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Psoriasis on Face Problems. The Complete Information Guide

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Psoriasis Definition

Capricious and annoying, psoriasis is known as the most perplexing and persistent among skin diseases. It kills your confidence when you got psoriasis on face. The definition of psoriasis is a bunch of symptoms that appear in psoriasis. Psoriasis is a non-contagious (not spread by physical contact), a chronic autoimmune skin disease that causes a thick, patchy, red rash with chalky, silvery-white dry scales.Psoriasis on arms

Sometimes these patches crack and bleed. Unfortunately, when you get psoriasis on face, it is no longer just itch and bleeds, but also becomes a great embarrassment.

What Psoriasis means

Psoriasis was originated from a Classical Latin word psōra or its etymon ancient Greek ψώρα meaning “to itch” or “mange” and -iasis means “action, condition”.

Defined Meanings

In medicine, “psora” is termed as a cutaneous disease, especially the itch. This term was known to be used for the first time during the late 16th century by John Baptist Banister (1654 – May 1692), an English clergyman and one of the very first naturalists in North America.

Some literature claims that this term was using way earlier than John, as in ancient Rome by an encyclopaedist Aulus Cornelius Celsus (25 BC – 50 AD). The development of confined lacerations, due to skin injury, was first termed as an isomorphic response (Koebner reaction) by Koebner in 1872 and it endorses psoriasis.

Psoriasis in different languages

  • Psoriasis in Urdu:  Chambal (Chum-bal) چنبل
  • Psoriasis in French: psɔʀjazis (Sor-ya-zees)
  • Psoriasis in Chinese: 牛皮癣 (Niúpíxuǎn/ New-pee-shian)
  • Psoriasis in Russian: псориаз (Sorias)
  • Psoriasis in Spanish: la psoriasis (La So-ria-sis)
  • Psoriasis in Arabic: Alsadfia الصدفية
  • Psoriasis in Malay: സോറിയാസിസ്
  • Psoriasis in Portuguese: psoríase (so-rya-zee)
  • Psoriasis in Greek: ψωρίασις (so-lia-see)
  • Psoriasis in Bosnian: psorijaza (so-ri-aza)
  • Psoriasis in Macedonian: Псоријаза (So-wi-aza)

Confused terms about psoriasis

suriusus, pscoriasis, scoriesis, psoriusis, pariosis, psarasis, psoreasis, syriusis, psorousis, phoriosis, psirisis, ceriases, soriyas

Psoriasis Prevalence

Psoriasis can come and go irregularly, occasionally getting better and worse. Psoriasis may spontaneously hide for many years staying in remission. Many people claim that their symptoms get worse in lower temperatures. According to the World Health Organization, approximately, 2-3% of the world population is affected by psoriasis. Men and women are equally vulnerable to develop psoriasis. In the United States, more than 8 million people are suffering from psoriasis.

Is Psoriasis race/age-specific?

Psoriasis is not specific to any racial group and hit them all at variable rates. Caucasians have been reported to be more susceptible (3.6%) than Asia-Africans (1.9%). Although psoriasis is not age-specific, most patients are first reported with Psoriasis in their adolescence. The self-confidence and social life of psoriasis patients are often disrupted because of the appearance of their skin, especially if they get psoriasis face.

Now it has been established that people having psoriasis are more prone to have diabetes, high blood fats, cardiovascular disease. Later studies showed that the conditions mentioned above are due to stressed eating and abnormal life patterns. Many other inflammatory diseases may imitate incompetence to control inflammation.

Psoriasis symptoms

Psoriasis symptoms are different for everyone under a different type of Psoriasis. The most common symptoms are:

Psoriasis symptoms Red patchy skin with silvery white scales

  • Red, heaved, inflamed skin patches due to the emergence of rapidly proliferating skin cells towards the outer skin.
  • Whitish-silver scales or plaques on the red patches especially under Plaque Psoriasis. White-Silvery scales are due to the accumulation of newly generated skin cells that are mostly dislocation on the areas of more movement like joints. Another reason for scales is excessive secretion of glucocorticoids on the skin.
  • tenderness around patches
  • itchy and burning vibes around patches
  • dry skin, that in worse scenarios, cracks, and bleeds
  • Red patchy skin with silvery-white scales 
  • Small red spots covered with scales (commonly seen in children)
  • Thickened, eroded or wavy nails
  • Swollen and stiff joints that usually cause pain due to the release of glucocorticoids. It happens in psoriatic arthritis.types of psoriatic arthritis

It is very rare that all of the above symptoms appear in a single individual. The people having a less common type of psoriasis may exhibit entirely different symptoms confusing it with other skin disorders. Mostly, these symptoms are on rotation.

Sometimes symptoms are so severe for a few days or weeks and then they are cleared up as there was nothing wrong. Then, in a few weeks, the condition may flare up again if triggered by Psoriasis invoking factors.

In remission, there will be no sign or symptoms of Psoriasis but that doesn’t mean psoriasis is cured. A few examples are discussed below about skin conditions that may be confused with psoriasis.

Psoriasis on black skin

Psoriasis on white skin is recognized by red patches of skin covered with silvery-white scales. Psoriasis on non-white skin has different attributes. In the case of darker skin, discoloration results in purple or brownish patches covered with grey scales. Hispanic persons are likely to have salmon color patches with silvery-white scales.

black skin psoriasis

African-American population may exhibit purple patches with greyish scales. In darker skin, brown rashes appear that are difficult to observe.

When psoriasis disappears from colored skin, it leaves light or dark patches that are not scaly. If lighter patches are left behind, this is called hypopigmentation.

When darker spots are left behind, this is called hyperpigmentation. This phenomenon is called “dyspigmentation”. These patches may go in 3 to 12 months. Treatment for dark skin psoriasis is the same as for white skin.Dyspigmentation and hypopigmentation after psoriasis

                                                 Dyspigmentation and hypopigmentation after psoriasis is gone

Why Psoriasis occurs?

The excessively rapid proliferation (approximately 10 times faster than normal) of skin cells is responsible for the making of dry flakes of silvery-white skin scales. T-cells are specialized white blood cells that produce inflammatory chemicals during infection. These chemicals then trigger the proliferation of skin cells. Due to this rapid proliferation, subjacent cells rise towards the skin’s epidermis and perish. Their utter accumulation causes bulged, red plaques surfaced with white scales causing itching and sometimes pain.

Normally, skin cells have a life cycle of one month. In people with psoriasis, this life cycle reduces to just a few days which is not letting the skin cells to peel off and this leads to the piling up of skin cells.

The most affected areas in psoriasis are the scalp, elbows, knees, lower back as well as torso, palms, and sole of feet. In less common types of psoriasis, groin area, mouth, and nails can also be affected.

Comparison of Psoriasis with other Skin Conditions

Psoriasis vs eczema

Psoriasis and eczema (atopic dermatitis) look-alike most of the time but their basis is quite different. It is highly suggested to visit a doctor to determine what that condition might be. But for the first step, some features are described here.

How to distinguish between Psoriasis and Eczema?

psoriasis vs eczema picture
                                                       how to differentiate between psoriasis and eczema

Psoriasis and eczema both have red, dry, itchy patches of skin that can also be scaly or crusty in severe cases. But, the major difference between psoriasis and eczema is that psoriatic skin usually has silvery-white scales due to the over-production of skin cells. Or it may look like leather or purple scales on black skin. On the other hand, skin affected by eczema does not have silvery-white scales rather it has an oozing appearance as blood sneaks out from it.

The difference between psoriasis and eczema can also be “felt”. Psoriasis has less itchy and more burning sensation (like bitten by fire ants). Eczema is too much itchy that you will feel comfort until blood comes out of scratching. The location preferred by eczema is usually folded regions like the neck, backside of your elbow and knee joints, ankles, wrists.

In rare or severe cases, it can appear on the face, legs, and scalp. On the other hand, psoriasis appears mostly on dryer areas of the body like face, elbows, palms, foot soles, scalp, and lower back or even, in worse conditions, on nails, lips or inside the mouth.

The frequency of occurrence is also different in both conditions. Eczema is prevalent in infants as they have very soft and sensitive skin, and it may affect early adult age. Whereas, psoriasis affects mostly the adult phase (~15-35 years).

Eczema is a hypersensitivity reaction against dyes, textiles, detergents, animals, and other irritants, that’s why it is prevalent in those having soft or sensitive skin such as infants. While psoriasis is auto-immune, a non-contagious disease associated with the immune system (over-production of skin cells due to inflammation).

Most of the eczema is cured by topical treatment but for psoriasis, treatment is quite complex and time taking. It must be remembered that psoriasis and eczema are not mutually exclusive skin conditions. People have experienced psoriasis and eczema at the same time.

Psoriasis vs seborrheic dermatitis

When comparing seborrheic dermatitis with psoriasis, we are specifically talking about scalp psoriasis because, in both conditions, the victim area is a scalp. After examining your scalp, skin, and nails, the doctor can determine whether you have scalp psoriasis or seborrheic dermatitis or both. In both cases, the skin is usually red and scaly, which is a common observation with an inattentive eye.

how to tell the difference between Psoriasis and Seborrheic dermatitis?

scalp psoriasis vs seborrheic dermatitis

In psoriasis, the scales are thicker, silvery-white and drier and tend to occur on more than just one body part. On the other hand, in seborrheic dermatitis, scales are thinner and greasy white/yellowish, usually present on scalp and hairline.

A common name of seborrheic dermatitis is dandruff (also known as cradle cap in babies) that may attach to the hair tube.

In psoriasis, scales may be present on different body parts like elbows, palms, foot soles, groin, scalp, and face, whereas in seborrheic dermatitis, affected area is often just hairline, and in severe conditions, upper chest and back too. Psoriasis is always itchy but seborrheic dermatitis may itch sometimes.

Any medical condition affecting the immune system, like HIV and AIDS, makes seborrheic dermatitis worse. Surprisingly, it makes psoriasis better because psoriasis is an overreaction of the immune system and when the immune system fails, so does psoriasis.

Both conditions share some common treatments like medicated shampoo or topical corticosteroids. But psoriasis is more persistent than seborrheic dermatitis and often needs more of just topical treatment.

Psoriasis vs Ringworm

Psoriasis and ringworm (tinea corporis) are characterized by red scaly patches of skin that cause itching. The main difference between psoriasis and ringworm is their appearance.

psoriasis vs ringworm picture

How do Psoriasis and Ringworm Look Different?

In ringworm, borders of the affected area are raised and center in sunken look like a worm, however, ringworm has nothing to do with a worm. It is a fungal infection caused by dermatophytes (a fungus living on dead skin cells).

It is highly contagious i.e. rapidly transferred to other individuals upon skin contact. Psoriasis is an autoimmune, non-contagious (non-transferrable) skin disorder presumably due to genetic and immune system defects.

Psoriasis can occur on drier areas i.e. big joints like knee and elbow, palms, foot soles, groin area. Sometimes it can occur on face, mouth, armpits, and scalp. The most favorite place for ringworm is a warm and moist area of the body like groin (tinea cruris, or jock itch), scalp (tinea capitis), beard (Tinea Barbae or barber’s itch) and the web of the foot (tinea pedis, or athlete’s foot).

Dermatophytes grow happily in such an environment. Red patches of psoriasis have no definite shape while ringworm infections usually get a circular shape that looks redder at the borders and normal in the center. Scales of ringworm appear as some caterpillar is residing on the site.

Psoriasis vs Shingles

Psoriasis and shingles (a.k.a Herpes Zoster) both are responsible for an itchy painful rash on a large area of the body but it is crucial to differentiate between these two conditions.

how to distinguish between psoriasis and Shingles?

Psoriasis is a chronic autoimmune skin disorder affecting a large area of the body like Joints, palms, foot soles, face, armpits, groin, and sometimes inside mouth and ears (potential drier areas).

The causative agent for shingles is a varicella-zoster virus (VZV). It is the same virus that causes Chickenpox. Its potential target area is dermatome (surrounding area of a single spinal nerve) e.g. one side of chest, abdomen or limb. In psoriasis, the skin develops red scaly patches covered with a silvery-white appearance.

On the other hand, shingles are characterized by red rashes with blisters appear on the skin. The rashes are very painful. They remain painful even before the appearance of the rash and after blisters are healed (a condition called postherpetic neuralgia).

Shingles VS Psoriasis

Psoriasis vs Shingles Symptoms

Other heads-up symptoms of shingles are high fever, weakness, chills, muscle aches, and more severely, vision loss. Unlike psoriasis, shingles are transferable only when the rash is blistering. Only then the virus can be contracted and affect the person who has never experienced chickenpox followed by shingles or the one who has not been vaccinated for shingles.

The virus resides in the nervous system and stays silent for many years. While psoriasis affects the people between 15-35 years, shingles mostly affect the persons aged 50 or above, inferring that chances of shingles are directly associated with aging that confers the weakening of the immune system.

As far as the difference between treatment for psoriasis and shingles, we have described in detail the potential treatment for psoriasis in this article. Although there is no cure for shingles, the doctor may prescribe some antiviral drugs and painkillers only to lower the severity of disease and pain, respectfully.

Psoriasis pathophysiology

Although clinical characteristics and rigorousness fluctuate among victims as well as periodically, psoriasis is characterized by four anomalies.

  • Papillary blood vessels become stretched and warped through certain vascular alterations. Due to these changes, redness or erythema appears, one major symptom of psoriasis.
  • When granulocytes (polymorphonuclear neutrophils) enter the epidermis, they produce inflammation. Activated CD4+ and CD8+ T cells gather to form lesions due to the release of pro-inflammatory cytokines.
  • Increased proliferation of the basal layer/stratum basale (acanthosis).
  • Fluctuated differentiation of epidermis, where nuclei of keratinocytes are retained in the cornified layer (parakeratosis) while the granular layer decays. These changes in the epidermis are responsible for scaling which is another assurance of psoriasis.

Mechanism of Psoriasis

Psoriasis is characterized by an atypical fast growth of the skin epidermis. During psoriasis, multi-level pathological pathways cause non-regulated production and accumulation of skin cells (especially after an injury) in psoriasis.

Which cells are involved in Psoriasis

The life cycle of Skin cells (28-30 days) is shrunk to 3-5 days in psoriasis. An inflammatory cassette in the dermis, comprised of three subtypes of white blood cells i.e. T-cells, macrophages, and dendritic cells, forces the keratinocytes to mature early. After traveling from dermis to the epidermis, these immune cells secrete inflammatory chemical signals (cytokines). These signals are tumor necrosis factor-α, interleukin-22, interleukin-36γ, interleukin-6, and interleukin-1β.

All of these help keratinocytes to proliferate. They also inhibit the apoptotic mechanism.  Due to these actions, cell accumulation is increased. According to a very careful study, Psoriasis is caused by a fault in regulatory T cells (CD4+ T-cells) as well as in the cytokine interleukin-10 (IL-10).

Genetic alterations of proteins that control the permeability of the skin have been identified as the exact culprit to develop Psoriasis. Shredded DNA strands from deceased cells invoke an inflammatory signal in Psoriasis and stimulating the receptors on certain dendritic cells, which, later on, produce the cytokine interferon-α.

After getting a message from these chemicals from dendritic cells and T cells, keratinocytes also secrete cytokines such as tumor necrosis factor-α interleukin-1 and interleukin-6. Which call upon inflammatory cells to travel and invoke further inflammation.

Dendritic cells serve as a messenger between the natural immune system and adaptive immune system by processing any external antigen and present it to the court of the cell surface in front of a grand jury consists up of T cells. These cells are produced abundantly in psoriatic lacerations. They prompt T cells and type 1 helper T cells (Th1) to proliferate. When these dendritic cells are killed by highly specific immunization along with “Psoralen and ultraviolet A (PUVA)” therapy, the Th1/Th17 cell cytokine profile is blocked.

As a result, the Th2 cell cytokine secretion pattern is initiated. As a result, psoriatic T cells leave the dermis and secrete interferon-γ and interleukin-17 into the epidermis. Also, Interleukin-23 has been reported to facilitate interleukin-17 and interleukin-22 production. IL-17/IL-22 complex forces keratinocytes to secrete cytokines that are attracted to neutrophils.

Psoriasis Causes

What causes the psoriasis is yet an unresolved question of the modern age, but we have the idea that the immune system and genetics are key stakeholders for its development. Many scientific attempts have been made to understand the way Psoriasis occurs.

Immune system and Psoriasis

Psoriasis is possibly an immune system glitch of T cells and neutrophils. T cells normally petrol through the body to take down any external unwelcomed substances (antigens), such as bacteria or viruses. But in Psoriasis, the T cells get confused and start attacking normal skin cells in an attempt to heal a wound or to fight against infection.

The strong relation

Hyperactive T cells also encourage elevated production of healthy skin cells, T cells, and neutrophils using IL-22 which is protective and regenerative interleukin. All these cells travel through dilated blood vessels into the skin causing redness and sometimes pus in pustular lesions. Stretched blood vessels in psoriasis-affected areas produce heat and redness in the skin lesions.

The process of sending new skin cells to the outermost layer of the skin continues rapidly, and the life cycle of skin cells is completed quite earlier than normal. New over-produced skin cells are converted into thick, scaly patches on the skin’s surface. The reason for T cells malfunctioning in psoriasis patients isn’t fully understood. Researchers believe both genetics and environmental factors are key factors.

Genetic causes

The error in the immune system that causes psoriasis is believed to be inherited, yet the connection between genetics and psoriasis has not been fully comprehended. Since Psoriasis is an autoimmune disorder, investigations were initialized in early 1970 focusing on human leukocyte antigen (HLA) complex on chromosome 6p21. The first reported association with HLA-B13 was reported by Russell et al. Afterwards, other promising associations with Cw6 and DR7 were identified in the Finnish and German population.

Further Development

Henseler and Christophers suggested that psoriasis has genetically two types: a familial, early age of onset (<40 years) type which is frequently associated with HLA-(Cw6, DR7, B13, and B57); and a non-familial (>40) at onset type that is associated with HLA-Cw2 and HLA-B27.

HLA-Cw6 alleles are responsible for major psoriasis manifestations

However, according to the National Psoriasis Tissue Bank and other studies, the average age of onset in all families was <40 years, and only two of these families showed any association with HLA-Cw6, meaning HLA-cw6 association may not depict as a familial type because of low frequency.

Only ∼10% of HLA-Cw6-positive individuals were diagnosed with Psoriasis that is also non-significant and more is needed to cause psoriasis, suggesting other genes and/or environmental factors may be responsible.

Role of Immune system in Psoriasis

As mentioned above, the immune system plays a direct role in establishing psoriasis.

When macrophages are activated, an immune response is generated that releases cell signaling proteins like Tumor necrosis factor (TNF-α), Interleukin 1 beta (IL1β), IL-12, and IL-23.

Genes involved in the immune response are thought to be responsible for psoriasis e.g. TNFα, IL12B, and IL23R. However, psoriasis is also a rapid production and accumulation of new skin cells, it has also been associated with genes not related to immune machineries, such as the early differentiation keratinization markers involucrin (IVL) and small proline-rich protein (SPRR). These genes regulate proper epidermal later formation and differentiation, just up-regulated in Psoriasis.

Additionally, T helper 17 (Th17) lymphocytes discharge IL22 and IL17, which are significantly known to be highly expressed in Psoriatic skin. In addition to IL-22 and IL-17, other factors like IL-2, IFN-γ, and TNF-α are also produced by lymphocytes.

TNF

The pro-inflammatory cytokine TNFα is a major factor for the pathogenesis of Psoriasis. Differential expression of TNF-α in healthy individuals may be directly related to polymorphism in its genes.

As far as the genetic location associated with Psoriasis is concerned, early scientists believed that 17q25 locus is highly associated with Psoriasis. This locus was designated as PSORS2. Later studies have also shown the involvement of 4q, 6p as well as Ext1 locus.

16q

Although 16q locus is associated with Crohn’s disease, the presence of 16q is highly associated with Psoriasis also, as Psoriasis is highly associated with Crohn’s disease. Crohn’s disease is an inflammatory bowel disease that causes inflammation of the digestive tract and is recognized by intense diarrhea, abdominal pain, muscle fatigue, weight loss due to malnutrition.

CX3CL1

CX3CL1 (previously known as fractalkine) and its receptor, CX3CR1 stand possible pathogenicity genes in Psoriasis.  Both genes, existing on Psoriasis linked genomic regions, play a role in leukocyte seeping and co-regulate the activity of immunocompetent cells wherever any disease-causing infection and inflammation is expressed.

Factors

There is a 3X increased risk of psoriasis in those twins having the same genetic allele (monozygotic) compared to fraternal twins (having different alleles on the same loci). However, as the susceptibility for psoriasis is not a must-be-happening among monozygotic twins, and can be as low as one third for monozygotic, the rest of the factors can be considered environmental related.

Environmental Causes/factors that flare-up psoriasis

Although it is already established that genetics has already plotted a scheme for developing Psoriasis, but for true disease occurrence, only genetics is not enough. The presence of another risk factor is feared to convert that scheme into a real threat. A few risk factors that can ignite the condition initially can also cause it to flare by the passage of time.

Infection

Any kind of infection can revolt Psoriasis to flare. Guttate psoriasis is the best example of how infection wakes up psoriasis, especially when a streptococcal infection is inbound. More details about Guttate psoriasis will be found later in this article.

HIV is another infection that is often linked with psoriasis. The frequency of Psoriasis is not quite variable among patients with HIV or without HIV, but the severity of the condition is much worse for non-HIV patients. This is a very strange and interesting thing to hear, “Really? HIV helps to reduce Psoriasis?”

Since the Immune system is involved in Psoriasis and HIV kills the immune system, so there should be typically no Psoriasis.

Skin Injury

Any kind of skin injury e.g. cut or wound, even a tattoo/skin piercing or overexposure to the sun—can cause psoriasis to jump in, known as the “Koebner phenomenon”.

Scientists don’t fully understand how a skin injury would have invoked this effect in someone with psoriasis yet they suspect that a combination of cytokines, stress proteins, adhesion molecules, and auto-antigens may rally towards the “crime scene” to take part in “Koebner reactions”.

Koebner lesions are usually very easy to be triggered. Sometimes only rubbing or scratching the skin is enough, so a person having psoriasis must take great care of one’s skin to avoid unnecessary skin contact as much as possible.

We should cover our arms and legs by wearing long sleeves and pants respectively when working or going out, never ignore even tiny skin injuries, clean scrapes, and cuts with soap and water, apply an antibiotic cream or lotion, and cover with a bandage. If you see any slow-healing wounds or any signs of infection, consult your dermatologist immediately.

Obesity

Some roughly estimated studies suggest that obesity is a major risk factor for worsening Psoriasis. It is assumed that too much accumulation of fat causes elevated production of inflammatory cytokines.

Besides causing inflammation, cytokines make of psoriasis symptoms worse by forming plaques in the fat-rich area like skin folds.

Obesity can also obstruct Psoriasis treatment, escalating the threat of potential side effects from medications and lowering the efficacy of certain treatments that have to be adjusted according to body weight.

Medications that cause psoriasis flares

A few examples of the drugs and classes of drugs proved to exacerbate few or all types of psoriasis are given below.

  • High blood pressure regulating medications such as beta-blockers e.g. Inderal (propranolol); and angiotensin-converting enzyme (ACE) inhibitors e.g. enalapril (Vasotec), benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), lisinopril (Prinivil, Zestril), perindopril (Aceon), quinapril (Accupril), trandolapril (Mavik)   and ramipril (Altace).
  • Lithium, which helps to treat bipolar disorders by reducing the severity and frequency of mania, has many skin side effects, one of them is psoriasis.
  • Anti-malarial drugs, such as Plaquenil (hydroxychloroquine) and Aralen (chloroquine), have been found to invoke psoriasis flares with a frequency of 30 by 100 in consuming Psoriatic patients. Plaquenil is often used for the treatment of lupus and rheumatoid arthritis.
  • Interferons, mainly for the treatment of hepatitis C.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) prescribed to minimize pain, fever, prevent blood clots and, in higher doses, decrease inflammation.
  • Terbinafine, an antifungal antibiotic used to treat infections caused by fungus affecting the fingernails or toenails (onychomycosis).
  • The antibiotic tetracycline
  • TNF-α inhibitors, including Remicade (infliximab), Humira (adalimumab), and Enbrel (etanercept). The irony of these drugs is that they are used to treat chronic Psoriasis and Psoriasis arthritis, but sometimes they appear as psoriasis friendly (Paradoxical psoriasis), worsening the symptoms. Researchers suggested that inhibition of TNF-alpha may stimulate the uncontrolled production of interferon-alpha (IFN- α) devising the development of the disease.
  • Tar and anthralin (common topical treatments for plaque psoriasis)

Using oral steroids is not a “free-for-all” kind of therapy to fight against psoriasis, as when the steroids are left using, psoriasis fights back with harsher reactions. So it is necessary to ask your doctor before using any material against psoriasis.

Is smoking bad for psoriasis?

Although smoking is quite injurious to health in all aspects, there is a research study showing a strong connection between smoking and psoriasis. Smoking not only increases a person’s susceptibility to developing psoriasis, but the extent of smoking also has an impression on how grave their psoriasis is and how well they respond to treatment. In other words, smokers never get the maximum benefits of medications and other remedies.

Stress can trigger psoriasis flares

Stress is also the worst enemy of the immune system and, therefore, can have a drastic effect on psoriasis. When a person gets psoriasis flare-ups, one can go into deep depression and anxiety, which further adds up all the damages to the condition. It is like the same if you wish to extinguish the fire with liquid fuel.

Emotional stress has many faces. Though stress in psoriasis is not fully unavoidable, there are several ways to control it assisting in keeping psoriasis flares aside. These ways include regular exercise (even daily walks), yoga, aerobics, meditation, and deep-breathing techniques. Physical stress e.g. surgery or labor pain is also a common prompter for psoriasis epidemics.

Psoriasis gets worse during cold weather

When the temperature drops, the relative humidity of air increases to the dew point value and decreasing the humidity in the air, which in turn leads the skin to be dry.

That is why psoriatic patients show flare-ups in winter or when they visit a low-temperature environment. It has been usually observed that low-temperature zones often lack sunlight.

Since UV radiation is beneficial to psoriatic skin and when there is no sunlight, there will be less radiation remedy for psoriatic skin, hence psoriasis flares up again. Here, it also must be kept in mind that staying in the sun too much can also be harmful as sunburn can also initiate psoriasis flares on the area that is burnt (Koebner’s Effect).

Gluten and psoriasis

Certain foods are rich in gluten e.g. rye, barley, malts, soups, French fries, mayonnaise, ketchup, sausages as well as pasta, bread, crackers, and spices. Beer is the richest source of interest.

The link between gluten and psoriasis is still not understood but few researchers have observed that some psoriasis patients have high levels of gluten antibodies in their blood, suggesting that their cells are reacting against the gluten (even if they haven’t been identified with celiac disease or non-celiac gluten sensitivity).

This aspect requires more research to be carried out to confirm the exact mechanism of how psoriasis is associated with gluten.

However, if someone has psoriasis and also has been diagnosed with celiac disease, he should adapt to a gluten-free diet plan so that celiac disease may be treated.

Additionally, it might help to reduce the severity of psoriasis. If someone has psoriasis as well as high gluten antibodies, he can reduce the flares of psoriasis if he prefers a gluten-free diet.

Types of Psoriasis

Plaque psoriasis

Plaque psoriasis is also known as Psoriasis Vulgaris or chronic stationary psoriasis. It is the most common form and affects 85%–90% of people with psoriasis. Plaque psoriasis symptoms are enough for distinguishing them from other anomalies.

Psoriatic plaques generally appear as upturned patches of swollen skin covered with silvery-white scales. These areas are known as plaques and are most commonly appear on the elbows, knees, hair skin, and lower back.

Plaque psoriasis palm psoriasis

Plaque Psoriasis vs Palm Psoriasis

The plaques might be itchy or painful that may ultimately crack and bleed. They may be present anywhere on your body, including your genitals and the soft tissue inside your mouth and they may occur few or many in a certain area. They are shaped as irregular or oval patches sized from 1 cm to many with fine boundaries.

In children suffering from plaque psoriasis, plaques are not as thick, and the lesions are less scaly. Psoriasis often appears in the area covered with the diaper in early age and flexural areas in children.

The disease more commonly affects the face in children than it does in adults as children scratch and rub their faces more. As far as Plaque psoriasis treatment is concerned, we have provided a detailed treatment plan for every type of psoriasis later in the article.

Nail psoriasis

Psoriasis can target fingernails and toe-nails, causing pitting, abnormal nail growth, whitening of nails, thickening of the skin under the nail (subungual hyperkeratosis), small areas of bleeding from the capillaries just under the nail and discoloration (yellow-reddish discoloration of the nails known as the oil drop or salmon spot).

Psoriasis on nails

Approximately 70 % of cases have exhibit pin-head sized depressions on nails. Psoriatic nails might get loose and detached from the nail bed (onycholysis). In severe cases, nails may be crumbled.

Guttate psoriasis

This type mainly attacks young adults and children. Its main cause is a bacterial infection such as strep throat (Streptococcal pharyngitis). It’s identified by small, water droplet type lesions (Papules) on trunk, scalp, arms, and legs.

guttate psoriasis picture                                                                                              

The lesions are covered by a thin scale and aren’t as thick and raised as plaques usually are. You may have a single eruption that disappears by its own, or you may have multiple reoccurrences. This is the second most prevalent type of psoriasis after plaque psoriasis. Guttate psoriasis occurs in approximately 10% of psoriatic patients.

Inverse psoriasis

Inverse psoriasis is also known as flexural psoriasis and is very painful. It mainly affects the skin folds like in the armpits, in the groin, under the breasts, the skin folds of an overweight abdomen (known as panniculus), between the buttocks in the intergluteal cleft and around the genitals. it is called inverse psoriasis against Plaque psoriasis because, in plaque psoriasis, lesions occur on the outer or extensor surfaces like elbows and knees.

Inverse psoriasis

Inverse psoriasis is not always scaly, in the case of Inverse psoriasis the lesions are smooth patches of red, inflamed skin that worsen with Heat, trauma, infection, friction, and sweating. The main reason of patches being shiny and smooth is the affected area is often not exposed or dried hence preventing the formation of scales. Fungal infections may trigger this type of psoriasis.

Pustular psoriasis

Pustular psoriasis is an unusual form of psoriasis that can occur in extensive patches (generalized pustular psoriasis/ von Zumbusch psoriasis) or smaller areas on the palms of the hands, sole or fingertips of feet (Palmoplantar pustulosis), or only toes and fingers are affected (focal form/Acropustulosis).

It generally causes skin redness, swelling and develops quickly into tender white pus blisters (pustules) appearing just a few hours later when your skin becomes red and gentle.

The pus is non-infectious whitish fluid comprises of white blood cells and it is not contagious. The blisters may appear and disappear frequently. Pustular psoriasis can occur as a reaction against topical treatments like tar and anthralin or certain psoriasis medications like lithium, indomethacin or high blood pressure regulators such as Propranol. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.

Seborrheic-like psoriasis

Seborrheic-like psoriasis is a common form of psoriasis with the same clinical features of psoriasis as well as seborrheic dermatitis (a.k.a seborrheic eczema), but it is quite difficult to distinguish between psoriasis and seborrheic dermatitis. This form of psoriasis typically exhibits itself as red plaques with greasy scales in areas of higher oily sebum production such as the scalp, forehead, skin folds next to the nose, skin surrounding the mouth, skin on the chest above the sternum, and in other skin folds. These are the areas of high sweating.

Erythrodermic psoriasis

The rare type of psoriasis, erythrodermic psoriasis can spread over the entire body with a red, peeling rash that has severe itching and burning sensation. It can make the skin come off in sheets like a peel-off mask. It is rare, occurring in only 3% of people who have psoriasis during their entire life span. It generally appears on people who have unstable plaque psoriasis. Individuals having an erythrodermic psoriasis flare should see a doctor immediately.

This form of psoriasis can be life-threatening. The skin more likely looks as sunburned. It is very common for a person with this type of psoriasis to run a fever or become very ill, so individuals should see a doctor immediately when they find such symptoms.

Psoriatic arthritis

The British dermatologist Thomas Bateman determined a potential association between psoriasis and arthritic symptoms in 1813. In addition to swollen scaly skin, psoriatic arthritis causes swollen, painful joints that is a characteristic feature of arthritis. Usually, arthritis appears after 10 years from when the first psoriasis symptom appeared and it affects approximately 30% of psoriatic patients.

Sometimes the arthritic symptoms are the first or only manifestation of psoriasis or sometimes only nail changes are seen. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint, most of the time knee joints as they are lifting the heaviest load. Although the disease usually is not as deadly as other forms of arthritis, it can cause rigidity and subsequent joint damage that in the most serious cases may lead to permanent disfigurement. The apparent reason for arthritis associated with psoriasis is a low level of calcium and VitaminD. Studies have shown that approximately 32% of psoriatic patients are hypocalcemic (having low blood calcium and low Vitamin D).

Psoriasis on Different body parts

To differentiate psoriasis on different body parts, we have to determine the difference of physiology of each characteristic skin types. Skin is the biggest organ of our body and it covers most of the area. Though the major physiology of the skin is the same, few differences make the skin of one organ slightly different from the others and similarly the specific type of psoriasis. There are certain attributes to consider while differentiating the skin physiology, these are as follows:

  • Skin Thickness: Skin thickness is not uniform throughout the body surface. Thickness is an evolved attribute of the skin according to the apparent function of that body part. For example, the skin of the eyelid is the thinnest which is ~0.5mm, and the skin of the sole is the thickest (~5mm).
  • Oiliness: The presence of sebaceous glands in different proportions also specifies the skin. These glands secrete sebum (oil) to provide lubrication (necessary for skin hydration), antioxidants and many antimicrobial substances. Sebum contains cholesterol, glycerides, fatty acids, squalene, and wax and cholesterol esters. The face skin and scalp skin have more oil glands than other body parts, as it is exposed to the external environment the most.
  • Sweating: There are other glands in the skin that secrete sweat. They are usually called apocrine glands. Apocrine glands in skin and eyelids produce sweating. These are scent glands whose secretion has some scent or odor. The human body has approximately 2-4 million sweat glands. The highest density of sweating glands in at bottom of feet and the least density is on back.
  • Hair follicles: Density and type of hair also make a certain skin unique. For example, facial skin has the highest density of hair follicles but their thickness is quite low. Facial hair is usually quite fine and hard to see. Skin of palm, joints and foot sole have no hairs at all.

    Psoriasis on back

psoriasis-on-back-picture

Psoriasis on Face (Facial Psoriasis)Psoriasis on Face

The most embarrassing type of psoriasis is psoriasis on face as the face is the first motif of your personality. Most of the people have reported that they are worried more about their psoriasis on face than any other type. Even for face, not all areas have the same skin features. Skin thickness varies from eyelids to chin and cheeks, thinnest to thickest respectively.

Based on comparative skin characteristics, psoriasis on the face has different appearances. Major psoriasis-affected areas on the face are eyelids, the skin between the nose and upper lip, the upper forehead and the hairline. Psoriasis has also been reported to appear on the nose, cheeks, and chin as well. But psoriasis on face is embarrassing than on other parts of body.

Psoriasis on eyes

Psoriasis around the eyes is very rare, yet the most annoying. Since the skin of the eyelids is the thinnest, psoriatic scales are also very small in size. When psoriasis affects the eyelids, scales may cover lashes. The edges of the eyelids may become red and brittle. If such condition remains untreated for a long time, the rims of the eyelids may turn up or down. If the rim turns down, lashes can rub against the eyeball and cause irritation, which may produce drying of the cornea (the clear layer on the front of the eye) or allow the eyelashes to scratch the cornea leading to the permanent damage and vision loss. Approximately 7% of people having psoriasis or psoriatic arthritis can develop Uveitis, an inflammatory disorder of the uvea, the middle layer of the eye that consists of the iris, ciliary body, and choroid.

Psoriasis on eyes symptoms

  • Red scales around eyes
  • Dry patched skin that can bleed
  • Difficulty in moving eyelashes
  • Pain while opening and closing eyes
  • Eyelashes rubbing against the cornea
  • Dryness on the eyeballs due to scales pulling the eyelid outwards

Psoriasis on eyes treatment

Psoriatic eyes demand more careful treatment than any other type as eyes are a very sensitive part. National Psoriasis Foundation recommends the following methods:

  • Washing the affected lids and lashes with homemade eyelash cleanser (a mixture of water and very soft detergent like baby shampoo) and rubbing them gently so that scales may be peeled off.
  • Use OTC eyelid cleaner like Avenova, Ocusoft, Heyedrate, and Cliradex, which help to remove scales.
  • FDA has approved two medications i.e. Elidel (pimecrolimus) and Protopic (tacrolimus) to apply around the eyes but these medications require a prescription by the doctor. One thing must be taken care of while using these topical medications. You should go for intraocular eye pressure (IOP) using tonometry, regularly, to determine whether these medications are harming your eyes or not. Consult your ophthalmologist to undergo this test.
  • Dermatologists may prescribe low-potency steroids to apply on eyelids. This can be helpful if used beyond the doctor’s recommendation can put you in the risk of cataract and glaucoma development.

Psoriasis on the eye is something very tricky to treat and any mishap can lead to uveitis or iritis that in the long run can cause permanent vision loss.

Psoriasis on Hands

psoriasis on hands

Psoriasis in and around the ears

Ear psoriasis is also an uncommon area-wise type and can be annoying and painful as well. Psoriasis occurs either around the ear or in the external ear canal. The main symptom of ear psoriasis is like of other types of psoriasis e.g. red patches with scales. In the external ear canal, scales/patches accumulate ear wax above and around them, hence, blocking the ear canal passage causing partial or complete hearing loss.

Ear psoriasis can be confused with the Swimmer’ ear and ear wax blockage due to overlapping symptoms. In this case, your doctor can examine the appearance of your skin or he may go for microscopic observation to confirm which disorder is this.

Ear psoriasis treatment

Topical treatment or medication cannot be applied for ear psoriasis as they are applied to the other types of psoriasis. The most important and sensitive part of the ear is eardrum and any medication can cause severe damage to the eardrum resulting in permanent hearing loss.

Since the psoriatic ear is characterized by a heap of wax around the patchy scales, some people try to remove wax with the help of cotton buds which adversely pushes the wax further towards the eardrum, inflicting more damage. The very first step is to consult your doctor. He may use ear suction apparatus to remove earwax that can help to recover the hearing.

This methodology needs regular trips to your otolaryngologist.

Following are the methods to reduce ear psoriasis:

  • Oils such as olive, coconut, and jojoba oil to moisturize the area around the ear and ease the pain. Soda glycerine can also be used to sooth the wax pile making it easy to remove.
  • Psoriasis medications can put your eardrum at risk, so be cautious when you apply any inside the ear. Your doctor may recommend: A prescription corticosteroid you can drip in your ear or apply to the outside of your ear canal
  • Calcipotriene (brand name Dovonex) or tazarotene usually mixed with a corticosteroid cream or ointment (Taclonex)

Your doctor can prescribe some liquid steroid ear drops i.e. Fluocinonide topical (e.g. Fluocinonide-E, Vanos, Lidex, Licon, Lidex-E, Dermacin, Fluex etc), but these must not be used if there is some infection in your ears. These drops help with itching, swelling, and pain.

Psoriasis on Nose/cheeks/chin

Unlike psoriasis on eyes or psoriasis in ears, psoriasis on the nose, cheeks, and chin is easy to treat and there is no over sensitive body part around them. Among all these, psoriasis appears on the upper edge of the nostrils (Alar groove) because it is the area where less hair can appear.

This kind of psoriasis is treated with the same method as other generalized psoriasis types are treated. We have added many details about treating psoriasis, below.

Psoriasis in mouth

Mouth psoriasis is very rare among psoriasis patients. It affects primarily the lips, gums and sometimes tongue. It is also very disturbing and painful as in the presence of mouth psoriasis, it is very hard to eat, chew or sometimes difficult to speak. Diagnosis for mouth psoriasis is very difficult as its symptoms are different from the other types of psoriasis.

It may confuse with other disorders such as stomatitis, oral thrush, or chronic eczema. Symptoms of mouth psoriasis may include oral pain, burning, or changes in taste perception. Other symptoms include gum bleeding, chronic irritation, intolerance to salt and spicy food, and frequent occurrence of painful mouth ulcers with a fissured tongue. People with mouth psoriasis (around 15%) may develop a condition called geographic tong characterized by red areas of varying sizes surrounded by a white border on the top and sides of the tongue.

Psoriasis in mouth treatment

  • The very first approach to minimize the mouth psoriasis is to maintain oral hygiene including the use of alkaline oral rinses (baking soda with water as a home-made remedy for mouth psoriasis)
  • Avoid smoking and alcohol intake
  • Regular dental checkup
  • The doctor may prescribe an anesthetic rinse like Xylocaine Viscous (lidocaine) or a hydrochloride solution if you have an oral painful irritation.

Psoriasis Diagnosis

The first stage of psoriasis diagnosis is usually carried out by examining the appearance of the skin. The typical psoriatic skin is characterized by crusty, erythematous plaques, papules, or red patches of skin causing an itchy, painful or burning sensation. The primary diagnosis does not include/require any blood test or specialized diagnosis.

Certain conditions can be confused with psoriasis, like discoid eczema, seborrhoeic eczema, pityriasis rosea (confused with guttate psoriasis), nail fungus (confused with nail psoriasis) or cutaneous T cell lymphoma (50% confusion rate for misdiagnosis). In this case, for affirmation, the differential diagnosis of psoriasis is carried out.

Skin reactions caused by other diseases such as the rash of secondary syphilis may also be confused with psoriasis.

When the clinical diagnosis is not helping to assure the presence of psoriasis, a skin biopsy or scraping can rule out the presence of other diseases or allergies. When the skin from a biopsy is observed under a microscope, the following observations can confirm the presence of psoriasis:

  • clubbed epidermal projections
  • Epidermal thickening due to migration and accumulation of keratinocytes from the dermis to the epidermis
  • The stratum granulosum layer of the epidermis is often missing or significantly reduced in psoriasis
  • The skin cells from the most superficial layer of skin are also abnormal as they never fully grown.
  • Unlike their mature counterparts, these superficial cells maintain their nuclei.

Inflammatory chemical infiltrates can usually be observed on microscopy when examining skin tissue or joint tissue affected by psoriasis. Epidermal skin tissue affected by psoriatic inflammation often has enormous CD8+ T cells while the inflammatory infiltrates of the dermal layer of skin and the joints are rich in CD4+ T cells.

Why Psoriasis has no cure?

There are usually two reasons why Psoriasis has no cure. First, it is an autoimmune disease means the body’s protecting cells have started to believe that the body is at risk and they attack the normal healthy cells. You can imagine what happens if a country’s army invades its civilians.

The same happens in Psoriasis. Moreover, there is no sound explanation for what causes psoriasis. Without the knowledge of causing roots, we cannot arrest the culprit, hence we can’t catch the disease.

But several management strategies are deployed to reduce the severity of symptoms.

Psoriasis Treatment

Conventional Treatment for psoriasis

Topical treatment

Creams and lotions can help reduce less severe psoriasis if applied directly to the skin.

psoriasis treated

Topical psoriasis treatments include:

  • Topical corticosteroids help to reduce the inflammation of the skin by weakening the immune system. A very strong corticosteroid is Clobetasol propionate (with brand names like Temovate, Clobex, Olux, Impoyz) which is used for the variety of psoriasis but it must be applied only on external skin surfaces and away from face and armpits. Clobetasol mixed with Coal-Tar become even more powerful topical.
  • Topical retinoids also reduce inflammation by inhibiting various immune factors, including leukocytes activity and release of proinflammatory cytokines.
  • anthralin is beneficial during mild psoriasis. Anthralin is a natural ingredient found in goa powder obtained from the araroba tree. It reduces skin cell growth, ultimately helping to reduce psoriatic adversities.
  • Vitamin D analogs– a higher deficiency of Vitamin D has been reported as highly associated with psoriasis. Vitamin D plays a major role in the maintenance of skin by regulating the synthesis of glycosylceramides necessary for the barrier integrity and permeability in the stratum corneum. A decrease in 1,25(OH)D (active analog of Vitamin D) or a loss of function of its receptor has been associated with disruption of the differentiation of the epidermis, involucrin and loricrin levels reduction and loss of keratohyalin granules, leading to hyperproliferation of the basal layer worsening the psoriasis symptoms. Vitamin D acts as a multi-potential immune stabilizer that inhibits the proliferation of T lymphocytes. Since psoriasis can lead to psoriatic arthritis, vitamin D supplements can help to reduce the bone degeneration too.
  • Salicylic acid serves as a keratolytic agent that maintains skin’s moisture binding capacity and helps to peel off warts, calluses, and other skin cells accumulations. Salicylic acid treats psoriasis as scale lifter i.e. shredding the dry scales and soften the skin. In a case where a high concentration of Salicylic acid is applied, it must be washed away quickly otherwise it will cause skin irritation. This must be applied to specific skin portion and it is not a massage therapy otherwise the body will absorb too much of it. Since salicylic acid is a skin softener, it also soothes the hair shaft and causing temporary hair loss. Dermatologists prefer salicylic acid as a primo-secondary treatment of psoriasis.
  • Coal Tar is extracted from both coal and plants. It helps in slowing down the rapid growth and proliferation of skin cells, consequently, reducing psoriatic symptoms.
  • Tazarotene is also a 3rd generation retinoid that belongs to an acetylenic class of retinoids. It is sold in the form of cream and gel.

Dermarest Psoriasis: Best shampoo for scalp psoriasisbest shampoo for scalp psoriasis

  • Dermarest Psoriasis Medicated Shampoo Plus Conditioner with 3% Salicylic Acid.
  • Made with Green Tea Extract, Kukui Nut Oil and Safflower Extract. Fragrance-Free
  • A unique zinc complex is specially formulated to truly treat psoriasis and relieve symptoms.
  • Relieves and helps prevent recurrence of: scalp itching, irritation, redness, flaking and scaling due to psoriasis.
  • Recognized by the National Psoriasis Foundation.

Moisturizer–The main cause of scales formation in psoriasis is the dryness of the skin. Patients should use chemical-free natural moisturizers to keep skin soft and waxy. It helps to reduce the scaling of the skin.

Systemic medications

Systemic medications are defined by the medications that are broad-spectrum or affecting the whole body, and they have very low target specificity. When symptom-inhibiting or natural ways are failed to minimize the severity of psoriasis, people with mild to severe psoriasis need to use medications either through oral or injections. Most of these medicines have their side effects so doctors prescribe them for a very short period.

These medications are below:

  • methotrexate (also known as amethopterin) is a chemotherapy agent and immuno-suppressant. Methotrexate is used only in severe cases where all other options fail. It does not work on your skin or remove outer symptoms, it suppresses the immune cells that cause psoriasis. The drug is metabolized in the liver and filtered by kidneys. longer use of this drug can harm both organs.
  • cyclosporine is also an immunosuppressant and natural product from a fungus Tolypocladium inflatum Gams. It is used in severe cases and like methotrexate, it can damage both kidneys and liver.
  • Acitretin is second generation retinoid, a synthetic form of Vitamin A. Acitretin is the only retinoid approved by the FDA for treating psoriasis. When symptoms start to get milder, usage must be reduced or stopped immediately, as this drug also brings some side effects with it. Acitretin must not be used by pregnant women, those who are allergic to retinoids, those having liver or kidney diseases and those having high triglycerides in the system.

Biologics for psoriasis

Biologics (Biological drugs) are laboratory made, highly target specific protein drugs that hit only specific parts of the immune system, hence, causing very few side effects. The targets of biologics are T-cells or specific proteins of the immune system like Tumor Necrosis factor-Alpha (TNF-α), interleukin 17-A, or interleukins 12 and 23. These cells and proteins are the building material for psoriasis.

Below are few Biologics widely used for the treatment of Psoriasis:

Interleukin 12/23 (IL-12/23) inhibitors

As mentioned above, Interleukins-12/23 are associated with psoriatic inflammation. Stelara (ustekinumab) selectively targets the cytokines like interleukin-12 (IL-12) and interleukin 23 (IL-23) and disrupts their activity. Recently approved Taltz (ixekizumab) is also a good injection therapy for moderate to severe plaque psoriasis. Risankizumab, guselkumab, tildrakizumab and brodalumab are pending for approval and they promise total skin clearance in trials.

Interleukin 17 (IL-17) inhibitors

Cosentyx (secukinumab), and Taltz (ixekizumab) block a cytokine called interleukin-17 (IL-17), which is involved in inflammatory and immune responses. Siliq (brodalumab) blocks the IL-17 receptor A (IL-17 RA) through which IL-17 mediates the inflammatory and immune responses. There are higher levels of IL-17 in psoriatic plaques. By hindering IL-17 signaling, Cosentyx, Siliq, and Taltz interrupt the inflammatory cycle of psoriasis. The patients treated with these drugs have shown improvements in their psoriasis.

Tumor necrosis factor-alpha (TNF-alpha) inhibitors

Enbrel (etanercept), Cimzia (certolizumab pegol), Remicade (infliximab), Humira (adalimumab), Simponi Aria (golimumab) and Simponi (golimumab) are drugs that inhibit TNF-alpha activity. TNF-alpha is a cytokine that prompts the body to create inflammation. In psoriasis and psoriatic arthritis, excessive production of TNF-alpha in the skin or joints is observed. This overproduction leads to the rapid growth of skin cells and/or damage to joint tissue. Hindering TNF-alpha production helps stop the inflammatory cycle of psoriasis.

Interleukin 23 (IL-23) inhibitors

Tremfya (guselkumab) and Ilumya (tildrakizumab-asmn) act by targetting interleukin 23 (IL-23). This cytokine is linked with inflammation in psoriasis and psoriatic arthritis. Tremfya and Ilumya work to reduce psoriatic symptoms and slow disease progression.

Tremfya Reviews

The Canadian Skin Patient Alliance (CSPA), Canadian Association of Psoriasis Patients (CAPP) and Canadian Psoriasis Network (CPN) conducted a patients review survey to inquire about the effects of Tremfya. 

T-cell inhibitors

Orencia (abatacept) attacks T cells in the immune system and it inhibits T cells from becoming activated to reduce inflammation. Almost all the patients claimed to have effective relief with first 4-8 weeks of Tremfya administration. After that, 80% of them reported no further improvement and some reported newer psoriatic spots.

Keziah Austin said:

“I have been on Tremfya for 8 months now. It cleared me up quite a lot within the first 3 months but sadly I saw no more progress since then. I have never been completely clear within the entire time I’ve been on it. I’ve also experienced multiple BAD flare ups while taking it. Sadly.. it just didn’t work for me. I was hoping to be fully clear by 6 months but that just wasn’t the case. I’m seeing my Dermatologist this week to hopefully swap to something else.”

Lee said: 

“Tremfya did not work quick enough for my Palmar plantar psoriasis After 3rd shot finally some improvement. . The problem is the 1st 2 weeks it finally starts to work then u get relief and feel elated. Then the 6th week it completely wears off and u suffer for 2 weeks until you can take another shot . Then it takes another 2 weeks to feel relief. Shots need to be closer than 8 weeks .”

Natural Treatment for psoriasis

Natural Topical Treatment for Psoriasis

It has been mentioned above many times that Psoriasis has no cure but, no need to worry, psoriatic symptoms are not very hard to control. Luckily, several natural topical agents can reduce symptoms without much hassle.

However, we have to be aware that natural does not mean 100% risk-free or without side effects. Go to your doctor before using natural products because any natural herb or agent can contradict with your current medication or flare-up other symptoms.

Given below are a few natural remedies used for external treatment:

Aloe Vera for psoriasis

Gel from the aloe plant can be applied to the skin up to three times a day. Few studies revealed that it helps to reduce redness and scaling associated with psoriasis.

It is better to use creams containing 0.5% aloe. Aloe Vera has a positive effect only when it is used topically. Tablet containing aloe is not helpful but can be harmful.

Apple cider vinegar for psoriasis

Ancient cultures have used Apple Cider Vinegar as a disinfectant. It can help by relieving scalp itch caused by psoriasis. It is available easily at the grocery store and it must be applied to scalp several times a week.

Some people report diluting vinegar with water on a 1-to-1 ratio helps prevent a burning sensation, but in this case, you must wash the scalp when the solution gets dried to avoid irritation.

You must immediately stop this remedy if your skins react to it. If you have open wounds, vinegar will only irritate your skin and cause a burning sensation. If it works for you, you should see results within a few weeks.

Tea tree oil for psoriasis

Tea tree oil is extracted from the leaves of a plant that is primarily grown in Australia. Tea tree oil is believed to have antiseptic features and can be applied to the skin.

Some people claim that using shampoos with tea tree oil helps relieve their scalp psoriasis. However, there are no scientific studies to prove the effectiveness of tea tree oil in reducing symptoms of psoriasis. Some people are found to be allergic to this oil.

Lavender oil for psoriasis

With calming and anti-inflammatory properties, it helps soothe the skin while also promoting new skin growth and healing. It is also believed to be helping reducing anxiety and depression (another post-traumatic condition in psoriasis).

But this therapy has not been approved by the FDA so it cannot be used instead of regular treatment.

Frankincense oil for psoriasis

Frankincense oil contains a-Pinene, a-Phellandrene, (+)-Limonene, B-Myrcene, B-Pinene, B-Caryophyllene, p-Cymene, Terpinen-4-ol, Verbenone Sabinene, and Linalool. With antiseptic, antibacterial, antioxidant and anti-inflammatory properties, frankincense (Olibanum) can help provide relief for stubborn psoriasis patches.

Myrrh oil for psoriasis

Myrrh essential oil is extracted from the gum of the Commiphora myrrha tree (a plant native to the Arabian peninsula and Africa). This oil is excellent at healing the chapped, blistering and cracked patches of psoriatic skin.

Geranium oil for psoriasis

Geranium oil is derived from the external parts of the geranium plant (Pelargonium graveolens). The main chemical constituents of geranium oil include eugenol, citronellyl formate, geraniol, terpineol, geranic, citronellol, linalool, citral, sabinene, methone, and myrtenol.

Geranium oil is non-hazardous, itching-free and generally non-stimulating. The therapeutic properties of it account for acting like an antidepressant, an antiseptic, and wound-healing.

It is best for its dermatological use against aging, wrinkled and dry skin (dry skin is an open target to bring on plaque psoriasis). Geranium essential oil has a characteristic ability for synthesizing novel anti-inflammatory drugs with reduced side effects.

Geranium oil obstructs the inflammatory reactions in the skin. Since psoriasis is an over-inflammatory response of skin, arthritis is of joints and heart diseases are of arteries, Geranium oil helps to get rid of all these three conditions by reducing the inflammation.

This way, Geranium oil not only helps the skin but also gives relief in psoriatic arthritis. Many studies believe that this oil also has remedies for stress reduction, another side effect of psoriasis. So there are several ways this oil can help with psoriasis.

Coconut oil for psoriasis

It’s not an essential oil, but it is the best candidate as a base oil. It is better to mix essential oils with some base oil before spreading them over problem areas. Coconut oil is a very interesting thing to study concerning psoriasis.

Coconut oil has an abundance of medium-chain triglycerides (MCTs), which are transferred directly to the liver for energy releasing, providing instant energy as compared to other long-chain triglycerides and heavy lipids.

The true therapeutic potential of coconut oil is due to two main compounds namely lauric acid and caprylic acid. These two ingredients, according to many studies, have great anti-inflammatory and analgesic properties.

These just not heal the psoriatic skin by banishing the over inflammation, but also relieve that joint pain due to arthritis. One thing should be noted if consuming coconut oil worsen your psoriasis symptoms, stop using it as diet, this can happen because coconut oil boosts your immune system, hence, it can lead to severe psoriasis inflammatory reactions.

Capsaicin for psoriasis

Capsaicin might be a new name for you but it is the ingredient in chili peppers that make your mouth feel hot.  Capsaicin creams and ointments block nerve endings that communicate a sense of pain.

Researchers found that Over-The-Counter creams containing capsaicin may help reduce the pain, inflammation, redness, and scaling linked with psoriasis. But, one should be careful in noting the adverse effects of capsaicin when applied to the skin.

Some people have experienced the side effects of it that are the same that capsaicin claims to heal.

Turmeric for psoriasis

Turmeric, a relative of ginger, is one of the most studied herbs for its great anti-inflammatory and antioxidant properties. Curcumin, the active ingredient in turmeric also can modify the gene expression of TNF cytokine. That is why some patients find it helpful in minimizing psoriasis and psoriatic arthritis flares. Turmeric can be used in curries, creams, and ointments and capsules. The FDA approves 1.5 to 3.0 grams of turmeric per day to be safe. However, it is better to consult your naturopathic doctor before starting the use of turmeric for medicinal purposes.

Dead Sea Salts for psoriasis

Dead Sea salt refers to salt and other mineral deposits obtained from the Dead Sea. The composition of this substance is very different from oceanic salts as Dead Sea salts are rich in magnesium, potassium, sodium, calcium, and sulfates, but majorly, chloride and bromide ions. Ancient Egyptian, Greek, and Roman people used to bathe in the floating waters and rub marine mud all over their bodies to cleanse, soothe, and rejuvenate the skin. This practice is now called thalassotherapy. Taking a warm bath in a bathtub with added Dead Sea salts or Epsom salts and staying in there for about 15 minutes and repeating this for 3 weeks may help to soothe your skin, remove scales and relieve itching. It is very crucial to apply moisturizer to your skin as soon as you leave the Dead Sea tub.

Oats for psoriasis

Oats are believed to be one of the best natural skin mediators. Although oat’s effectiveness is not yet proved scientifically, ut people who have used oat paste or taken bath in oat water, claimed their skin itch and redness has been healed to a great extent. There are many over-the-counter oatmeal bath mixes, lotions, and soaps. But all you need is plain ground oats and a bathtub to get the helpful effects.

Mahonia Aquifolium (Oregon Grape) for psoriasis

Mahonia belongs to the barberry family and the habitat of forests on the North American Pacific coast. It is a powerful antimicrobial herb that plays a role in the immune response. Extract from the bark and root possesses alkaloids i.e. berberin, protoberberine, berbamine, and oxycanthine. These alkaloids are believed to be strong antimicrobial and antifungal factors. Few treatment studies have claimed that cream containing 10% mahonia has helped to treat mild psoriasis. Mahonia should be used only topically because it belongs to the alkaloid family.

Strange Remedy for Psoriasis:

When you are suffering from psoriasis and stuck in a situation where you cannot find any remedy, natural or composed, we proposed the strangest therapy for reducing psoriasis flares.

Saliva to treat Psoriasis:

Yes, Saliva, secretion from your mouth. Saliva contains 99% of water and the rest of the constituents are some proteins, sodium, potassium, and other enzymes. Immunoglobulin A (IgA) is an antibody from mucous membranes. It has great potential for anti-inflammatory activities. By applying saliva on psoriatic lesions will reduce inflammation as well as stop skin dryness and help remove the scales without bleeding. Medically or scientifically, it is not proved but many psoriasis patients with pets (who enjoy licking their master’s skin) have claimed their psoriasis symptoms are gone for good.

Food for Psoriasis

Certain food items produce inflammation in the body, hence causing psoriasis symptoms to flare, others act in the opposite direction. One thing should be noted that there is no scientifically proven link between diet and Psoriasis. Every individual may experience the unique effects of each diet. So it is wise to study your body with a closer look. After your doctor, only you can decide what to eat to help psoriasis banished.

Food to avoid in psoriasis

Many surveys have been conducted about food and psoriasis flare-ups and here are given major threatening food items (people believe so). Foods that may cause inflammation include:

Alcohol

Alcohol is the worst possible habit a psoriatic patient can have. Alcohol opens/relaxes the blood vessels in the skin. When your blood vessels are dilated and wide open enough, white blood cells, including the T-cells that are believed to be responsible for psoriasis, can infiltrate the skin dermal layer more easily. That is a case you never wanted.  Psoriasis symptoms may get worse even if alcohol usage is low to medium.

Junk Food

Junk foods are usually rich in saturated and trans fats and refined starches and sugars. High-fat meals promote endotoxin [e.g., lipopolysaccharide (LPS)] translocation into the bloodstream, stimulating innate immune cells and leading to a transient postprandial inflammatory response. Another reason to avoid junk foods is that that they are high in calories with little nutritional value, and people with psoriasis often have weight problems. Anti-social behavior is a major outcome in patients of psoriasis. Due to this, they usually stay depressed and eat more junk food than healthy people. As a result, fat contents in the body are raised to an alarming level that results in high inflammation, heart diseases as well as arthritis.

Red Meat

Red meats contain a polyunsaturated fat called arachidonic acid. Soon after the injury or irritation, this kind of fat is released and oxygenated into inflammatory mediators, the eicosanoids which can worsen psoriasis symptoms. Similarly, processed meats, such as sausage and bacon are also not counted as friendly meat. On the other hand, red meat produces more uric acid that causes high blood pressure (more blood movement to the skin as well), inflammation of joints (another hallmark of psoriasis), and heart diseases.

Dairy Products

Like red meat, dairy products also contain the natural inflammatory arachidonic acid which is synthesized by desaturation and chain elongation of the plant-rich essential fatty acid, linoleic acid.

Cow’s milk also contains the protein casein, which has been linked to inflammation. In susceptible individuals, A1 casein is broken down to form a powerful inflammatory opiate known as casomorphin.

One interesting fact is that casein is very similar to gluten, so those individuals who are gluten susceptible are also casein susceptible. Certain breeds of cow contain A1 casein but others contain A2 casein in their milk which is not harmful.

Egg yolks, too, are high in arachidonic acid, so eliminating these contents from the diet can help combat psoriasis.

Nightshade Plants

Nightshade plants belong to the major group of the Solanum and capsicum families. Some people report that consuming plants from the “nightshade family” e.g. peppers, white potatoes, eggplant, and tomatoes, ignite their psoriasis.

These vegetables contain solanine, an alkaloid compound that has been shown to trigger pain and increase inflammation in some people. This fact is yet to be proven scientifically.

Some other studies have shown that allowed nightshade plants may improve the symptoms of psoriasis.

Citrus Fruits

Sometimes an allergic reaction can make psoriasis to flare up as they introduce the same allergic symptoms as psoriasis does. Citrus fruits, such as grapefruit, oranges, and lemons are common allergens.

People with psoriasis must read their bodies by eschewing the citrus fruit and reintroduce them if they ring a bell.

Gluten

This protein is commonly found in some herbaceous grains, including rye, wheat, and barley. Those who are gluten-intolerant, as well as psoriatic patients, may experience severe flare-ups for psoriasis when consuming gluten.

Some surveys suggest that taking a gluten-free diet may help to soothe psoriasis but this diet plan is not easy to follow.

Condiments

Condiments and spices tend to be enemies to psoriatic patients. Condiments are edible materials used in small amounts to impart flavor to food.

These include culinary herbs, spices, and plants from which flavourful chemicals can be extracted. The most threatening condiments are pimento, paprika, curry, vinegar, Tabasco sauce, cinnamon, mayo, Worcestershire sauce, and ketchup. These condiments must be removed from your diet if you are disturbed by psoriasis.

Although research has yet to confirm a direct link between what you eat and psoriasis flare-ups, you might find that your symptoms improve when you avoid one or more of these foods.

The best food for psoriasis

Some studies suggest that antioxidants, like vitamin C, vitamin E, beta carotene, and selenium, may make a difference. And some research suggests fatty acids from fish oil can be helpful. More research is needed to establish a law here.

Foods that may reduce inflammation include:

  • fatty fish, such as salmon and tuna
  • seeds, such as flax seeds and pumpkin seeds
  • nuts, especially walnuts, peanuts, and almonds
  • Avocados
  • Probiotic food
  • High fiber foods
  • High-Zinc foods like Grass-fed beef, lamb, pumpkin seeds, kefir, and chickpeas
  • green leafy vegetables, such as spinach and kale
  • Lean meat (white meat)
  • Anti-inflammatory foods may also be helpful in psoriasis. They include:
  • Fruits and vegetables especially berries, cherries, carrots, squash and leafy greens which are a great source of anti-oxidants
  • Salmon, sardines, and other fish containing a high dose of omega-3 fatty acids
  • Anti-oxidant-rich herbs and spices, like thyme, sage, cumin, and ginger
  • Heart-healthy sources of fat, like olive oil, seeds, and nuts

Lifestyle for Psoriasis patient

When a person has psoriasis, he undergoes certain physical and psychological changes that in turn worsen the symptoms and heat goes on. Previously, it was thought that psoriasis is a contagious disease so people used to avoid contacting psoriatic patients leaving them in a social cascade.

If a person has psoriasis on his face, then it is even worse as the face is the first motif of your personality.

We have proposed some tips above to make psoriasis sleep including medications, topicals, foods but here we include some practices that can make your life better even if you have psoriasis.

Exercise

Exercise is quite a necessity for every human being to keep their body up to date. Psoriatic patients must follow a daily exercise plan to reduce weight, maintaining metabolism, normalizing blood flow throughout the body and to see the environmental beauty out there.

Social Activities

It is cordially advised not to imprison yourself in the house with embarrassment. Psoriasis is not a crime. If you stay at home avoiding people, it can take you to the depression that is a welcome note to psoriatic symptoms.

Go out and meet friends and family, listen to them, and talk to them. Share your feelings about psoriasis and how you are combating with it. This will help to reduce your depression and make you a healthier person.

Habits

  • Change your habits if you are a smoker and/or alcoholic. These two things are your worst enemy, not only in psoriasis but also in normal life.
  • They can reduce your frustration or depression for a while but depression may come back with greater force when smoking/drinking invokes psoriasis flares.
  • Always take care of your sleep as it is quite crucial for both physical and mental health, and both can be disturbed during the psoriatic reign.

Clothes and Fabrics

  • At the top, a psoriatic patient is highly advised to cover the body area especially elbows, knees and back as psoriasis appear here the most. If left exposed, certain environmental triggers like allergen, rough surfaces can bring psoriasis in.
  • Always wear soft fabric in psoriasis. Fabric made from 100% natural fiber is the best choice as it does not stick to the body as synthetic polyester or other blends do.
  • Always prefer Smooth Egyptian or American Grown Pima cotton sheets in bedding as they are long-fibred that is why they are less irritating and breathable. The silk fiber is also a good choice as it is quite smooth and it won’t chafe.
  • Flannel sheets are often made from a blend of wool, synthetic fiber, and cotton. Since the first two are quite the irritants, use only 100% pure cotton flannel.
  • Always use cotton fiber filler pillows. Feather filled or polyester filled pillows may enhance psoriatic symptoms. Always wash your fabric weekly with soft washing detergents. Try to cover your body area maximum to reduce and skin friction to any unavoidable surface.

ICD-10 Code for Psoriasis

ICD-10 Psoriasis code is L40 that is non-billable, means it is not reimbursed by insurance companies. Below is detailed code for Psoriasis ICD-10:

Disease Code Billing status
Psoriasis L40 Non-Billable
Psoriasis vulgaris L40.0 Billable
Generalized pustular psoriasis L40.1 Billable
Acrodermatitis continua L40.2 Billable
Pustulosis palmaris et plantaris L40.3 Billable
Guttate psoriasis L40.4 Billable
Arthropathic psoriasis L40.5 Non-Billable
Arthropathic psoriasis, unspecified L40.50 Billable
Distal interphalangeal psoriatic arthropathy L40.51 Billable
Psoriatic arthritis mutilans L40.52 Billable
Psoriatic spondylitis L40.53 Billable
Psoriatic juvenile arthropathy L40.54 Billable
Other psoriatic arthropathy L40.59 Billable
Other psoriasis L40.8 Billable
Psoriasis, unspecified L40.9 Billable

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