Psoriatic Disease

What is psoriatic disease?

Psoriatic disease is a chronic disease driven by an overactive immune system that attacks the skin and the joints.

It causes itchy, red, scaly patches (plaques) to appear on the skin (called psoriasis). Psoriasis is the most common inflammatory skin disease, affecting about 4% of the population. About a third of all people with psoriasis develop an inflammatory arthritis that causes pain and swelling in the joints (called psoriatic arthritis).

Most common symptoms

Psoriasis tends to appear on skin on the outside of the elbows, front of the knees, or the scalp. Though it can appear on any part of the body, including large plaques covering the torso. The plaques may itch and burn for some people.

Psoriatic arthritis causes swelling, pain, and stiffness in the joints. It can affect the large joints (e.g., knees), the small joints of the hands and feet, and the spine.

Main symptoms

• Red, itchy skin plaques
• Dry skin
• Scaly skin
• Reddish skin in areas
• Scalp redness and scaling
• Redness around the belly button
• Ear canal redness and itching
• Swollen, stiff, painful joints
• Swollen fingers and toes
• Tenderness and swelling in tendons, such as Achilles tendon
• Low back pain that is worse at night with long morning stiffness

Causes of psoriatic disease

Psoriatic disease is an autoimmune disease where the immune system attacks skin and joints. There is a genetic component to the disease. A person is more likely to get it if a first degree relative, such as a mother, father, or sibling, has psoriasis.

Changes in the microbiome (the type of bacteria that live in the gut) have also been associated with an increased risk. Environmental factors such as exposure to cold, UV radiation, pollution, and smoking may also play a role.

Psoriatic disease is associated with other conditions such as diabetes, obesity, and depression.

Trauma to the skin (such as scratching or picking on the scales) can worsen skin psoriasis (known as Koebner phenomenon).

Treatment of psoriatic disease

If you only have psoriasis (skin symptoms), see a dermatologist. If you have joint symptoms (or both skin and joint symptoms) see a rheumatologist (a doctor specializing in autoimmune disease and arthritis).

Mild skin symptoms (like a rash) can be treated with topical (applied to the skin) ointments, lotions, creams, and gels. These contain corticosteroids or vitamin D. Phototherapy (light therapy), which is being exposed to ultraviolet A (UVA) in a controlled way, may also be recommended.

If you have severe psoriasis or psoriatic arthritis, you will need to take oral medication or have injections or infusions. There are a range of medications to try. A few options include biologics, immunosuppressants, and disease-modifying antirheumatic drugs (DMARDs).

Over-the-counter (OTC) Treatment Options

• Salicylic Acid Creams and Ointments: These can help reduce scaling and soften lesions. Use as directed to avoid irritation.
• Coal Tar Products: Shampoos, creams, and bath solutions with coal tar can help slow skin cell growth and reduce inflammation.
• Moisturizers: Keeping your skin moisturized can help manage dryness and irritation. Look for heavy creams or ointments specifically for psoriasis.
• Aloe Vera Gel: Aloe vera can soothe and moisturize your skin, providing some relief from itching and scaling.
• Anti-Itch Lotions: Products containing ingredients like menthol or camphor can provide temporary relief from itching.

Follow up

You should continue to have follow-up visits with your doctor (dermatologist and/or rheumatologist). Talk to your doctor before stopping any medication, as it may lead to a rebound of the disease.

You can take the following steps to help prevent recurrences or flare-ups:

• Use moisturizer
• Avoid dry, cold weather
• Use a humidifier
• Stop smoking
• Eat healthy and exercise, avoid excess alcohol
• Avoid scrapes, bumps, and tattoos
• Ask your doctor about substitutes for medication you’re taking that can make psoriasis worse (beta blockers, lithium, hydroxychloroquine, quinidine)
• Avoid or reduce stress