Psoriasis, Scalp Psoriasis and 7 Types of Psoriasis

 Psoriasis

What Is Psoriasis?

Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times faster than normal. This makes the skin build up into bumpy red patches covered with white scales. They can grow anywhere, but most appear on the scalp, elbows, knees, and lower back. Psoriasis can't be passed from person to person. It does sometimes happen in members of the same family.

Psoriasis usually appears in early adulthood. For most people, it affects just a few areas. In severe cases, psoriasis can cover large parts of the body. The patches can heal and then come back throughout a person's life.

Symptoms

The symptoms of psoriasis vary depending on the type you have. Some common symptoms for plaque psoriasis -- the most common variety of the condition -- include:

• Plaques of red skin, often covered with silver-colored scales. These plaques may be itchy and painful, and they sometimes crack and bleed. In severe cases, the plaques will grow and merge, covering large areas.
• Disorders of the fingernails and toenails, including discoloration and pitting of the nails. The nails may also crumble or detach from the nail bed.
• Plaques of scales or crust on the scalp.

People with psoriasis can also get a type of arthritis called psoriatic arthritis. It causes pain and swelling in the joints. The National Psoriasis Foundation estimates that between 10% to 30% of people with psoriasis also have psoriatic arthritis.

Types

Other types of psoriasis include:

• Pustular psoriasis, which causes red and scaly skin with tiny pustules on the palms of the hands and soles of the feet.
• Guttate psoriasis, which often starts in childhood or young adulthood, causes small, red spots, mainly on the torso and limbs. Triggers may be respiratory infections, strep throat, tonsillitis, stress, injury to the skin, and taking antimalarial and beta-blocker medications.
• Inverse psoriasis, which makes bright red, shiny lesions that appear in skin folds, such as the armpits, groin, and under the breasts.
• Erythrodermic psoriasis, which causes fiery redness of the skin and shedding of scales in sheets. It's triggered by severe sunburn, infections, certain medications, and stopping some kinds of psoriasis treatment. It needs to be treated immediately because it can lead to severe illness.

What Causes Psoriasis?

No one knows the exact cause of psoriasis, but experts believe that it’s a combination of things. Something wrong with the immune system causes inflammation, triggering new skin cells to form too quickly. Normally, skin cells are replaced every 10 to 30 days. With psoriasis, new cells grow every 3 to 4 days. The buildup of old cells being replaced by new ones creates those silver scales.

Psoriasis tends to run in families, but it may be skip generations. For instance, a grandfather and their grandson may be affected, but not the child's mother.

Things that can trigger an outbreak of psoriasis include:

• Cuts, scrapes, or surgery
• Emotional stress
• Strep infections
• Medications, including blood pressure medications, anti-malarial drugs, lithium and other mood stabilizers, antibiotics, and NSAIDs

Diagnosis

Physical exam. It’s usually easy for your doctor to diagnose psoriasis, especially if you have plaques on areas such as your:

• Scalp
• Ears
• Elbows
• Knees
• Belly button
• Nails

Your doctor will give you a full physical exam and ask if people in your family have psoriasis.

Lab tests. The doctor might do a biopsy -- remove a small piece of skin and test it to make sure you don’t have a skin infection. There’s no other test to confirm or rule out psoriasis.

Treatment

Luckily, there are many treatments. Some slow the growth of new skin cells, and others relieve itching and dry skin. Your doctor will select a treatment plan that is right for you based on the size of your rash, where it is on your body, your age, your overall health, and other things. Common treatments include:

• Steroid creams
• Moisturizers for dry skin
• Coal tar (a common treatment for scalp psoriasis available in lotions, creams, foams, shampoos, and bath solutions)
• Vitamin D-based cream or ointment (a strong kind ordered by your doctor. Vitamin D in foods and pills has no effect.)
• Retinoid creams

Treatments for moderate to severe psoriasis include:

• Light therapy. A doctor shines ultraviolet light on your skin to slow the growth of skin cells. PUVA is a treatment that combines a medicine called psoralen with a special form of ultraviolet light.
• Methotrexate. This drug can cause bone marrow and liver disease as well as lung problems, so it’s only for serious cases. Doctors closely watch patients. You will have to get lab tests, perhaps a chest X-ray, and possibly a liver biopsy.
• Retinoids. These pills, creams, foams, lotions, and gels are a class of drugs related to vitamin A. Retinoids can cause serious side effects, including birth defects, so they’re not recommended for women who are pregnant or planning to have children.
• Cyclosporine. This drug, made to suppress the immune system, may be taken for serious cases that do not respond to other treatments. It can damage the kidneys and raise blood pressure, so your doctor will closely watch your health while you take it.
• Biologic treatments. These work by blocking the part of the body's immune system that is overactive in psoriasis. Biologic medications include adalimumab (Humira), brodalumab (Siliq), certolizumab pegol (Cimzia) etanercept (Enbrel), guselkumab (Tremfya), infliximab (Remicade), ixekizumab (Taltz), risankizumab-rzaa (SKYRIZI), secukinumab (Cosentyx), tildrakizumab (Ilumya), and ustekinumab (Stelara).
• An enzyme inhibitor. The medications apremilast (Otezla) or deucravacitinib (Sotyktu) are new kinds of drug for long-term inflammatory diseases like psoriasis and psoriatic arthritis. They are pills that blocks a specific enzyme, which helps to slow other reactions that lead to inflammation.
• An aryl hydrocarbon receptor (AHR) agonist.Tapinarof (Vtama) is a steroid-free once a day topical cream and can also be used on all body areas, including on sensitive locations.

Is There a Cure?

There’s no cure, but treatment greatly reduces symptoms, even in serious cases. Recent studies have suggested that when you better control the inflammation of psoriasis, your risk of heart disease, stroke, metabolic syndrome, and other diseases associated with inflammation go down.

Psoriasis Statistics

Psoriasis affects:

• 2%-3% of people throughout the world
• About 2.2% of people in the United States
• Some cultures more than others. Worldwide, psoriasis is most common in northern Europe and least common in eastern Asia.

Scalp Psoriasis

What Is Scalp Psoriasis?

Scalp psoriasis is a common skin disorder. It may look different on different skin tones. If you’re light- to medium-skinned, it often shows up as raised, reddish or salmon-colored patches with white scales. On darker skin, the patches may be purple and the scales gray. It can be a single patch or several, and can even affect your entire scalp. It can also spread to your forehead, the back of your neck, or behind and inside your ears.

You can’t catch scalp psoriasis from another person. As with other types, we don’t know what causes it. Doctors believe it comes from something wrong with your immune system that causes skin cells to grow too quickly and build up into patches. You may be more likely to get scalp psoriasis if it runs in your family.

About half of the estimated 7.5 million Americans with psoriasis, which can affect any skin surface, have it on their scalp. Sometimes the scalp is the only place they have it, but that’s uncommon.

Scalp psoriasis can be mild and almost unnoticeable. But it can also be severe, last a long time, and cause thick, crusted sores. Intense itching can affect your sleep and everyday life, and scratching a lot can lead to skin infections and hair loss.

Symptoms of Scalp Psoriasis

Symptoms of mild scalp psoriasis may include only slight, fine scaling. Symptoms of moderate to severe scalp psoriasis include:

• Scaly, red or purple bumpy patches
• Silvery-white or gray scales
• Dandruff-like flaking
• Dry scalp
• Itching
• Burning or soreness
• Hair loss

Scalp psoriasis itself doesn’t cause hair loss, but scratching a lot or very hard picking at the scaly spots, harsh treatments, and the stress that goes along with the condition can lead to temporary hair loss. Fortunately, your hair usually grows back after your skin clears.

If you have any of these symptoms, see your doctor or dermatologist. They may simply take a look or do a skin biopsy to rule out similar conditions like seborrheic dermatitis.

Treatments for Mild Scalp Psoriasis

The first line of defense is treatment you use directly on your skin (topical treatments).These include medicated shampoos, creams, gels, lotions, foams, oils, ointments, and soaps. You can get some of these products over the counter, but stronger ones require a prescription.

Over-the-counter products often contain one of two medications approved by the FDA for psoriasis:

Salicylic acidis a peeling agent available in over-the-counter (OTC) and prescription shampoos and soaps. It can soften scales, making them easier to remove.

Coal tar products are available OTC as shampoos, creams, gels, ointments, foams, and soaps. They can help slow skin growth and reduce inflammation, itching, and scaling. To apply a coal tar shampoo, massage it into the scalp and leave on 5 to 10 minutes before rinsing out. You can leave other tar products on overnight. Staining and odor are the main drawbacks. A non-medicated conditioner after shampooing can help against the odor of tar shampoo.

Medicated shampoos are available in coal tar and non-coal tar varieties. Some OTC shampoos have menthol or phenol creams as an active ingredient. You can use these daily for scalp plaques, but follow the directions.

You can also check with your doctor about taking OTC antihistamine pills.

Prescription products for scalp psoriasis may have higher concentrations of either or both of these, as well as other FDA-approved medications, such as:

• Anthralin, an older prescription medication
• Antimicrobials, which treat bacterial or yeast infections that can come with scalp psoriasis
• Calcipotriene, a strong derivative (different form) of vitamin D
• Calcipotriene and betamethasone dipropionate (a vitamin D derivative combined with a strong steroid)
• Other topical steroids
• Tazarotene, a derivative of vitamin A

To work, these treatments must be put on your scalp, not just your hair. Follow the directions exactly until your skin heals, which can take 8 weeks or more. Once your psoriasis has cleared, you can help keep it from coming back by shampooing regularly or twice weekly with a product that has coal tar or other medications.

To ease itchiness:

• Use a conditioner after shampooing.
• Limit hot tools for hair styling.
• Use wet towels, cold packs, or cold water on itchy spots.

Scalp Psoriasis Treatments at the Doctor’s Office

If you have mild scalp psoriasis in a few areas, your doctor or dermatologist may consider intralesional steroid injections. They’ll use a small needle to inject medication into scalp plaques to reduce inflammation. You can have this procedure at the doctor’s office.

If your symptoms don’t respond to topical treatments, phototherapy with a laser or non-laser light source may help. For example, the excimer laser focuses high-intensity light on affected areas and avoids the surrounding healthy skin.

Ultraviolet (UV) light -- sometimes delivered with a handheld device called a UV comb -- can be used to treat the entire scalp. Hair can block the light from reaching your scalp, so if you have thick hair, it may help to part it in rows. If you have very thin hair or a shaved head, your doctor may recommend that you go out in natural sunlight for brief periods.

Systemic and UV Treatments for Scalp Psoriasis

If you have moderate to severe scalp psoriasis, your doctor may prescribe a drug you take by mouth or one that's injected or pumped through a needle into a vein. Oral medications include:

• Acitretin (Soriatane), a strong derivative of vitamin A
• Apremilast (Otezla), a small molecule inhibitor taken twice daily
• Corticosteroids
• Cyclosporine (Sandimmune) lowers immune system function, which helps to reduce the inflammation of psoriasis.
• Methotrexate (Rheumatrex) slows an enzyme involved in the rapid growth of skin cells.
• Tapinarof (Vtama) cream 1%
• Upacitinib (Rinvoq), a Janus kinase inhibitor taken once daily

Since these medications can cause serious side effects, including liver damage, they require a doctor’s close watch. It's also important to know that oral vitamin derivatives are different from -- and more powerful than -- vitamin supplements bought over the counter. Ordinary vitamin A and D supplements do not help.

The latest class of FDA-approved medications is called biologics. These drugs, which you get by injection or IV, may keep your skin from making too many cells. According to the American Academy of Dermatology, 11 biologics may work:

TNF blockers

• Adalimumab (Humira)
• Certolizumab peg (Cimzia)
• Etanercept (Enbrel)
• Infliximab (Remicade)

Interleukin inhibitors

• Brodalumab (Siliq)
• Guselkumab (Tremfya)
• Ixekizumab (Talz)
• Risankizumab-rzaa (Skyrizi)
• Secukinumab (Cosentyx)
• Tildrakizumab-asmn (Ilumya)
• Ustekinumab (Stelara)

Complications of Scalp Psoriasis

If your scalp psoriasis becomes infected, you may have crusting, discoloration, warmth, tenderness, and sometimes swelling of your lymph nodes. Your doctor may prescribe an antibiotic treatment for this problem.

Preventing Scalp Psoriasis Flares

There is no cure, but many treatments can help cut down on the number of flares you have and ease symptoms when they do happen. People who follow their treatment plan rarely have to endure severe scalp psoriasis for long.

Psoriasis support groups can also offer valuable tips to help medical treatments work better and ease the stress and sadness that this common condition can cause.

7 Types of Psoriasis

 

Knowing which kind of psoriasis you have helps you and your doctor make a treatment plan. Most people have only one type at a time. Sometimes, after your symptoms go away, a new form of psoriasis will crop up in response to a trigger.

In general, most types of psoriasis result from the same triggers:

• Stress
• Skin injury
• Medications
• Lithium
• Antimalarial drugs
• Inderal
• Quinidine
• Indomethacin
• Infection

Other things that may trigger psoriasis include:

• Allergies
• Diet
• Weather

Here's how you can spot the 7 types of psoriasis and what you can do to treat them.

Plaque Psoriasis

Plaque Psoriasis

This is the most common type. About 8 in 10 people with psoriasis have this kind. You may hear your doctor call it "psoriasis vulgaris."

Symptoms:
Plaque psoriasis causes raised, inflamed, red skin covered with silvery, white scales. These patches may itch and burn. It can appear anywhere on your body, but it often pops up in these areas:

• Elbows
• Knees
• Scalp
• Lower back

Treatments:

• Topical treatments: These go on your skin and are usually the first thing doctors try. Some have steroids; others don’t. Prescription products slow skin cell growth and ease inflammation.
• Phototherapy: This treatment uses ultraviolet light. You’ll get it at your doctor's office or at home with a phototherapy unit.
• Systemic medications: These prescription drugs work throughout your body. You’ll get them if you have moderate to severe psoriasis that doesn’t respond to other treatments. You could take them by mouth or get them as a shot or IV. This category includes drugs called biologics, which target specific parts of your immune system that play a role in the inflammatory process. Learn more about systemic treatments for psoriasis.

Guttate Psoriasis

Guttate Psoriasis

This type often starts in children or young adults. It happens in less than 2% of cases.

Guttate psoriasis causes small, pink-red spots on your skin. They often appear on your:

• Trunk
• Upper arms
• Thighs
• Scalp

This type of psoriasis may go away within a few weeks, even without treatment. Some cases, though, are more stubborn and require treatment.

Inverse Psoriasis

Inverse Psoriasis

This type usually found in these locations:

• Armpits
• Groin
• Under the breasts
• Skin folds around the genitals and buttocks

Symptoms include:

• Patches of skin that are bright red, smooth, and shiny, but don't have scales
• Getting worse with sweating and rubbing

Common triggers are:

• Friction
• Sweating
• Fungal infections

 

Pustular Psoriasis

Pustular Psoriasis

This kind of psoriasis is uncommon and mostly appears in adults. It causes pus-filled bumps (pustules) surrounded by red skin. These may look infectious, but are not.

This type may show up on one area of your body, such as the hands and feet. Sometimes it covers most of your body, which is called "generalized" pustular psoriasis. When this happens, it can be very serious, so get medical attention right away.

Symptoms include:

• Fever
• Chills
• Nausea
• Fast heart rate
• Muscle weakness

Triggers include:

• Topical medicine (ointments you put on your skin) or systemic medicine (drugs that treat your whole body), especially steroids
• Suddenly stopping systemic drugs or strong topical steroids that you used over a large area of your body
• Getting too much ultraviolet (UV) light without using sunscreen
• Pregnancy
• Infection
• Stress
• Exposure to certain chemicals

Erythrodermic Psoriasis

Erythrodermic Psoriasis

This type is the least common, but it's very serious. It affects most of your body and causes widespread, fiery skin that appears to be burned.

Other symptoms include:

• Severe itching, burning, or peeling
• A faster heart rate
• Changes in body temperature

If you have these symptoms, see your doctor right away. You may need to get treated in a hospital. This type of psoriasis can cause severe illness from protein and fluid loss. You may also get an infection, pneumonia, or congestive heart failure.

Triggers include:

• Suddenly stopping your systemic psoriasis treatment
• An allergic drug reaction
• Severe sunburn
• Infection
• Medications such as lithium, antimalarial drugs, cortisone, or strong coal tar products

Erythrodermic psoriasis may also happen if your psoriasis is hard to control.

Nail Psoriasis

Nail Psoriasis

Up to half of those with psoriasis have nail changes. Nail psoriasis is even more common in people who have psoriatic arthritis, which affects your joints.

Symptoms:

• Pitting of your nails
• Tender, painful nails
• Separation of the nail from the bed
• Color changes (yellow-brown)
• Chalk-like material under your nails

Psoriatic Arthritis

Psoriatic Arthritis

Psoriatic arthritis is a condition where you have both psoriasis and arthritis (joint inflammation). In 70% of cases, people have psoriasis for about 10 years before getting psoriatic arthritis. About 90% of people with it also have nail changes.

Symptoms:

• Painful, stiff joints that are worse in the morning and after rest
• Sausage-like swelling of the fingers and toes
• Warm joints that may be discolored

 

Reference:

1. https://www.webmd.com/skin-problems-and-treatments/psoriasis/understanding-psoriasis-basics