Knowing the Difference Between Eczema and Psoriasis
Dr. Marc-André Doré
Psoriasis is a widespread chronic inflammatory disease with autoimmune components, mainly occurring on the skin, but can also affect the joints and other organs as associated diseases.
This condition is usually recognised by the formation of thick red patches and silvery-white scales that flake off. However, the severity of the symptoms varies from one individual to another and depending on the type of psoriasis.
Psoriasis affects both men and women and can appear at any age, although it usually appears between the ages of 15 and 35. One form of psoriasis, guttate psoriasis, usually appears earlier in life, in childhood.
The exact causes of psoriasis are not yet fully understood. However, researchers believe that the disease may be due to a combination of genetic, environmental and immune factors.
Psoriasis usually develops when the immune system malfunctions. The white blood cells of the immune system are stimulated and cause inflammation, which results in skin cells migrating to the surface and scaling ten times faster than normal.
There are several triggers that can cause a permanent or episodic flare-up of psoriasis.
Respiratory tract infections caused by bacteria or viruses can lead to the development of psoriasis or a new flare-up of skin lesions.
Stress is a trigger for many health problems, including psoriasis, and can make symptoms worse.
Skin lesions or any trauma to the skin, such as a small cut while shaving, a burn, an insect bite, a cut, a graze, a sunburn, a needle puncture, a blister or a bruise can be a trigger for psoriasis.
Certain medications such as antidepressants, beta-blockers and oral corticosteroids can also cause a flare-up, first appearance or even worsening of psoriasis symptoms.
Cold, dry weather in winter has a particularly negative effect on psoriasis because it dries and irritates the skin. It is crucial to keep the skin protected from winter weather.
Smoking has also been associated with the risk of developing and worsening the disease.
There are five main types of psoriasis:
Plaque psoriasis (also known as psoriasis vulgaris) is the most common type of psoriasis, affecting about 90% of patients.
It appears as patches of inflamed skin, covered by an accumulation of skin cells that form a white, scaly layer called a squama.
Red patches with white flakes are usually seen in lighter skin types.
Darker skin types tend to have more purple to grey patches and to be thicker. There is also a greater tendency for depigmentation.
Plaque psoriasis can develop on any part of the body, but most often occurs on the elbows, knees, scalp and trunk.
Guttate psoriasis comes from the Latin word gutta, which means "drop".
This form of psoriasis is characterised by small red, scaly patches of skin that often look like tears or raindrops. Hundreds of these small, drop-shaped patches can appear on the arms, legs, chest and sometimes the scalp. It usually affects children and young adults.
Although triggers vary, guttate psoriasis is strongly associated with strep throat and various sinus infections. If left untreated, guttate psoriasis can sometimes disappear on its own, or disappear and reappear as plaque psoriasis.
It is estimated that 21-30% of people with psoriasis suffer from inverted psoriasis (also called intertriginous psoriasis or flexural psoriasis). It occurs in areas such as the armpits, groin, under the breasts or buttocks, or any other area where the skin folds or bends. This type of psoriasis is characterised by smooth, inflamed lesions and may be moist to the touch. Inverse psoriasis lacks the scaling associated with plaque psoriasis due to the moist environment.
Inverse psoriasis is more commonly found in overweight or obese people, as they usually have excess skin and deeper folds. Symptoms of reverse psoriasis include irritation and itching and can be aggravated by rubbing or sweating. Loose, comfortable clothing is recommended, as it helps to avoid rubbing on the painful skin and prevents moisture from being trapped in the skin folds.
Pustular psoriasis is described as blister-like lesions filled with non-infectious pus and surrounded by reddened skin. It is a rare but severe type of psoriasis, usually seen in adults and often requiring immediate medical attention.
There are three different forms of pustular psoriasis: generalised, localised and acropustulosis.
Generalised pustular psoriasis is more severe, affecting larger areas of the body, and can develop suddenly and progress rapidly. Generalised pustular psoriasis can endanger the functioning of the kidneys and liver. Symptoms may include fever, chills, change in heart rate, muscle weakness and fatigue.
Erythrodermic psoriasis is the rarest form of psoriasis, but also the most severe. It is estimated to affect 1-2% of people with psoriasis and is described as a skin-like rash over the entire body. It can cause intense itching or burning and usually spreads rapidly.
Psoriasis erythroderma interrupts the body's normal temperature and fluid balance, which can lead to episodes of chills and swelling due to fluid retention.
Most people with psoriasis have only one type of psoriasis, but some may have more than one type at a time or at different stages in their lives.
In addition to its obvious effects on the skin, psoriasis can also affect other organs of the body. Some psoriasis patients also develop a form of arthritis, called psoriatic arthritis. This form of psoriasis, which is recognised as a disease in its own right, can be severe and cause inflammation, stiffness and pain in the joints (arthritis) in addition to plaques on the skin. Skin plaques and joint pain do not occur at the same time, so a flare-up of psoriasis may manifest as joint pain in the absence of visible lesions and vice versa. Most often, the arthritic component appears about ten years after the onset of skin plaques.
Although there is no cure for psoriasis, a wide range of treatments are available to help control the disease. Generally, treatments fall into three categories: topical treatments, phototherapy and systemic treatments.
The choice of the most appropriate type of treatment depends on the form and severity of the disease, the size and extent of the plaques, the patient's response to a given treatment and the patient's preferences.
The doctor may change the dose of a patient's treatment, combine one type of treatment with another, or switch treatments to find one that works better for the patient.
Many types of emollients such as creams, ointments, salves, foams and sprays.
Topical prescription treatments
Topical prescription medications, such as creams and ointments, are often the first type of treatment recommended for the management of psoriasis.
Systemic medications are available by prescription only. They are administered orally or by injection and have a whole-body effect.
This treatment for psoriasis is based on the use of natural or artificial ultraviolet light.
In order to achieve satisfactory control of their symptoms, patients sometimes need to use more than one drug to treat their psoriasis.
Biological agents and biosimilars
Biologics are the newest class of drugs approved for the treatment of moderate to severe psoriasis.
You may be able to make lifestyle changes to reduce the severity of psoriasis and improve your quality of life.
Understanding psoriasis and becoming more informed about the effects of psoriasis on people with the disease will lead to better management of the disease and better treatment outcomes.
If you think you have psoriasis, dermago can help.
Looking to learn more?
Dr. Marc-André Doré
Dr. Marc-André Doré