Symptoms, causes, and forms of Psoriasis.

Symptoms of Psoriasis

Individuals with psoriasis experience symptoms such as itching, cracking, stinging, burning, or bleeding (ICN Pharmaceuticals, Inc.). Lack of sunlight and low indoor humidity in the winter months can cause the psoriasis symptoms to worsen (Hall 132). The skin is most likely to crack at the joints where the body bends, or in areas where the individual scratches. Scratching should be strictly avoided, because it can cause bleeding and infection. Psoriasis has also been known to cause pits or dents to form in fingernails and toenails. There is also the possibility that the soft tissue inside the mouth and genitalia can be affected. In some cases, psoriasis will cause joint inflammation that produces arthritis symptoms. This condition is called psoriatic arthritis.

New skin cells take about a month or so to move from the deepest skin layer where they're produced, to the surface where they die and flake off. With psoriasis, the entire skin cell life cycle takes only days leading to an accumulation on the skin surface causing irritation, itching and redness.

People with psoriasis may notice that there are times when their skin worsens, then improves. Conditions that may cause flareups include changes in climate, infections, stress, and dry skin. Also, certain medicines, most notably beta-blockers, which are used in the treatment of high blood pressure, and lithium or drugs used in the treatment of depression, may cause an outbreak or worsening of the disease.

Causes of Psoriasis

There are many beliefs as to the cause of psoriasis. Although no one knows for sure, many scientists believe that a biochemical stimulus triggers the abnormally high skin growth which will in turn cause the skin lesions (National Psoriasis Foundation). Heredity also plays a role in the development of psoriasis. Individuals who have a family member with a severe case of psoriasis tend to experience early onset of the disease (Camisa 55). Researchers have isolated 9 gene mutations that may be involved in the occurrence of psoriasis. One of these mutations on chromosome 6, called PSORS-1, has been identifed as a major factor that can cause psoriasis. Mutations on genes cause certain cells to function differently. With psoriasis, these mutations seem to largely affect T-helper cells. Recent research studies indicate that psoriasis may be a disorder of the immune system. When the immune system is functioning normally, the T cell, a white blood cell, normally works to fight off infection and disease. Scientists believe that having an abnormal immune system may cause abnormal activity by T cells in the skin. These abnormally active T cells cause skin inflammation and increased cell production. These T-cells "attack" the skin and set off a cascade of events that make the skin cells multiply so fast they start to stack up on the surface of the skin. Normal skin cells form, mature, then are sloughed off every 30 days. But in plaque psoriasis the skin goes through this whole process in 3-6 days. Diet and vitamin influences are thought to play a role in psoriasis development and progression (Kligman 729).

Not everyone who has these gene mutations gets psoriasis and there are several forms of psoriasis that people can develop. Lifestyle factors also play a role in causing psoriasis in people who have these gene mutations.

Other psoriasis trigger factors include:

Injury to the skin can cause the formation of a psoriasis patch known as the Koebner Phenomenon, and it can occur in other skin diseases, such as eczema and lichen planus. It can take 2 to 6 weeks for a psoriasis lesion to develop after an injury. Types of injuries that can trigger a flare include: Abrasion - even mild abrasion, Increased friction from clothing or skin rubbing against skin in folds, such as armpits or under breasts, Sunburn, Viral rashes and rashes.resulting from a reaction to medication.

Weather is a strong factor in triggering psoriasis. Exposure to direct sunlight, which usually occurs in the warmer months, often improves the rash. On the other hand, cold, short days seen in the winter months can trigger the rash to worsen.

Stress plays a major role in all skin conditions. Stress can trigger a psoriasis flares, but scientists are still unclear about exactly how this occurs. Studies do show that not only can a sudden, stressful event trigger a rash to worsen, daily hassles of life can also trigger a flare.

Infections caused by bacteria or viruses can cause a psoriasis flare. Streptococcal infections that cause tonsillitis, or strep throat, tooth abscesses, cellulitis, and impetigo can cause a flare of guttate psoriasis in children. The human immunodeficiency virus (HIV) does not increase the frequency of psoriasis, but it does increase the severity of the disease.

Low levels of calcium have been reported as a trigger for psoriasis. Oddly enough, even though medications made from vitamin D are used to treat psoriasis, low levels of vitamin D do not trigger a flare-up.

Because psoriasis is a lifelong condition, the levels of its severity and improvement can fluctuate over time. Psoriasis is not a contagious skin condition. Instead, an individual has a genetic predisposition for psoriasis, which can be activated by certain environmental factors or emotional stress. Individuals with psoriasis may find that their condition tends to flare up due to stress, certain medications, winter weather, and infections (ICN Pharmaceuticals, Inc.). Most often psoriasis affects the scalp, knees, elbows, hands, and feet (National Psoriasis Foundation).

Forms of Psoriasis

Plaque-type psoriasis is the most common form of the disease and is commonly referred to as psoriasis vulgaris (Camisa 56). Plaque-type psoriasis is characterized by inflamed skin lesions topped with silvery white scales. This type of psoriasis can assume many different appearances based on its location, the activity of the disease, and the treatment being administered. Plaque-type psoriasis is most commonly found on the elbows, knees, scalp, sacrum, umbilicus, intergluteal cleft, and genitalia (Camisa 56). Red inflamed skin lesions topped with silvery white scales would be an indication of Plaque Psoriasis. Plague psoriasis can assume many different appearances based on where it is located, the activity of the disease, and the treatment being administered.

Guttate psoriasis is characterized by small dot-like lesions. Guttate psoriasis is the most common cause of psoriasis in children and young adults who have a prior history of upper respiratory infection, pharyngitis, or tonsillitis (Camisa 64). The lesions are not as scaly as plaque-type psoriasis and are likely to be found on the trunk and involve the face (Camisa 64).

Pustular psoriasis is characterized by pustules, which are blister-like lesions of non-infectious fluid, and cause intense scaling. Individuals with pustular psoriasis are often among the most seriously ill and may have to be hospitalized (Camisa 67).

Erythrodermic psoriasis is the rarest form of psoriasis and is characterized by intense redness and swelling, exfoliation of dead skin, and pain. Erythrodermic psoriasis usually develops during the course of chronic psoriasis. However, in some cases erythrodermic psoriasis is the first manifestation of psoriasis, even in children (Camisa 74). Individuals with this type of psoriasis may experience chills and low grade fever, and may be rather uncomfortable (Camisa 75).

Inverse psoriasis is characterized by smooth inflamed lesions in the body folds -- armpits, under the breast, skin folds of the groin, buttocks, and genitals.

Seborrheic scalp psoriasis usually consists of red, scaly patches that may appear lumpy. The edges of these patches tend to be well defined. Psoriasis on the scalp is common and, in many cases, it is the only area affected. Seborrheic scalp psoriasis can extend beyond the hairline, onto the forehead. Psoriasis of the scalp does not damage the hair follicle and is not associated with hair loss, but if the scale is thick and forms hard lumps, it may lead to temporary hair thinning. The scalp may be the first site on the body to be affected by psoriasis.

Koebner's Phenomenon psoriasis are psoriatic lesions which appear at the site of injury, infection or other skin psoriasis, or may be a new lesion in an existing case.

Psoriatic arthritis usually occurs in the joints of the fingers and toes. Arthritic disease causes painful inflammation of one or several joints, with the inflammation destroying the cartilage in the joints.

Ear Psoriasis can appear as dry scales in the ear canal. Psoriasis in the ears can cause scale buildup that blocks the ear canal. This scaling, when combined with normal earwax, can sometimes produce the physical blockage of the external ear canal leading to a temporary decrease in hearing. Psoriasis generally occurs in the external ear canal, not inside the ear or behind the eardrum. It also occurs behind the ear so this area has to be checked to look for the plaques if the diagnosis of psoriasis is considered.

Nail Psoriasis can affect both the toenails and fingernails. Psoriasis of the fingernails and toenails is common but can be very difficult to treat. About 50 percent of persons with active psoriasis have psoriatic changes in fingernails and/or toenails. In some instances psoriasis may occur only in the nails and nowhere else on the body.

Ocular psoriasis can cause inflammation of the eye, dryness and discomfort. When psoriasis affects the eyelids, scales may cover lashes. The edges of the eyelids may become red and crusty. If inflamed for long periods, the rims of the lids may turn up or down. If the rim turns down, lashes can rub against the eyeball and cause irritation. In a prolonged ocular episode vision impairment may occur. Ocular symptoms may occur in approximately 10% of psoriasis patients.

The degree of psoriasis can also vary from individual to individual. It ranges in severity from mild (affects less than 2% of body) to moderate (affects 2-10% of body) to severe (affects greater than 10% of the body). Skin injury and irritation, sun exposure, diet, stress and anxiety, medications, and infections have been known to make psoriasis worse.

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This page was last updated on March 8, 2010 .

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