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Psoriasis can take emotional, physical toll

A woman I know, who had psoriasis in childhood, told me that other kids’ parents would not allow her to play at their house because the skin condition was visible and her family did not know what it was. A young man I knew with psoriasis said he was afraid to go on dates until it had cleared up.

Psoriasis is the most common disease related to immune dysfunction in the United States. It cannot be cured, but it can be treated and symptoms may disappear for long periods of time.

Like many visible skin conditions, it can have both an emotional and a physical effect. Many people who have it may not even realize the cause of their skin problems.

Psoriasis is not contagious, but it tends to run in families.

Smoking, secondhand smoke, excessive alcohol use, and obesity also increase the risk of developing psoriasis. Men are more likely to have psoriasis than women.

In psoriasis, skin cells grow faster than normal and do not slough off in the usual way, often causing red, raised skin lesions with a rough and thickened surface. The skin lesions usually appear following some kind of trigger. The first appearance is often after:

• a stressful event;

• an illness, particularly strep throat;

• taking a particular medication such as lithium or anti-malarial medicine;

• cold, dry weather; or

• skin damage (e.g., a cut, scratch or bad sunburn).

There are several types of psoriasis. Plaque psoriasis looks like raised, red patches on the knees, elbows, lower back and scalp. Patches may have a silvery-white top layer. The patches may itch, but scratching causes thicker lesions. Nail changes like pitted nails can also be from plaque psoriasis.

Guttate psoriasis is more common in children and often appears after infections. It shows up as small red spots that look like they were dropped on the skin – usually on the trunk, arms and legs. It may clear up in a few months without any treatment, but if it starts after a strep throat, a course of antibiotics is important to help clear it up and to reduce other possible complications.

Inverse psoriasis occurs as tender, shiny and smooth lesions in skin folds such as the armpits, between the buttocks, under the breasts and in the genital area that are irritated by rubbing and perspiration.

Pustular psoriasis causes small painful blisters on palms and soles that eventually dry and leave brown dots and/or scale on the skin. If pustular psoriasis develops all over the body, especially with severe itching and flu-like symptoms, it requires immediate medical attention.

Treatment can reduce signs and symptoms of all types of psoriasis. In some cases, with proper care and attention, your skin may be completely clear for long periods of time, but regular preventive medical visits are important because people with psoriasis can be at risk of other health problems, including diabetes and heart disease. About 11 percent of people who have it develop arthritis with enlarged and painful joints.

Treatments include creams, lotions, oral medications and UV light therapy. Recently a new antibody therapy called ustekinumab has been used to interfere with the inflammatory response that causes psoriasis. Its use has risks, but it has been very effective in stubborn cases. If standard therapy is not effective, a dermatologist may be able to find the right treatment combination to keep your psoriasis in check.

Get more information on psoriasis, treatments, related conditions, research and more at

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.

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