What is plaque psoriasis?
Psoriasis is an autoimmune condition when the body’s immune system mistakenly targets its skin cells, leading to persistent inflammation. This inflammatory response manifests as thickened patches of skin, often characterized by discoloration and a layer of silvery scales, which are medically referred to as plaques. These plaques can vary in size and severity.
Understanding Plaque Psoriasis
As the immune system attacks the skin cells, the affected area becomes thick and raised, with the scales developing on the surface. The discolored appearance results from the accelerated production of skin cells, causing them to accumulate more rapidly than the body can shed them. This process contributes to forming the plaques, creating a visually distinct and often uncomfortable skin condition.
Psoriasis can occur anywhere on the body but is found on the elbows, knees, scalp, lower back, and sometimes on the face. The severity and extent of psoriasis can differ from person to person, with some experiencing mild, isolated patches and others dealing with more widespread and severe symptoms.
Understanding and effectively managing psoriasis is essential for those affected by this autoimmune condition to maintain healthy skin and overall well-being.
Causes of Plaque Psoriasis
An overreacting immune system causes psoriasis by creating inflammation in the skin. In individuals with psoriasis, the immune system, which protects the body from foreign invaders like bacteria, can mistakenly target healthy cells. The immune system generates inflammation or swelling, visibly appearing as skin plaques on the surface.
Usually, it takes around 30 days for new skin cells to grow and replace the older ones. However, the over-reactive immune system alters this natural process, accelerating the development of new skin cells to a mere three to four days. This rapid replacement of old cells with new ones leads to the formation of scales and frequent shedding of skin over the skin plaques.
Psoriasis tends to have a genetic component, with the potential for the condition to be passed down from biological parents to their children.
Plaque psoriasis flare-ups vary from person to person and can be initiated by various common triggers, including:
- Emotional stress
- Infections, particularly streptococcal infections
- Skin injuries like cuts, scrapes, or surgery
- Certain medications, like lithium and beta-blockers
- Changes in body temperature due to weather conditions
1. Genetic Predisposition
In a specific genome region called psoriasis susceptibility 1, or PSORS1, researchers have pointed out the genes associated with the development of psoriasis. This gene segment contributes to as much as 50% of psoriasis’ hereditary component and is typically linked to early onset psoriasis.
The genes within this region guide the body in producing proteins crucial in recognizing antigens, molecules that trigger immune responses. Under normal circumstances, these antigens are typically found on the surface of foreign invaders like bacteria or viruses.
However, mutations in these genes can cause the immune system to misidentify the body’s cells as foreign, ultimately leading to the development of autoimmunity.
2. Immune System’s Role
In plaque psoriasis, healthy skin cells are targeted by immune cells known as T cells. These T cells release signals that recruit other immune cells, creating an inflammatory environment within the skin.
This increased inflammation prompts the body to produce new skin cells more rapidly than necessary, accumulating extra skin cells on top of each other. This process results in the formation of the characteristic plaques seen in psoriasis.
It’s important to note that this immune system misdirection can extend beyond just the skin, as psoriasis often co-occurs with other autoimmune disorders such as Arthritis, Alopecia, Thyroiditis, Vitiligo, Inflammatory bowel disease, and Rheumatoid arthritis.
3. Environmental Factors
Variable clinical features characterize this chronic relapsing disease. Its manifestations can be exacerbated or triggered by several factors, including traumatic skin injury, physical and psychological stress, cold weather, excessive alcohol intake, and drugs such as lithium and Beta-blockers. Other factors include certain medications, starting or stopping medicines, and infections.
Symptoms and Signs
Plaque psoriasis is typified by raised, reddened patches of skin covered with a silvery-white accumulation of dead skin cells or scales, which is its defining characteristic.
Pruritus and Discomfort:
Afflicted skin often presents with itching and discomfort, leading to irritation.
Dry and Cracked Skin:
The skin in and around the plaques may become dry and susceptible to cracking, potentially causing discomfort.
Plaque psoriasis can also influence the nails, causing alterations such as pitting, discoloration, or detachment from the nail bed.
In certain instances, the skin on the plaques may become so dehydrated and fragile that it may crack and bleed.
Sometimes psoriasis may coincide with psoriatic arthritis, leading to joint pain and swelling.
Plaques generally appear symmetrically on the body, affecting corresponding areas on both sides.
Variable Clinical Features:
The display of plaque psoriasis can diverge from person to person, with distinctions in severity, size, and placement of the plaques.
Plaque psoriasis presents with several noticeable symptoms. It is characterized by raised, discolored plaques, which can appear in shades of red, brown, gray, or purple and typically have a white or silvery surface. These plaques can sometimes develop cracks, known as fissures, which can be painful and may even lead to bleeding. Additionally, individuals with plaque psoriasis often experience itching, which can be distressing, and the affected skin may become irritated or painful. These symptoms vary in intensity and can significantly impact the quality of life for those affected by this skin condition. If you suspect you have plaque psoriasis or are experiencing these symptoms, consulting a healthcare professional is essential for proper diagnosis and implementing suitable options.
Plaques typically manifest as raised, red patches covered with a silvery-white buildup of dead skin cells or scale. On skin of color, the plaques may assume a darker and thicker appearance, often displaying shades of purple, grayish, or darker brown.
These plaques can manifest on various body parts, although they most frequently appear on the scalp, knees, elbows, and torso. They tend to appear symmetrically on the body, affecting corresponding areas on both the right and left sides.
Nail psoriasis often accompanies plaque psoriasis, manifesting as discoloration, pitting, or separation of the nail from the nail bed.
Affected Areas of the Body
Plaque psoriasis most commonly affects the elbows, back, knees, and scalp (the skin on your head is usually covered with hair). In severe cases, plaque psoriasis may extend to affect your entire body, including the face, feet, genitals (penis, vagina, vulva), hands, and legs. The severity and extent of the condition can vary among individuals, with some experiencing localized symptoms while others contend with more widespread and extensive manifestations.
A cure for plaque psoriasis does not currently exist. People with this condition may experience flare-ups and periods when the plaques disappear (remission). Plaque psoriasis treatment can offer relief from the symptoms. Specific foods and drinks may influence plaque psoriasis flare-ups. If you have plaque psoriasis, maintaining a food journal to keep track of your dietary intake is advisable. In mild cases of plaque psoriasis, healthcare providers may prescribe creams, lotions, or gels as plaque psoriasis treatment.
For treating widespread cases of plaque psoriasis, your healthcare provider may prescribe the following treatments:
Your healthcare provider will use a thin needle to inject medicine into your skin or a vein in your arm. These medicines may include adalimumab, etanercept, or ustekinumab.
You swallow these pills or tablets with water. Oral medicines for plaque psoriasis may include acitretin, cyclosporine, or methotrexate.
Specialized lamps emit ultraviolet light, typically ultraviolet B (UVB), which can help manage various skin disorders, including plaque psoriasis, by your healthcare provider.
- Your healthcare provider may also prescribe other topical plaque psoriasis treatments, such as anthralin, coal tar, corticosteroids, and salicylic acid.
Artificial drugs known as corticosteroids closely resemble cortisol, a hormone naturally produced by your adrenal glands. The shortened term “steroids often refers to these drugs.” Specific corticosteroid medications include cortisone, prednisone, and methylprednisolone. Steroids find application in treating numerous conditions where the body’s defense system malfunctions, leading to tissue damage. In situations where inflammation threatens critical body organs, steroids can serve as life-saving and, in many cases, organ-saving treatments.
Topical retinoids slow down skin cell growth in psoriasis, thereby preventing the typical signs of the condition, including shedding, skin thickening, redness, swelling, scales, and inflammation.
Coal Tar and Calcineurin Inhibitors
Coal tar diminishes swelling, redness, itching, or rashes triggered by skin conditions like psoriasis. It operates by decreasing redness, irritation, and scaling on the skin. Calcineurin inhibitors, like tacrolimus (Protopic) and pimecrolimus (Elidel), soothe the rash and lower scaly buildup. They prove particularly beneficial in areas of thin skin, such as around the eyes, where steroid creams or retinoids can be irritating or harmful.
An autoimmune disease, plaque psoriasis, leads to thick patches on your skin or scalp. It can cause discomfort if it itches or is painful, making you self-conscious. However, it’s crucial to note that plaque psoriasis is not contagious, and treatments are available to help improve your symptoms.
Vigilance about your skin condition is essential. Contact your dermatologist to be aware of your skin conditions.
You can also access your hair and skin health information on our website.
What are the primary causes or triggers of plaque psoriasis?
Emotional stress, streptococcal infections, skin injuries like cuts, scrapes, or surgery, certain medications, like lithium and beta-blockers, and changes in body temperature due to weather conditions are some of the triggers of plaque psoriasis.
What are the most common symptoms of plaque psoriasis, and how can I recognize them?
Plaques, pruritus and discomfort, dry and cracked skin, nail discoloration, epidermal bleeding, joint pain, scalp involvement, redness, and swelling are common symptoms of plaque psoriasis.
How is plaque psoriasis diagnosed, and what should I expect during a medical evaluation?
Your healthcare provider will examine the affected areas, look for common signs of plaque psoriasis, and ask about your symptoms, family history, and any recent changes in product or medication use before a flare-up. The tests may involve:
- Conducting an allergy test
- Performing a biopsy
- Carrying out blood tests to check for rash causes unrelated to plaque psoriasis
Is plaque psoriasis a genetic condition, and can it be passed down in families?
Familial links exist in psoriasis risk. PSORS1, a gene cluster, contributes up to 50% of genetic influence, especially for early-onset cases.