Overview of Different Psoriasis Types

Psoriasis

This research paper is going to introduce the topic of psoriasis. Psoriasis is a disease that affects the skin. This condition causes rashes and scaly patches to form on the skin (© 1996-2019 National Psoriasis Foundation/USA). Knowing that Psoriasis affects the skin, it is labeled as a skin condition or disease. Psoriasis can also be associated with other serious health conditions such as diabetes, heart disease, and depression (© 1996-2019 National Psoriasis Foundation/USA). Psoriasis typically affects the outside of the elbows, knees, or scalp, though it can appear on any location (© 1996-2019 National Psoriasis Foundation/USA). According to the National Psoriasis Foundation, men and women develop this at equal rates. In general, there are more than three million cases per year involving psoriasis. This condition usually requires a medical diagnosis from a dermatologist or another health care provider. Unfortunately, this skin condition is incurable. Though this disease is incurable, there are many ways to treat this condition and its symptoms. Doctors and scientists recommend treatment options like oral pills and ointments to help fight this disease. This disease is so prevalent, and because of that, scientists are constantly working on new innovative ways to cure and treat psoriasis. There are five different forms of psoriasis. This research paper will cover the following: Plaque, guttate, inverse, pustular, and erythrodermic psoriasis. This paper will also discuss therapeutic options for those who prefer a more “medicine-free” method, as well as medicinal options.

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The most common type of psoriasis is plaque psoriasis. This type of psoriasis appears on about 85-90% of people with this condition. Psoriasis usually develops as raised, red patches covered with a silvery-white accumulation of dead skin cells or even scales on people with lighter skin. On the other hand, according to psoriasis.org, those with darker skin tones tend to have a more greyish/silver or dark brown discoloration. These patches are commonly found on the elbows, knees, scalp, neck, hands, feet and arms part of the body. These patches can be itchy and/or painful. They can form anywhere on your body, which includes your genitals and the soft tissue inside your mouth (© 1998-2019 Mayo Foundation for Medical Education and Research). This type of psoriasis can cause dermatitis, also known as skin inflammation. “Dale, a man in his fifties in North Carolina, copes daily with his severe plaque psoriasis. As a skilled construction worker, he has had to give up working due to the severe pain affecting his swollen hands”, (© World Health Organization 2016).

The second most common type of psoriasis is guttate psoriasis. This type of psoriasis is a condition that often starts at an early age from childhood to a young adult (© 1996-2019 National Psoriasis Foundation/USA).  According to psoriasis.org, only about 8 percent of people with psoriasis develop guttate psoriasis. This type of psoriasis appears as small, round spots called papules that are raised and sometimes scaly. The lesions, or wounds, usually appear on the arms, legs, and torso. In some rare cases, it can be seen forming in the scalp, face, and ears. This condition usually develops suddenly and the exact cause is still unknown. Doctors think genes and the immune system are involved. Though the causes aren’t known, common triggers include the following: upper respiratory infections, streptococcal infections, tonsillitis, stress, injury to the skin, and certain drugs including antimalarials and beta-blockers (© 1996-2019 National Psoriasis Foundation/USA). This type of psoriasis can also be triggered by a bacterial infection such as strep throat (© 1998-2019 Mayo Foundation for Medical Education and Research). According to medlineplus.gov, guttate psoriasis is diagnosed based on what the spots look like. Doctors use skin biopsies, throat cultures, and blood tests for recent exposure to strep bacteria to confirm the diagnosis.

The third type of psoriasis is inverse psoriasis. Inverse psoriasis is also known as intertriginous psoriasis. This type of psoriasis shows up as red smooth lesions in body folds. According to psoriasis.org, many people have another type of psoriasis elsewhere on the body at the same time. This type of condition is found in the armpits, groin, under the breasts, and in other skin folds on the body. Unlike plaque psoriasis, this type of condition doesn’t scale as much. The reason is that the irritation from rubbing and sweating causes the environment where these lesions are to be moist. The friction and sweating may worsen this type of psoriasis. Since these places are tender, it makes the condition of the lesion even worse. Dr. King-man HO described this type of psoriasis as “More wet looking and with erosion in extramammary Paget’s disease” (Medical Bulletin Vol.15 No.5 May 2010). A dermatologists usually diagnosis this by the way it looks. Sometimes, this type of psoriasis is mistaken for fungal infection. Doctors may take small skin samples to examine if they are unsure.

The fourth type of psoriasis is pustular psoriasis. This type of psoriasis is characterized by white pustules (blisters of noninfectious pus) surrounded by red skin (© 1996-2019 National Psoriasis Foundation/USA). The wounds pustular psoriasis causes are blisters with pus that consists of white blood cells. According to Dr. King-man HO’s book, the roof of the pustules is easily broken. This condition usually affects adults and the lesions are commonly seen on certain body locations like the hands, arms, and feet. Factors that may trigger pustular psoriasis include the following: Internal medications, irritating topical agents, overexposure to UV light, pregnancy, systemic steroids, infections, emotional stress, and sudden withdrawal of systemic medications or potent topical steroids. There are various types of pustular psoriasis. One of them is Von Zumbusch and this type of pustular psoriasis can be severe and life-threatening.

The final type of psoriasis we’ll cover is erythrodermic psoriasis. This type of psoriasis is a particularly inflammatory form of psoriasis that often affects most of the body surface (© 1996-2019 National Psoriasis Foundation/USA). Although the lesions of this condition are not clearly defined, erythrodermic psoriasis shows up as fiery redness and exfoliation of the skin. It’s symptoms can include the following: Severe redness, shedding of skin over a large area of the body, exfoliation in large “sheets” instead of smaller scales, skin looks as if it has been burned, heart rate increase, severe itching and pain, and body temperature may go up and down (© 1996-2019 National Psoriasis Foundation/USA). This type of psoriasis can cause protein and fluid loss. With this condition, edema may also develop. Edema is the swelling from fluid retention.

Like all diseases and conditions, the first choice of treatment usually depends on disease severity (Copyright © 1996-2019 National Psoriasis Foundation/USA). Doctors also have to look at your reactions to previous treatment options. There are about 5 basic different types of ways to treat psoriasis. Using biologic drugs, systemic treatments, phototherapy, new oral treatments, and topical treatments can all help treat psoriasis. Though psoriasis isn’t curable, doctors find ways to make victims of it comfortable. The American Academy of Dermatology recommends practicing a biologic agent if you have moderate to severe psoriasis that hasn’t improved using more traditional systemic agents or you can’t tolerate those treatments because of side effects (© 2005 – 2019 Healthline Media). Biological agents are just another way to refer to medicinal pills. As we know, traditional methods of treating psoriasis have to be taking daily for effectiveness. On the other hand, using a biological agent takes less time and are taken less frequently. According to psoriasis.org, tumor necrosis factor-alpha, interleukin 12 and  23, interleukin 17, and T-cell inhibitors are all helpful in treating psoriasis. The second way to treat psoriasis is by using synthetic treatments. Systemic treatments are taken by mouth in a liquid or pill form or given by injection. Acitretin, cyclosporine, methotrexate, and off-label systemic can all be part of the treatment. The third way to treat psoriasis is by practicing phototherapy. This type of treatment is also known as light therapy. Patients with refractory lesions may benefit from this form of treatment (© 2019 American Academy of Family Physicians). First-time treatment options include UVB phototherapy and/or Excimer laser. These treatments target areas of the skin affected by mild-to-moderate psoriasis. The fourth way to treat psoriasis is by taking new oral medicinal pills. The following are a few types that help treat psoriasis: Otezla (apremilast), Xeljanz, and Xeljanz XR. These medicinal pills target specific parts of immune cells. Doing this helps reduce the inflammation in psoriasis. The final way we’ll cover is topical treatments. This type of treatment is medications applied to your skin. While most medications can be bought over the counter, some have to be medically prescribed. These kinds of medications should be used selectively because many can be irritating to inflame or broken skin (© 2019 American Academy of Family Physicians). If your psoriasis continues, your doctor might suggest a combination of treatments. Second-line treatment options include the following: Cosentyx, Siliq, Enbrel, Stelara, Humira, Taltz, Remicade, and Tremfya (© National Psoriasis Foundation – October 2017). Mild cases of psoriasis such as mild guttate, are usually treated at home. Your provider may recommend any of the following: Cortisone or other anti-itch and anti-inflammatory creams, dandruff shampoos, lotions that contain coal tar, and moisturizers (© 1997-2019, A.D.A.M., Inc.). For inverse psoriasis specifically, steroid creams and ointments are considered very effective. Every medication works differently on each patient. One type of treatment might not work for the other and must seek whats best for their type of skin.

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The National Psoriasis Foundation Research is a foundation that was formed in efforts to find a cure for this type of skin condition. They have committed more than $11 million to psoriatic disease research since their inception (© 1996-2019 National Psoriasis Foundation /USA). This foundation has a collection of biological samples and clinical information named the National Psoriasis BioBank. This foundation was established in 2006 and is used by qualified scientists to furthermore their knowledge about psoriasis. This foundation helps us move closer to finding other treatments, the causes, and hopefully someday a cure. According to psoriasis.org, researchers used National Psoriasis Victor Henschel BioBank samples to uncover a rare mutation in the CARD14 gene that, when activated by an environmental trigger, can result in psoriasis. This discovery helped researchers get closer to finding the unknown cause of psoriasis. “A comparative proteomic analysis was performed with non-lesional and lesional skin from psoriasis patients and skin from healthy individuals. Strikingly, 79.9% of the proteins that were differentially expressed in lesional and healthy skin exhibited expression levels in non-lesional skin” (© 2019 Springer Nature Limited). This research helps doctors see how people suffering from this skin disorder have different proteins. This information can also help doctors and scientists find ways for new treatments and medications specifically for this skin condition. “Comparison of non-lesional and lesional skin proteomes led to the identification of 56 proteins exhibiting at least 2-fold differences in relative abundances. Of these proteins, 32 exhibited higher protein abundance in non-lesional skin compared to lesions, whereas 24 exhibited lower abundance. Functional enrichment analysis of these 56 proteins revealed several biological processes identified in psoriasis pathomechanism, including development, and response to stimulus” (© 2019 Springer Nature Limited). Researchers also use these kinds of information to figure out how different types of treatments work for different types of psoriasis.

Psoriasis, a skin condition that can be divided into five different types. Though there isn’t a cure yet, doctors and researchers are working hard to find a way to cure it. Like all diseases and conditions, it sometimes takes time to figure out a solution. Some types of psoriasis are more severe than others and may take more than one type of treatment. All they can do for now is to keep researching new ways to treat it and make victims of it feel comfortable.

Works Cited

• “© 1996-2019 National Psoriasis Foundation/USA” “Psoriasis.org”
•  https://www.psoriasis.org/about-psoriasis
• “© 1998-2019 Mayo Foundation for Medical Education and Research (MFMER)” “Psoriasis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 13 Mar. 2019,
• https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840
• “© World Health Organization 2016”  https://apps.who.int/iris/bitstream/handle/10665/204417/9789241565189_eng.pdf.psoriasis;jsessionid=54912784D28C9F36ECCD45471AC5775B?sequence=1
• “Medical Bulletin Vol.15 No.5 May 2010”
• http://www.fmshk.org/database/articles/03mb2_10.pdf
• “© 2005 – 2019 Healthline Media”
• https://www.healthline.com/health/psoriasis/moderate-to-severe/5-reasons-to-switch-to-biologic-for-psoriasis#2

Works cited (continued)

• “© 2019 American Academy of Family Physicians”
• Pardasani, Asha G., et al. “Treatment of Psoriasis: An Algorithm-Based Approach for Primary Care Physicians.” American Family Physician, 1 Feb. 2000,
• https://www.aafp.org/afp/2000/0201/p725.html#sec-3
• “© 1997-2019, A.D.A.M., Inc.”
• Guttate Psoriasis: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, https://medlineplus.gov/ency/article/000822.htm.
• https://medlineplus.gov/ency/article/000822.htm
• “© Hilton, Lisette, et al. Dermatology Times, 22 Oct. 2019, http://www.dermatologytimes.com/dermatologytimes/.
• © 2019 Springer Nature Limited
• “Comprehensive Proteomic Analysis Reveals Intermediate Stage of Non-Lesional Psoriatic Skin and Points out the Importance of Proteins Outside This Trend.” Nature News, Nature Publishing Group, 6 Aug. 2019,
• https://www.nature.com/articles/s41598-019-47774-5
• . “Comprehensive Proteomic Analysis Reveals Intermediate Stage of Non-Lesional Psoriatic Skin and Points out the Importance of Proteins Outside This Trend.” Nature News, Nature Publishing Group, 6 Aug. 2019, https://www.nature.com/articles/s41598-019-47774-5.