Psoriasis is an autoimmune-mediated disease that may lead to skin disorders. It consists of several sub-groups, and each one of them has a unique manifestation. The most common among them is Plaque Psoriasis. According to the stats, 1 to 2% of the United States population deals with plaque psoriasis. The disease usually differs from other types of psoriasis based on its characteristic flaky scales, giving it a name, the plaque.
Causes Of Plaque Psoriasis
It is known that the development of most diseases depends on either a genetic or an environmental factor. The same goes for this disease.
It seems like psoriasis runs in families as one of three individuals with psoriasis has someone in the family with the disease. However, not all individuals with psoriatic genes develop the disease.
There can be any triggering agent that can elicit an immune response. These triggering agents can range from a minor allergen to an innocuous medicine. But, most of the time, it is an infection caused by streptococcus that brings psoriasis.
Plaque Psoriasis Symptoms
Individuals dealing with plaque psoriasis can show several symptoms. However, few of them are of significant concern and give a definite diagnosis. Here are a few characteristic features of plaque psoriasis which help to rule out the disease and its treatment.
Red patches over the skin generally indicate inflammation, which is a common pathophysiologic finding of psoriasis. However, red patches in psoriasis are different from the general red patches found in measles and other diseases.
As we know, psoriasis occurs because of a long-standing immune dysfunction; such pathologies can lead to inflammation. Regarding the differential features of red patches in plaque psoriasis and in general, there are several hypotheses out there. Robert T. Brodell, MD, HOD dermatology at the University of Mississippi Medical Center, described how the dermatologist could differentiate into those red patches.
According to Brodell, dermatologists can identify psoriasis “just by looking at the skin.” Rashes in some skin conditions are in the form of macules that are flat and red. However, that’s not the case for psoriasis. People surviving from plaque psoriasis usually have raised patches.
Dr. Brodell said if you close your eyes and touch macular rashes, you wouldn’t feel them. But, in the case of plaque psoriasis, you would feel that area of red patches. These raised patches give psoriasis its characteristic feature, The Psoriatic Rash.
In plaque psoriasis, the immune system works faster and keeps on attacking the innocuous skin cells. As a result of repetitive insult, the skin can develop scales over its surface.
Since we know our skin regenerates new cells, and in the meantime, it sheds off the older ones. But with plaque psoriasis, the skin cells multiply themselves at a much faster pace because of a hyper-responsive immune system. Not only this, the skin cells do not fall off that quickly in plaque psoriasis and instead gather on the surface resulting in the formation of scales. In conclusion, these scales consist of heaped-up epithelium.
These scales are also known as “micaceous” since they resemble the mineral mica. They are like thin flakes that can split apart easily. However, the color of these scales can vary from person to person, depending upon the melanin concentration. People with lighter skin tones can exhibit pink, white, or silvery scales, as described by Dr. Brodell. In contrast, people with a higher concentration of melanin can present with yellowish to brown scales.
Dr. Adam Friedman, professor of dermatology at George Washington School of Medicine and Health Sciences, agreed with Dr. Brodell. However, he added that “this may cause the scales to look purple or yellowish.”
The wordy meaning of psora is an “itch,” one of the most common findings of plaque psoriasis. People with inflammatory lesions related to plaque psoriasis develop itchy areas. But, not in all cases. According to Dr. Brodell, around 50 to 60% of individuals with psoriasis develop itching.
Inflammation is considered the most common cause of itching in psoriasis as it initiates a series of inflammatory cascades, including the release of chemokines and other chemical mediators.
Regarding the treatment, very few relieving methods are available. Some dermatologists recommend applying topical creams, and some suggest oral meds to get rid of the itch. However, scratching is not suggestive as it is of no relief. Furthermore, in contrast to eczema, where scratching the irritated or itchy patches feels good, scratching in psoriasis can hurt badly.
Dr. Brodell says scratching the inflamed areas can make it worse. There are chances that scratching can break open the skin. Moreover, scratching the irritated areas can scrape off the scales, which can be painful and lead to pinpoint bleeding. As a result, the patient can present with the Auspitz sign, one of the common findings in individuals dealing with plaque psoriasis.
In addition, in the worst-case scenario, it can elicit an infection, and new psoriatic lesions can also develop. This kind of formation of new lesions is known as the Koebner effect. The term refers to new lesions on such sites where a person didn’t experience a lesion before. This phenomenon is commonly observed in vitiligo and psoriasis.
Pain And Discomfort
Having scaly irritated areas on different parts of the body is a notable cause of discomfort in itself. For instance, people with plaque psoriasis can experience a limit in their mobility and a burning or, say, painful sensation even on a slight movement. In addition, these thickened lesions can become more painful when they are at the knees or elbows.
Apart from the skin manifestations, people can also experience severe pain in their joints. It is because of the inflammation of joints as the body’s immune cells are attacking. As a result, the patient develops Psoriatic Arthritis. The characteristic feature of Psoriatic Arthritis is stiffness of the joints along with swelling and pain.
Intervertebral and interphalangeal joints are more prone to develop arthritis. As a result, a person can develop severe backache and swollen fingers or toes, respectively. If left untreated, the pain can get worse over a while and can hamper mobility. Moreover, it can cause permanent joint damage that is difficult to treat and may leave an individual disabled or unable to move. In order to avoid such irreversible damage, it’s better to seek medical attention for psoriatic arthritis before it gets too late.
It is supposed that one of three individuals with skin conditions develops psoriatic arthritis. However, the progress from the skin to psoriatic arthritis doesn’t occur over a week or a month. There are several hypotheses available regarding the inflammation of joints in psoriasis. Most of the cases begin with skin psoriasis, progress to joint pain in 7 to 10 years.
Other Plaque Psoriasis Symptoms
Apart from the symptoms mentioned above, people can manifest other symptoms as well. Although they are rare and can not be present altogether at a time, they are of great importance for diagnosis and treatment.
- Thickened, ridged, or pitted nails
- Dry, cracked skin
- Swollen and stiff joints
When Does Symptom Start Showing up?
Symptoms of psoriatic arthritis can appear suddenly at any age. However, they often show at the age of 15 to 25. Both males and females are susceptible to the manifestation of these diseases.
In the beginning, a large patch appears on the skin, mainly on the torso. And with the progression in time, more patches begin to appear on other parts of the body. Then, within two weeks, they appear on arms, legs, and trunk. After a few times, scales will start to develop on these lesions, which can be painful on itching. Hence, at this stage, a patient can present with all characteristic diagnostic features. There is an observation that the symptoms appear in a cycle, i.e., soaring for a few days then subsiding or going to remission.
The treatment regimen for psoriasis depends on the severity and extent of the lesion. However, most of the treatment plans are supportive and help to negotiate the severity of the lesion.
Topical Medicines – Doctors usually prescribe topical creams when there are only a few lesions.
Light Therapy – when lesions have spread widely, the dermatologist seeks help by treating them with UV light. But it can increase the chances of skin cancer. That’s maybe the reason it is not that prevailing.
Systemic And Biologic Drugs – these drugs are effective in severe cases of psoriasis. They help to calm down the immune system and target the hyperactive immune cells.
To conclude, plaque psoriasis is an autoimmune disease that typically affects the skin. People battling with plaque psoriasis usually present with patchy red skin covered by scales. They often exhibit an itch that can also be painful upon scratching. In addition, they can also develop arthritis associated with psoriasis over a period, leading to swollen and painful joints.
There is no therapy available for complete remission, but the supportive treatment provides a pave to a better life.