Clinical Manifestations Of Nail Bed Psoriasis Include
Oil spot or salmon patch
They result from focal nail bed parakeratosis which leads to focal onycholysis, where serum and cellular debris accumulate and become entrapped. There is usually a yellowish brown margin visible between the white oily spot or salmon patch lesion and the normal pink nail. Extension of an oil spot to the distal free edge leads to onycholysis .
Onycholysis along with salmon patches on thumbnails in a patient with psoriasis
Results from psoriasis affecting the distal nail bed or hyponychium or extension of oil spots distally. Onycholysis allows air to enter the distal end of the nail plate leading to white color .6]. Serum exudates may accumulate and appear yellowish.
Onycholysis along with pitting and salmon patches in fingernails
It affects the toenails more frequently than the fingernails. It results from raising of the nail plate off the nail bed as a result of deposition of cells that have not undergone desquamation .b]. This accumulated tissue is friable and is liable to be infected by Candida and Pseudomonas leading to either yellow/green discoloration.
Nail plate thickening with discoloration and subungual hyperkeratosis of the toenail Subungual hyperkeratosis affecting toenails
What Else Should I Know
Making healthy choices can help with psoriasis. Here are some things you can do:
- If you smoke, quit. Smoking can trigger outbreaks of psoriasis in some people.
- Avoid alcohol. It can make psoriasis treatments less effective.
- Eat healthy foods. Eating a lot of fruits and vegetables can help fend off diseases that might trigger psoriasis.
- Stay at a healthy weight. This decreases the risk of inverse psoriasis.
- Keep skin clean and well moisturized. Bathing daily with bath salts or oils and then applying moisturizer can help ease the symptoms of psoriasis.
People who have psoriasis may feel self-conscious about how it looks. Thats one reason why some people turn to a therapist or join a support group of people who understand what they might be going through.
The key to psoriasis treatment is keeping up on whatever your doctor prescribes. If that means applying an ointment twice a day, then find a way to remind yourself to do it so you dont forget. Psoriasis is one of those things that you need to stay focused on treating, even when youre feeling OK.
Whether your psoriasis is mild or severe, learn all you can about it. Talk to your doctor or check websites like:
How Psoriasis Is Diagnosed
A GP can often diagnose psoriasis based on the appearance of your skin.
In rare cases, a small sample of skin called a biopsy will be sent to the laboratory for examination under a microscope.
You may be referred to a specialist in diagnosing and treating skin conditions if your doctor is uncertain about your diagnosis, or if your condition is severe.
If your doctor suspects you have psoriatic arthritis, which is sometimes a complication of psoriasis, you may be referred to a doctor who specialises in arthritis .
You may have blood tests to rule out other conditions, such as rheumatoid arthritis, and X-rays of the affected joints may be taken.
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Before Stopping Psoriasis Treatment Talk With Your Dermatologist
Because psoriasis is a lifelong disease, its understandable that you may want to stop treatment at some point. Alwaystalk with your dermatologist before you stop treatment.
Some treatments can be stopped immediately. Others need to be discontinued slowly to prevent psoriasis from worsening .
When psoriasis rebounds, it may become a more serious type of psoriasis. A person who had plaque psoriasis may suddenly have pustular psoriasis or erythrodermic psoriasis.
The best way to prevent a rebound is to talk with your dermatologist. Your dermatologist can tell you whether you can stop the treatment abruptly or slowly. Sometimes, the best approach is to gradually switch to another treatment.
Dealing With A Psoriasis Flare
If you have psoriasis, you may choose your wardrobe and even your activities based on how active your disease is. The inflamed, itchy, scaly plaques that cover your skin can make you feel self-conscious and affect the way that others react to you, too.
Our expert dermatologists at Specialists in Dermatology in Houston, and The Woodlands, Texas, offer cutting-edge, effective psoriasis therapies including topical and oral medications, and biologics to clear your skin quickly and beautifully. If you do have a flare-up, here are a few tips on how to stay comfortable until you can get treatment.
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How Often Does Psoriatic Arthritis Affect The Nails
Psoriasis limited to the nails is uncommon and estimated to occur in only 5-10% of people with psoriasis, although many people who first present with psoriasis only in their nails later develop psoriasis of the skin and/or joints. Nail psoriasis is more likely to occur in adults than children.1
Psoriasis of the skin, scalp and/or nails often occurs before the appearance of PsA, and psoriasis of the nails has been associated with a greater likelihood of developing PsA. Nail lesions occur in about 87% of people with PsA.2
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Seborrheic Dermatitis: Itchy Scaly Patches
A psoriasis skin rash tends to itch, burn, and feel sore. Patches of psoriasis commonly occur on your knees and elbows. Many people also have scalp psoriasis. The common skin rash seborrheic dermatitis also causes scaly, itchy skin patches. It can occur on your scalp, where it may be called dandruff, or on your face and chest. While doctors dont know the exact cause of seborrhea, it occurs across the age spectrum, in babies as well as in adults, and is usually treated with creams and lotions.
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Ways To Treat Psoriasis At Home
Even though it affects your skin, psoriasis actually begins deep inside your body in your immune system.
It comes from your T cells, a type of white blood cell. T cells are designed to protect the body from infection and disease. When these cells mistakenly become active and set off other immune responses, it can lead to psoriasis symptoms.
Even though theres no cure, many treatments exist to ease the symptoms of psoriasis. Here are 12 ways to manage mild symptoms at home.
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What Happens If You Stop Treating Psoriasis
If a person stops treating psoriasis, progression of the disease is possible, and the condition will worsen with time. Psoriasis inflammation can also progress, which increases your risk for complications that affect the rest of the body.
According to The American Journal of Managed Care , untreated moderate-to-severe psoriasis can develop into PsA. PsA can be painful and disabling, and AJMC reports people with psoriasis and PsA have a more significant disease burden .
Additional complications of untreated psoriasis the increased risk for:
- Cardiovascular disease: Including heart attack, stroke, heart valve problems, and heart failure
- Metabolic syndrome: A combination of different metabolic disorders, including insulin resistance, elevated blood sugar, high cholesterol, high blood pressure, and abdominal obesity
- Type 2 diabetes: Condition in which the body does not correctly regulate and use sugar as fuel
- Anxiety and depression
- Inflammatory bowel disease: Inflammation of the gastrointestinal tract, including ulcerative colitis and Crohn’s disease
- Kidney disease: Condition in which the kidneys cannot filter blood normally, resulting in fluid and waste staying in the body
- Some cancers: Including squamous cell carcinoma, lymphoma, and basal cell carcinoma
- Serious and life-threatening infections
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What Are The Signs And Symptoms Of Psoriasis
The main symptom of psoriasis is the development of raised plaques or patches of skin that are red, crusty, itchy and flaky. Plaques can develop on any part of the body and will vary in size from person to person and over time as well. Sometimes the thickened areas of skin can crack and bleed, particularly if they are scratched or over a flexible area such as a joint, which leaves the skin open to infection.
As well as affecting the skin, psoriasis can affect the finger and toe nails too, leaving them with an uneven pitted surface and growing thicker over time. Psoriasis can also affect the joints causing swelling and soreness this is referred to as psoriatic arthritis.
A Feeling That Never Goes Away
My psoriasis is currently suppressed due to an effective treatment, but those feelings of not feeling good enough and those fears of not being desirable due to my skin still erode my soul, as if I was currently 90 percent covered with plaques. Its a feeling that never goes away. It sticks with you forever, no matter how clear your skin may currently be.
Unfortunately, Ive conversed with many men and women living with psoriasis who feel the same way, never revealing to their partners how psoriasis truly affects their soul and well-being. Some hide their insecurities behind anger or avoidance. Some avoid sex, relationships, touch, and intimacy altogether, due to fears of rejection or inadequacy.
Some of us living with psoriasis feel seen, but for the wrong reasons. We feel seen for the imperfections of our skin. Societal standards of beauty and the misunderstandings associated with visible diseases like psoriasis can make you feel as though people see your condition before they actually see you.
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Cause & Risk Factors Of Inverse Psoriasis
Doctors arenât sure what causes psoriasis, but they know that your genes and your immune system play a major role. About 40% of people with psoriasis have at least one close relative with the disease. Many of the genes linked to psoriasis are those that help run your immune system.
In addition to your genes, these things can make you more likely to get psoriasis:
Skin irritation or any injury to the skin
Why Do I Have Guttate Psoriasis
Like other types of psoriasis, no one knows for sure what causes guttate psoriasis. That said, the prevailing theories point to various triggers that kick your immune system into high gear and cause it to overreact.
One of the main culprits is strep throat, a bacterial infection. It may also be triggered by tonsilitis or respiratory infections.
Some believe that guttate psoriasis can be brought on by high levels of stress, hormonal disorders, certain drugs , skin injuries, and even excess alcohol consumption.
Whatever the cause, its important to know that psoriasis isnt contagious. But keep in mind that if its accompanied by a viral or bacterial infection, those definitely are contagious.
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When Time Is Of The Essence
Casey Gallagher, MD, is board-certified in dermatology and works as a practicing dermatologist and clinical professor.
Speed is only one characteristic of a drug which may be of importancesafety, side effects, cost, and medical reasons why a certain drug cant be used are just a few of the many others. But when time is of the essence, a faster drug may be just what the doctor ordered. Imagine that youre a month away from a cruise and you want to relax by the pool, but feel uncomfortable due to a breakout of psoriasis. Thats just the type of situation when you want to get cleared up, fast. Here are a few medications with very rapid onset of action and clearing ability to consider.
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Is There A Cure For Psoriasis
Unfortunately, not at the moment. Much research is being done and in the last decade great strides have been made in understanding what goes wrong in psoriasis, so there is good cause for optimism. In the meantime there are a number of treatments that are effective in keeping the problem under control. The art of treating psoriasis is finding the best form of treatment for each individual. There is no single solution that is right for everyone.
What is the history of psoriasis?
Psoriasis has a fascinating story, from ancient times, through to the modern scientific breakthroughs. Read more.
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Will My Psoriasis Ever Go Away
For the majority of people, psoriasis doesnt go away on its own. Its caused by a combination of genetics and the environment.
In genetically predisposed people, an environmental factor acts as a trigger to unmask psoriasis. In rare cases, behavioral modification like weight loss or smoking cessation may be associated with improvements or complete clearing.
If your psoriasis is caused by a medication, then stopping that medication may improve your psoriasis. Certain high blood pressure and depression medications are strongly associated with triggering psoriasis. Speak to your doctor about any medications youre taking and whether they may contributing to your psoriasis.
Joshua Zeichner, MD, is the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. He actively lectures to international audiences and is involved in daily teaching to residents and medical students. His expert opinion is commonly called on by the media, and hes regularly quoted in national newspapers and magazines, such as The New York Times, Allure, Womens Health, Cosmopolitan, Marie Claire, and more. Dr. Zeichner has been consistently voted by his peers to the Castle Connolly list of New York Citys best doctors.
Lifestyle Changes And Home Remedies
The most important lifestyle change that people with psoriasis can make is to avoid triggers, which might include cold weather, stress, or smoking.
People may also wish to try the following home remedies. While they will not cure psoriasis, they may reduce itching, dryness, and other types of discomfort:
- applying aloe vera gel to reduce redness and itching
- avoiding alcohol and tobacco
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Psoriasis Doesn’t Have To Be A Life
Peter Amento avoided shorts and short sleeves for most of his life, no matter how warm the weather. When he did wear them, People would comment: What have you got? Poison ivy? Thats how bad my psoriasis would look, says the 61-year-old husband and father of three from Hamden.
Weve worked together to find the best treatment for his condition. Its a great partnership.Keith Choate, MD, PhD
The skin disorder appeared when Amento was 15, and over the years he tried everything to make it go away. I started with sunlamps, which was the way to go back then, he says. It didnt do much. He moved on to ointments, slathering them on the red patches on his arms, legs and torso, then covering the areas with plastic wrap to help the medication seep in. Theyd go away for a couple of weeks, then youd have to repeat the whole process.
Later, he would fly to Florida and sunbathe on the beach until his skin was crisp. The sunburn killed me for a couple of days, but it got rid of the psoriasis for a month, he says.
Amento assumed he would struggle with the condition for the rest of his life. Then his local dermatologist referred him to Yale Medicine, where physicians had a new approach.
How Is Psoriasis Diagnosed And Treated
Psoriasis often has a typical appearance that a primary care doctor can recognize, but it can be confused with other skin diseases , so a dermatologist is often the best doctor to diagnose it. The treatment of psoriasis usually depends on how much skin is affected, how bad the disease is , or the location . Treatments range from creams and ointments applied to the affected areas to ultraviolet light therapy to drugs . Many people who have psoriasis also have serious health conditions such as diabetes, heart disease, and depression. Some people with psoriasis also have an inflammatory condition which affects their joints, called psoriatic arthritis.
Psoriatic arthritis has many of the same symptoms as other types of arthritis, so a rheumatologist is often the best doctor to diagnose it. The treatment of psoriatic arthritis usually involves the use of drugs .
Psoriatic disease may be treated with drugs or a combination of drugs and creams or ointments.
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Is Your Stomach to Blame?
Who would have thought that a severe psoriasis outbreak could start because of something going wrong inside of your stomach and intestines? Yet, new research developed by psoriasis expert Edgard Cayce shows a distinct link between a leaky gut and a scaly psoriatic episode. According to Cayce, the primary source of psoriasis can be found in the intestinal tract, where toxins are leached into the body. This causes the immune system to react by thickening the skin. At the same time, the skin tries to purge the toxins through its layers, which can cause scabs and sores to form.
Could Arthritis Be the Cuplrit?
The intestines arent the only link to psoriasis found by researchers arthritis seems to also contribute to it. As many as one-third of all psoriasis patients eventually develop some form of psoriatic arthritis. Unlike normal forms of arthritis, those with psoriatic arthritis do not exhibit a rheumatoid factor when their blood is tested. This indicates that the arthritic condition comes solely from either the psoriasis itself or the underlying cause of the skin affliction.
Could a Virus Be the Cause?
Arthritis has been linked to certain virus and so have other auto-immune disorders. This leads some researchers to think that psoriasis too may start with a virus, which is what kicks the immune system into overdrive.
The Link Between Psoriasis And The Immune System
No one ever really considered that the immune system had any real role in psoriasis, or its painful outbreaks. Not until a new drug Cyclosporine was offered to arthritis patients. What happened next was both surprising and unexpected. Patients who were prescribed the immune suppressing drug for their arthritis symptoms , began to report a decrease in their skin attacks. Without warning, researchers were faced with the theory that the immune system could be causing psoriasis.
It didnt take long before researchers began to figure out the mystery of psoriasis in regards to how the immune system can impact it.
The Role of the Immune System on the Skin
The immune system is responsible for standing guard and attacking any invaders which penetrate the body. Since the skins main job is to act as the bodys first defense mechanism against invasion, it is no wonder that the immune system works in close connection with each layer of the skin. Heres how it all works:
1. Immune cells patrol the entire body for dangers. No Carb Makes Psoriasis Go Away
2. When an invader is detected, these immune send out chemical and nervous system messages to the immune system to ready itself for an attack
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