Psoriasis can cause big, red patches that may be covered with dry, silver-colored scales to develop on a person’s head, knees, elbows, feet, hands and other body parts. Mostly the lesions are itchy, but they can also burn or hurt.
The reactions of other people, though, may be the most painful part.
“There are many misconceptions about this disease,” says UNC Health dermatologist Aida Lugo-Somolinos, MD. “When you have a disease on your skin, you might feel that everybody is looking at you, talking about you, they don’t want you to touch them.”
These misconceptions can leave patients with low self-esteem, depression and isolation.
“I want people to know two things,” she says. “Psoriasis is not contagious. And there are many new, effective treatments that can clear up the lesions completely for most people. Nobody needs to sit home and suffer.”
Psoriasis Typically Erupts in Adulthood
Psoriasis, an autoimmune disorder that causes the body to make new skin cells in days rather than weeks, affects more than 8 million people in the United States.
Although it can appear in childhood, psoriasis symptoms usually begin later in life, Dr. Lugo-Somolinos says. “There are two peaks when people typically develop lesions for the first time or see worsening of them: in their 20s and 30s and in their 50s and 60s.”
The most common type of psoriasis is plaque psoriasis, she says, characterized by “red areas on the skin that are covered with very distinctive dry, silvery scales.” These patches look similar on all skin tones, although it may look redder in lighter skin and more purple in darker skin.
Lesions develop most commonly on the elbows, scalp, knees, abdomen, lower back, hands and feet. They also can form on the groin and in areas below the abdomen or breasts. Because these areas are often moist, the dry scales may not form, Dr. Lugo-Somolinos says, but big red patches will still be there. This condition is known as inverse psoriasis.
Less common than plaque psoriasis and inverse psoriasis are types that cause small red spots, pustules and skin-shedding.
Causes of Psoriasis
Up to 20 percent of people with psoriasis appear to have a genetic predisposition, Dr. Lugo-Somolinos says. When something triggers the immune system, psoriasis lesions may develop.
“Sometimes a viral or bacterial infection can make it appear,” she says. “Also, trauma predisposes skin to have lesions.”
Such trauma could be from a surgical scar, or from simple wear and tear on areas like elbows and knees.
Medications, including some blood pressure medicines, also can trigger or aggravate psoriasis, Dr. Lugo-Somolinos says.
Complications of Psoriasis Beyond the Skin
Psoriasis affects the whole body, not just the skin, Dr. Lugo-Somolinos says. Chronic inflammation can affect various tissues and lead to disease.
“The same inflammatory process can affect other organs, too,” she says, “leading to cardiovascular disease and metabolic syndromes: diabetes, high cholesterol and triglycerides, and obesity.”
About a third of people with psoriasis develop psoriatic arthritis. Chronic inflammation may affect joints and areas where tendons and ligaments connect to the bone. The result can be swelling, pain, fatigue and stiffness of the joints.
“Psoriasis needs to be treated early before joints are irreversibly affected,” she says.
Treatment for Psoriasis
Psoriasis is a chronic disease that will not go away on its own.
“We don’t have a cure,” Dr. Lugo-Somolinos says, “but with today’s treatments, we can manage it. It can be completely cleared. If people don’t take their medications, though, it will come back.”
In general, psoriasis lesions can be cleared up in about three months with the right medication, which focuses on decreasing inflammation and can be found in pills, injections and creams.
People with psoriasis often benefit mentally from treatment for the condition, which can lead to low self-esteem and depression, Dr. Lugo-Somolinos says.
“I have patients who have gone years and years without wearing shorts or going to the beach. They’re embarrassed to be in a bathing suit,” she says. “But when they find treatments that clear up their skin, they can start dressing like they want to, going out, participating in sports. It’s life-changing.”
If you have questions about skin health, talk to your doctor or dermatologist or find one near you.