What is psoriasis?

Psoriasis is a chronic autoimmune skin condition that results in the rapid buildup of skin cells, leading to the formation of thick, silvery scales known as plaques and itchy, dry, and red patches on the skin. In healthy individuals, a standard turnover rate for skin cells is about a month. But in those with psoriasis, the skin cell turnover rate is reduced to a matter of days. There are many different types of psoriasis that all manifest in their own unique combination of symptoms.

1. Plaque psoriasis

This is the most common form of psoriasis, characterized by raised, red patches covered with silvery-white plaques. These plaques can occur anywhere on the body, but they are most often found on the elbows, knees, scalp, and lower back.

2. Guttate psoriasis

Guttate psoriasis often starts in childhood or young adulthood and is characterized by small, red spots that look similar to drops on the skin. This type of psoriasis is often triggered by bacterial infections like strep throat.

3. Pustular psoriasis

This form of psoriasis is characterized by the presence of white, pus-filled blisters, also known as pustules, surrounded by red skin. Pustular psoriasis can be localized to specific areas of your body or involve larger areas.

4. Inverse psoriasis

Inverse psoriasis affects areas of your body where skin touches skin, such as your armpits, groin, under breasts, and in skin folds. It can include smooth, red lesions that can be aggravated by friction and sweating.

5. Erythrodermic psoriasis

This is a rare but severe form of psoriasis that can affect the entire body. It causes widespread redness, severe itching, and the shedding of scales in sheets.

Symptoms of psoriasis

While the symptoms of psoriasis can vary depending on the type of psoriasis a person has, the most common symptoms include:

• Plaques (raised, red patches covered with a silvery-white buildup of dead skin cells)
• Itchiness
• Dry, cracked skin
• Thick or ridged nails
• Guttate lesions (small red spots or lesions)
• Pustules (white, pus-filled blisters)
• Joint pain

Is psoriasis an autoimmune disease?

Many of my patients ask me what is the root cause of psoriasis. Ultimately, it all comes back to your immune system. Like other autoimmune conditions, psoriasis is a case of mistaken identity. Thinking your skin cells are foreign invaders, your immune system ends up attacking your perfectly healthy skin cells, causing an inflammatory response that accelerates the skin cell turnover process, resulting in plaques all over your body.

During this overactive immune response three things happen:

1. Autoantibodies - antibodies produced by your immune system - mistakenly target your body’s own cells and tissues, triggering an immune response against itself. 
2. Antigens - substances that stimulate the production of antibodies - from your body's own cells are incorrectly identified as foreign, leading to an immune response against these self-antigens. 
3. Lymphocytes - a type of white blood cell, play a central role in immune responses - mistake these self-antigens as foreign and initiate an immune response against your body's own tissues (in this case, your skin cells), contributing to inflammation and damage.

While researchers are still learning more about the exact mechanisms behind psoriasis, it’s understood that a variety of different triggers can influence your immune system and cause it to go into overdrive. These are some of the risk factors linked (1) to the development of psoriasis. 

• Genetics: There is a strong genetic component to psoriasis, as it often runs in families. Individuals with a family history of psoriasis are at a higher risk of developing the condition.

• Environment: Certain environmental factors like infections (streptococcal), stress, skin injuries (cuts and sunburns), and medications (lithium, antimalarial drugs, and beta-blockers) can both trigger and perpetuate psoriasis symptoms.
• Lifestyle: Unhealthy lifestyle choices, such as smoking, excessive alcohol consumption, and obesity, have been linked to an increased risk of psoriasis and may even contribute to the severity of symptoms.
• Hormones: Hormonal changes, especially during puberty, pregnancy, and menopause, can lead to the onset of psoriasis and perpetuate symptoms.