Psoriasis is a very common chronic inflammatory skin disorder affecting 2-3% of the population in North America. However, it can ranged from very mild to very severe. The severity may change over time. The most common types are chronic plaque psoriasis, guttate psoriasis and palmo-plantar psoriasis. A family history is common in patient with early onset of disease. 30% of patients with psoriasis may develop psoriatic arthritis. Early treatment of arthritis is important, patients should report any joint pain, joint swelling, morning stiffness and tendon insertion site pain to their physician. Many forms of chronic psoriasis are highly treatable with different options such as topical medication, phototherapy, and, oral and injectable medications. We are happy to provide you with information in consultation and help you to choose one that is most suitable for you.
TYPES OF PSORIASIS
Chronic Plaque Psoriasis
This presents with small or large scaly raised lesions with well defined borders on the scalp, face or body. They can be itchy or non-itchy. Common areas are elbows, knees, scalp and central face.
This type of psoriasis close resembles seborrheic dermatitis, usually causes redness and scaling of central face, chest and scalp. Treatment is with topical agents such as topical steroids, calcineurin inhibitors (tacrolimus/Protopic or pimercolimus/Elidel) and vitamin D analogue ointment (calitriol/Silkis). Sun avoidance may also be helpful.
Psoriasis may affect the nail in isolation or affect the nail and the skin. Nail changes seen include brown spots, onycholysis (early separation of the nail from the nail bed), petechiae hemorrhages (small red lines), thickening, ridging and changing of shape. Having nail psoriasis increases your chance of having joint disease (psoriatic arthritis). Nail psoriasis is extremely difficult to treat but will response to oral or injectable medications.
Psoriasis can also primarily affects the folds such as axillae and groins. Scaling is usually less obvious. Treatment is with mild topical steroids, topical non-steroidal calcineurin inhibitors e.g. tacrolimus or pimercolimus, or vitamin D analogue e.g. calcitriol.
Typically occurs in children and young adults, this condition causes mildly itchy rain drop like scaly bumps of the trunk. Less prominent disease is seen on the limbs. A preceding streptococcal sore throat or upper respiratory tract infection is common. Treatment is with medium strength topical steroids and sometimes Ultraviolet B phototherapy. It is usually self-resolving but the patient may develop chronic plaque psoriasis later in life.
Pustular Psoriasis (Localized or Generalized)
Pustules (white pus spots) can sometimes be associated with a flare of regular chronic plaque psoriasis. In some cases, pustular lesion predominates and this type of psoriasis can occur in localized patches or more widespread. Localized disease can be treated with potent topical steroids. Widespread cases (generalized pustular psoriasis) are often associated with pregnancy or steroid withdrawal. Generalized pustular psoriasis is a medical emergency and should be treated in hospital.
Psoriasis of palms and soles are treated with topical creams such as Dovobet gel/ointment (a combination of vitamin D analogue and steroid), potent topical steroids, and topical salicylic acid or lactic acid to remove scale and increase penetration of the treatments into the skin. Oral medications such as Toctino and Acitretin can also be considered. The latter is not appropriate for women of childbearing age because of teratogenicity (ability to cause infant abnormality).
This is a severe form of psoriasis which involves more than 90% of body surface area. It is medical emergency and should be treated in the hospital with rehydration, rest and supportive measures. The patient may also be treated with injectable biologic medication.
MORE INFORMATION ABOUT PSORIASIS
Canadian Dermatology Association
American Academy of Dermatologists
PSORIASIS SUPPORT GROUP
Canadian Association of Psoriasis Patients