Psoriasis Symptoms and Signs
Psoriasis symptoms usually appear on the skin, hair, and nail plates. They appear in the form of rashes and skin exfoliation. The disease is characterized by the alternating periods of exacerbations and relative stability, or remission. Since the disease is not caused by micro-organisms, it is neither infectious nor contagious. The statistics claims that about 4 percent of the population suffers from the disease. Psoriasis can occur in people of any age, but it usually affects young people aged 18-23. The incidence of the disease in men and in women is equal.
Why Does It Appear?
The first signs and symptoms of psoriasis appear as an abnormal response of the body to exogenous irritants. The epidermis in certain areas of the body rapidly dies off (instead of 28 days of normal cells lifecycle, it shortens to 3-5 days when the patient suffers from psoriasis).
Today, most experts tend to believe that psoriasis is a multifactorial hereditary disease. There are several theories about the origin of the disease. According to the first one, there are two types of psoriasis:
- the first one results from the immune system disorder; it affects the skin, is inherited, and appears at a young age;
- the second appears in patients of over 40 years old; it affects the joints and nails, it is not genetically determined and is not associated with the immune system disorder.
The supporters of the immune system theory claim that the disease may be provoked by a range of factors:
- infectious diseases;
- poor diet;
- cold climate;
- alcohol abuse.
According to this theory, psoriasis can affect internal parts of the body, joints, and other tissues. If the joints get involved, psoriatic arthritis develops affecting small joints of hands and legs. The following factors enhance the beginning signs of the disease:
- dry thin skin;
- constant contact with irritating agents: household cleaning products, alcohol solutions, cosmetics;
- excessive hygiene which leads to disruption of the natural skin protective barrier;
- smoking, drugs or alcohol use (they contribute to the deterioration of blood supply and nutrition of the skin);
- certain medications;
- fungal and bacterial infections;
- climatic change;
- spicy, sour foods and chocolate;
- allergic conditions;
Classification of the Disease
The early signs of psoriasis on skin and their effect on the body are determined by the particular kind of pathology. Today there are several classifications of the disease. One of the most common divides the disease into two types:
We can define the non-pustular (or simple) form as a stable chronic pathology. This group includes erythrodermic psoriasis. Its main symptom is affecting the major part of the skin.
Pustular psoriasis includes:
- annular pustular psoriasis;
- pustular psoriasis of the Barber type;
- von Zumbusch psoriasis;
- palmoplantar psoriasis.
These types make a separate category:
- medically induced form;
- seborrheic-like psoriasis;
- napkin psoriasis;
- inverse psoriasis (appears on the flexor surfaces).
Depending on the localization of the pathological process and the first manifestations of psoriasis, the disease is divided into:
- scalp psoriasis;
- facial psoriasis;
- psoriasis on elbows;
- psoriasis on hands;
- psoriasis on feet;
- psoriatic arthritis;
- nail psoriasis;
- plantar psoriasis;
- plaque psoriasis;
- guttate psoriasis;
- erythrodermic psoriasis.
Early Signs of Psoriasis
Psoriasis is a systemic pathology which, in addition to skin and nails, can affect the spine, the joints, tendons, immune, endocrine, and nervous systemі. It often damages liver, kidneys, and thyroid gland. The first signs and symptoms of psoriasis most often are:
- general weakness;
- chronic fatigue;
One of the early signs of psoriasis on skin is the appearance of rounded papules covered with psoriatic plaques of bright red or pink color. Their main peculiarity is symmetrical appearance on the scalp, the flexor surfaces of the back, less often on the genitals. The papules’ size at the early stages makes a few millimeters and can reach 10 cm in the future.
The upper layer of the papules is formed with scaly plaques (dead skin) which are easy to remove. Initially, the scales are formed in the central part of the plaque and gradually spread towards the edges. Sometimes a pink ring is formed around the elements and that is a growth area of the plaque and the spread of inflammation. The skin around remains unchanged.
When you remove the layer, a shiny surface of bright red color appears. It is formed by capillaries with thinned walls and covered on the top with a very thin film. The skin structure changes as a result of the incomplete maturation of keratinocytes cells.
The main symptom of scalp psoriasis is the appearance of psoriatic plaques that raise above the skin. They are abundantly covered with scales that resemble dandruff. The hair itself is not involved in the pathological process. From beneath the hair zone, the rash can spread on the smooth skin of the neck and behind the ears. This process is caused by the rapid division of keratinocytes in the affected area.
Psoriasis of Palms and Feet
This form of psoriasis provokes considerable thickening of the horny layer of the skin in these areas. The skin becomes rough and covered with cracks. The reason is intensive cell division (their reproduction rate is almost 8 times higher than normal) and the fact that they stay on the surface. At an early stage, the pustules with transparent content form on the skin. Later, the content of the pustules becomes white. Eventually, dark scars appear. In most cases, the signs of the disease appear both on feet and on palms but sometimes the plaques occur only in one area. When the process reaches the back of the hand, we are talking about a different form of psoriasis (it is no longer palmoplantar psoriasis).
Symptoms of Nail Psoriasis
What are the symptoms of nail psoriasis? This type of the disease is characterized by a variety of symptoms. There are basically two kinds of destruction of nail plates:
- thimble type (when the nail is covered with small pits that resemble the traces of needle sticks);
- onychomycosis type (the affected tissues resemble nail fungus: nails change color, thicken considerably and start to exfoliate. Through the nail plate one can see the psoriatic papule surrounded by a reddish rim which resembles an oil slick).
Plaque Psoriasis Symptoms
Chronic plaque psoriasis symptoms appear gradually, although sometimes the disease occurrence is acute. The first sign of plaque psoriasis is pink or red papular rash on the skin. These are dense nodules you can see above the skin surface; they are covered with grayish white scales. The rashes may be scanty and they are located for a long time on the same areas. This may be the skin of the large joints, scalp, etc.
Depending on the size of the affected area, the disease may be divided into three severity levels:
- mild (the rash affects up to 3 percent of the skin);
- moderate (up to 10 percent of the patient’s body are covered with rash);
- severe (more than 10 percent of the skin is affected by the disease).
Dependence of the Symptoms on the Disease Stage
The manifestations of psoriasis range depending on the season and stage of the disease. Many patients experience “winter” kind of the disease in which there are periods of exacerbation in late fall or in winter. Thanks to the UV intensity during warmer months the situation improves. “Summer” type is quite rare.
There are the following stages of the pathology:
- Progressive (new items appear regularly, the existing plaques actively grow, there is pink color zone around the plaques, they are itchy and exfoliating);
- Stationary (papules growth stops, no new lesions form, one can see small folds on the top layer of the skin around the plaques);
- Regressive (no exfoliating, plaques begin to disappear, instead of the plaques there are areas with increased pigmentation).
With psoriasis on face, the inflammations concentrate around the eyes, on the upper and lower eyelids, eyebrow area, and nasolabial folds. It can also affect the mucous membrane of the mouth (in approximately 3 percent of the patients). Sometimes psoriatic plaques cover the mucous membrane of the tongue, cheeks, and lips. In this case, individual papules raise slightly above the skin surface. When scraping the papules one can clearly see bright red color.
Psoriasis on Legs
With psoriasis on legs, the primary psoriatic elements create isolated inflamed papules with a precise contour that raise above the skin surface. Their surface is covered with silvery white scales, which are easily removed by scraping.
The surface of inflammatory cells is loose and plaques themselves are of a homogenous structure. The psoriatic triad is observed when scraping:
- Stearin stain which occurs as a result of the scaly crusts breaking.
- Terminal film (horny scales are taken off as a film).
- The phenomenon of blood dew (the pinpoint bleeding), resulting from damage to the capillaries in the elongated papillae.
Psoriasis in Children
Babies and elder children suffer from various types of psoriasis. Psoriasis in children is associated with the appearance of red homogeneous rash areas with silver-white patches. The first signs of psoriasis in children are associated with painful feelings and itching. The resulting scaly plaques that have appeared crack and cause minor bleeding in these areas. That can become a reason of the secondary infection development. Psoriasis in babies is manifested in the form of diaper rash or eczema. The treatment for adults and for children is prescribed on the basis of the form of the disease, the symptoms, and the patient’s sensitivity to medication.