Psoriasis is an autoimmune disease that results when the overactive immune system mistakenly attacks its own skin cells. It's classified as a chronic inflammatory disease that drives inflammation throughout the body causing rapid skin cell growth which in turn leads to plaque and scale formation.
"Psoriasis is a chronic, auto-immune skin condition where you have red, scaly patches on the skin," Dr. Saakshi Khattri, a dermatologist/rheumatologist at Mount Sinai Health System, previously told SurvivorNet. "It is a chronic condition, which can ebb and flow. You can have good days and bad days.
Read More- Eyes
- Joints
- Elbows
- Knees
- Scalp
- Lower back
- Legs
- Face
- Hands
- Feet
Early diagnosis and treatment are the best ways to prevent symptoms of this condition before they worsen and become noticeable. Thus, identifying the early signs and symptoms of the disease is key to better outcomes.
Psoriasis doesn't discriminate and can start at any age, race, or gender. But according to the journal of Psoriasis and Psoriatic Arthritis psoriasis symptoms usually start between the ages of 15-25.
Symptoms in the Early Stages
In its earlier stages, psoriasis generally presents with the following symptoms:
- Dry patches on the skin
- Inflammation and itching of the skin
- Silvery scales above the patches
- Raised patches on the skin
There are other signs and symptoms which vary according to the following:
- Amount of psoriasis
- Affected area with psoriasis
- The different subtypes of psoriasis
Subtypes of Psoriasis
There are seven subtypes of psoriasis with varying features and early symptoms, these include the following:
Plaque psoriasis. This is the most common of all psoriasis types that make up around 80-90% of all cases. It's characterized by:
- Thick and raised patches of the skin known as plaques
- Dry white or silvery scale covering these plaques
- The appearance of small and large plaques
- Small plaques may merge to form a large plaque
In the early stages, the most noticeable symptoms are raised, red and swollen areas that feel itchy and scratchy.
Guttate psoriasis. This type of psoriasis is characterized by spots and bumps on the skin that are red or purple and have a scaly texture. In the beginning stages of the disease, these spots generally appear on the torso, legs, and arms, but later when the disease progresses, they spread to other areas of the body like the face, scalp, and ears. These spots and bumps are:
- Very small in size (giving rise to the name “guttate,” which means “drop-like”).
- Scaly in texture
- Has a light pinkish color
- They can suddenly appear and go away on their own without any treatment
Young adults and children who had previously been infected are at a higher risk of developing guttate psoriasis. There is a strong association between recent streptococcal pharyngitis, and guttate psoriasis.
Inverse psoriasis. This type differs from other types of psoriasis by the smoothness, flatness, and raw-looking rashes they form. They usually appear in areas where the skin folds continuously rub against each other, these include areas like armpits, under the breasts, and the genitals.
Early symptoms of inverse psoriasis include the following:
- Red patches of the skin that look like a rash (can be red or purple in color)
- Little or no white silvery scales
- Pain and discomfort in the affected areas especially after sweating
Inverse psoriasis can also be known as intertriginous psoriasis or flexural psoriasis.
Pustular psoriasis. One of the rarest types of psoriasis that can be very serious and fatal. In its early stages, pustular psoriasis can be mistaken for pustular acne lesions as they're both characterized by pus-filled, inflamed, and painful bumps. They appear in various areas of the body and when they dry out, they cause brown scaly spots.
Flare-up symptoms of pustular psoriasis include the following:
- Red, dry, and sore skin in various areas of the body
- Bumps are filled with pus
- Pus-filled bumps can leak into the skin in only one day
- After the pus dries, the skin starts to peel
- This cycle repeats every week which makes patients very sick
People who have pustular psoriasis suffer significantly and may need medical help, aside from symptoms affecting their skin they can also have other symptoms which include the following:
- Fever
- Fatigue
- Headache
- Weakness in the muscles
Pustular psoriasis can also be known as von Zumbusch psoriasis. According to an interview with Dr. Sylvia Hsu, M.D., Professor, and Chair of Dermatology at the Lewis Katz School of Medicine at Temple University by the National Psoriasis Foundation, she shared her thoughts saying: "Because pustular psoriasis has such a significant impact on patients, effective treatment is critical; however, it is a challenging condition to manage since many of the treatments for plaque psoriasis are not as effective for pustular psoriasis"
Erythrodermic psoriasis. Similar to pustular psoriasis, erythrodermic psoriasis is rare, extremely life-threatening and needs immediate medical intervention. It's characterized by skin shedding and debilitating pain. Early symptoms of erythrodermic psoriasis include the following:
- Intense pain and itching
- Red and dry skin that's very sensitive to touch
- Widespread burn sensation in over 90% of the body
Complications of erythrodermic psoriasis include the following:
- Dehydration
- Fever
- Chills
- Increased heart rate
- Muscle weakness
- Hypothermia (Dangerous low blood temperature)
This is the least common type of psoriasis and usually occurs in association with other psoriasis types. Therefore, if you notice your psoriasis symptoms are getting worse, contact your doctor right away.
Nail psoriasis. This type is very common in that it occurs in more than 50% of people with other types of psoriasis. Early symptoms of the disease include the following:
- Nail discoloration
- Crumbling of nails
- Dainty nails
As the disease progresses, other symptoms can appear like:
- Large pits in the nails
- Nails become rougher
- Cells may accumulate under the nails
- Nails may fall off their nail beds
Psoriatic arthritis (PsA). The earliest signs of psoriatic arthritis include the following:
- Pain in the heel
- Swollen fingers
- Painful and tender joints
- Joint stiffness
These symptoms can be very noticeable in the morning. Psoriatic arthritis can occur as a result of severe psoriasis. Thus, you should pay extra attention if you start to feel pain in the joints with your psoriasis.
It's important to consult your doctor about possible treatment for your psoriatic arthritis. If you ignore your condition, you'll put yourself at risk of physical disability.
“Half of the patients with psoriatic arthritis are not being treated with a systemic medicine,” Dr. George Han, a dermatologist at Northwell Health/Lenox Hill Hospital, said in a previous interview with SurvivorNet. “That is just not okay in this day and age when we have so many treatments that can really stop the joint damage in its drugs.
“So, I think we are in a place where we’ve got great treatments, but we need to make sure we connect that to the right people.”
Treatment for Psoriasis
There are varying treatment options for psoriasis, all carrying their risks and benefits. Before deciding on a treatment, your doctor will take into consideration the following parameters:
- Your overall health
- Your medical history
- Subtype of psoriasis
- The severity of your condition
But the most common psoriasis treatments include the following:
- Topicals treatment
- Phototherapy or light therapy
- Retinoids
- Coal Tar
- Vitamin D analogues
- Steroids
- Immunosuppressants
- Biologics
Questions to Ask Your Doctor
- How can I improve my quality of life with this disease?
- Which treatment do you recommend for my case?
- What are the risks and benefits of this treatment?
- What symptoms should I be on the lookout for?
- Am I at risk of getting psoriasis complications?
- Is there anything I should avoid doing to reduce my symptoms?
The Bottom Line
Noticing the earlier symptoms of psoriasis can significantly improve outcomes and prevent the onset of debilitating flare-ups. However, it's important to note that psoriasis has various subtypes each having its unique symptoms. Thus, it's important to follow up with your doctor if you experience any new symptoms that don't improve as time goes by.
Treatment for psoriasis mainly focuses on preventing flares and alleviating symptoms, which is another reason to share your symptoms with your doctor and get an early diagnosis to find a better treatment response and avoid unwanted complications.
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