Psoriasis

What is the cause of Psoriasis

   The exact cause of psoriasis is not known. Scientists believe that your genetic
makup may determine whether you are likely to develop psoriasis. However, it is
not clear that genetic factors alone determine this. Psoriasis is not contagious.
It cannot be passed from person to person.
  Doctors believe that the immune system is a factor in the development of psoriasis.
This is because increased numbers of white blood cells are present between the
abnormal layers of skin. Psoriasis responds to drugs that suppress the immune
system.
   Other factors may contribute to the development of psoriasis, make the condition
worse, or make it return, including:
      • Climate. Cold, dry weather causes symptoms to become worse. Hot weather,
sunlight, and humidity may improve symptoms.
      • Skin injury. An injury to the skin can cause psoriasis patches to form
anywhere on the body, including the site of the injury. This includes injuries to
your nails or nearby skin while trimming your nails.
      • Stress and anxiety. Stress can cause psoriasis to appear suddenly (flare)
or can make symptoms worse.
      • Infection. Infections such as strep throat can cause psoriasis to appear
suddenly (guttate flare), especially in children.
      • Certain drugs. Certain drugs have been found to make psoriasis symptoms
worse. Tell your doctor you have psoriasis before medications are
prescribed for you.

Symptoms

   The classic symptoms of psoriasis are red areas of raised patches (plaque)
topped with white scale on the knees or elbows.
   There are several types of psoriasis. In general, the major symptoms of
psoriasis include:
      • Bright red areas of raised patches (plaque) on the skin, often covered with
loose, silvery, scales. Plaque can occur anywhere, but commonly they occur on
the knees, elbows, scalp, hands, feet, or lower back. Nearly 90% of people with
psoriasis have plaque-type psoriasis.
      • Tiny areas of bleeding when skin scales are picked or scraped off
(Auspitz's sign).
      • Mild scaling to thick, crusted plaque on the scalp.
      • Itching, especially during sudden flare-ups or when the psoriasis patches
are in body folds, such as under the breasts or the buttocks.
      • Nail disorders. One study found nail disorders in about half of people with
psoriasis. Nail symptoms include:
          • Tiny pits in the nails (not found with fungal nail infections).
          • Yellowish discoloration of the toenails and possibly the fingernails.
          • Separation of the end of the nail from the nail bed.
          • Less often, a buildup of skin debris under the nails.
   Other symptoms of psoriasis may include:
      • Symmetrical plaques on the same areas on both sides of the body (for
example, both knees or both elbows).
      • Flare-ups of many raindrop-shaped patches. Called guttate psoriasis, this
condition often follows a strep infection and is the second most common type of
psoriasis. It affects less than 10% of those with psoriasis.
      • Joint swelling, tenderness, and pain. Called psoriatic arthritis, these
symptoms occur in 5% to 10% of people with psoriasis.
   Koebner's phenomenon is a response to injury and can occur when a person
who has psoriasis has an injury (such as a cut, burn, or excess sun exposure) to
an area of the skin that is not affected by psoriasis. Psoriasis patches then appear
on the injured skin or any other part of the skin several days to about 2 weeks
after the injury. Because this response is common, it is important for people who
have psoriasis to avoid irritating or injuring their skin.
   Several other skin conditions have symptoms similar to psoriasis. Some drug
reactions can cause symptoms (such as reddened skin) similar to psoriasis.
Talk to your doctor about any medications you are taking.

What Happens

   Psoriasis is usually long-lasting, returns often (chronic), and can be
unpredictable. Symptoms may come on suddenly (flare) and then improve and
go away (remission). This cycle continues over and over. In some cases, psoriasis
may go away without treatment. However, in moderate to severe cases, it is best
to treat psoriasis so that it does not get worse.
   Several factors influence the course of psoriasis. These factors include cold,
dry climates; stress; infection; skin injury; certain drugs; and the type of psoriasis.
   The severity of psoriasis depends on the amount of redness and scaling, the
thickness of the large areas of raised skin patches (plaque), and the percentage
of your skin that is affected.
   Mild psoriasis causes plaque that covers a small portion of the body, such as
the elbows or knees.
   Moderate psoriasis causes:
      • Several large areas of plaque. For example, most of the scalp may be affected.
      • Plaque that may cover up to 20% of the skin (about equal to having both
arms completely covered).
      • Concern about plaque being visible to other people.
      • Mild joint pain that is not disabling.
Severe psoriasis includes:
      • Plaque that may cover large areas (20% to 30%) of the body.
      • Psoriasis on the face.
      • Pustular psoriasis with large, fluid-filled plaque and severe scaling, or
erythrodermic psoriasis with severe inflammation and shedding (sloughing) of the
skin.
   Psoriasis arthritis, which includes ongoing joint swelling, tenderness, limitation
of range of motion, or joint warmth or redness. Severe cases can result in joint destruction. Psoriasis may persist for long periods of time without getting better
or worse.
   Psoriasis day care centers can provide specialized treatment and emotional
support.

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