Plaque Psoriasis
Understanding Plaque Psoriasis
Plaque psoriasis (psoriasis vulgaris) is a long-lasting, chronic immune-mediated skin disease characterized by inflammation and caused by the immune system malfunctioning. In plaques psoriasis, the immune system is overactive and speeds up skin cell growth, causing thick, scaly patches (plaques) to develop.
Symptoms of Plaque Psoriasis
Psoriasis plaques appear as raised, inflamed and scaly patches of skin that may also be itchy and painful. On Caucasian skin, plaques usually are raised, red patches covered with a silvery white buildup of dead skin cells or scale. On skin of color, the plaques may appear darker and thicker and more of a purple or grayish color or darker brown.
Plaques can appear anywhere on the body, but are most common on the scalp, knees, elbows, and torso. Plaques generally appear on the same areas of the body on the right and left side. Plaque psoriasis often accompanies nail psoriasis which may look like discoloration, pitting or separation of the nail from the nail bed.
Diagnosing Plaque Psoriasis
Dermatologists and most primary care professionals are able to diagnose classical psoriasis based on the appearance of the lesions and the tendency to form plaques. The location of the plaques on the elbows, knees and scalp are also a sign for diagnosis. Examination of the fingers and toes may show a resemblance to fungal infections. On occasion, an unusual looking lesion may need a biopsy for clinical evaluation. Blood tests are rarely helpful for diagnosis. Common triggers for plaque psoriasis include certain medications, infections, skin injury, stress, and tobacco or alcohol use.
Treating Plaque Psoriasis
There is not a cure for plaque psoriasis. Patients may have flare-ups and times where the plaques go away (remission). Treatment can provide symptom relief. Treatment of mild cases may include topical medications (creams, lotions, tars, shampoos containing corticosteroids, anthralin, and salicylic acid). Treatment of more severe or widespread cases may include phototherapy (light therapy), traditional oral medications and biologics. Traditional oral medications include acitretin/Soriatane®, cyclosporine/Neoral®, methotrexate, and nonsteroidal anti-inflammatory drugs. Biologics medications target only specific parts of the immune system and may be taken orally or by injection (under the skin/subcutaneously or into the blood stream/intravenously). Oral biologics include apremilast/Otezla®, tofacitinib/Xeljanz® and Xeljanz XR®. Injection biologics include infliximab (e.g., Inflectra®, Remicade®) administered intravenously, golimumab administered intravenously (Simponi Aria®) or subcutaneously (Simponi®) and ustekinumab (Stelara®) administered subcutaneously.
Resources:
- Psoriasis | Mayo Clinic
- Plaque Psoriasis: What It Is, Causes, On Scalp & Treatment | (clevelandclinic.org)
References:
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