Psoriasis Triggers

Stress to the skin can trigger a flare-up of psoriasis. Patients have reported new plaques appearing about two weeks after the skin is cut, scratched, rubbed or severely sunburned. Psoriasis typically starts as small, red bumps that develop into larger scaly plaques.

Infections, such as strep throat, can encourage a flare-up, as can the use of certain medications such as lithium. Emotional stress has been linked to outbreaks of psoriasis. Climate can also be a contributing factor; many patients say their psoriasis is worse in the winter, when their skin is dry and exposed to less sunlight.

There are five types of psoriasis.

Click the links thru the National Psoriasis Foundation to learn more.

• Plaque: Most common form of the disease
• Guttate: Appears as small red spots on the skin
• Inverse: Occurs in armpits, groin and skin folds
• Pustular: White blisters surrounded by red skin
• Erythrodermic: Intense redness over large areas

Where it Occurs

Psoriasis commonly affects the elbows, knees, groin, buttocks, scalp and nails. Nails affected by psoriasis may become pitted or discolored. The nails may loosen, thicken or crumble. Inverse psoriasis shows up in the armpit, the skin under the breast, and in skin folds around the groin, buttocks and genitals. Guttate psoriasis affects children and young adults. It often occurs after a sore throat and may clear up in weeks or a few months. Pustular psoriasis may be widespread or localized with pus-filled blisters that form on the skin, and then dry and peel. Erythrodermic psoriasis is the rarest form, but can affect most of the skin and causes tremendous discomfort.

Psoriasis often appears in the same place on both sides of the body. About 10% of all cases are described as extensive, involving more than 20% of the body's surface area. Mild to moderate psoriasis affects less of the body's surface area. (One percent of the body surface area is usually the size of the palm of the hand.)

Approximately 10-30% of those with psoriasis also develop arthritis. Similar immune cells affect inflammation in both skin and joints. Some patients say their arthritis improves when the condition of their skin gets better and vice versa.

Treatments for Management of Psoriasis

Topical lotions, ointments, creams, gels, and shampoos for the skin and scalp are prescribed for mild-to-moderate cases of psoriasis or in combination with other treatments for more severe cases. FDA-approved prescription topicals to treat psoriasis include corticosteroids, retinoids, calcipotriene, and coal tar products. These drugs slow down skin cell production and reduce inflammation.

Moderate to severe psoriasis may be treated with one of the new "biologics" which are injectable proteins. Dr. Cobos may recommend the biologic Enbrel. Injections are once weekly for 12 weeks followed by periodic injections and topical support therapy. (More information on Enbrel)