by extensive skin
    redness and inflammation that resembles a sunburn.
Who is affected by psoriasis?
All forms of psoriasis can affect people at any age, however it is more common in adults. There are two common ages for the onset of psoriasis: age 30 to 39 and 50 to 69 years old. Guttate psoriasis typically occurs in childhood and adolescence. Men and women are equally affectedby psoriasis.
What are the symptoms of psoriasis? What does psoriasis look like?
Psoriasis looks different depending on the type of psoriasis. The symptoms of:

  • Plaque psoriasis are itching and well-defined areas of redness, dryness and silvery-white scaling known as a lesion or a plaque. The lesions have raised edges and may be painful. The size of the lesions vary from less than 1 cm to more than 10 cm.
  • Guttate psoriasis are itching and small (less 1 cm) drop-like plaques or lesions. This form of psoriasis often appears after an upper respiratory infection like a Streptococcus throat infection.
  • Pustular psoriasis are pustules or small bumps that are filled with pus.
  • Inverse psoriasis are smooth red lesions instead of raised and scaling lesions that are characteristic of plaque psoriasis.
  • Erthyrodermic psoriasis are extensive skin redness and inflammation that resembles a sunburn.

Psoriasis can also cause abnormalities in the nails such as pitting and abnormal colour. In some people suffering from psoriasis, there may be joint pain, swelling and stiffness. This is known as psoriatic arthritis.

Is psoriasis painful? Does psoriasis hurt?
Psoriasis can be painful or uncomfortable since there may be open sores or the sores can bleed because of persistent scratching or rubbing. For some people suffering from psoriasis, there may be joint involvement. Therefore, the joints may be stiff, swollen and painful.
Where can you get psoriasis? Where does psoriasis usually appear?
Psoriasis can appear on any skin surface. Typically, psoriasis affects the scalp, elbows, knees,and trunk area  including the chest and the lower back. Psoriasis can also affect the nail bed causing pitting and other nail abnormalities. The typical areas of the body affected by psoriasis is dependent on the type of psoriasis.

  • Plaque psoriasis typically affects the scalp, elbows and knees. Lesions may also appear in the ear canal, the soles of the feet, the palms and the nails. For plaque psoriasis, the plaques are usually symmetrically distributed on the body.
  • Guttate psoriasis typically affects the trunk (chest and back).
  • Inverse psoriasis typically affects the skin folds such as the genital area, between the buttocks, under the breasts and under the arms.
  • Erthyrodermic psoriasis affects the entire body (head to toe).
What causes psoriasis? How do you get psoriasis?
Psoriasis is a complicated disease, which is caused by the interaction of a variety of factors that are not fully understood. Research has shown that psoriasis is caused by genetic factors, environmental factors and a overactive immune system.

  • Psoriasis is hereditary meaning that the disease can be passed down from parents to their children.
    • People suffering from psoriasis have at least one family member that is affected by psoriasis.
  •  Research has shown that environmental factors and lifestyle choices such as smoking, alcohol use, obesity are associated with an increased risk of developing psoriasis.
  • The levels of immune cells known as Th17 and Th1 cells and proteins associated with inflammation are elevated at the site of the lesion or plaque, as well as systemically (whole body).
  • The inflammation associated with psoriasis causes the cells of the skin known as keratinocytes to rise to the surface and shed at approximately 10 times the normal rate (higher turnover) causing scaling.
Is psoriasis genetic?
Psoriasis is genetic, meaning that the disease can be passed down from the parents to their children.

  • Research has shown that people suffering from psoriasis have at least one family member that also has psoriasis.
  • Concordance studies with monozygotic or identical twins (twins share the same genetic material) shows that psoriasis has a concordance rate of approximately 0.7. This means that 70% of the identical twins used in the study both had psoriasis.
  • Genome wide association studies (GWAS) have identified genetic variations in genes related to the immune system that increase the risk of developing psoriasis. GWAS studies compare the genetic material of people with and without psoriasis to determine if there are variations in specific genes that may be associated with psoriasis.
What can trigger psoriasis?
The triggers that can cause the symptoms of psoriasis to appear or worsen are different for each person. However, the common triggers include:

  • Skin injury such as a cut, burn, insect bite, sunburn or bruise
  • Infection
  • Stress
  • Medications such as lithium, beta-blockers, anti-malarial drugs
  • Dry and cold weather
  • Lifestyle choices such as consuming alcohol, smoking or being overweight
Is psoriasis contagious?
Psoriasis is not contagious, therefore you can’t catch psoriasis by touching the affected skin area or you can’t pass it on to other people.
How is psoriasis diagnosed?
There is no clinical test to diagnose psoriasis. Therefore, a doctor will diagnose psoriasis based the shape and location of the rash as well your medical history. Sometimes, a skin biopsy is needed to rule out other diseases.
How are the severities of psoriasis determined?
The severities of psoriasis are determined based on the area of the skin that is covered in lesions or plaques. The area of the palm is considered 1% of the body.

  • For mild psoriasis, less than 3% of the body is covered in lesions or plaques.
  • For moderate psoriasis, between 3% and 10% of the body is covered in lesions or plaques.
  • For severe psoriasis, more than 10% of the body is covered in lesions of plaques.
Am I at risk of any other diseases if I have psoriasis?
Research has shown that people with psoriasis are at a higher risk of developing psoriatic arthritis, which cause joint pain, stiffness and back pain. People with psoriasis are at a higher risk of developing systemic diseases associated with chronic inflammation, lifestyle choices and adverse effects of the treatment such as cardiovascular disease, diabetes, hypertension and inflammatory bowel syndrome.
Is there a cure for psoriasis?
There is no cure for psoriasis, however there are treatments that are available that can manage the symptoms of psoriasis. Since there is no cure for psoriasis the symptoms may reappear after a period of improvement (i.e. after discontinuation of treatment).
What are the available treatments for psoriasis?
In general, the main goal of the treatments for managing the symptoms of psoriasis will be to reduce the turnover of the skin cells, to reduce inflammation of the affected areas, suppressing the immune system. It is also important to avoid the triggers that causes the symptoms of psoriasis to appear or worsen.

The treatments for psoriasis may be topical (i.e. cream) or oral (i.e. pill) or injection or infusion depending on the severity of the disease. The topical treatment can come in different vehicles such as gels, foams, lotions and sprays for easy applications, especially for psoriasis on the scalp.

The treatments differ for people suffering from mild, moderate or severe psoriasis.

How is mild to moderate psoriasis treated?
For mild to moderate psoriasis, a combination of the following non-prescription and prescription treatments are used:

Non-prescription

  • Emollients such as petroleum jelly and thick creams for dry skin
  • Coal tar to reduce inflammation

Prescription medicine

  • Topical steroids to reduce inflammation of the affected area
  • Different potency and different forms may be prescribed depending on the areas
    affected by psoriasis
  • Topical vitamin D3 analogues such as calcipotriene to reduce the proliferation of keratinocytes
  • Topical retinoids
  • Calcineurin inhibitors
  • Anthralin
How is severe psoriasis treated?
For severe psoriasis, the following treatments are used in addition to the treatments for mild to moderate psoriasis. These treatments are strong and are only used if the topical treatments used for mild to moderate psoriasis don’t work. The treatment for severe psoriasis includes a combination of:

Prescription medicine:

  • Systemic immunosuppressants such as methotrexate and cyclosporine.
  • Systemic retinoids
  • UV phototherapy to reduce inflammation
  • Biologics that block specific molecules that contribute to inflammation such as infliximab and adalimumab
  • Phosphodiesterase 4 inhibitor to reduce inflammation
What are the complications of suffering from psoriasis? Is psoriasis dangerous?
If the symptoms of psoriasis go untreated, then there is a risk of developing a skin infection due to the broken skin barrier caused by scratching allowing bacteria to penetrate. Erthyrodermic psoriasis may be dangerous since the generalized skin inflammation can cause the skin to lose vital functions such as controlling body temperature and protecting against infectious organisms (i.e. bacteria).
What is the difference between psoriasis and eczema?
Both psoriasis and eczema are chronic inflammatory skin diseases but they differ in the appearance and location of the rash or lesions. Also, eczema is more common in children, whereas psoriasis is more common in adults.

Additional Resources
1. Canadian Dermatology Association: https://dermatology.ca/public-patients/skin/psoriasis/
2. American Academy of Dermatologists: https://www.aad.org/public/diseases/scaly-skin/psoriasis
3. National Psoriasis Foundation: https://www.psoriasis.org
4. Psoriasis Speaks: https://www.psoriasis.com/psoriasis-severity



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