Psoriasis: Scaly Skin Patches, Triggers and When to Be Seen

What it involves

MedlinePlus defines psoriasis as a skin condition that causes redness, silvery scales, and irritation. The most common form, plaque psoriasis, shows up as thick red patches covered by flaky silver-white scales. It is not contagious, so it cannot be caught from another person.

Who this is for

• Patients with itchy, scaly patches on the elbows, knees, scalp, or trunk that keep returning
• Patients whose nails have pits, thickening, or a yellow-brown color along with a skin rash
• Patients with a skin condition and new joint pain or stiffness who want it looked at together
• Patients who want a primary care home for ongoing skin concerns and referrals when needed

What to expect

• Questions about where the patches are, how long they last, and what seems to set them off
• A look at your skin, scalp, and nails, since MedlinePlus says diagnosis is usually made by examination
• A review of medicines and other health conditions, including heart and joint concerns
• A plan that may include skin treatments, a referral to a dermatologist, or a referral for joint symptoms

What is happening in the skin

MedlinePlus explains that skin cells normally rise to the surface about once a month. In psoriasis that trip takes only 7 to 14 days, so dead cells pile up as scales. It most often begins between ages 10 and 35, or later in life, and it seems to run in families to some degree. Many people notice it goes away for a while and then returns.

The five types

MedlinePlus separates psoriasis by how it looks, and the pattern changes what a provider will ask:

• Plaque, with thick red patches and silver-white scales, the most common type
• Guttate, with small pink-red spots, often following a strep infection
• Inverse, with red irritated skin in the armpits, groin, and skin folds
• Pustular, with yellow pus-filled blisters ringed by red skin
• Erythrodermic, with intense redness over a large area

Common triggers

According to MedlinePlus, flares can follow infections such as strep throat, dry air or dry skin, injuries to the skin, stress, and too much or too little sun. Some medicines, including beta-blockers, lithium, and antimalarial drugs, can also set it off. If a sore throat came just before the spots, the sore throat guide explains how strep is sorted from a virus.

More than skin deep

MedlinePlus notes that some people with psoriasis also develop psoriatic arthritis, and that psoriasis comes with a higher chance of fatty liver disease and cardiovascular problems such as heart disease and stroke. For that reason a primary care provider looks at the whole picture, including numbers like those on a lipid panel and joint pain that the knee pain guide or elbow pain guide describes.

How treatment is described

MedlinePlus groups treatment in three ways: creams, ointments, and shampoos put on the skin; medicines that act on the immune system through the whole body; and light therapy done under medical supervision. Mild disease is usually treated on the skin, while moderate to severe disease is more likely to call for body-wide medicines. Light therapy and prescription immune medicines are specialist decisions, so this practice would refer for them rather than perform them.

Simple things at home

MedlinePlus suggests a daily bath or shower without hard scrubbing, since scrubbing can trigger a flare, oatmeal baths to loosen scales, keeping skin moist, and avoiding your own triggers. It says a little sunlight may help but warns against getting burned, which can make psoriasis worse. The sunburn guide explains how to protect skin.

When to be seen promptly

MedlinePlus advises a visit for symptoms that keep going despite treatment, and says to mention joint pain or fever during flares. It says to go to the emergency room or call 911 for a severe outbreak covering all or most of the body.

Sources

• MedlinePlus — Psoriasis
• MedlinePlus — Psoriasis health topic