a chronic, autoimmune disease that appears on the
skin. It occurs when the immune system sends out
faulty signals that speed up the growth cycle of
skin cells. Psoriasis is not contagious.
There are five types
of psoriasis: plaque, guttate, inverse,
pustular and erythrodermic. The most common form,
plaque psoriasis, appears as raised, red
patches or lesions covered with a silvery white
build-up of dead skin cells, called scale.
Psoriasis can occur on any part of the body
and is associated with other serious health
conditions, such as diabetes, heart disease and
appears in a variety of forms with distinct
characteristics. Typically, an individual has only
one type of psoriasis at a time. Generally,
one type of psoriasis will clear and
another form of psoriasis will appear in
response to a trigger.
Plaque Psoriasis -
(psoriasis vulgaris) is the most prevalent
form of the disease. About 80 percent of those who
have psoriasis have this type. It is
characterized by raised, inflamed, red lesions
covered by a silvery white scale. It is typically
found on the elbows, knees, scalp and lower back.
Guttate Psoriasis -
psoriasis is a form of psoriasis
that often starts in childhood or young adulthood.
The word guttate is from the Latin word meaning
"drop." This form of psoriasis appears as small,
red, individual spots on the skin. Guttate lesions
usually appear on the trunk and limbs. These spots
are not usually as thick as plaque lesions.
often comes on quite suddenly. A variety of
conditions can bring on an attack of guttate
psoriasis, including upper respiratory
infections, streptococcal throat infections (strep
throat), tonsillitis, stress, injury to the skin
and the administration of certain drugs including
antimalarials and beta-blockers.
Inverse Psoriasis -
is found in the armpits, groin, under the breasts,
and in other skin folds around the genitals and
the buttocks. This type of psoriasis
appears as bright-red lesions that are smooth and
shiny. Inverse psoriasis is subject to irritation
from rubbing and sweating because of its location
in skin folds and tender areas. It can be more
troublesome in overweight people and those with
deep skin folds.
Pustular Psoriasis -
Primarily seen in adults, pustular psoriasis is
characterized by white blisters of noninfectious
pus (consisting of white blood cells) surrounded
by red skin. There are three types of pustular
Pustular psoriasis may be localized to
certain areas of the body, such as the hands and
feet, or covering most of the body. It begins with
the reddening of the skin followed by formation of
pustules and scaling.
psoriasis may be triggered by internal
medications, irritating topical agents,
overexposure to UV light, pregnancy, systemic
steroids, infections, stress and sudden withdrawal
of systemic medications or potent topical
Erythrodermic Psoriasis -
psoriasis is a particularly inflammatory form of
psoriasis that affects most of the body
surface. It may occur in association with von
Zumbusch pustular psoriasis. It is
characterized by periodic, widespread, fiery
redness of the skin and the shedding of scales in
sheets, rather than smaller flakes. The reddening
and shedding of the skin are often accompanied by
severe itching and pain, heart rate increase, and
fluctuating body temperature.
Psoriasis of a
the symptoms of erythrodermic psoriasis
flare should go see a doctor immediately.
Erythrodermic psoriasis causes protein and
fluid loss that can lead to severe illness. The
condition may also bring on infection, pneumonia
and congestive heart failure. People with severe
cases of this condition often require
Known triggers of
erythrodermic psoriasis include the abrupt
withdrawal of a systemic psoriasis treatment
including cortisone; allergic reaction to a drug
resulting in the Koebner response; severe
sunburns; infection; and medications such as
lithium, anti-malarial drugs; and strong coal tar
Causes of psoriasis
No one knows exactly
what causes psoriasis. However, it is
understood that the immune system and genetics
play major roles in its development. Most
researchers agree that the immune system is
somehow mistakenly triggered, which causes a
series of events, including acceleration of skin
cell growth. A normal skin cell matures and falls
off the body in 28 to 30 days. A skin cell in a
patient with psoriasis takes only 3 to 4
days to mature and instead of falling off
(shedding), the cells pile up on the surface of
the skin, forming psoriasis lesions.
that at least 10 percent of the general population
inherits one or more of the genes that create a
predisposition to psoriasis. However, only
2 percent to 3 percent of the population develops
the disease. Researchers believe that for a person
to develop psoriasis, the individual must
have a combination of the genes that cause
psoriasis and be exposed to specific external
factors known as “triggers.”
Learn more about genetic
and immune system involvement in psoriasis
and psoriatic arthritis.
triggers are not universal. What may cause one
person’s psoriasis to become active, may
not affect another. Established psoriasis
Stress can cause
psoriasis to flare for the first time or
aggravate existing psoriasis. Relaxation and
stress reduction may help prevent stress from
Injury to skin
appear in areas of the skin that have been injured
or traumatized. This is called the Koebner [KEB-ner]
phenomenon. Vaccinations, sunburns and scratches
can all trigger a Koebner response. The Koebner
response can be treated if it is caught early
are associated with triggering psoriasis,
Lithium: Used to
treat manic depression and other psychiatric
disorders. Lithium aggravates psoriasis in about
half of those with psoriasis who take it.
Antimalarials: Quinacrine, chloroquine and
hydroxychloroquine may cause a flare of psoriasis,
usually 2 to 3 weeks after the drug is taken.
Hydroxychloroquine has the lowest incidence of
Inderal: This high blood pressure medication
worsens psoriasis in about 25 percent to 30
percent of patients with psoriasis who take it. It
is not known if all high blood pressure (beta
blocker) medications worsen psoriasis, but they
may have that potential.
Quinidine: This heart medication has been reported
to worsen some cases of psoriasis.
Indomethacin: This is a nonsteroidal
anti-inflammatory drug used to treat arthritis. It
has worsened some cases of psoriasis. Other anti-inflammatories
usually can be substituted. Indomethacin's
negative effects are usually minimal when it is
taken properly. Its side effects are usually
outweighed by its benefits in psoriatic arthritis.
scientifically unproven, some people with
psoriasis suspect that allergies, diet and weather
trigger their psoriasis. Strep infection is known
to trigger guttate psoriasis.
one of the most prevalent autoimmune diseases in
According to the
National Institutes of Health (NIH), as many as
7.5 million Americans—approximately 2.2 percent of
the population--have psoriasis.
125 million people
worldwide—2 to 3 percent of the total
Studies show that
between 10 and 30 percent of people with
psoriasis also develop psoriatic arthritis.
prevalence in African Americans is 1.3 percent
compared to 2.5 percent of Caucasians.1
Quality of life related to
not a cosmetic problem. Nearly 60 percent of
people with psoriasis reported their
disease to be a large problem in their everyday
Nearly 40 percent
with psoriatic arthritis reported their
disease to be a large problem in everyday life.3
moderate to severe psoriasis experienced a
greater negative impact on their quality of life.4
has a greater impact on quality of life in women
and younger patients.4
Age of onset related to
often appears between the ages of 15 and 25, but
can develop at any age.
usually develops between the ages of 30 and 50,
but can develop at any age.
Severity of psoriasis
National Psoriasis Foundation defines mild
psoriasis as affecting less than 3 percent of the
body; 3 percent to 10 percent is considered
moderate; more than 10 percent is considered
severe. For most individuals, the palm of the hand
is about the same as 1 percent of the skin
surface. However, the severity of psoriasis is
also measured by how psoriasis affects a person's
quality of life.
Nearly one-quarter of people with psoriasis
have cases that are considered moderate to severe.
Genetic aspects of psoriasis
About one out of three people with psoriasis
report having a relative with psoriasis.
If one parent has psoriasis, a child has
about a 10 percent chance of having psoriasis. If
both parents have psoriasis, a child has
approximately a 50 percent chance of developing
concerns associated with psoriasis
and psoriatic arthritis
psoriasis are at an elevated risk to develop
other chronic and serious health conditions also
known as "comorbid diseases" or "comorbidities."
These include heart disease, inflammatory bowel
disease and diabetes. People with more severe
cases of psoriasis have an increased
incidence of psoriatic arthritis, cardiovascular
disease, hypertension, diabetes, cancer,
depression, obesity, and other immune-related
conditions such as Crohn's disease1.
An October 2006
study confirmed the increased risk of
cardiovascular disease for psoriasis
patients, especially those with severe
psoriasis in their 40s and 50s. Psoriasis
patients should examine their modifiable risk
factors—for example, quit smoking, reduce stress
and maintain a normal weight.
cause considerable emotional distress for
patients, including decreased self-esteem, and an
increased incidence of mood disorders, such as
depression. One study estimates that approximately
one-fourth of psoriasis patients suffer
from depression. Learn more about the risk for
A number of studies
have found an increased risk of certain types
of cancer in psoriasis patients, such
as a form of skin cancer known as squamous cell
carcinoma and lymphoma. In some instances, these
cancers have been associated with specific
psoriasis treatments which suppress the immune
system. Patients should follow recommended regular
health screenings for cancer and avoid high risk
Psoriasis Foundation Medical Board urges
psoriasis patients to work with their doctors
to outline an appropriate preventative program
based on individual medical histories and known
risk factors to ensure they are continually
monitoring for the potential onset of any health
issues related to psoriasis.
Conception and pregnancy
psoriasis does not affect the male or female
reproductive systems. However, many psoriasis
treatments require special precautions before and
during pregnancy. It is important to consult with
your doctor to verify your psoriasis
treatments are safe for pregnancy and nursing.
How psoriasis changes during
Some women see an
improvement in the severity of their psoriasis
during pregnancy, while others report their
psoriasis gets worse. Changes in severity of
psoriasis vary by individual and from
pregnancy to pregnancy.
Psoriatic arthritis and
should be limited during conception and pregnancy,
this may be impossible for those who have psoriatic
arthritis. Some pain medications can be used
safely during pregnancy. Talk with your doctor
about all over-the-counter and prescription
medications you take before conception, during
pregnancy and while nursing.
Genetic aspects of psoriasis
believed to be a genetic disease, but it
does not follow a typical dominant or recessive
pattern of inheritance. No one can predict who
will get psoriasis as researchers do not
completely understand how psoriasis is
passed from one generation to another. The pattern
of inheritance probably involves multiple genes or
combinations of many genes, and the search is on
to find those genes.
About one out of
three people with psoriasis report that a
relative has or had psoriasis. If one
parent has psoriasis, a child has about a
10 percent chance of having psoriasis. If
both parents have psoriasis, a child has
approximately a 50 percent chance of being
diagnosed with the disease.
Studies of identical
twins with psoriasis show that psoriasis
is at least partially genetic. But those same
studies also reinforce the complexity of
psoriasis. In about one-third of identical
twin pairs where psoriasis is present, only
one twin has the disease, indicating that
environmental factors or “triggers” play a
role in who develops psoriasis. The theory
that psoriasis is triggered by a
combination of genes and external forces is called
"multifactorial inheritance." Once the genes
responsible for psoriasis are discovered,
the inheritance pattern may be better understood.
Many people with
psoriasis report facing discrimination in
public places such as swimming pools, hair salons
and gyms because others fear psoriasis is
contagious. Fortunately, there are federal laws
designed to protect you from discrimination. When
it comes to challenging discrimination, you are
your own best advocate.
Accessing health care
As with most
chronic, autoimmune diseases, psoriasis and
psoriatic arthritis require ongoing treatment. In
order to best manage your condition, it is
important to see a doctor regularly who
specializes in treating psoriasis and/or
health care system and applying for disability are
not always easy, so we've compiled this list of
resources for you to help you access the care
you need to get—and stay—healthy with a
About psoriasis in children
a genetic skin disease associated with the immune
system. The immune system causes skin cells to
reproduce too quickly. A normal skin cell matures
and falls off the body’s surface in 28 to 30 days.
However, skin affected by psoriasis takes
only three to four days to mature and move to the
surface. Instead of falling off (shedding), the
cells pile up and form lesions. The skin also
becomes very red due to increased blood flow.
Who is affected?
The disease affects
as many as 7.5 million people in the U.S, about
2.6 percent of the population. Psoriasis
occurs nearly equally in men and women across all
socioeconomic groups. It occurs in all races,
though Caucasians are slightly more affected.
have their first outbreak between the ages of 15
and 35, but it can appear at any age.
Approximately one-third of those who get
psoriasis are under 20 years old when the
disease first surfaces.
Every year, roughly
20,000 children under 10 years of age are
diagnosed with psoriasis. Sometimes it is
misdiagnosed because it is confused with other
skin diseases. Symptoms include pitting and
discoloration of the nails, severe scalp scaling,
diaper dermatitis or plaques similar to that of
adult psoriasis on the trunk and
extremities. Psoriasis in infants is
uncommon, but it does occur. Only close
observation can determine if an infant has the
Cause of Psoriasis
No one knows exactly
what causes psoriasis, but it has a genetic
component. Most researchers agree that the immune
system is somehow mistakenly triggered, which
speeds up the growth cycle of skin cells.
that for a person to develop psoriasis,
certain steps must happen. The individual must
receive a combination of different genes that work
together to cause psoriasis. The individual
must then be exposed to specific factors that can
trigger his or her particular combination of genes
to cause the disease. These triggers are not yet
fully understood or defined; however, certain
types of infection and stress have been identified
as potential triggers.
If one parent has
the disease, there is about a 10 percent chance of
a child contracting it. If both parents have
psoriasis, the chance increases to 50 percent.
No one can predict who will get psoriasis.
Scientists now believe that at least 10 percent of
the general population inherits one or more of the
genes that create a predisposition to psoriasis.
However, only 2 to 3 percent of the population
develops the disease.
Some young people
report the onset of psoriasis following an
infection, particularly strep throat. One-third to
one-half of all young people with psoriasis
may experience a flare-up two to six weeks after
an earache, strep throat, bronchitis, tonsillitis
or a respiratory infection.
Areas of skin that
have been injured or traumatized are occasionally
the sites of psoriasis, know as the
“Koebner [keb-ner] phenomenon.” However, not
everyone who has psoriasis develops it at
the site of an injury.
The cause of psoriasis is
not known, but it is believed to have a genetic
component. Factors that may aggravate psoriasis
include stress, excessive alcohol
consumption, and smoking. There
are many treatments available, but because of its
chronic recurrent nature psoriasis is a
challenge to treat.
Psoriasis is a chronic relapsing disease of
the skin, which may be classified into nonpustular
and pustular types as follows:
vulgaris (Chronic stationary psoriasis,
erythroderma (Erythrodermic psoriasis)
pustular psoriasis (Pustular psoriasis of von
palmaris et plantaris (Persistent palmoplantar
pustulosis, Pustular psoriasis of the Barber
type, Pustular psoriasis of the extremities)
Additional types of
- The National
National Psoriasis Foundation