August is Psoriasis Awareness Month — time to understand a common condition.
Get some of your questions answered about psoriasis, a disease affecting around 2 to 4 percent of the population worldwide.
What Psoriasis Is
Psoriasis is a disease that causes a rash on the skin and, in some people, arthritis in the joints. It’s caused by inflammation resulting in skin cells developing at an abnormally fast rate. It often first appears in people ages 15 to 35.
What activates the immune system in psoriasis sufferers is not fully understood, but it’s likely that both genetics and environmental factors play a role. In some cases, psoriasis runs in families. And environmental triggers such as infections, medicines, and cold weather can bring on psoriasis or make it worse.
While skin rashes in people with psoriasis can become infected, it’s important to note that psoriasis itself is not contagious.
The hallmark of psoriasis is its characteristic skin rash, which is often red, scaly, and can be itchy or painful. The most common kind of psoriasis, called plaque psoriasis, typically shows up on the outside of the elbows and knees, and in the scalp.
Up to 30 percent of people with psoriasis will develop arthritis, also due to inflammation. Symptoms of that condition — called psoriatic arthritis — include pain and swelling over tendons, stiffness and tenderness in joints, morning stiffness, and swollen fingers and toes that can have a sausage-like appearance.
The skin and joint manifestations of psoriasis can vary greatly in severity, ranging from very mild to quite severe.
The physical and emotional toll of psoriasis varies greatly. For people with more severe psoriasis, the impact on quality of life is often like that seen in people with other chronic diseases.
In the past 15 years we’ve learned that psoriasis is associated with serious diseases, possibly because of increased inflammation in the body. People with psoriasis are at higher risk for cardiovascular diseases, diabetes, obesity, and inflammatory bowel disease, for example.
On the skin, psoriasis can be quite visible, both to the person who has it as well as to others. That can lead to feelings of embarrassment or shame, depression and stress, and poor self-esteem.
If your skin is bothering you, or you have questions about a rash, ask your doctor. The first step is making a diagnosis. Because psoriasis can look like other skin conditions, talk to your doctor to better understand what’s going on in your skin and to develop a treatment plan.
The range of treatments available for psoriasis has really expanded over the past 2 decades. They now include newer medicines that target very specific components of the immune system that are involved in psoriasis, as well as older medicines that remain very effective, are often less expensive, and have well understood side effects.
We often talk about a “treatment ladder” for psoriasis, in which each rung of the ladder represents a type of treatment. Lower rungs — moisturizers; prescription and nonprescription creams, ointments, and shampoos; and light therapy — represent treatments that can be effective and have a lower chance of side effects. As we move to higher rungs, which include oral or injected medicines that affect the whole body, effectiveness increases, but with it so does the chance of side effects.
Unfortunately, as for many other inflammatory diseases, there is no cure for psoriasis. But with an increasing range of treatments available, psoriasis can be a very controllable condition for most people.
Dr. Kenneth A. Katz is a dermatologist at Kaiser Permanente’s Mission Bay campus in San Francisco.