What is Psoriasis? Symptoms, Causes, Treatments, and Medications

Psoriasis, a chronic autoimmune skin condition, presents in several forms and varying degrees of severity. Characterized by red, itchy, and scaly patches, psoriasis extends beyond a simple skin issue, influencing daily activities and mental well-being. The unpredictable nature of flare-ups and persistent symptoms can make management challenging for those affected.

This blog will explain triggers, symptoms, and the potential treatment options available through professional dermatological care. 

What is psoriasis?

While research continues to unfold the exact cause of psoriasis, it is believed to have a combination of genetic, immune, and environmental factors. Psoriasis is a chronic inflammatory disorder that occurs when the body’s immune system mistakenly attacks healthy cells. In the case of psoriasis, this immune misfire speeds up the skin cell growth process. Normally, skin cells grow and shed over a month. However, in psoriasis, this cycle is drastically accelerated to just a few days, causing cells to build up rapidly on the surface of the skin.

These changes result in the most common form of psoriasis, known as plaque psoriasis, which appears as raised, red to violet-patches that are often covered with a silvery-white buildup of dead skin cells or scale. These patches or plaques can be itchy and painful and crack and bleed. While psoriasis can occur on any part of the body, it’s most commonly found on the scalp, elbows, knees, and lower back.

Like eczema, psoriasis tends to be exacerbated by winter. This is partially due to cold, dry air and reduced exposure to vitamin D-rich sunlight, which can help reduce the skin growth psoriasis causes.

Symptoms of psoriasis

Psoriasis symptoms can vary depending on the type of psoriasis and the severity of the outbreak. Common signs include:

• Plaques of red to violet skin, often covered with loose, silver-colored scales; these lesions may be itchy and painful and sometimes crack and bleed.
• Disorder in nail growth such as pitting, discoloration, thickening, or detachment from the nail bed.
• Scalp psoriasis can appear as a single patch or can cover the entire scalp.
• Joint pain, stiffness, or swelling can indicate psoriatic arthritis, a related condition affecting up to 30% of individuals with psoriasis.

These symptoms can be permanent or come and go in cycles, flaring for a few weeks or months, then subsiding for a time, or even going into complete remission. During remission, symptoms may be minimal or absent, but during flare-ups, they can be intense and disabling, emphasizing the chronic, unpredictable nature of the disease.

Causes of psoriasis

Stress: Psychological stress is a well-known trigger that can cause the immune system to react and exacerbate psoriasis symptoms. Stress management techniques such as mindfulness, meditation, regular exercise, and adequate sleep can help manage this trigger.

Skin injuries: Known as the Koebner phenomenon, this trigger involves psoriasis plaques forming at sites of skin injury, including cuts, bruises, and sunburns. Protecting the skin by wearing appropriate clothing and using sunscreen can help minimize this risk.

Medications: Certain medications, including beta-blockers (sometimes used for treating high blood pressure), lithium (a mood stabilizer), and antimalarial drugs, have been known to trigger or worsen psoriasis. It’s important for patients to discuss their medication use with their healthcare provider, who may be able to suggest alternatives.

Infection: Upper respiratory infections caused by viruses or bacteria like Streptococcal infections, can trigger psoriasis up to 2 to 6 weeks after the infection in children and young adults. Maintaining good hygiene and treating infections promptly can help manage this trigger.

Weather: Cold, dry weather can worsen symptoms by drying out the skin, which irritates the skin and makes it more susceptible to psoriasis. Conversely, (providing you avoid sunburns with sunscreen) warm, sunny climates can alleviate symptoms due to the natural sunlight’s beneficial effects on slowing skin cell turnover. Using humidifiers and applying moisturizers regularly can help mitigate the effects of dry weather.

Diet: While no specific diet is recommended for all psoriasis patients, certain foods may trigger flare-ups in some individuals. Commonly reported culprits include gluten (for celiac or gluten sensitivities), sugars, alcohol, tomatoes, and dairy. Being overweight has been linked to developing increased severity of psoriasis. Keeping a food diary or working with a dietitian can help identify and eliminate foods that worsen or trigger symptoms.

How to treat psoriasis

While moisturizing and soothing baths can help ease symptoms at home, psoriasis has no cure and can vary in severity. 

As a result, psoriasis can significantly impact your quality of life. For individuals battling psoriasis, a variety of treatments are available, each targeting different aspects of the disease mechanism. Overall goals of psoriasis treatments are to slow down and better regulate the skin cell turnover and reduce the associated inflammation. Treatment options can be used individually or in combination.

Treatment options include: 

• Emollients and steroid-based creams: Moisturizing treatments soothe and hydrate the skin, reducing scaling and dryness, while steroid-based creams reduce inflammation, relieve itching, and block the overproduction of skin cells.
• Topicals like activated vitamin D, tar, vitamin A derivatives, and more: Unlike dietary vitamin D, topical forms directly help modulate the skin’s immune response and cell turnover. Vitamin A helps normalize skin cell growth and can be used for scaling and plaque mitigation. Coal tar, one of the oldest psoriasis treatments, reduces scaling, itching, and inflammation. 
• Oral prescriptions: Retinoids, immune modulators like methotrexate, inflammatory reducing medicines like phosphodiesterase-4 enzyme inhibitors, immune system suppressants like cyclosporin
• Phototherapy: This treatment involves exposing the skin to ultraviolet light under medical supervision. Regular sessions can significantly improve symptoms by slowing down the excessive skin cell growth that characterizes psoriasis.
• Injectable biologics: Biologics are advanced medications that target specific parts of the immune system. These drugs are used for moderate to severe psoriasis that hasn’t responded to other treatments. They can be highly effective but require careful monitoring for side effects.
• A rheumatology referral: For psoriatic arthritis, a common comorbidity of psoriasis, a referral to a rheumatologist may be necessary. This specialist can offer treatments that reduce joint pain and prevent joint damage.

What are the differences between eczema, rosacea, and psoriasis?

Eczema, rosacea, and psoriasis are all chronic skin conditions, each with distinctive features and triggers.

Eczema typically presents as patches of dry, itchy skin that may become inflamed or infected due to scratching. It’s often associated with other allergic conditions like asthma or hay fever and can be triggered by environmental factors, allergens, or stress. 

Rosacea, on the other hand, primarily affects the face and is characterized by redness, flushing, and visible blood vessels, sometimes accompanied by acne-like bumps. It can be provoked by factors like heat, spicy foods, or alcohol.

Psoriasis is marked by thick, red patches covered by silvery scales, often found on the scalp, elbows, and knees. It’s an autoimmune condition, meaning it results from the immune system mistakenly attacking healthy skin cells, leading to rapid cell turnover.

Getting treatment for psoriasis

If over-the-counter remedies haven’t worked, prescription options are available through primary care providers. Primary care providers may refer to dermatologists if they are unsure about diagnoses or if more specialized treatments and maintenance are required. However, if you’re among the 6.5 million Canadians without a family doctor, you can use Maple to book an appointment with a Canadian-licensed dermatologist directly without a referral.

Dermatologists on Maple are the same specialists you’d see in person, but they also practice outside of their own clinic hours to see patients virtually. 

While living with psoriasis can be challenging, understanding the condition and working closely with qualified healthcare providers to manage it can significantly improve the quality of life. 

The information presented here is for educational purposes and is not meant to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.