Psoriasis

In this comprehensive guide, you'll delve into the details surrounding psoriasis, gaining a deep understanding of this common, yet often misunderstood skin condition. From uncovering various types of psoriasis to discovering the unique signs and symptoms, you will gain critical knowledge in differentiating psoriasis from similar skin conditions, notably eczema. Unearth what triggers this skin issue and explore practical ways to manage and care for psoriasis. This exploration aids nurses, healthcare professionals and individuals living with psoriasis to navigate the challenges of this condition more effectively.

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Psoriasis Psoriasis

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Table of contents

    Understanding Psoriasis: An Overview

    Psoriasis is a common skin condition that affects millions of people globally. It accelerates the life cycle of skin cells, causing them to build up rapidly on the surface resulting in scales and red patches that are sometimes painful.

    What is Psoriasis?

    Psoriasis is a chronic autoimmune condition that results in the overproduction of skin cells. The dead cells and white blood cells cannot shed quickly enough and, instead, build up on the skin's surface causing scaly, red patches.

    Consider an individual who suddenly notices red, inflamed patches appearing on their elbows and knees. The patches are covered with silvery scales and are sometimes itchy or painful. This is likely a sign of plaque psoriasis, the most common type of psoriasis.

    Interestingly, the exact cause of psoriasis remains unknown. It's believed to be related to an immune system issue with T cells and other white blood cells, called neutrophils, in your body.

    Defining Plaque Psoriasis

    Plaque psoriasis is the most common form of the disease and appears as raised, red patches covered with a silvery white buildup of dead skin cells or scale. These patches may be itchy and painful and can occur anywhere on your body.

    • Symptoms include red, raised, inflamed patches
    • Silver-white scales or plaques on the red patches
    • Severe itching, especially at night
    • Tiny changes in the colour or shape of your nails

    Recognising Scalp Psoriasis

    Scalp psoriasis is a common skin disorder that produces raised, reddish, and often scaly patches. It can appear as a single patch or several, and can even affect your entire scalp. It can also spread to your forehead, the back of the neck, or behind the ears.

    Symptoms
    Red patches of skin covered with silvery scales
    Dry scalp
    Itching, burning, or soreness
    Hair loss

    Identifying Guttate Psoriasis

    Guttate psoriasis is a type of psoriasis that appears as small, salmon-pink bumps on the skin. The word 'guttate' comes from the Latin word gutta, meaning drop. It's characteristically seen in younger individuals, often after a viral or bacterial infection.

    Imagine noticing small pinkish-red drops appearing suddenly on your skin, especially on your trunk, limbs, and scalp. You may also experience some itchiness. This is a common presentation of guttate psoriasis.

    Did you know? Guttate psoriasis is often preceded by certain infections, particularly streptococcal infections. Strep throat, especially, is known to trigger an onset or flare-up of guttate psoriasis.

    Symptoms and Detection of Psoriasis

    The symptoms of psoriasis can be easily confused with other skin conditions. Reliable detection requires understanding common and unusual symptoms, as well as the most affected areas. Constant vigilance is key to early identification and treatment of psoriasis.

    Common Psoriasis Symptoms

    The most common symptoms of psoriasis include red patches of skin covered with thick, silvery scales. These patches can vary in size, ranging from small, isolated areas to large patches that cover significant portions of the body.

    • Itching or burning sensation in and around the patches
    • Dry, cracked skin that may bleed or itch
    • Joint pain and swelling
    • Thick, pitted nails

    Psoriasis symptoms are often cyclical, flaring up for a few weeks or months, then subsiding for a time or even going into complete remission.

    Inverse Psoriasis: Uncommon Symptoms

    Inverse psoriasis (also known as intertriginous psoriasis) involves bright red, smooth (not scaly) patches occurring in the skin folds. Areas that may be affected include the armpits, groin, under the breasts, and around the genitals and buttocks.

    • Smooth patches of redness
    • Worsening of symptoms with friction and sweating
    • Yeasty smell due to secondary fungal infections

    Suppose you notice a shiny, red rash in the armpit that worsens after physical activity. The area is quite tender and gives off a foul odour. This is a typical presentation of inverse psoriasis.

    Understanding Nail Psoriasis Symptoms

    Nail psoriasis is a manifestation of psoriasis that affects the fingernails and toenails. It is characterised by a variety of changes in the appearance of the nail.

    Small dents or pits on the nail surface
    Unusual nail colouration (yellow-brown)
    Comprehensive thickening of the nail
    White areas on the nail plate
    Loosening or lifting of the nail

    Visualise looking at a hand where the nails are discoloured and covered with small indentations. Some nails have white areas, and others seem to be lifting away from the finger. This is a clear example of how nail psoriasis can manifest.

    Nail psoriasis occurs in about 50% of all people with skin psoriasis and at least 80% of all people with psoriatic arthritis. It's crucial to communicate these changes to a healthcare professional because treating nail psoriasis can be challenging and may require patience.

    Psoriasis vs Eczema: Spot the Difference

    Although Psoriasis and Eczema might appear similar to the untrained eye, there are distinct differences between these two skin conditions. The ability to distinguish between them is key to ensuring the most effective treatment and management strategies.

    Identifying Key Differences between Psoriasis and Eczema

    While both psoriasis and eczema cause changes to the skin, they are fundamentally different conditions. Here are some factors that can help you distinguish between the two.

    Psoriasis is an autoimmune disease that causes the body to produce skin cells at an accelerated rate. It often results in red, scaly patches of skin.

    On the other hand, eczema, or atopic dermatitis, is a chronic skin condition that causes the skin to become red, itchy, and inflamed. It's often caused by a combination of genetic, environmental and immune system factors.

    Appearance
    Psoriasis typically presents as red or pink areas of thickened, raised, and scaly skin—often silvery in colour.
    Eczema, in contrast, is often darker than the surrounding skin, leathery in texture, and may even ooze or weep.
    Location
    Psoriasis often occurs on the elbows, knees, scalp, lower back, face, palms, and soles of the feet.
    Eczema often affects the insides of the elbows, backs of the knees, and the face, but can cover most of the body.
    Itchiness
    Psoriasis can cause moderate to severe itching.
    Eczema often causes intense itching—often severe enough to interfere with sleep and daily activities.

    Putting Psoriasis and Eczema Side by Side

    To better understand the differences between psoriasis and eczema, it can be beneficial to compare them side by side factoring in symptoms, causes, and typical affected areas.

    Plaque psoriasis, the most common form, can cause plaques to appear anywhere on the body, but they are most commonly found on the knees, elbows, lower back and scalp. The plaques are often itchy and can be painful. There can also be changes to the nails, such as pitting (small dents in the surface), or changes in colour.

    Suppose you're observing two patients. The first has red, itchy patches on the insides of their elbows, a history of asthma, and their symptoms worsened when they wore a wool sweater. That's likely eczema. The second patient has dry, scaly patches on their knees and elbows. They've noticed pitting in their nails, and there's no particular trigger causing their symptoms. That's likely psoriasis.

    • Eczema Symptoms: Dry, sensitive skin; red, inflamed skin; severe itching; dark-coloured patches of skin; oozing or crusting.
    • Psoriasis Symptoms: Inflamed, red skin covered with loose, silvery scales; itching or burning sensation where the rash is; swollen and stiff joints.

    While these conditions are starkly different in nature, it's important to remember that neither psoriasis nor eczema is communicable. You cannot catch either condition through contact with a person who has it.

    Causes and Triggers of Psoriasis

    Psoriasis is a complex medical condition with varied causes and triggers. It's an immune-mediated disease, meaning that it's caused by a dysfunctional immune system. However, there's a wide range of external factors that can trigger or worsen the symptoms of psoriasis. It's crucial for you to understand what can lead to the development of this skin condition to manage it effectively.

    Understanding What Causes Psoriasis

    Psoriasis is an autoimmune condition, which means the body's immune system attacks healthy cells as if they are dangerous invaders. This immune system malfunction leads to an overproduction of skin cells.

    Your body produces new skin cells and sheds old ones in a constant balance. In people without psoriasis, this turnover process takes about a month. However, in people with psoriasis, the turnover process happens in just a few days, leading to a buildup of skin cells that form the characteristic signs of psoriasis.

    Genes also play a role in the development of psoriasis. Around one-third of people with psoriasis have a family member with the condition. However, having a genetic predisposition doesn't mean you'll definitely develop psoriasis. Environmental triggers often need to be present as well.

    Interestingly, scientists have found that people with psoriasis have an increased level of certain immune cells in their bodies, including T cells and neutrophils. They believe an excess of these cells can lead to inflammation, leading to an increase in skin cells and the other symptoms of psoriasis.

    Let's imagine a scenario. You have a family history of psoriasis and recently you've noticed a patch of dry, red skin on your elbow that doesn't go away with regular moisturising lotion. Then you experience a strep throat infection, and suddenly, you notice the skin patch is getting bigger and itchier. This is an example of a genetic predisposition combining with an immune response to trigger psoriasis.

    Common Triggers of Psoriasis

    Psoriasis often tends to develop or flare-up in response to specific triggers. Recognising these triggers can help you anticipate and manage potential flare-ups, and reduce the severity of your symptoms.

    Stress
    Psoriasis itself can cause stress, and stress is also known to trigger flare-ups, leading to a vicious cycle.
    Infections
    Certain infections, such as strep throat or skin infections, can trigger psoriasis.
    Skin Injury
    Cuts, scrapes, sunburns, and other skin injuries can cause a flare-up of the disease, a phenomenon known as the Koebner reaction.
    Certain Medications
    Some medicines, including lithium and antimalarials, can cause psoriasis to flare-up.
    Weather
    Cold, dry weather often worsens psoriasis, while warm, sunny climates may help control the symptoms.

    Consider a person with psoriasis who is feeling stressed due to work. They soon begin noticing new psoriasis patches on their skin. In response, they start to feel anxious, which further exacerbates their skin condition. This is how stress can trigger and worsen psoriasis.

    The Koebner phenomenon, also known as Koebner response or isomorphic response, is the appearance of skin lesions on lines of trauma. This response is noted in certain diseases, one of which is psoriasis.

    Management and Care for Psoriasis

    Managing psoriasis requires a comprehensive approach that addresses not just the physical lesions but also psychosocial issues and comorbid health conditions. Each type of psoriasis may require different strategies for management and care.

    Living with Scalp and Plaque Psoriasis

    Scalp and plaque psoriasis are common types of psoriasis that can be particularly challenging to manage due to the visibility of symptoms and the discomfort they can cause. However, with effective treatment strategies, it is possible to manage these types and lead a fulfilling life.

    Scalp psoriasis is when psoriasis affects the scalp causing red, itchy areas with silvery-white scales. Plaque psoriasis, meanwhile, is characterised by raised, inflamed, red patches covered with silvery white scales, often found on the elbows, knees, scalp and lower back.

    Topical treatments, phototherapy, and systemic medications can be used to manage these types of psoriasis effectively. Topical treatments involve applying medication directly to the affected areas of the skin or scalp.

    • Topical corticosteroids - The most common treatment for scalp psoriasis, reducing inflammation and itching.
    • Vitamin D analogues - These synthetic compounds similar to vitamin D slow skin cell growth.
    • Topical retinoids - Vitamin A derivatives that may decrease inflammation.
    • Anthralin - This medication helps slow skin cell growth and remove scales, making the skin smoother.
    • Coal Tar - One of the oldest treatments for psoriasis, reducing scaling, itching, and inflammation.

    Imagine a daily routine of someone living with scalp psoriasis. They begin their day by gently washing their hair with a therapeutic shampoo containing coal tar. During the day, they apply a topical corticosteroid to the affected areas of their scalp. At the end of the day, they might receive phototherapy treatment at a healthcare provider's office. In this way, they manage their symptoms and prevent psoriasis flare-ups.

    Handling Inverse and Nail Psoriasis

    Inverse and nail psoriasis present unique challenges due to their specific locations. However, with the right approach, these challenges can be efficiently managed.

    Inverse psoriasis causes smooth patches of red skin that worsen with friction and sweat. It's frequently found in skin folds such as those around the groin, buttocks, and breasts. Nail psoriasis is characterized by a variety of nail changes, including pitting, deformation, and discoloration.

    Treatment of inverse psoriasis usually involves topical corticosteroids or other prescribed creams. Given the sensitive areas affected, a healthcare provider might recommend diluting the topical corticosteroids to reduce the risk of skin thinning.

    Managing nail psoriasis involves therapies such as emollients, topical corticosteroids, nail debridement, or antifungal treatment, depending on the specific symptoms. In more severe cases, more potent medication or treatment modalities may be required, such as systemic treatment or phototherapy.

    Professional nail care by a dermatologist can be a part of the management strategy for nail psoriasis. It can help improve the appearance of the nails and potentially prevent the development of further complications, such as fungal infections.

    Tips for Managing Guttate Psoriasis

    Guttate psoriasis is a type of psoriasis that typically starts in childhood or young adulthood. It often comes on quite suddenly and is usually triggered by a bacterial infection, such as strep throat.

    Guttate psoriasis is characterized by small, drop-shaped lesions that appear on the arms, legs, scalp, and torso. It's the second most common type of psoriasis after plaque psoriasis.

    The first-line treatment for guttate psoriasis often involves topical therapies, including corticosteroids and vitamin D analogues. Mild sunlight exposure can help improve guttate psoriasis symptoms, but it's important to avoid sunburn. Regular moisturising can also help soothe the skin and reduce flaking.

    Imagine someone with guttate psoriasis who notices an improvement in their symptoms during a sunny beach vacation. Recognising this, they incorporate limited, safe sunlight exposure into their daily routine, alongside regular moisturising and prescribed topical therapies. As a result, they're able to manage their guttate psoriasis more effectively.

    It's worth noting that guttate psoriasis is often a one-off condition that may not recur again, or that comes back very infrequently. However, for some people, it can progress to the more chronic plaque psoriasis.

    Psoriasis - Key takeaways

    • Psoriasis: An autoimmune disease that results in accelerated production of skin cells causing red, scaly patches of skin.
    • Plaque psoriasis: The most common form of psoriasis causing raised, inflamed, red patches covered with silvery white scales typically on elbows, knees, scalp and lower back.
    • Scalp psoriasis: When psoriasis affects the scalp causing red, itchy areas with silvery-white scales.
    • Heatmap Psoriasis: Appears as small, salmon-pink bumps especially on the trunk, limbs, and scalp often after an infection.
    • Inverse psoriasis: Results in bright red, smooth (not scaly) patches in skin folds such as armpits, groin, under the breasts, and around the genitals and buttocks.
    • Nail psoriasis: Affects the fingernails and toenails causing changes in appearance such as small dents on surface, unusual colouration, and thickening of the nail.
    • Psoriasis vs Eczema: While both cause changes to the skin, psoriasis is an autoimmune disease characterised by red or pink thickened, raised, and scaly skin while eczema causes skin to become red, itchy, and inflamed, often darker than the surrounding skin and with a leathery texture.
    • Causes of psoriasis: Primarily an autoimmune condition leading to overproduction of skin cells. Also related to genetics and influenced by environmental triggers.
    Psoriasis Psoriasis
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    Frequently Asked Questions about Psoriasis
    What is the relationship between psoriasis and nursing care?
    Nursing care for psoriasis involves managing symptoms, promoting skin health, and educating patients about the chronic nature of the disease. Nurses provide emotional support, help with medication management, and monitor for potential complications.
    Can the treatment of psoriasis be managed by a nurse in a UK healthcare setting?
    Yes, psoriasis treatment can be managed by a nurse in the UK, particularly by those in advanced or specialist roles, such as dermatology or nurse consultant, often working in conjunction with other healthcare professionals.
    How can a nurse aid in managing the symptoms of psoriasis in a patient?
    A nurse can aid in managing psoriasis symptoms by educating patients about the importance of regular skin care, guiding them on appropriate use of topical treatments, advising on lifestyle changes such as stress management and maintaining a balanced diet, and offering emotional support.
    What specialised knowledge should nurses have to effectively care for psoriasis patients?
    Nurses should have knowledge of the pathophysiology of psoriasis, the varying clinical presentations, and the wide range of management and treatment options. They need skills in psychological support to address self-esteem and body image issues linked with psoriasis.
    What role do nurses play in educating patients about psoriasis management?
    Nurses play a pivotal role in educating patients about managing psoriasis. They provide information on the nature of the disease, the importance of adherence to medication regimens, lifestyle modifications and trigger avoidance. Additionally, they offer emotional support and help patients navigate potential psychosocial impacts.

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