Psoriasis

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Overview

Psoriasis is a chronic skin disorder that affects about 2% of the population. It is characterized by red, elevated plaques that are often overlaid with thick, silvery white scales. The most commonly affected areas are the elbows, knees, scalp, lower back, and genitalia. Some people have psoriasis on their hands and feet. A condition called inverse psoriasis manifests plaques in folded areas, such as in the armpits and groin.

While psoriasis can develop at any age, it seems to have two peaks of onset incidence: in the third and sixth decades of life. Psoriasis can be physically and emotionally disabling. This disease is often inherited and carries the potential for causing arthritis (psoriatic arthritis).

Causes

Although the likelihood for familial transmission may not seem significant, there is a definite genetic predisposition for psoriasis. When one parent is affected, there is roughly a 10% risk of a child acquiring psoriasis. The risk rises to almost 50% when both parents have psoriasis. One study analyzing psoriasis in twins found 65% of identical twin siblings had psoriasis when the other twin was affected. The exact mode of inheritance is complex and variable. The National Psoriasis Foundation reported that researchers have discovered evidence that psoriasis is an autoimmune disorder.

Most people with psoriasis report that no particular event or illness preceded or brought about their condition, but several well-known triggers include stress, strep infection, and some medications.

Signs and Symptoms

Typically, psoriasis lesions are round, red, and have sharply defined edges with an overlying silvery white scale. These plaques usually begin as small spots that progressively involve very large areas. The scales can be scraped off, resulting in pinpoint bleeding of the lesions.

One form of the condition, guttate (drop-like) psoriasis, appears as a sudden eruption of numerous small, pink, scaly lesions scattered over the body. This variant typically follows a strep infection, such as strep throat.

Pustular psoriasis is a distinct variant that occurs as an eruption of small pustules, or pimples, all over the body. This may be accompanied by fever. The pustules can also appear on the palms, soles, and in the nail beds.

Nail involvement occurs in about 50% of psoriasis patients and can manifest as pitting on the surface, as thickening of the nail itself, or as a dissassociation of the nail with the bed. Psoriatic arthritis develops in about 5% of psoriasis patients when they are between 30 and 50 years of age. Psoriasis usually precedes the onset of arthritis by several years.

The course of psoriasis generally is prolonged and chronic, with unpredictable flare-ups. Some patients experience spontaneous improvement and resolution.

Diagnosis

Psoriasis can be diagnosed by physical examination. To confirm the diagnosis, a skin biopsy can be obtained and sent for pathological analysis. The distinct features of psoriasis under the microscope usually confirm or exclude the diagnosis.

Psoriasis Resources

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