Psoriasis – Symptoms and Causes

Overview

Psoriasis affects the skin, creating itchy, red patches with scales that often appear on elbows, knees, trunk, and scalp. This long-term condition has no cure but follows cycles. Symptoms flare up for weeks or months, then decrease temporarily.

People with genetic tendencies toward psoriasis may experience triggers such as:

• Infections
• Wounds (cuts or burns)
• Certain medications

The condition can be uncomfortable, disrupt sleep, and affect concentration. While psoriasis cannot be cured, various treatments help manage symptoms effectively. Additionally, lifestyle adjustments and coping strategies can improve quality of life for those living with psoriasis.

Signs of Psoriasis

Psoriasis shows up differently on each person’s skin. Common signs include:

• Patchy rashes that can appear as small spots or cover large areas
• Rashes appearing purple with gray scales on darker skin tones, or pink/red with silver scales on lighter skin
• Small scaling spots (often seen in children)
• Skin that’s dry, cracked, and sometimes bleeds
• Feelings of itching, burning, or soreness
• Cycles of flare-ups lasting weeks or months followed by periods of improvement

Psoriasis appears in several forms, each with distinct characteristics:

Plaque Psoriasis

This most common type causes raised skin patches (plaques) with scales that can itch. They typically show up on elbows, knees, lower back, and scalp.

The color varies depending on your skin tone. After healing, the skin might temporarily change color, especially on darker skin.

Nail Psoriasis

When psoriasis affects nails, you might notice:

• Pitting (small dents)
• Abnormal growth
• Discoloration
• Loosening from the nail bed
• Crumbling in severe cases

Guttate Psoriasis

This type mainly affects children and young adults, often after a bacterial infection like strep throat. Look for small, drop-shaped scaling spots on the:

• Trunk
• Arms
• Legs

Inverse Psoriasis

This form appears in skin folds of the:

• Groin
• Buttocks
• Breasts

It creates smooth, inflamed patches that worsen with sweating and friction. Fungal infections may trigger this type.

Pustular Psoriasis

This rare form produces clearly defined blisters filled with pus. It may appear as widespread patches or in small areas on palms or soles.

Erythrodermic Psoriasis

The least common type can cover the entire body with a peeling, intensely itchy or burning rash. It may be short-term or chronic.

When to Contact a Healthcare Provider

If you think you might have psoriasis, make an appointment with a healthcare provider. You should also seek medical attention if your psoriasis:

• Becomes widespread or severe
• Causes pain or discomfort
• Makes you feel self-conscious about your appearance
• Doesn’t improve with treatment

Your fingernails can offer important clues about your health beyond psoriasis. While some nail changes like vertical ridges are normal parts of aging, other changes may indicate health concerns.

Watch for these nail changes that might need attention:

1. Pitting – small dents that may indicate psoriasis.
2. Clubbing – fingertips that appear wider or rounder, possibly related to low oxygen.
3. Spooning – nails that curve upward like spoons, possibly linked to iron deficiency or liver problems.
4. Horizontal lines – may show previous injury or infection.
5. Nail separation – might result from injury, infection, or medication.
6. Yellowing – could be related to respiratory issues.

What Causes Psoriasis

People who might develop psoriasis can live without symptoms for many years. Then something in their environment can activate the condition. Here are common triggers that can start or worsen psoriasis:

• Infections: Throat infections like strep throat or skin infections can trigger flare-ups.
• Cold or dry weather: Winter conditions often make symptoms worse.
• Skin damage: Cuts, scrapes, insect bites, or bad sunburns can lead to new patches.
• Tobacco: Both smoking and being around secondhand smoke increase risk.
• Alcohol: Drinking too much can trigger symptoms or make them worse.

Medication triggers include some blood pressure drugs, lithium, and antimalarial treatments. Quickly stopping steroid medications can also cause flare-ups.

The immune system plays a key role in psoriasis. The body’s defense cells mistakenly attack healthy skin cells. This makes skin cells grow too fast, causing the scaly patches.

While we know genetics and environment both matter, scientists still don’t fully understand what causes psoriasis. The condition cannot spread from person to person.

Risk Factors

Psoriasis can affect anyone, with about one-third of cases starting during childhood. Several factors may increase your chances of developing this skin condition:

Family Connection

• Having one parent with psoriasis raises your risk
• Having two parents with psoriasis significantly increases your risk

Tobacco Use

• Smoking not only makes you more likely to develop psoriasis
• It can also make symptoms more severe when the condition does appear

Health Issues Linked to Psoriasis

People with psoriasis face a higher risk of developing several other health conditions. These related problems can affect various body systems and may require additional medical attention.

Joint Problems

Psoriatic arthritis affects about 30% of people with psoriasis. This condition causes:

• Pain and stiffness in joints
• Swelling around affected areas
• Reduced range of motion
• Morning stiffness that improves with activity

The inflammation that drives psoriasis can also attack joint tissues, leading to permanent damage if not treated promptly.

Skin Changes

After psoriasis plaques heal, they sometimes leave behind temporary skin color changes. These include:

• Hypopigmentation: Lighter patches where plaques have healed.
• Hyperpigmentation: Darker areas that may take months to return to normal coloration.

These changes typically fade over time but can be concerning for patients.

Eye Conditions

Psoriasis increases the risk of several eye problems:

Eye Condition	Description
Conjunctivitis	Inflammation of the membrane covering the eye
Blepharitis	Inflammation of the eyelids
Uveitis	Inflammation of the middle layer of the eye

These conditions may cause redness, pain, sensitivity to light, and blurred vision. Regular eye exams are important for early detection.

Metabolic and Cardiovascular Issues

The inflammation associated with psoriasis can affect the whole body, contributing to:

1. Obesity – Often develops alongside psoriasis and can worsen symptoms.
2. Type 2 Diabetes – Higher risk due to shared inflammatory pathways.
3. High blood pressure – More common in those with severe psoriasis.
4. Heart disease – Increased risk of heart attacks and strokes.

These conditions share inflammatory triggers with psoriasis and can significantly impact long-term health.

Other Autoimmune Conditions

Having one autoimmune disease raises the risk for others. People with psoriasis are more likely to develop:

• Celiac Disease: Immune reaction to gluten.
• Multiple Sclerosis: Immune system attacks nerve coverings.
• Crohn’s Disease: Inflammatory bowel condition.

The connection lies in shared genetic factors and immune system dysfunction that can trigger multiple autoimmune responses.

Mental Health Impact

Living with a visible skin condition takes a psychological toll. Common mental health challenges include:

• Depression: People with psoriasis have nearly twice the risk of depression compared to the general population. The chronic nature of psoriasis and its unpredictable flares can lead to feelings of helplessness.
• Anxiety: Concerns about appearance and symptoms can cause significant worry and social avoidance.
• Poor self-image: Visible plaques may lead to embarrassment and reduced confidence, especially during flares.
• Social isolation: Some people avoid activities or situations where their skin is visible, limiting their social connections.

The emotional impact often goes unaddressed but requires attention as part of comprehensive psoriasis care.

Regular checkups with healthcare providers can help catch these related conditions early. A team approach—involving dermatologists, rheumatologists, and other specialists—offers the best management for people with psoriasis and its associated health concerns.