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RA CD UC AS PsO PsA

Plaque Psoriasis (PsO)

  • About PsO

    What is psoriasis ?

    Psoriasis is a common, chronic (lifelong) condition that causes red, scaly patches on the skin. 1,2
    It can occur on any part of the body, but most commonly on the knees, elbows, trunk and scalp. 1,2
    Psoriasis is not contagious. 1,2 Although there is no cure for psoriasis, treatments are available to help manage your symptoms. 1,2

    The difference between normal skin and psoriatic skin 3

    • The outer layer of skin (the epidermis) contains skin cells that are continuously replaced by new cells.
      This process normally takes between three and four weeks.
    • In psoriasis, skin cells divide more quickly, causing cells to form and shed in as little as three to four days. These cells build up and develop a thick and scaly skin surface.

    What type of psoriasis do I have?

    There are several types of psoriasis, including:

    • Plaque Psoriasis

      This is the most common form of the disease. 1, 3
      It causes dry, raised, often itchy red skin patches (plaques) covered with a silvery scaly surface layer. 1, 3
      On skin of color, the discoloration is darker and thicker. 3
      Plaques usually appear on the knees, elbows, scalp, and lower back. 1, 3

    • Nail psoriasis

      Affects fingernails and toenails, causing pitting, abnormal nail growth and discoloration.
      Sometimes nails will separate from the nail bed or crumble.1,
      The prevalence of nail involvement in psoriasis patients is approximately 50%. It is thought that 80-90% of patients with psoriasis will at some point present with nail involvement.

    • Scalp psoriasis

      Causes red patches of skin covered with silvery scales and a thick crust on the scalp, often extending just past the hairline that may bleed when removed. 1

    • Guttate psoriasis

      Usually affects young adults and children, and is triggered by a bacterial infection such as strep throat. It causes small, drop-shaped, scaling lesions on the trunk, arms or legs. 1

    • Inverse (flexural or intertriginous) psoriasis

      Affects the skin folds of the groin, buttocks and breasts, and may be triggered by fungal infections. It causes patches of smooth or shiny red skin that worsen with friction and sweating. 1

    • Pustular psoriasis

      A rare type of psoriasis characterised by white pustules occurring on the palms of the hands or the soles of the feet. 1 It can be localised or generalised and can flare rapidly necessitating hospital admission for treatment.

    • Erythrodermic psoriasis

      The least common and most severe type of psoriasis, in which the whole body may be covered by an itching or burning, red, peeling rash. 1 It can sometimes require hospital admission for treatment.

    • Psoriatic arthritis

      Causes swollen, painful joints that are characteristic of arthritis. In some cases, the joint symptoms are the only sign of psoriasis. 1 Among patients with psoriatic arthritis, the prevalence of nail involvement may be as high as 80.5%.

    What causes psoriasis?

    • Psoriasis is caused by the immune system sending signals to speed up the growth cycle of skin cells in some places on the body. 1,2
    • Psoriasis affects both men and women, and occurs in all racial groups. 3
    • Psoriasis can develop at any age, but usually develops between the ages of 15 and 35.
      It is uncommon for children under the age of 10 years to have psoriasis. 1, 3

    Most common risk factors for developing psoriasis:

    Risk factor Description
    Genetic Family history of PsO increases the risk of developing the disease by nearly 20 times.
    Environment Obesity doubles the risk of PsO.
    Smoking, combined with other risk factors, increases the risk for PsO by 2~9 times.

    What can trigger a flare-up of psoriasis symptoms? 1

    • Infections, such as strep throat or skin infections
    • Cold, dry weather conditions or overexposure to sunlight
    • Injury to the skin
    • Stress
    • Smoking
    • Heavy alcohol consumption
    • Certain medications such as beta-blockers (used to treat high blood pressure and angina), lithium and antimalarial drugs
    • Alcohol
  • Symptoms

    What are the symptoms of psoriasis?

    Psoriasis signs and symptoms vary from person to person, and depend on the type of psoriasis you have. 1, 2

    Common signs and symptoms of psoriasis 1

    Symptoms Description
    Plaques Red, patchy skin with silvery scales
    Dryness Dry cracked skin
    Skin sensitivity Itching, burning, or sore skin, sometimes bleeding in affected area
    Nail changes Thickened, pitted nail beds of fingers/toes
    Joint pain Swollen and stiff joints

    • Psoriasis can range from a few small spots on the skin that resemble scales of dandruff, to numerous large patches of affected skin.1 Commonly affected parts of the body are the lower back, elbows, knees, legs, soles of the feet, scalp, face and palms.1 Often, people with psoriasis experience flare-ups for a few weeks or months and after this period, symptoms subside.1, 2

  • Diagnosis

    How is psoriasis diagnosed?

    There are no special tools to diagnose psoriasis.
    A doctor or other health care provider usually examines the affected skin to make the diagnosis of psoriasis. 3
    About one-third of people with psoriasis have a family member with the condition, so your doctor will likely ask you about your family history. 3

    Psoriasis may be assessed by your doctors using a variety of scores that measure the severity in your skin and joints, how psoriasis is affecting your mood and daily activities, and whether you are at risk of heart disease.
    These scores include the PASI (Psoriatic Arthritis Severity Index - a score that measures the severity of joint symptoms in psoriasis) and
    DLQI (Dermatology Life Quality Index - a score that measures the impact of psoriasis on your daily activities).

  • Treatment

    How is psoriasis treated?

    Treating your psoriasis is important to manage your symptoms, reduce your risk for comorbidities, and improve your overall health and quality of life.2
    Treatment depends on the type and severity of psoriasis. 2 It can differ based on how much psoriasis affects the body and the quality of life. 3

    What are the treatment options for psoriasis?

    There is no cure for psoriasis and complete clearance of skin lesions may not always be possible. There are several effective treatments available to control your psoriasis. Most people with mild psoriasis are able to manage their skin complaint with topical treatments. Moderate or severe psoriasis usually needs additional therapy such as phototherapy or systemic drugs.

    • Topicals 2,4,5
      • Applied directly onto your skin in the form of creams, ointments, lotions or shampoos
      • Moisturisers and emollients, vitamin D-based topicals, topical steroids, coal tar preparations, dithranol preparations and calcineurin inhibitors can provide symptom management and relief
    • Phototherapy 2,4
      • Appropriate for psoriasis that is considered too extensive to be treated and/or ineffective by topical therapy
      • Mostly administered in hospitals or specialist dermatology clinics
      • Uses ultraviolet light (UVB and UVA) to treat the skin symptoms of psoriasis
    • Systemic treatments 2,4
      • Usually taken by mouth (tablets, capsules, liquids)
      • Treat the cause of psoriasis inside the body by targeting specific immune cells or the immune system as a whole
    • Biologic treatments 2,4
      • Given as an injection or intravenous infusion by a doctor or at a specialised clinic
      • Specifically target overactive immune pathways
  • FAQs

    Frequently asked Questions

    1. What's the difference between psoriasis and eczema?
      Psoriasis and eczema FEEL different 6
    • Eczema causes itching that can be so intense that you scratch enough to make your skin bleed.
    • Psoriasis can also be itchy, but in a different way. Your skin may sting or burn, similar to an insect bite.
    • Psoriasis and eczema LOOK different 6
    • Eczema makes your skin red and inflamed. It may be scaly, oozing, or crusty. You may see rough, sometimes dark colored leathery patches.
    • Psoriasis can also cause red patches. They may be silvery, scaly and raised. But the skin is thicker and more inflamed than with eczema.
    2. Is psoriasis contagious?

    Psoriasis is not contagious, it cannot be caught by person-toperson contact, or by sharing of bodily fluids (such as by kissing or sharing food or drinks). It also cannot be caught by others in close contact public areas, such as in swimming pools or in saunas. 7

    3. Will I develop psoriatic arthritis?

    About one-third of people with psoriasis will eventually develop psoriatic arthritis. In its milder forms, psoriatic arthritis often goes undiagnosed. However, psoriatic arthritis should be treated as early as possible to avoid permanent joint damage. 3
    And if you have psoriatic arthritis, the choice of drug to treat your psoriasis should be decided in consultation with a rheumatologist.

References

1. Psoriasis. Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840#dialogId5054742 Accessed July 2020.

2. Psoriasis Fact Sheet. Available at: https://www.psoriasis.org/sites/default/files/psoriasis_fact_sheet_0.pdf Accessed July 2020.

3. About Psoriasis. National Psoriasis Foundation. Available at: https://www.psoriasis.org/about-psoriasis Accessed July 2020.

4. Psoriasis Association. Available at: https://www.psoriasis-association.org.uk/ Accessed July 2020.

5. Psoriasis Association. Available at: https://www.psoriasis-association.org.uk/psoriasis-and-treatments/treatments/from-a-gp Accessed July 2020.

6. Psoriasis vs. Eczema: How to Tell the Di-erence. WebMD. Available at: https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-or-eczema Accessed July 2020.

7. Psoriasis Association. FAQ. Available at: https://www.psoriasis-association.org.uk/psoriasisand-treatments/faq Accessed July 2020.

Abbreviations

DLQI, dermatology life quality index; PASI, psoriatic arthritis severity index; PsO, psoriatic arthritis