Every year in August, the National Psoriasis Foundation (NPF) celebrates Psoriasis Action Month to show support and dedication to people with psoriatic disease. In the United States, 2 to 3 percent of the population, or more than 8 million people, have psoriasis. Statistics are similar worldwide of this illness that affects both children and adults.
Many people associate psoriasis with a rash on the body, believing it to be solely a cosmetic problem, but, actually, it is a debilitating disease with no cure. In fact, many people with psoriasis, around 30 percent of sufferers, have a painful form known as psoriatic arthritis, one of the most common autoimmune diseases.
What Is Psoriasis?
Psoriasis is a noncontagious, chronic skin disease characterized by red, itchy patches, particularly on the knees, elbows, trunk, and scalp. It is caused by an overactive immune system that raises false alarms, leading to inflammation and a rapid turnover of skin cells. Instead of taking the normal one month to grow, in people with psoriasis, skin cells reproduce in a matter of days, before having a chance to mature. The new and old cells accumulate on the surface of the skin, causing redness, irritation, and discomfort.
People with psoriasis experience flare-ups that can last a few weeks or months before subsiding for a while and going into remission. Symptoms can be managed, but there is no way to rid the body of the disease.
There are several types of psoriasis, including:
- Plaque psoriasis: This form causes dry, raised, red skin patches, or lesions, covered with silvery scales that can itch or be tender. Quantity varies, but they typically appear on elbows, knees, the lower back, and the scalp.
- Nail psoriasis: Fingernails and toenails appear pitted, and there is abnormal nail growth and discoloration. Nails may loosen and separate from the nail bed.
- Guttate psoriasis: Young adults and children experience this type of psoriasis that is triggered by a bacterial infection such as strep throat. Small scaly lesions in the shape of droplets appear on the trunk, arms, or legs.
- Inverse psoriasis: Smooth patches of red skin that worsen with friction and sweating are concentrated in the skin folds of the groin, buttocks, and breasts and may be triggered by fungal infections.
- Pustular psoriasis: This rare form of psoriasis is characterized by pus-filled lesions that appear in widespread patches or in smaller areas of the palms of the hands or soles of the feet.
- Erythrodermic psoriasis: The rarest of all forms, erythrodermic psoriasis can cover the entire body with a red rash that can itch or burn.
- Psoriatic arthritis: This form causes swollen, painful, arthritic joints. The joint pain may be the first sign of psoriasis. Sometimes only changes in the nails are seen. Symptoms can range from mild to severe and lead to progressive, and sometimes permanent, joint damage.
Psoriasis usually first appears in people aged 15 to 25, but it can develop at any age. Psoriatic arthritis is often first noticed in adults between the ages of 30 and 50, but it, too, can develop at any age.
Cases of psoriasis range from mild (affecting less than 3 percent of the body) to moderate (affecting 3 percent to 10 percent of the body) to severe (affecting more than 10 percent of the body).
More on Psoriatic Arthritis
Psoriatic arthritis (PsA) is an inflammatory form of arthritis that affects tendons and ligaments that connect to bone in the body. The immune system mistakenly attacks healthy tissue and creates the inflammation, which leads to swelling, pain, fatigue, and stiffness in the joints.
PsA symptoms typically start about 10 years after psoriasis begins. Although not common, people can develop PsA without ever having experienced psoriasis.
A rheumatologist will help diagnose and treat the disease. Early recognition, diagnosis, and treatment of PsA are critical to help ease pain, protect joints, and stop the progression of the disease.
Symptoms of Psoriatic Arthritis
Symptoms can develop slowly and be mild or develop quickly and be severe. They include:
- tenderness, pain, and swelling around tendons
- swollen fingers and toes
- stiffness, pain, throbbing, swelling, and tenderness in one or more joints
- morning stiffness and tiredness
- reduced range of motion
- nail changes
- redness and pain of the eye (uveitis) or redness and pain in tissues around the eye (pink eye)
If unchecked, PsA can lead to the following:
- damage to cartilage and bones
- gastrointestinal problems
- shortness of breath and coughing
- damage to blood vessels and the heart muscle
- weak bones that break easily (osteoporosis)
- metabolic syndrome (obesity, high blood pressure, and poor cholesterol levels)
Testing for Psoriatic Arthritis
There is no definitive test for PsA. A doctor will make observations and note the patient’s symptoms. A patient’s medical history will be discussed, and the doctor will perform a physical examination, often ordering blood tests to detect inflammation and taking images of the bones and joints.
Because symptoms of PsA are similar to those of other arthritic diseases, namely rheumatoid arthritis (RA), gout, and reactive, or infectious, arthritis, a rheumatologist will perform tests such as those looking for C-reactive protein and fluid around a joint to rule out the other diseases. Although PsA shares symptoms with RA, gout, and reactive arthritis, PsA is distinguished by psoriasis on the skin and changes in the nails.
Treatments include topical treatments such as ointments or corticosteroids, light therapy, pills and injectable medicines, combination therapy of more than one treatment, and psychological support.
Psoriatic Arthritis in Children
Psoriasis and psoriatic arthritis tend to be inherited, but an individual’s immune system and environmental factors also play a role in the onset of the disease. If one parent has psoriasis, a child has a 10 percent chance of having it as well. If both parents have the disease, a child’s chances increase to 50 percent.
The Arthritis Foundation estimates that nearly 300,000 American children have some type of pediatric arthritis, including PsA. Children tend to experience symptoms of both psoriasis and psoriatic arthritis concurrently, and arthritis may even precede psoriasis symptoms in as many as half the children who have PsA.
The NPF offers a site called Our Spot that is just for children and youth with the disease. Patients can sign up for a welcome kit and read stories of other young people living with psoriasis and PsA, get tips on communicating about the disease, and watch educational webcasts.
Because psoriatic arthritis is a progressive disease, getting help early is imperative to help fight its progression and reduce the risk of developing related health conditions, including heart disease.
Diet and Psoriatic Disease
According to NPF, although no diet is scientifically proven to be effective against psoriatic disease, many people find relief when eating an anti-inflammatory, or Mediterranean, diet. This diet is low in processed foods, dairy products, and other substances that can cause inflammation in the body.
Foods that have been associated with promoting inflammation in the body and are not recommended for people with psoriasis include:
- Fatty red meats: Opt for leaner proteins, such as chicken, fish, tofu, and beans, and lean cuts of red meat.
- Processed foods: Avoid microwavable dinners, packaged deli meats, high-sodium canned goods, and chips, sweets, and other snacks that often contain high levels of trans fats, sodium, and sugar.
- Dairy products: Cow-based dairy products can worsen psoriatic disease symptoms in some people. Alternatives include coconut, oat, almond, and soy milks.
- Gluten: Around 25 percent of people with psoriasis have a known sensitivity to gluten, which is prevalent in wheat-, barley-, and rye-based products. Look for gluten-free options.
Foods that are recommended:
- Coldwater fish, like albacore tuna, salmon, herring, and lake trout, are low in saturated fat and a great source of omega-3 fatty acids that reduce heart disease and metabolic syndrome.
- Flaxseeds, olive oil, pumpkin seeds, and nuts also contain omega-3s.
- Colorful fresh fruits and vegetables, such as carrots, spinach, kale, broccoli, blueberries, strawberries, and figs, can lower blood pressure, reduce the risk of heart disease, and not interfere with blood sugar levels.
Seeking Help and Information
Unfortunately, there are fewer resources for people living with PsA than there are for those living with more prominent autoimmune diseases, such as rheumatoid arthritis. A lack of research into the disease and a misunderstanding of PsA symptoms among patients as well as health-care providers have led to the following:
- PsA being misdiagnosed or a patient receiving a delayed diagnosis
- symptoms not being treated effectively
- misinformation being given to patients on managing the disease
- lack of understanding of how the disease impacts those diagnosed
In a way to advocate for people with psoriatic disease, NPF offers what it calls the Patient Navigation Center to provide free and personalized assistance to patients, family members, and caregivers. People contacting the center will be connected to a representative called a patient navigator, who will answer questions, handle concerns, and help people find a rheumatologist in their area.
The center, which offers assistance in Spanish as well as English, can be reached by calling 800-723-9166, texting 503-410-7766, emailing to firstname.lastname@example.org, or chatting online. Information is also available by clicking on Ask a Question on the site. A representative will email back with an answer.
People seeking information on treatment options and PsA symptoms can request a free PsA e-kit from NPF. For those wondering if they have the disease, NPF offers a quick five-question quiz to see if their symptoms align with those of PsA.
Anyone in San Diego County wishing to become involved in psoriatic disease fundraising, advocacy, events, or volunteering can contact the Southwest region of the NPF.
Sources: Arthritis Foundation, Psoriatic Arthritis, https://www.arthritis.org/diseases/psoriatic-arthritis; Mayo Clinic, Psoriasis, https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840; National Institutes of Health, Itchy, Scaly Skin? Living with Psoriasis, https://newsinhealth.nih.gov/2010/08/itchy-scaly-skin; National Psoriasis Foundation, About Psoriatic Arthritis, https://www.psoriasis.org/about-psoriatic-arthritis; NPF, Anti-Inflammatory Diet, https://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/diet-and-nutrition/anti-inflammatory-diet; NPF, Do Gluten-Free Diets Improve Psoriasis? https://www.psoriasis.org/advance/do-gluten-free-diets-improve-psoriasis; NPF in Your Area—Southwest Region, https://www.psoriasis.org/in-your-area/southwest; NPF, Our Spot, https://www.psoriasis.org/our-spot; NPF, Patient Navigation Center, https://www.psoriasis.org/navigationcenter?utm_source=advance&utm_medium=article
Images: National Institutes of Health, https://newsinhealth.nih.gov/2010/08/itchy-scaly-skin; National Psoriasis Foundation, https://www.psoriasis.org/