Psoriasis is an inflammatory skin condition which is not contagious. There are five different types of psoriasis, of which by far the most common is plaque psoriasis which is a form that is suffered by approximately 80% of psoriasis sufferers. This particular form of psoriasis (also known as ‘psoriasis vulgaris’, with the latter word meaning common) usually appears as reddish patches of raised skin which are often covered in a silvery-white scale. These skin patches, otherwise known as plaques (hence the condition name) or lesions are most commonly found on the elbows and knees, the scalp or sometimes in the lower back area of the sufferer.
Having said this, they are not restricted to these particular areas of the body and can appear anywhere on the head, torso or limbs.
The other less common types of psoriasis are:
• Guttate psoriasis which is characterized by small red spots on the skin. This particular form of psoriasis most commonly develops in children or teenagers who have a history of streptococcal infections;
• Erythrodermic psoriasis where the patient suffers widespread redness, severe itching and often pain. This is the least common type of psoriasis which is suffered by only 1% to 2% of people who have psoriasis, which is fortunate, because this particular type of psoriasis can in the most extreme cases be life-threatening. This is because in the most severe cases, large sections of skin are shed, meaning that there are areas of exposed, unprotected flesh which could be prone to infections (it is often compared to those who have suffered very bad burns);
• Inverse psoriasis is where the sufferer is likely to find small, smooth red lesions forming in bodily skin folds where warm, moist conditions (such as in the armpits, genital area etc) encourage smooth, non-scaly but nevertheless painful to the touch plaques and
• Pustular psoriasis which is characterized by patches of red skin at the centre of which there are likely to be white pustules. This type of psoriasis occurs in less than 5% of sufferers, and is usually seen only in adults. Irrespective of the particular type of psoriasis that an individual is suffering from, it usually causes at least a degree discomfort which in some cases can become mild to severe pain. For psoriasis sufferers, it is a fact of their life that their skin is almost always itchy, and that it can often crack and bleed as well. In the most severe cases, the pain suffered by someone who has psoriasis can be significant enough to prevent them handling every day tasks whilst also making settled sleep extremely difficult as well. In medical terms, the treatment that medical professionals and other doctors would recommend for psoriasis will to a very large extent depend upon the severity of the condition being suffered by the individual seeking advice. Some dermatologists would classify psoriasis in three different categories, being mild, moderate and severe with the definition of each of these categories depending on the percentage of the patient’s body that is covered with psoriasis lesions. By these standards, anyone who has lesions cover between 5% and 10% of their body would fall into the mild category, 10% to 20% would be moderate and anyone who has more than 20% of their body covered in psoriasis lesions would fall into the severe category. It has already been suggested that up to 20% of the population of the USA (and by extension of the rest of the Western world) may suffer psoriasis, with the vast majority falling into the mild or even very mild category. For many of these people, their condition is nothing more than a mild annoyance with moderate skin lesions and minor itching, often on a temporary basis. At the other end of the scale, there are some unfortunates whose condition is so severe that they develop lesions all over their body and have to be hospitalized so that the condition can be treated. For these people, their psoriasis is likely to be extremely painful and in addition, it can also be disfiguring and even potentially disabling. And unfortunately, because psoriasis is a chronic condition, meaning that it is one that is a lifelong thing, there can be no total relief for any sufferer. Psoriasis is a condition that can apparently clear up and then return (often with a vengeance) many times throughout life, and because there is no recognized cure for the condition, this is a fact that every psoriasis sufferer has to get used to and live with.
As with a surprising number of medical conditions, the exact causes of psoriasis have not as yet been established beyond all doubt. But, whilst the traditional view of psoriasis was that it is a condition of the epidermis, the uppermost layer of the skin, research over the past few years has begun to indicate otherwise. This research has indicated that far from being a condition that is only related to the epidermis, the causes of psoriasis go much deeper than this. In fact, this research indicates that psoriasis is a condition that is caused by malfunctions in the sufferer’s immune system when certain immune cells are activated and subsequently become overactive. In any individual who has a perfectly normally functioning immune system, white blood cells or T-cells produce antibodies that are designed to repel bacteria and viruses. However, it is now believed that in the case of a psoriasis sufferer, these cells begin to fight an imaginary infection or try to heal a wound that doesn’t exist by creating a surfeit of new skin cells to repel the imaginary invader or to repair the nonexistent damage. This in turn causes the plaques or skin lesions that are endemic to plaque psoriasis to appear. Under normal circumstances, the life cycle of the average skin cell for someone who is totally healthy is around about 28 days, but it is believed that in psoriasis sufferers, their immune system is creating far too many cells. Moreover, because these cells are being produced so quickly, they mature in as little as three to six days before moving to the surface of the skin. Consequently, because these cells are not dying quickly enough, they build up on the surface of the skin, layer upon layer, and thus the psoriatic plaques are formed. Because of this research, we now have what is believed to be a reasonably accurate idea of what causes psoriasis. What we do not know however is exactly why some individuals suffer from psoriasis whereas others do not. There are on the other hand some generally accepted factors that make some individuals more likely to suffer psoriasis than others.
How you get psoriasis
Research indicates that some 30% of people who develop psoriasis have a family history of the condition, but it is also true that many parents who suffer from psoriasis will have the children who have no problems of their own. On the other hand, there will be people who develop psoriasis who have no family history of the condition, so to suggest that psoriasis is hereditary could be a little misleading.
It is however true that researchers have established that there are certain genetic combinations and/or mutations that seem to make anyone who has them predisposed to suffering from psoriasis. At the present time, researchers believe that there are nine different genetic mutations that might play a part in making certain people predisposed to suffering from psoriasis. However, there is one particular mutation of chromosome-6 known as PSORS-1 (for psoriasis susceptibility 1) which appears likely to be the particular mutation that plays the biggest role in deciding who is likely to become a psoriasis sufferer, and who is not. According to a study published in the American Journal of Human Genetics in 2006, research has established that the role of this particular genetic mutation was seen in more than 2700 psoriasis sufferers drawn from nearly 680 families in which one or both parents were psoriasis sufferers. It is now generally agreed within the research and scientific community that this particular mutation causes the T-cells to behave differently, hence the connection with psoriasis. But it is also the fact that this particular genetic mutation does not necessarily mean that an individual is certain to become a psoriasis sufferer. Indeed, the same research study which was carried out by James T. Elder, MD, PhD suggests that for every individual with the PSORS-1 gene that develops psoriasis, there will be 10 other individuals carrying exactly the same gene who do not develop the condition. Moreover, it should also be noted that many of the same mutations that are believed to make an individual predisposed to psoriasis can also have a connection with other immune mediated conditions such as type 1 diabetes or rheumatoid arthritis as well. It therefore follows that whilst some people who have a particular genetic mutation might be more prone to psoriasis, it is possible that instead of psoriasis, they may suffer from diabetes or rheumatoid arthritis. In fact, whilst the risk of developing psoriasis is increased if one or both parents are also suffererlets, the risks of developing other immune mediated conditions especially Crohn’s disease or diabetes are both increased in the same situation. From all this, it might be natural to assume that having some family history of psoriasis is likely to mean that you will develop psoriasis yourself, but in many cases, this simply does not happen.