Psoriasis
Medical Author: Nili N. Alai, MD, FAAD
Medical Editor: William C. Shiel Jr., MD, FACR, FACP
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Psoriasis PUVA Treatment Can Increase Melanoma Risk
Medical Editor: Melissa Conrad Stöppler, MD
 Psoriasis is a chronic disorder of the skin
characterized by reddish, scaly patches of inflammation, most
commonly affecting the elbows, knees, scalp, and/or groin. Psoriasis
can be mild or severe. When it is severe, it can adversely affect
functions of daily living including work and social activities.
Psoriasis has been reported to affect approximately
2% of the world's population.
The treatment of psoriasis depends on its severity
and location. Treatments range from local (cortisone cream
application, emollients, coal tar, anthralin preparations, and sun exposure)
to systemic (internal medications, including methotrexate and
cyclosporine).
PUVA (psoralen and ultraviolet A radiation) treatment
has been used for over two decades to treat severe psoriasis. In
this "combination" therapy, the psoralen, taken internally,
acts as a skin sensitizer. The "sensitized" skin affected
by psoriasis can then be treated by ultraviolet A radiation.
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What is psoriasis?
Psoriasis is a noncontagious common condition of the skin that causes rapid
skin cell reproduction resulting in red, dry patches of thickened skin. The dry
flakes and skin scales are thought to result from the buildup of the rapid
production of skin cells. Psoriasis commonly affects the skin of the elbows,
knees, scalp, and ears.
Some people have very mild involvement with small dry patches on their
elbows, knees, or scalp and may not know they have the disease because it is so
mild. Others have very severe disease where virtually their entire body is fully
covered with psoriasis.
Psoriasis is considered a long-term (chronic) skin condition. It has a
variable course with periodic ups and downs. Sometimes psoriasis may clear for
years and stay in remission. Some people have worsening of their symptoms in the
colder winter months. Many people report improvement in warmer months, climates,
or with increased sunlight exposure.
Psoriasis is seen worldwide, in all races, and both sexes. Although psoriasis
can be seen in people of any age, from babies to seniors, most commonly
patients are first diagnosed in their early adult years.
Patients with more severe psoriasis may have social embarrassment, job
stress, emotional distress, and other personal issues because of the appearance
of their skin.
What causes psoriasis?
The exact cause remains unknown. There may a combination of factors, including
genetic predisposition and environmental factors. The immune system is thought
to play a major role. Despite research over the past 30 years looking at many
triggers, the "master switch" that turns on psoriasis is still a mystery.
What does psoriasis look like? What are the symptoms?
Psoriasis typically looks like red or pink areas of thickened, raised, and dry
skin. It classically affects areas over the elbows, knees, and scalp.
Essentially any body area may be involved. It tends to be more common in areas
of trauma, repeat rubbing, use, or abrasions.
Psoriasis has many different appearances. It may be small flattened bumps,
large thick plaques of raised skin, red patches, and pink mildly dry skin to big
flakes of dry skin that flake off.
There are several different types of psoriasis including psoriasis vulgaris
(common type), guttate psoriasis (small, drop like spots), inverse psoriasis (in
the folds like of the underarms, navel, and buttocks), and pustular psoriasis
(liquid-filled yellowish small blisters).
Sometimes pulling of one of these small dry white flakes of skin causes a
tiny blood spot on the skin. This is medically referred to as a special
diagnostic sign in psoriasis called the Auspitz sign.
Genital lesions especially on the head of the penis are common. Psoriasis in
moist areas like the navel or area between the buttocks (intergluteal folds) may
look like flat red patches. These atypical appearances may be confused with
other skin conditions like fungal infections, yeast infections, skin irritation,
or bacterial Staph infections.
On the nails, it can look like very small pits (pinpoint depressions or white
spots on the nail) or as larger yellowish-brown separations of the nail bed
called "oil spots." Nail psoriasis may be confused with and incorrectly
diagnosed as a fungal nail infection.
On the scalp, it may look like severe dandruff with dry flakes and red areas
of skin. It may be difficult to tell the difference between scalp psoriasis and
seborrhea (dandruff). However, the treatment is often very similar for both
conditions.
Next: Can psoriasis affect my joints? »
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