What is Psoriasis and its types? How do you manage it?

Psoriasis : What’s Behind the Flaky Skin?

August 27, 2024

Dr Adrian Yong, Health Hub Blog, Psoriasis, Dermatologist, Beacon Hospital Doctor, Cancer Centre

Understanding Psoriasis

Psoriasis is a chronic skin disease that causes skin cells to grow rapidly, resulting in thick, red patches covered with flaky, silvery scales. These patches can be itchy and painful, often affecting various parts of the body. However, psoriasis is more than just a skin condition, it has deeper implications for overall health.

What Causes Psoriasis?

The root cause of psoriasis lies in an overactive immune system. Normally, our immune system fights off infections, but in psoriasis, it mistakenly causes inflammation that triggers the rapid growth of new skin cells, resulting in the distinctive scaly patches.

Effects Beyond the Skin

This inflammation doesn’t stop with the skin—it can also affect the nails, causing them to thicken and become pitted. Additionally, it can lead to pain and deformities in the joints. Psoriasis is also linked to metabolic syndrome, a group of conditions that increase the risk of heart disease, stroke, and diabetes.

Long-Term Impact and Management

The overactive immune response makes psoriasis a chronic condition that persists over time and can significantly impact quality of life. Understanding the connection between psoriasis and the immune system helps explain why managing this condition often requires more than just skin treatment.

The 5 Main Types of Psoriasis

Psoriasis manifests in various forms, each with its own distinct features and challenges. Understanding the different types can help in effectively managing and treating this condition

1. Plaque Psoriasis

Most common type
Dry, red patches covered with silvery scales
Often appears on the elbows, knees, scalp, and lower back
Can be itchy and painful

2. Flexural Psoriasis

Affects skin folds (under breasts, in the groin, around buttocks)
Causes smooth, red, inflamed areas
Worsens with friction and sweating
No scales, unlike plaque psoriasis

3. Pustular Psoriasis

Pustules (blisters of noninfectious pus) surrounded by red skin
Can appear in specific areas like hands and feet or cover most of the body
Can be associated with pain, fever, chills, and severe itching

4. Guttate Psoriasis

May be triggered by bacterial infections such as streptococcal sore throat
Appears as small, red, drop-shaped spots on the trunk, arms, legs, and scalp
More common in children and young adults

5. Erythrodermic Psoriasis

Severe type that covers the whole body with a red, peeling rash
Can be dangerous as it disrupts the body’s ability to regulate temperature and fight infections
Often needs hospitalisation to bring it under control

Common Psoriasis Triggers

Emotional Stress
Stress is a major trigger for many people with psoriasis. High levels of emotional stress can worsen the condition by increasing inflammation, leading to flare-ups. Since stress affects the immune system and heightens inflammation, it can exacerbate existing psoriasis or trigger new outbreaks. Using relaxation techniques to manage stress can help control symptoms.

Infections (e.g. Streptococcal Infection)
Infections often trigger flare-ups by activating the immune system and increasing inflammation. Even minor infections can worsen symptoms, so prompt treatment is essential for managing their impact.

Skin Injuries (e.g., Cuts, Scrapes, or Surgery)
Skin injuries, such as cuts, scrapes, or surgical wounds, can trigger flare-ups. This reaction, known as the Koebner phenomenon, causes new patches to appear at the site of the trauma. Protecting the skin from injury and treating wounds carefully can help prevent these flare-ups.

Certain Medications (e.g., Lithium and Beta-Blockers)
Some medications, such as lithium for bipolar disorder and beta-blockers for heart conditions, can aggravate psoriasis or lead to new flare-ups. These drugs may worsen the condition by affecting the immne system or increasing inflammation. If you suspect a medication is contributing to your symptoms, consult your healthcare provider for alternative options.

Changes in Body Temperature Due to Weather

Extreme changes in body temperature due to weather can trigger or aggravate symptoms.
Cold weather can dry out the skin, while heat and sweating can irritate it, leading to flare-ups.
Keeping your skin moisturised and protected from temperature extremes can help manage these effects.

Managing Psoriasis: Practical Steps to Take

Eat a Well-Balanced Diet
Consuming a diet rich in fruits, vegetables, whole grains, and lean proteins can help support overall health and potentially reduce inflammation. Monitoring your diet for specific food triggers may help you avoid flare-ups.

Exercise Regularly
Regular physical activity helps maintain a healthy weight and can reduce inflammation in the body. Choose activities you enjoy to stay consistent, as exercise also improves mood and overall well-being.

Get Adequate Sleep
Quality sleep is essential for managing stress and supporting immune function. Aim for 7-9 hours of restful sleep each night to help your body recover and better manage symptoms.

Don’t Smoke
The vasoconstrictive effects of nicotine reduce blood flow to the skin, impairing circulation, slowing healing, and worsening flare-ups. Quitting smoking can improve skin health and enhance treatment results

Available Psoriasis Treatments

There is no one-size-fits-all approach; the best treatment depends on the severity of your condition and your individual needs. Below are some commonly used treatments:

Anti-inflammatory Creams: Reduce inflammation, redness and swelling.
Anti-inflammatory Ointments: Decrease inflammation and are more effective for very dry or thickened skin.
Moisturisers for Dry Skin: Regular use helps keep the skin hydrated and prevent dryness and irritation.
Medicated Lotions or Shampoos: Contain active ingredients to treat psoriasis on the scalp and other parts of the body.
Vitamin D3 Ointment: Slow down the growth of skin cells and improve symptoms.
Vitamin A or Retinoid Creams: Slows down rapid production of skin cells and improves symptoms.
Phototherapy: Alleviate symptoms by using targeted UV light exposure.
Systemic Immunomodulators: Modify the immune system’s response to reduce inflammation and manage symptoms, available as oral or injectable medications.
Biologic Injections: Target specific parts of the immune system to reduce inflammation and control symptoms.
Oral JAK Inhibitors: Interfere with specific immune system pathways to reduce inflammation and improve symptoms.

Treatment for Psoriasis:

Treatment decisions are based on factors such as:

Age

Severity of the Rash

Location of the Rash

Overall Health

Conclusion

Understanding and managing psoriasis effectively is key to achieving long-term relief.

Successful management involves a combination of personalised treatments. By maintaining a healthy lifestyle, managing stress, and avoiding triggers, you can reduce the likelihood of flare-ups and improve your quality of life.

If you have concerns about psoriasis, schedule an appointment with our dermatologist as soon as possible. Our experienced specialists will assess your condition and provide you with the next steps for treatment to help manage and alleviate any symptoms of psoriasis you may be experiencing.