- Psoriasis is a common, chronic, inflammatory disease of the immune system that mostly involves the skin and joints. It also may affect the fingernails, the toenails, the soft tissues of the genitals and inside the mouth.
- Other diseases and conditions can be associated with psoriasis and psoriatic arthritis, including diabetes, cardiovascular disease, and depression.1
- See your dermatologist for successful diagnosis and treatment of psoriasis.
- Psoriasis is a serious medical condition.
- Approximately 7.5 million people in the United States have psoriasis.
- Psoriasis occurs in all age groups, but it primarily affects adults. It appears about equally in males and females.
- Up to 40 percent of people with psoriasis experience joint inflammation that produces symptoms of arthritis. This condition is called psoriatic arthritis. Psoriatic arthritis patients have joint inflammation and also have other symptoms of arthritis.2,3,4
- The most common form of psoriasis, affecting about 80 to 90 percent of psoriasis patients, is plaque psoriasis. It is characterized by patches of raised, reddish skin covered with silvery-white scale. Psoriasis usually occurs on the scalp, knees, elbows, hands and feet. Approximately 80% of those affected with psoriasis have mild to moderate disease, with 20% having moderate to severe psoriasis affecting more than 5% of the body surface area.1
- There are various forms of psoriasis. The common subtypes of psoriasis are plaque, inverse, erthrodermic, pustular, guttate and nail disease.1
- In 2004, the total direct cost of treatment associated with psoriasis was $1.2 billion.5
CO-MORBIDITIES ASSOCIATED WITH PSORIASIS
The incidence of Crohn’s disease and ulcerative colitis, two types of inflammatory bowel disease, is 3.8-7.5 times greater in psoriasis patients than in the general population.6
- Patients with psoriasis also have an increased incidence of lymphoma,7,8, heart disease,9,10, obesity,11,12, type II diabetes,13 and the metabolic syndrome14. Depression and suicide,15 smoking,16 and alcohol consumption17 are also more common in psoriasis patients.
- Psoriasis can have a substantial psychological and emotional impact on the patients.
- The prevalence of depression in patients with psoriasis may be as high as 50%. Studies have shown that psoriasis patients experience physical and mental disability just like patients with other chronic illnesses such as cancer, arthritis, hypertension, heart disease, and diabetes.18
TREATMENT OPTIONS FOR PSORIASIS
Topical treatments are helpful for mild to moderate psoriasis but tend not to be effective for treating moderate to severe psoriasis. Topical treatments include anthralin, coal tar, emollients, salicylic acid, tazarotene, topical corticosteroids and vitamin D analogues. These topical medications can sometimes be used together with other medications.19
- Topical corticosteroids are available in many strengths and formulations.21
- Psoriasis patients with moderate to severe psoriasis can be treated with traditional systemics, phototherapy, or biologic agents.
- In cases of more extensive psoriasis, topical agents also may be used in combination with phototherapy, traditional systemic or biologic medications.20
- Phototherapy treatment includes narrowband and broadband ultraviolet B (UV-B) and psoralen plus UVA (PUVA).21
- Traditional systemic treatments (taken orally or by injection or infusion) include acitretin, cyclosporine and methotrexate.20
- Since biologic therapies target the immune system, it is important to prevent infections during therapy and patients need to be monitored and evaluated periodically.22
For more information on psoriasis, visit the Psoriasis section of Dermatology A to Z.
1. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008 May;58(5):826-50.
2. National Institutes of Health /NIAMS http://www.niams.nih.gov/Health_Info/Psoriasis/default.asp (last accessed June 1, 2013).
3. National Psoriasis Foundation - http://www.psoriasis.org/about/ (last accessed June 1, 2013).
4. Gottlieb A, Korman NJ, Gordon KB, Feldman SR et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol 2008 May;58(5):851-64
5. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol 2006 Sep;55(3):490-500
6. Najarian DJ, Gottlieb AB. Connections between psoriasis and Crohn's disease. Journal of the American Academy of Dermatology 2003; 48: 805-21; quiz 22-4.
7. Gelfand JM, Shin DB, Neimann AL, Wang X, Margolis DJ , Troxel AB. The risk of lymphoma in patients with psoriasis. J Invest Dermatol 2006;126:2194-201.
8. Gelfand JM, Berlin J, Van Voorhees A , Margolis DJ. Lymphoma rates are low but increased in patients with psoriasis: results from a population-based cohort study in the United Kingdom. Arch Dermatol 2003;139:1425-9.
9. Gelfand JM, Neimann AL, Shin DB et al. Risk of myocardial infarction in patients with psoriasis. JAMA 2006; 296: 1735-41
10. Neimann AL, Shin DB, Wang X et al. Prevalence of cardiovascular risk factors in patients with psoriasis. Journal of the American Academy of Dermatology 2006; 55: 829-35
11. Setty AR, Curhan G , Choi HK. Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses' Health Study II. Arch Intern Med 2007;167:1670-5.
12. Sterry W, Strober BE , Menter A. Obesity in psoriasis: the metabolic, clinical and therapeutic implications. Report of an interdisciplinary conference and review. Br J Dermatol 2007;157:649-55.
13. Qureshi AA, Choi HK, Setty AR , Curhan GC. Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses. Arch Dermatol 2009;145:379-82.
14. Gisondi P, Tessari G, Conti A et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study. The British Journal of Dermatology 2007; 157: 68-73.
15. Kurd SK, Troxel AB, Crits-Christoph P , Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol 2010;146:891-5.
16. Herron MD, Hinckley M, Hoffman MS, Papenfuss J, Hansen CB, Callis KP et al. Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol 2005;141:1527-34.
17. Poikolainen K, Reunala T, Karvonen J, Lauharanta J , Karkkainen P. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ 1990;300:780-3
18. Rapp SR, Feldman SR, Exum ML et al. Psoriasis causes as much disability as other major medical diseases. Journal of the American Academy of Dermatology 1999; 41: 401-7.
19. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM,et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 3. Guidelines of care for the treatment of psoriasis with topical therapies. J Am Acad Dermatol 2009 April; 60(4): 643-659
20. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol 2009;61:451-85.
21. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol 2010;62:114-35.
22. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Leonardi CL, Lim HW, Van Voorhees AS, Beutner KR, Ryan C, Bhushan R.Guidelines of care for the management of psoriasis and psoriatic arthritis Section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: Case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011 Jul;65(1):137-74