Psoriasis - Symptoms and Signs

Symptoms and Signs

The most common symptoms of psoriasis are reddish patches of inflamed skin covered by silvery scales

"Psoriasis can be painful and can be profoundly disruptive to a person's life," says Jill Lindstrom, M.D., an FDA dermatologist. She adds -"People who don't have it don't understand how burdensome the disease can be. There is constant shedding of scales. There can be functional impairment, itching, and pain."

The symptoms of psoriasis can manifest in a variety of forms. According to the symptoms, the disease can be classified into plaque, pustular, guttate and flexural psoriasis.

Plaque psoriasis.

a) Plaque psoriasis, also called psoriasis vulgaris - is the most common variant of the disease and is seen 80 to 90% of the affected individuals. In this form of psoriasis, inflamed skin displays elevated or bumpy areas (plaques) covered with silvery white scales.

b) Flexural psoriasis or inverse psoriasis - In this type of the disease, smooth inflamed patches appear in between skin folds. It is aggravated by sweat and friction and is therefore prone to fungal infection. This type of psoriasis is specific to the genital area ( between the thigh and groin) , under the breasts(infra-mammary fold), under thebelly fold (pannus) and in the armpits.

c) Pustular psoriasis is charecterized by bumps (pustules) filled with pus that is non-infectious. The skin adjoining the pustules is tender and red . These pustules, if localized to the hands and feet, are called palmoplantar pustulosis. They may also occur as widespread patches, distributed throughout the body or confined locally.

d) Nail psoriasis causes changes in the finger and toe nails such as

• Discolouring
• Pitting
• Formation of lines across the nails
• Thickening of skin beneath the nail
• Loosening and crumbling of nail

e) Guttate psoriasis - In this form of the disorder, numerous 'tear drop' spots appear over the trunk, limbs, and scalp. This form of psoriasis is also linked to streptococcal throat infection.

f) Erythrodermic psoriasis is charecterized by inflammation and exfoliation of the skin, accompanied by severe itching, swelling and pain in a widespread fashion. This type of psoriasis may sometimes be fatal.

g) Arthropathy- 5-10% of individuals with psoriasis have a chronic, rheumatoid factor negative type of inflammatory arthropathy which can assume a central pattern(ankylosing spondylitis) or a peripheral pattern (rheumatoid arthritis).

Psoriatic arthritis is a connective tissue inflammation which affects the joints particularly those of the fingers and toes resulting in a sausage-shaped swelling of these parts (dactylitis).

It affects 10-15% of people who suffer from psoriasis. This form of arthritis may also affect the hips, knees and spine.

Psoriasis in children -The type of psoriasis that is most commonly prevalent in young children and teenagers is guttate psoriasis. It usually occurs after an upper respiratory infection, although it must be noted that the infection is not the direct cause of psoriasis. The disease can also be triggered by stress, streptococcus infections and skin injuries.

References:

a) Br J Nurs. 2008 Mar 13-26;17(5):284-90.
Ryan S.

b) J Am Acad Dermatol. 2008 May;58(5):851-64
Gottlieb A, et al

c) J Reprod Med. 2008 Mar;53(3):183-7.
Ben-David G, Sheiner E, Hallak M, Levy A.

d) Clin Chim Acta. 2008 Apr 12.
Pietrzak AT, etal

e) Arch Dermatol Res. 2008 Apr 30
Gunes Y, etal

f)Principles & Practice of Medicine
Davidson

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