Nail changes, including thick nails, yellow-brown nails, dents in the nail, and nail lifts off from the skin underneath
Severe dandruff on the scalp
Psoriasis may affect any or all parts of the skin. There are five main types of psoriasis:
Erythrodermic -- The skin redness is very intense and covers a large area.
Guttate -- Small, pink-red spots appear on the skin.
Inverse -- Skin redness and irritation occurs in the armpits, groin, and in between overlapping skin.
Plaque -- Thick, red patches of skin are covered by flaky, silver-white scales. This is the most common type of psoriasis.
Pustular -- White blisters are surrounded by red, irritated skin.
Signs and tests
Your doctor or nurse can usually diagnose this condition by looking at your skin.
Sometimes, a skin biopsy is done to rule out other possible conditions. If you have joint pain, your doctor may order x-rays.
The goal of treatment is to control your symptoms and prevent infection.
Three treatment options are available:
Skin lotions, ointments, creams, and shampoos. These are called topical treatments.
Pills or injections that affect the body's immune response, not just the skin. There are called systemic, or body-wide, treatments.
Phototherapy, which uses light to treat psoriasis.
Most of the time, psoriasis is treated with medications that are placed directly on the skin or scalp. This may include:
Cortisone creams and ointments
Creams or ointments that contain coal tar or anthralin
Creams to remove the scaling (usually salicylic acid or lactic acid)
Dandruff shampoos (over-the-counter or prescription)
Prescription medicines containing vitamin D or vitamin A (retinoids)
SYSTEMIC (BODY-WIDE) TREATMENTS
If you have very severe psoriasis, your doctor will likely recommend medicines that suppress the immune system's faulty response. These medicines include methotrexate or cyclosporine. Retinoids such as acitretin can also be used.
Newer drugs called biologics are used when other treatments do not work. Biologics approved for the treatment of psoriasis include:
Some people may choose to have phototherapy.
Phototherapy is a medical treatment in which your skin is carefully exposed to ultraviolet light.
Phototherapy may be given alone or after you take a drug that makes the skin sensitive to light.
Phototherapy for psoriasis can be given as ultraviolet A (UVA) or ultraviolet B (UVB) light.
If you have an infection, your doctor will prescribe antibiotics.
AT HOME CARE
Follow these tips at home:
Oatmeal baths may be soothing and may help to loosen scales. You can use over-the-counter oatmeal bath products. Or, you can mix 1 cup of oatmeal into a tub of warm water.
Sunlight may help your symptoms go away. Be careful not to get sunburned.
Relaxation and antistress techniques may be helpful. The link between stress and flares of psoriasis is not well understood, however.
Psoriasis is a life-long condition that can be controlled with treatment. It may go away for a long time and then return. With appropriate treatment, it usually does not affect your general physical health.
Secondary skin infections
Side effects from medicines used to treat psoriasis
Skin cancer from light therapy
Calling your health care provider
Call your health care provider if you have symptoms of psoriasis or if the skin irritation continues despite treatment.
Tell your doctor if you have joint pain or fever with your psoriasis attacks.
If you have symptoms of arthritis, talk to your dermatologist or rheumatologist.
Go to the emergency room or call the local emergency number (such as 911) if you have a severe outbreak that covers all or most of your body.
There is no known way to prevent psoriasis. Keeping the skin clean and moist and avoiding your specific psoriasis triggers may help reduce the number of flare-ups.
Doctors recommend daily baths or showers for persons with psoriasis. Avoid scrubbing too hard, because this can irritate the skin and trigger an attack.
Gottlieb A, Korman NJ, Gordon KB, Feldman SR, Lebwohl M, Koo JY, et al. Guidelines for the management of psoriasis and psoriatic arthritis. Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on biologics. J Am Acad Dermatol. 2008;58:851-864.
Menter A, Korman NJ, Elmets Ca, Feldman SR, Gelfand JM, Gordon KB, et al. American Academy of Dermatology guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60:643-659.
Menter A, Gottlieb A, Feldman SR, Voorhees ASV, Leonardi CL, Gordon KB, et al. Guidelines for the management of psoriasis and psoriatic arthritis. Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;5:826-850.
Stern RS. Psoralen and ultraviolet a light therapy for psoriasis. N Engl J Med. 2007;357(7):682-690.
Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.