Creating Waves of Awareness
Psoriasis is an immune-mediated, noncontagious, genetic disease manifesting in the skin and/or the joints. Psoriasis is a, lifelong skin disease.
These are unknown but it is believed to have a genetic component. Most researchers agree that the
immune system is somehow mistakenly triggered, which speeds up the growth cycle
of skin cells. A normal skin cell matures and falls off the body's surface in
28 to 30 days. But a psoriatic skin cell takes only three to four days to
mature and move to the surface. Instead of falling off, the cells pile up and
form the lesions.
Risk factors to trigger Psoriasis
There are five types of psoriasis.
Plaque psoriasis is the most prevalent form of the disease. Its scientific name is psoriasis
vulgaris (vulgaris means common). It is characterized by raised, inflamed, red
lesions covered by a silvery white scale. It is typically found on the elbows,
knees, scalp and lower back, although it can occur on any area of the skin.
It first appears as small red spots which may enlarge gradually into well-defined patches of
red, raised skin called either "plaques" or "lesions."
They are covered by a flaky, silvery white buildup called "scale," which is composed of
dead skin cells. This scale becomes loose and sheds constantly from the
Psoriatic is generally very dry, and other possible symptoms include skin pain, itching and
Guttate psoriasis often starts in childhood or young adulthood. The word guttate is derived from
the Latin word meaning "drop." This type of psoriasis resembles
small, red, individual spots on the skin. Guttate lesions usually appear on the
trunk and limbs. These spots are not normally as thick or as crusty as lesions
of plaque psoriasis.
Guttate psoriasis often comes on quite suddenly. It may be due to upper respiratory infections,
streptoccocal infections, tonsillitis, stress, injury to the skin and the
administration of certain drugs (including antimalarials and beta-blockers). A
streptococcal infection of the throat is a common guttate psoriasis trigger.
Strep throat can be present without symptoms and can still cause a flare of guttate
psoriasis. This type of psoriasis may persist despite clearance of the strep
This form of psoriasis may resolve on its own, occasionally leaving a person free of further
outbreaks, or it may clear for a time only to reappear later as patches of
Inverse psoriasis is found in the armpits, groin, under the breasts, and in other skin folds around the genitals and the
buttocks. This type of psoriasis starts as very red lesions and usually lack
the scale associated with plaque psoriasis. It may appear smooth and shiny.
Inverse psoriasis is particularly subject to irritation from rubbing and
sweating because of its location in skin folds and tender areas. It is more
common and troublesome in overweight people and people with deep skin folds.
Erythrodermic psoriasis is a particularly inflammatory form of psoriasis that often affects
most of the body surface. It may occur in association with von Zumbusch
pustular psoriasis. It generally appears on people who have unstable plaque
psoriasis, where lesions are not clearly defined. It is characterized by
periodic, widespread, fiery redness of the skin. The erythema and exfoliation
of the skin are often accompanied by severe itching and pain.
Erythrodermic psoriasis can occur abruptly as the initial sign of psoriasis, or come on more
gradually in people with plaque psoriasis. Its causes are still unknown. But it
may be triggered by abrupt withdrawal of systemic treatment; the use of systemic
steroids (cortisone); an allergic, drug-induced rash that brings on the Koebner
response (a tendency for psoriasis to appear on the site of skin injuries); and
Primarily seen in adults, pustular psoriasis is characterized by white pustules (blisters of
noninfectious pus) surrounded by red skin. The pus consists of white blood
cells which is not an infection, nor contagious. It may be localized to certain
areas of the body–for example, the hands and feet. Pustular psoriasis also can
be generalized, covering most of the body. It tends to go in a cycle–reddening
of the skin followed by formation of pustules and scaling. It can appear
suddenly as the first sign of psoriasis, or plaque psoriasis can turn into
Causes of Pustular Psoriasis
Pustular psoriasis has been triggered by internal medications, irritating topical agents,
overexposure to UV light, pregnancy, systemic steroids, infections, emotional
stress and sudden withdrawal of systemic medications or potent topical
Several different types of pustular psoriasis exist.
Types of pustular psoriasis
a- Von Zumbusch
The onset of von Zumbusch pustular psoriasis can be abrupt. Widespread areas of reddened skin
develop, and the skin becomes acutely painful and tender. Within as little as a
few hours, the pustules appear. The pustules then dry and peel over the next 24
to 48 hours, leaving the skin with a glazed, smooth appearance. A fresh crop of
pustules may then appear. Eruptions often come in repeated waves that last days
It can be triggered by an infection; sudden withdrawal of topical or systemic steroids;
pregnancy; and drugs such as lithium, propranolol (Inderal) and other high
blood pressure drugs, iodides and indomethacin.
It may appear in a person with history of plaque psoriasis. It is associated with fever, chills,
severe itching, dehydration, a rapid pulse rate, exhaustion, anemia, weight
loss and muscle weakness.
b- Palmo-plantar pustulosis
Palmo-plantar pustulosis (PPP) is a type of pustular psoriasis that generally affects people
between the ages of 20 and 60 and causes pustules on the palms of the hands and
soles of the feet. This type of psoriasis affects females more than males.
PPP is characterized by multiple pencil eraser-sized pustules in fleshy areas of the
hands and feet, such as the base of the thumb and the sides of the heels. The
pustules appear in a studded pattern throughout reddened plaques of skin, then
turn brown, peel and become crusted. The course of PPP is usually cyclical,
with new crops of pustules followed by periods of low activity.
c- Acropustulosis (acrodermatitis continua of Hallopeau)
This rare type of psoriasis is characterized by skin lesions on the ends of the fingers and
sometimes on the toes. The eruption occasionally starts after an injury to the
skin or infection. Often the lesions are painful and disabling, producing
deformity of the nails. Occasionally bone changes occur in severe cases. This
form has traditionally been hard to treat.
Psoriasis can occur on any part of the body. Psoriasis sometimes appears on the eyelids,
ears, mouth and lips, as well as on skin folds, the hands and feet, and nails.
The type of skin at each of these sites is different and requires different
treatments. The skin on the face is very different from the thicker, rougher
skin of the elbow.
a- Pustular psoriasis of the palms and soles
This form of psoriasis is characterized by white pustules surrounded by red skin. The pus is
not contagious. The lesions are most prominent on the palm toward the base of
the thumb, the fleshy part of the palm toward the ring and little finger, and
on the soles and sides of the heels. Often, the lesions are painful and
disabling. Plaque psoriasis can appear elsewhere on the body at the same time.
b- Psoriasis around the eyes
When psoriasis affects the eyelids, lashes may become covered with scales, and the edges of
the eyelids may be red and crusty. If inflamed for long periods, the rims of
the lids may turn up or down. If the rim turns down, lashes can rub against the
eyeball and cause irritation.
Psoriasis of the eye is extremely rare. When it does occur, however, it can cause inflammation,
dryness and discomfort, and may impair vision.
c- Psoriasis in the ears
Psoriasis in the ears can cause scale build-up that blocks the ear canal. This build-up may lead
to temporary hearing loss. Psoriasis generally occurs in the external ear
canal, not inside the ear or behind the eardrum.
d- Psoriasis in and around the mouth and nose
Rarely psoriasis lesions appear on the gums, the tongue, inside the cheek, inside the nose or on
the lips. The lesions are usually white or gray. Psoriasis in these areas can
be relatively uncomfortable, and can cause difficulty in chewing and swallowing
e- Psoriasis in skin folds
Inverse psoriasis can occur in the armpits, groin, under the breasts and in other skin folds
around the genitals and buttocks. This type of psoriasis first shows up as
smooth, dry lesions that are very red. Inverse psoriasis is frequently
irritated by rubbing and sweating due to its location in skin folds and tender
f- Genital psoriasis
Psoriasis can occur in the genital area at the same time it occurs elsewhere on the body, or
it can appear in the genital area only. People with genital psoriasis may have
affected areas that range from small, red spots to large patches.
The most common type of psoriasis in the genital region is inverse psoriasis.
The six regions of the genital area that may be affected by psoriasis include:
In men, psoriasis of the penis may appear as many small, red patches on
the glans or shaft. The skin may be red and scaly, or it may be smooth and
shiny. Genital psoriasis affects both circumcised and uncircumcised males.
Children my also have genital psoriasis. Itching can cause irritation, which may become infected.
Scratching also can produce dryness, thickening and further itching of the
Scalp psoriasis is very common. Like psoriasis elsewhere on the body, skin cells grow too quickly
on the scalp and cause red lesions covered with scale to appear.
Scalp psoriasis can be very mild, with slight, fine scaling. It can also be very severe with
thick, crusted plaques covering the entire scalp, which commonly can cause hair
loss. Psoriasis can extend beyond the hairline onto the forehead, the back of
the neck and around the ears. Most of the time, people with scalp psoriasis
have psoriasis on other parts of their body as well. But for some, the scalp is
the only affected area.
Differential diagnosis of scalp psoriasis
Other skin disorders, such as seborrheic dermatitis, may look similar to psoriasis, but
there are differences. Scalp psoriasis scales appear powdery with a silvery
sheen, while seborrheic dermatitis scales often appear yellowish and greasy.
Despite these differences, the two conditions can be easily confused.
The nail problems most commonly experienced by psoriasis patients are:
Psoriasis, in and of itself, does not affect the reproductive system of a woman or a man. Some
women report their psoriasis improves or worsens during pregnancy.
Psoriasis often changes because of pregnancy.
In the postpartum phase, psoriasis usually gets worse, most often within four months of delivery.
Psoriatic arthritis is a chronic inflammatory disease of the joints and connective
tissue, was first described in 1818 by a French physician, Baron Jean Louis
About 10 percent to 30 percent of people with psoriasis also develop psoriatic arthritis, which
causes pain, stiffness and swelling in and around the joints. Both genetic and
environmental factors seem to be associated with the development of arthritis.
The immune system plays an important role.
Signs and symptoms
Psoriatic arthritis causes stiffness, pain, swelling and tenderness of the joints and the
tissue around them. Movement of the joint(s) may be difficult.
Some cases of psoriatic arthritis cause deterioration of the spine and deformity of the
joints, leading to disability.
It can develop slowly with mild symptoms, or it can develop quickly and be severe. Major
Types of Psoriatic Arthritis
There are five
types of psoriatic arthritis:
This form of psoriatic arthritis is much like rheumatoid arthritis but generally milder with
less deformity. It usually affects multiple symmetric pairs of joints (occurs
in the same joints on both sides of the body) and can be disabling. The
associated psoriasis is often severe.
2- Asymmetric arthritis
Asymmetric (not occurring in the same joints on both sides of the body) arthritis can involve a
few or many joints. It can affect any joint, such as the knee, hip, ankle or
wrist. It could involve just one finger or a number of them. The hands and feet
may have enlarged "sausage" digits. The joints may also be warm,
tender and red. Patient may experience periodic joint pain.
3- Distal interphalangeal predominant (DIP)
This form of arthritis, although the "classic" type, occurs in only about 5
percent of people with psoriatic arthritis. Primarily, it involves the distal
joints of the fingers and toes (the joint closest to the nail).
In about 5 percent of individuals with psoriatic arthritis, inflammation of the spinal column is
the predominant symptom. Inflammation with stiffness of the neck, lower back,
sacroiliac or spinal vertebrae are common symptoms in a larger number of
patients, making motion painful and difficult. Peripheral disease can be
present in the hands, arms, hips, legs and feet. Spondylitis, when severe, may
be associated with generalized symptoms.
5- Arthritis mutilans
This is a severe, deforming and destructive arthritis that affects fewer than 5 percent of people
with psoriatic arthritis. It principally affects the small joints of the hands
and feet, though there is frequently associated neck or lower back pain.
Arthritic attacks and remissions tend to coincide with skin flares and
Differential Diagnosis of Psoriatic Arthritis
Psoriatic arthritis can develop without the skin lesions characteristic of psoriasis or
the nail changes. Generally, psoriasis appears before the arthritis.
Synthesis Repertory- SKIN - ERUPTIONS – psoriasis with remedy
alum.-1 am-c.-1 ambr.-1 ant-t.-2 ars.-2 ars-i.-3 ars-s-f.-1 ars-s-r.-1 aur.-1 aur-ar.-1 bell-p.-1 berb-a.-1 borx.-1 bry.-1 bufo-1 calc.-2 calc-s.-2 canth.-2 carb-ac.-1 carb-v.-1 chin.-2 chrys-ac.-2 chrys-ac.-2 cic.-1 clem.-2 cor-r.-1 cupr.-1 dulc.-1 gali.-1 graph.-2 hydrc.-1 iod.-1
iris-2 kali-ar.-2 kali-br.-1 kali-c.-2 kali-p.-1 kali-s.-2 led.-1 lob.-2 lyc.-3 mag-c.-1 mang.-2 merc.-2 merc-c.-1 merc-i-r.-1 merc-k-i.-1 mez.-2 naphtin.-1 nat-m.-1 nit-ac.-2 nuph.-1 petr.-2 ph-ac.-1 phos.-2 phyt.-3 pix-1 psor.-2 puls.-2 rad-br.-1 ran-b.-1 rhus-t.-2 sars.-2 sep.-3 sil.-2 staph.-1 stel.-1 still.-1 sul-i.-1- sulph.-2 tell.-1- teucr.-1- thuj.-1 thyr.-1 tub.-1 x-ray-1
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