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Psoriasis: Forms and Complications | 1 of 3 Appearance of Severe Dandruff Clinical Types of psoriasis although rarely the face. There are many different types of psoriasis. Most Sometimes plaque psoriasis patches can be patients have just one, but it is possible to have itchy and sore, and in severe cases skin around Module 1832 two different types occurring together, or for one the joints may crack and bleed. How much of the type to change into another. body is affected varies from person to person – some will have a few patches, while others will Psoriasis: forms and Plaque psoriasis have large plaques several centimetres wide. In This is the most common type of psoriasis and addition, sometimes small plaques can merge accounts for about 80% of cases. Most patients together to form larger ones. complications will have patches or plaques of rough, pink or red From this module, you will learn: skin, with silvery scales. Guttate psoriasis There is normally a sharp, well-defined border In guttate psoriasis small, drop-shaped plaques, • What psoriasis is and what causes it between the plaques and normal skin. Patches less than 1cm in size, appear on the chest, arms, • The different types of psoriasis and how they can be triggered usually appear on the knees, elbows and lower legs and scalp. It is often triggered by infection – • Complications and risk factors associated with psoriasis back, but any area of the body can be affected, such as a streptococcal sore throat – and is more • Useful advice that pharmacists can give to patients about psoriasis FIONA PARAgpURI, PHARMACIST faster turnover than usual. Normally, the cells of the epidermis are continuously being replaced, a Psoriasis is a common inflammatory skin process which takes about three to four weeks. condition that has well-defined patches – known However, in psoriasis the process is sped up, as plaques – of red skin, often covered with so the cells are formed and shed in three or silvery scales. These plaques usually appear on four days. This leads to a build-up of immature the elbows, knees, scalp and lower back; but any cells on the surface of the skin, causing the part of the body may be affected. The severity characteristic red, flaky patches covered with of this chronic condition varies from person to silvery scales. person. Some may only have a few patches that There are also changes in the blood vessels come and go, while others will have large areas that supply the skin, as small blood vessels can of the body affected. dilate and increase in number. This causes the Psoriasis affects around 2% of people in the skin under the psoriasis patches to redden. UK, with men and women equally affected. People with psoriasis tend to have an increased Symptoms will normally occur before the age of number of skin cells involved in inflammation. 35, although it is rare in children. The causes of this increased skin cell turnover Patients usually have periods with no or and inflammatory response is not known. mild symptoms, followed by periods when the However, there is a genetic element, as 30% symptoms are more severe. The condition is not of people with psoriasis have a close relative infectious and does not become cancerous – two who is affected. Overreaction of the immune factors that patients may have worries about. system and environmental factors may also have However, psoriasis can have a major impact on a a role. patient’s quality of life. It is thought that smokers have an increased risk of developing psoriasis. This may be due What causes psoriasis? to the effect of the toxins in cigarette smoke In patients with psoriasis, the skin cells have a affecting the immune system. chemistanddruggist.co.uk/update-plus Module 1832 | Psoriasis: forms and complications | 1 of 3 appearance of severe dandruff. It may be • smoking can trigger psoriasis initially, but can intensely itchy, affect the whole of the scalp, and also worsen plaque psoriasis – in some cases – lead to hair loss. • drinking excessive alcohol • hormonal changes – some women find that Pustular psoriasis their psoriasis is worse during puberty and This causes pus-filled pustules (small fluid-filled menopause. In contrast, pregnant women may spots) to appear on the skin. The pus is formed have periods of improved symptoms, although of white blood cells and is not a sign of infection. their psoriasis may worsen during the months There are a range of different presentations of after giving birth pustular psoriasis, for example: • sunlight improves psoriasis symptoms for • palmoplantar pustular psoriasis occurs on most patients, but for some it can worsen the palms of the hands and the soles of the them – with severe sunburn acting as a trigger feet, and is the second most common type of • medicines such as lithium, antimalarial psoriasis drugs, non-steroidal anti-inflammatory drugs • generalised pustular psoriasis occurs on a (NSAIDs), angiotensin-converting-enzyme wide area of skin on the body (ACE) inhibitors, beta blockers and some • acropustulosis causes pustules to appear on antibiotics can cause psoriasis; a response the fingers and toes. may not be seen until many months after taking them common in children and teenagers. condition. The skin is red and warm to the touch, Nail psoriasis • other immune disorders, such as HIV, can Guttate psoriasis normally only lasts a few while the psoriasis plaques merge together so Half of patients with psoriasis also have nail cause psoriasis to flare up or to appear for the weeks, although it can persist in some people for little normal skin can be seen – meaning it affects psoriasis, which causes small indentations first time. three to four months. Once it has cleared up, it nearly all of the skin on the body. in the nails about the size of a pinhead. Nails may not return. However, in some cases it may Patients with this condition should already may become discoloured and, in severe cases, Complications and the impact of having evolve into chronic plaque psoriasis. The disease have been seen by their doctor. If they have not, separate from the nail bed or crumble. psoriasis may also recur if the person is a strep carrier they need to be urgently referred to hospital – an individual who has streptococcal bacteria – as the condition can cause excessive protein Triggers for psoriasis Body image issues permanently present in their respiratory system. and fluid loss, as well as affecting the body’s For most patients, psoriasis symptoms tend Having an unsightly rash over large parts of their thermoregulation. to come and go throughout their life, but the Inverse or flexural psoriasis frequency of the flare up of symptoms varies. This is a form of plaque psoriasis, but it tends to Scalp psoriasis Some individuals may go for long periods with only affect the skin folds or creases. The skin will Scalp psoriasis is a form of plaque psoriasis clear skin, while others will have frequent flare appear red and inflamed, but it will be smooth affecting the scalp. Around half of patients with ups. and have no scaling. It can affect the following plaque psoriasis on their body will also have However, there are a number of factors that areas: scalp psoriasis, but in some cases it can occur can trigger symptoms, or lead to a flare up of • armpits alone. psoriasis. For example: • groin Identifiable features of scalp psoriasis include • stress • between the buttocks red patches of skin covered with thick silvery • injury to the skin – such as cuts, scrapes, insect • under the breasts. white scales on the scalp – this may have the bites, sunburn or excessive scratching. This is Inverse psoriasis is known to be made known as the ‘Koebner response’ or ‘Koebner worse by friction and sweating, and may be phenomenon’ uncomfortable in hot weather. “Half of patients with psoriasis also • infection – in some people a streptococcal have nail psoriasis, which causes small throat infection can trigger guttate psoriasis, Erythrodermic psoriasis indentations in the nails about the size of with children and young adults the most likely Erythrodermic psoriasis is a rare form of the a pinhead.“ to be affected chemistanddruggist.co.uk/update-plus Module 1832 | Psoriasis: forms and complications | 2 of 3 bodies can lead to patients with psoriasis having Around 10-20% of people with plaque psoriasis How can pharmacists help? strategies. You can signpost patients to useful body image issues and feeling embarrassed in also develop psoriatic arthritis. This can affect You can advise patients to take care of their own sources of information, such as the Psoriasis and situations where their skin is exposed. any joint, but most commonly those of the wellbeing. Eating a healthy diet, maintaining Psoriatic Arthritis Alliance, which has produced They may avoid wearing certain clothes and fingers and toes. a healthy weight and carrying out the a CBT-based online programme available at not undertake activities such as swimming, This can lead to pain, swelling and stiffness recommended 150 minutes of moderate exercise tinyurl.com/CBTpsoriasis. exercise and sports. of the effected joints. Tendons – such as a week can all help to reduce some of the risk You can also advise patients that wearing For some people, personal relationships can those of the heel and elbow – can also be factors for cardiovascular disease that might be loose clothing may help with irritated and be affected, and patients may also suffer from affected. Patients with psoriatic arthritis often increased for some patients with psoriasis. inflamed skin during a flare up or treatment. anxiety or depression. have additional symptoms of tiredness and Exercise can help with stress, anxiety, Some patients find that their psoriasis improves The Psoriasis Association and the Mental fatigue.
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