Psoriasis of Different Types

Introduction to Psoriasis

Psoriasis is an obstinate skin condition in which red patches of various sizes develop on the skin that are covered with dry, silvery scales. Psoriasis is a chronic skin disease that got its name from the Greek word meaning, ‘itch’.

In psoriasis the skin becomes inflamed and red eruptions appear on the surface of the skin that begin to itch excessively. These areas form thickened areas (plaques) that are covered with silvery scales over the reddened lesions. The skin at the joints may crack.


Psoriasis most often occurs on the elbows, knees, scalp, lower back, palms, and soles of the feet. However, no area of the skin is exempt, including the genital area. The disease may also affect the fingernails and toenails, and the soft tissues inside the mouth. About 15 percent of people with psoriasis have joint inflammation that produces arthritis symptoms. This condition is called psoriatic arthritis.

Psoriasis is categorized as mild, moderate, or severe, depending on the percentage of body surface involved and the impact on the patient’s quality of life.

Course of Diseases

The course of psoriasis is characterized by remissions and relapse. At some instances the patches disappear, just to appear after some period of time.

There are various factors ranging from climate, stress, infections and injuries that can trigger flare up of disease within short span of time even within few days. On the other hand there are certain other factors such as sunlight that significantly reduces the intensity of problem.

Impact on Health

In some cases, psoriasis is so mild that it may go unnoticed. At the opposite extreme, there are victims having psoriatic patches almost everywhere on the body. People with psoriasis may suffer discomfort, including pain and itching, restricted motion in their joints, and emotional distress.

The unpleasant appearance of the patches, the chronic itching and flaking of psoriasis although is not life threatening, has definite impact on the self-esteem and life style of the psoriasis victim. Substantial time and money are spent trying to keep it under control.


Psoriasis affects between 1-2 percent of general population. In US alone there are about 5.5 to 6 million people suffering from psoriasis.

Both males and females get psoriasis in equal numbers. It can strike at any age, but most often in adults between 15 and 35 years. However, a first-time diagnosis of psoriasis has been seen in very old people, and in newborn babies and small children.


Psoriasis is a chronic (long-lasting) skin disease characterized by scaling and inflammation.

Our skin is mainly made up of two layers: epidermis (outer layer) and dermis (inner layer). The cells of epidermis are borne in dermis and then they move up. At a regular interval of 28-30 days, the cells of epidermis are replaced by new cells formed in dermis.

In psoriasis, this process of cell production in dermis is sped up. New cells are formed and moved upward to the skin surface faster than they can be incorporated into skin. The excess cells accumulate and are scaled off in the form of flakes.

Psoriatic plaque has other features also, including inflammatory cells and dilated small blood vessels that contribute to both the appearance and the symptoms of a psoriatic lesion.

The exact cause of psoriasis is not fully understood. The processes involved in the development of psoriasis as largely understood. Although cold climate and some form of injury can aggravate the problem they cannot be labeled as the cause of disease. The precise cause of psoriasis continues to elude the medical fraternity. However, ongoing research in this field has improved our understanding of this disease to some extent. The recent discoveries point to an abnormality in the functioning of key white cells in the blood stream triggering inflammation in the skin. Because of the inflammation, the skin sheds too rapidly, every three to four days.
Actually, psoriasis stems from internal disharmony of the body (in terms of disturbed immunity and genetic predisposition) topped with some environmental triggers.

Internal Factors

  1. Defective immune system: Recent research indicates that psoriasis is likely to be a disorder of the immune system. This system includes a type of white blood cell, called a T cell, that normally helps protect the body against infection and disease. Scientists now think that, in psoriasis, an abnormal immune system causes activity by T cells in the skin. These T cells trigger the inflammation and excessive skin cell reproduction seen in people with psoriasis.
  2. Genetics and heredity: In about one-third of the cases, psoriasis is inherited. Often, the person with psoriasis has a parent or grandparent who also has the condition. In terms of probability it has been estimated that a person with one affected parent has about a 10% chance of also being affected. Having two parents with psoriasis increases the chances to about 30%.Researchers are studying large families affected by psoriasis to identify a gene or genes that cause the disease. (Genes govern every bodily function and determine the inherited traits passed from parent to child.)

External Factors

People with psoriasis may notice that there are times when their skin worsens, then improves. Conditions that may cause relapses of flare-ups include:

  1. Climate: Studies indicate that cold weather may be a predisposing effect or trigger for psoriasis, in contradistinction to hot and sunny climate that appears to be beneficial.
  2. Infections: Both dermatological and systemic infections have been known to trigger the onset of psoriasis or a worsening of psoriasis. Systemic infections that have been associated with triggering include viral upper respiratory disease, streptococcal pharyngitis (strep throat), and human immunodeficiency virus (HIV). Staphylococcal skin infections (boils) have been a trigger.
  3. Stress: Psychological stress is the cause as well as out come of disease like psoriasis. It is a well-known fact that there is inseparable bond between mind and body and psyche plays vital role in maintaining health or causing diseases. It is a common experience in practice of patient reporting the onset of psoriasis following major stress like divorce, death of close relatives, change of job, unhealthy family relationships etc. and this perception of patients that psychological stress can worsen psoriasis has been supported in clinical studies.
  4.  Certain medicines: Certain medicines, most notably beta-blockers, which are used to treat high blood pressure, and lithium or drugs used to treat depression, may trigger an outbreak or worsen the disease. The drugs may be listed as: lithium, anti-malarials, mepacrine, NSAIDs, beta-blockers, alcohol.
  5. Physical trauma: People often notice new spots 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. Analysis of patient records has indicated that up to 50 percent of persons with psoriasis have had a ‘Koebner’s phenomenon’ experience – that is, have had a psoriatic lesion develop at the site of an injury or skin condition.

A broad range of skin injuries and skin conditions have been linked with Koebner’s phenomenon:

Skin Conditions
  • Boils
  • Dermatitis
  • Herpes blisters
  • Lichen Planus
  • Skin parasites (scabies)
  • Vitiligo
Skin Trauma
  • Acupuncture
  • Bites, Cuts and scrapes
  • Bruises, Burns
  • Chemical irritation
  • Pressure against the skin
  • Shaving
  • Sunburn and peeling
  • Adhesive taping
  • Tattoos

Symptoms and Types of Psoriasis

Although psoriasis may be almost unnoticeable in its early stages, patients often report an itching and/or burning sensation as the disease progresses.

There are many variants and types of psoriasis. But usually the course follows like this: It starts with red small bumps on the skin that progress to bigger scaly patches. The condition is associated with lot of itching. As the scales accumulate, pink to deep red plaques with a white crust of silvery scales appear on the skin surface.

Although psoriasis may affect any area of the body, it is most commonly found on the scalp, elbows, knees, hands, feet, and genitals.

Types of Psoriasis

Psoriasis has many variants. The common ones are as follows:

  • Plaque psoriasis is the most common type of the disease and is characterized by raised, thickened patches of red skin covered with silvery-white scales. Its scientific name is psoriasis vulgaris.
  • Scalp psoriasis is a common variant of Psoriasis, which is relatively more difficult to treat.
  • Pustular psoriasis: is characterized by pus-like blisters. Attacks of pustular psoriasis may be triggered by medications, infections, emotional stress, or exposure to certain chemicals. Pustular psoriasis may affect either small or large areas of the body. Psoriasis video shows this variety.
  • Erythrodermic psoriasis characterized by intense redness and swelling of a large part of the skin surface, is often accompanied by itching or pain. Erythrodermic psoriasis may be precipitated by severe sunburn, use of oral steroids (such as cortisone), or a drug-related rash.

Palmo-plantar psoriasis is characterized by appearance of red patches of skin topped with scales typical of psoriasis on the palms and elsewhere on the body. There is thickening and scaling of the skin accompanied with the formation of deep, painful fissures on the palms and soles. It is commonly seen that some substances, such as detergents, washing up liquid and cleaning products, irritate lesions and prevent them from healing. One should be careful not to wash hands too often, and not to use water which is too hot, as this dries the skin. Psoriasis video shows this variety.

  • Guttate psoriasis is characterized by small, drop-like lesions on the trunk, limbs, and scalp. Guttate psoriasis is most often triggered by bacterial infections (for example, Streptococcus).
  • Palmo-planter psoriasis is a common variant of Psoriasis affecting either the palms or soles or palms as well as soles. Palmo-plantar psoriasis is a chronic, recurring condition that affects the palms of hands and soles of feet. Inverse psoriasis is characterized by smooth red lesions in the folds of the skin like in the folds of the skin near the genitals, under the breasts, or in the armpits.
  • Inverse psoriasis is related to increased sensitivity to friction and sweating and may be painful or itchy. For the most part people with psoriasis can function normally. Sometimes people experience low self-esteem because psoriasis appears unsightly. Psoriasis is often misunderstood by the public, and this can make social interactions awkward. This may lead to emotional problems such as anxiety, anger, embarrassment, and depression.
  • The Psoriatic Nail About 50 percent of persons with active psoriasis have psoriatic changes in fingernails and/or toenails. nail psoriasis. In some instances psoriasis may occur only in the nails and nowhere else on the body. Nail changes in psoriasis fall into general categories that may occur singly or all together:
  • The nail plate is deeply pitted or depressed
  • The nail has a yellow to yellow-pink discoloration
  • White areas appear under the nail plate. There may be reddened skin around the nail.
  • The nail plate crumbles in yellowish patches (onychodystrophy)
  • The nail may be entirely lost
  • Psoriatic arthritis Psoriatic arthritis is all the more difficult situation where you find psoriasis associated with joint pain (arthritis). This shows deeper affection of the underlying problems.

The diagnosis of psoriasis is usually clinical which means that the doctors would diagnose psoriasis after a careful examination of the skin. The white silvery scales of psoriasis are very distinctive and guiding feature for diagnosis. Also, consideration of the history, family history, the spread on affected areas, etc. is taken into account to conclude the diagnosis of psoriasis. In cases of doubt doctor may ask the patient to do skin biopsy that means examining a small skin sample under a microscope. However this is not a routine practice.

When psoriasis affects the scalp, it may resemble a few conditions such as:

  • Dandruff
  • Seborrhoeic dermatitis
  • Eczema
  • Lichen Planus.

Dietary Recommendations & Self-Help Tips

Diagnosis in terms of causative factors and triggers is also done through thorough case taking. A well studied case in terms of diagnosis of cause behind psoriasis, such as stress triggers, etc. would be beneficial while deciding the line of action.

Just to make a diagnosis of Psoriasis is not enough. Clinically trained eyes can make the diagnosis in minutes. What is more important is to understand and evaluated the origin, probable cause/s, genetic tendency, family history of certain diseases, the course of the disease, its spread, affection of joints, study of previous medications consumed by the patients, etc. Actual diagnosis of Psoriasis should entail in depth study and behavior of psoriasis over the long period, response to the treatment, etc.

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