What is Plaque Psoriasis?
Psoriasis is well-known as the most commonly experienced immune-related inflammatory disorder, affecting the skin and joints, and is also linked to issues in other areas of the body. The most typical form of psoriasis is called plaque psoriasis. While this condition won’t threaten your life, it can be challenging to treat, and the success of treatments can vary significantly from person to person.
Plaque psoriasis usually appears as large round or oval-shaped patches on the scalp, trunk, and the outer parts of the body. These patches show excessive scaling, resulting from rapid growth of the skin cells. Many patients experience sudden intense bouts and repeat incidents of plaque psoriasis. Sometimes these can grow very serious and change into another type, called the pustular subtype. It’s important to note that at least 15% of people with plaque psoriasis will also develop a condition called psoriatic arthritis, which causes joint pain and swelling.
What Causes Plaque Psoriasis?
Psoriasis is a skin condition whose causes are many and varied. This means it’s not down to just one thing, but a mix of things including your genes, life events, and behaviors. For instance, anything from getting injured, catching an infection, taking certain medications, stress, alcohol, smoking, and even exposure to sunlight can trigger psoriasis.
Specifically, medications such as antimalarials, beta-blockers (used for heart conditions), certain antidepressants, cholesterol medication, and some types of antibiotics can worsen psoriasis. You’re also more likely to develop it if someone in your family already has it. This is due to a gene, PSOR1 on chromosome 6, that makes people more susceptible to the disorder.
Psoriasis can also develop in response to physical trauma or an injury. Interestingly, excessive scratching can trigger spread of the condition. When psoriasis shows up at the site of injury, it’s referred to as the Koebner reaction.
Sunlight is usually seen as good for people with psoriasis, but for some it can actually cause the condition to worsen. There’s also a link between psoriasis and certain infections. For example, people with HIV or strep throat infections have a heightened risk, although HIV patients who are being treated with a special type of medicine called HAART tend to have milder symptoms.
Risk Factors and Frequency for Plaque Psoriasis
Psoriasis is a skin condition found all around the globe, affecting 1% to 8% of the world’s population. Interestingly, a third of all psoriasis cases start during childhood, with a recent trend showing an increase in cases among kids. Both males and females are equally prone to develop psoriasis.
- Two main age groups are most likely to see the first appearance of psoriasis — those aged 15-22 and those aged 55-70.
- On average, females tend to develop psoriasis a few years earlier than males.
- Caucasians are the most affected by psoriasis while Africans and Japanese people are the least affected.
Signs and Symptoms of Plaque Psoriasis
Plaque psoriasis is a skin condition that doesn’t cause symptoms for some people. However, for others, it can cause a lot of itching, especially if the scalp is involved. The condition might also cause pain and soreness if cracks form, particularly on the hands and feet.
The condition is characterized by red patches (plaques) that are very well-defined and often show up on the elbows, knees, and lower back. These plaques are usually symmetrical and covered by white scales. If the scales are scraped off, small bleeding spots might appear (known as the Auspitz sign). The color of these plaques can vary depending on the person’s skin type, and in some individuals, the redness and scaling may be less noticeable.
An active psoriasis might be signaled by the presence of similar sores appearing along a trauma line, a phenomenon known as the Koebner effect. Other common features include cracking of the skin on hands, feet, and thicker patches, especially on the limbs and lower back, and often shows up initially on the scalp. The condition may also affect the face in several different forms including along the hairline, and can combine with seborrheic dermatitis (another inflammatory skin condition).
- Rashes start appearing on the scalp or face
- Plaques form the size of droplets
- The spots may merge into larger plaques over time
Nail psoriasis is common in psoriasis patients (up to 40% of cases), and may cause pitting (small dents) on the nail surface. There are some more severe types with pronounced skin thickening. The severity of the disease is often assessed using the Psoriasis Area and Severity Index (PASI). Depending on the score, the severity can be rated as mild, moderate, or severe.
Some people with this condition may also experience arthritis in small joints, which can cause features like inflamed, deformed joints and finger swelling. These are seen in about 15% of patients. Most people (80%) experience mild to moderate symptoms. However, some people might have severe forms of psoriasis or comorbidities like type-2 diabetes, cardiovascular disease, high blood pressure, and metabolic syndrome. These can contribute to significant health issues.
Testing for Plaque Psoriasis
The process of diagnosing plaque psoriasis, a skin condition, mostly relies on a physical examination of the skin. It’s usually identifiable by patches of red, inflamed skin covered with white scales, that have clear boundaries and are typically symmetrically located on the body.
Dermoscopy, a microscopic skin examination, can further confirm the condition. This examination would typically show tiny blood vessels arranged in a pattern, nestled in a light red area, covered by white scales that are spread evenly.
A skin biopsy, which involves taking a small sample of skin for testing, may also be done to distinguish psoriasis from other skin conditions that cause inflammation.
If you’re diagnosed with moderate to severe psoriasis, your doctor might check you for other health issues that often accompany psoriasis. For example, inflammatory arthritis (joint inflammation), obesity, high blood pressure, diabetes, and a lipid disorder known as dyslipidemia. Your doctor might also ask about your smoking and drinking habits, as these can influence your psoriasis.
Treatment Options for Plaque Psoriasis
Treatment for plaque psoriasis, a skin condition, needs to be carefully personalized according to a patient’s age, quality of life, and the severity of their condition, represented by a score called the Psoriasis Area and Severity Index (PASI). Treatments can be categorized into topical applications, light therapy, medications, and other therapies.
Topical therapy includes creams or lotions applied to the skin that moisturize, reduce inflammation, or help skin cells shed. Some common types of topical treatments include moisturizers, corticosteroids (medications that reduce inflammation), keratolytics (medications that help remove the outer layer of skin), tar, anthralin, vitamin D3 analogs (medications that mimic the action of vitamin D), and calcineurin inhibitors (medications that suppress the immune system). Sometimes, using a combination of these topical agents can be more effective than using only one.
Light therapy is another common treatment for plaque psoriasis. This involves exposure to either whole-body or localized ultraviolet (UV) B light or a combination of psoralen (a drug) and UVA light (also known as PUVA therapy). Home phototherapy and laser therapy are also used in some cases.
Medication courses are used for more severe cases. Examples include acitretin, methotrexate, cyclosporine, tacrolimus, hydroxyurea, 6-thioguanine, mycophenolate, fumaric acid esters, apremilast and biological drugs such as etanercept, adalimumab, infliximab, secukinumab, ustekinumab, tildrakizumab, and ixekizumab. It’s important to note that long-term safety information isn’t fully available yet for some newer drugs.
Some alternative treatments, such as fish oil rich in omega-3 fatty acids, may also help some people manage their symptoms.
In pregnant women, treatment must be extra cautious. UVB light therapy is usually safe, and the risk from topical PUVA therapy is believed to be low. Certain medications are either recommended or not recommended during pregnancy based on their Food and Drug Administration (FDA) category.
Psoriasis is a long-term condition that often involves periods of reduced and then worsened symptoms. Therefore, treatment generally continues over a long period. When treating this condition, particularly in children, it’s important to consider the long-term side effects and to avoid sudden withdrawal of certain treatments. In children, the prescriber should also consider the child’s developing liver, kidney, and blood cell production systems before administering systemic drugs.
In summary, mild to moderate psoriasis is typically treated with topical therapy and light therapy, while more severe cases may require medication. Certain treatments, called biologics, should be used only under the management of a specialist and only when necessary.
What else can Plaque Psoriasis be?
When trying to diagnose Psoriasis, it is important for doctors to also consider other skin conditions that may present similarly. These can include:
- Tinea corporis, a type of fungal infection
- Eczema, a condition that makes the skin red and itchy
- Blaschko linear psoriasis, which can often be confused with a condition called ILVEN
- Squamous cell carcinoma in situ, a type of skin cancer
- Cutaneous T-cell lymphoma, a type of non-Hodgkin lymphoma that appears on the skin
In certain cases, these conditions can even occur together with psoriasis. For chronic plaques that don’t respond to treatment, doctors may need to carry out a histological examination, a test that looks at the tissue under a microscope, to rule out squamous cell carcinoma and cutaneous T-cell lymphoma.
What to expect with Plaque Psoriasis
Plaque psoriasis is a unpredictable skin condition, with no known cure and its patterns of flare-ups and remissions are hard to predict. It’s not life-threatening, but the continuous cycle of the disease flaring up can negatively impact a person’s quality of life. Factors that can make the condition worse include stress, having a family history of the disease, and experiencing symptoms at an early age.
Interestingly, warm weather and sunlight can typically help ease symptoms. However, a severe form of the disease, called pustular psoriasis, can increase the chance of a person dying. Furthermore, all available treatments have significant side effects such as increasing the risk of skin cancer, causing liver damage, and making a person more susceptible to infections.
The aesthetic impact, or how the disease affects a person’s appearance, is the major cause of distress, often leading to depression, social isolation, and withdrawal from society. Plaque psoriasis is also associated with obesity and heart-related problems.
Possible Complications When Diagnosed with Plaque Psoriasis
Psoriasis, a chronic skin condition, can cause certain complications such as:
- Changes in physical appearance
- Constant itchiness
- Decreased quality of life
- Negative effects from the treatments