What is plaque psoriasis and what are the symptoms?
Plaque psoriasis (also known as psoriasis vulgaris) is the most common form of psoriasis, and affects around 80% of individuals with psoriasis. This chronic autoimmune condition causes red, raised patches with silvery scales to appear on the surface of the skin. The silver build-up is made up of dead skin cells, which results due to abnormally fast skin cell production. Resulting plaques can be painful and itchy and may crack and bleed. Skin plaque psoriasis typically appears on the knees, elbows, lower back and scalp, but can develop anywhere on the body.
The condition typically occurs in cycles of alternating phases with or without symptoms. Many people are exclusively affected by plaque psoriasis, while others simultaneously have another type of psoriasis. If you observe a skin rash that has not subsided with over-the-counter medication, it is worth contacting your doctor.
How severe is my psoriasis?
We distinguish between three degrees of severity: mild, moderate and severe. This classification results from the extent of the affected skin area, but also from the perceived decline of quality of life. Depending on the severity, different treatment options are available to help manage the condition.
What is mild plaque psoriasis?
Those with mild psoriasis will exhibit red and scaly skin bumps on less than 3% of their body. Mild plaque psoriasis can still be very uncomfortable. Topical treatments applied to the body’s surface, such as moisturising creams, over-the-counter prescriptions or shampoos, are suggested to provide relief for this type of psoriasis.
What is moderate and severe plaque psoriasis?
While moderate plaque psoriasis appears on 3 - 10% of the body, severe plaque psoriasis (also known as chronic plaque psoriasis) covers at least 10%. If you experience moderate or severe forms of the condition, it is important to consult your dermatologist for a personalised treatment plan. This will usually involve a combination of different treatment methods: Besides topical prescription medications, you may also be advised to make use of light therapy (phototherapy), or systemic treatments given by injection, intravenous (IV) infusion, or oral ingestion.
What is plaque psoriasis caused by?
The causes of plaque psoriasis are not conclusive. However, it is thought that genetic and environmental factors play a major part. Scientists believe that mutations in genes are a significant reason behind the cause of psoriasis. While around 10% of the population carry these mutated genes, only 2 - 3% of the population actually develop psoriasis. It is assumed that external triggers in combination with these genes are responsible for the ultimate outbreak of psoriasis. These triggers can be manifold and include stress, injuries to skin, infections, or certain medications (like lithium, antimalarials, inderal, quinidine, or indomethacin). Although there is no confirming evidence, some people also assume diet, allergies and weather may act as a trigger of their psoriasis.
The formation of plaques is the result of an immune dysfunction: The skin of people affected by psoriasis is erroneously attacked by white blood cells. As a consequence, the skin constantly renews itself in an attempt to heal. Healthy skin cells are shed and replaced about once a month; for psoriasis skin cells, this process speeds up to just several days. As a consequence of this skin cell overproduction, red plaques consisting of dead skin layers build up.
How to treat plaque psoriasis
Plaque psoriasis treatment depends on the severity of the condition. While at present, a cure for plaque psoriasis is not available, there are several options which can help you manage the skin disease.
- Topical treatments: Topical medications are usually the first choice of treatment, as they are fairly easy to apply and readily available. This type of treatment includes all medications applied on the skin’s surface, like moisturising creams, ointments, over-the-counter prescriptions, or shampoos. Topical treatments are often sufficient to treat mild cases of plaque psoriasis. Furthermore, they can be used to support the treatment of moderate and severe psoriasis cases.
Topical treatments may include steroids (also called corticosteroids), to facilitate slowing down cell growth and reducing inflammation. Milder versions, such as hydrocortisone, can bepurchased over the counter, whereas more potent steroid creams are only available at prescription. It is important to use such corticosteroid treatments only for a limited amount of time and to apply them only to the affected areas of the skin. Otherwise, various side effects such as thinning of the skin may occur.
Similarly to how light irradiation can help psoriasis through phototherapy, the “sunshine vitamin” Vitamin D can also be beneficial in topical treatments. This is thanks to its ability to reduce the thickness of plaques and to make them less scaly.
Salicylic acid ointments are another option for topical over-the-counter medications. As peeling agents, they cause the outer skin layer to shed and are used for a variety of skin conditions. For psoriasis cases, they act as scale lifters by softening and reducing the appearance of scales. Please keep in mind that salicylic acid ointments can cause irritations after extended contactwith the skin and may also lead to temporary hair loss.
Coal tar is used in shampoos, lotions and creams to slow the rapid growth of skin cells and restore the skin's appearance. Its use, however, should be carefully considered, as it might not only stain clothes and bed sheets, but may also irritate the skin, make it more sensitive to sunlight and even promote skin cancer. Even though coal tar’s carcinogenic attributes are only assumed to hold true for concentrations much higher than those in psoriasis treatments, regular skin cancer check-ups are advised when using the substance regularly.
- Phototherapy: Phototherapy (or light therapy) is another popular type of treatment, which may be beneficial for psoriasis cases of all severities. In doing so, the skin is exposed to ultraviolet light on a regular basis. This treatment can either take place at your dermatologist’s office or at home with a phototherapy unit. Please note that phototherapy should not be equated with indoor tanning, as the radiation of solariums is not suitable for the treatment of psoriasis.
- Systemic drugs: In case you should not respond to other methods of treatment or if your quality of life is significantly impacted, your doctor may also prescribe systemic treatments. These medications take effect inside the body after being given by an injection, intravenous (IV) infusion, or oral ingestion. Biologic drugs for example are able to target specific parts of the immune system. In doing so, they block certain cells or proteins known to perform an important function in the formation of psoriasis. While this treatment may be effective to ease the symptoms of severe psoriasis, the involved risks need to be thoroughly considered beforehand. Your doctor will assist you in evaluating the potential benefits and risks.
- Natural remedies: Additionally to these conventional treatment methods, there is a whole range of natural skin remedies you may choose from. These are generally available and take effect rather gently. Even though there is limited scientific evidence proving the effectiveness for most of them, many people are convinced by the beneficial impact. Be it applying aloe vera gel on your skin or apple cider vinegar on your scalp, using shampoos with tea tree oil, taking a warm bath in Dead Sea salts, or consuming turmeric – there are many worthwhile natural methods at your disposal. Please always keep in mind to consult your dermatologist prior to employing any natural remedies, as they may imply dangerous interactions with other medications.
Common questions on plaque psoriasis
Is plaque psoriasis contagious?
It is a common misconception to assume that plaque psoriasis may be contagious. In reality, this is not the case. You cannot catch psoriasis by coming into physical contact with another person.
How are plaque and scalp psoriasis connected?
Red patches of skin with silvery scales can form plaques on the scalp. The scalp is a common place in which psoriasis can occur.
How can I differentiate between plaque psoriasis and eczema?
Plaque psoriasis can appear similar to eczema. However, plaque psoriasis tends to be thicker. Also, eczema is not generally characterised by silvery scales and does not appear as inflamed as psoriasis. Eczema also appears on places that bend, such as behind the knees, ankles, wrists and inner elbow.
What is the difference between plaque psoriasis and psoriatic arthritis?
Plaque psoriasis and psoriatic arthritis differ in several ways. Unlike plaque psoriasis, psoriatic arthritis is characterised by joint pain and swelling. Both conditions may come and go, however, those with plaque psoriasis may begin to suffer from psoriatic arthritis at a later date.
Outlook on living with plaque psoriasis
Even though ultimate healing of plaque psoriasis may not be possible, the right treatment can help you achieve long periods without symptoms. With the help of a dermatologist, it is possible to find the suitable treatment for you.
UK/IE MAT-09232 Date of prep: May 2017