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Plaque psoriasisPublished by Bupa's health information team, August 2008. This factsheet is for people who have plaque psoriasis, or who would like information about it. Psoriasis is a common skin condition causing patches of inflamed skin. Plaque psoriasis is the most common type of psoriasis. It is characterised by pinkish-red scaly plaques (patches), especially on areas such as your knees and elbows.
About plaque psoriasisIn psoriasis, the rate at which your skin is replaced is rapidly increased. Your skin is constantly shedding old cells and being replaced with new ones from underneath, in a cycle that usually takes about 28 days. In psoriasis, this process speeds up, only taking about three to four days. New skin cells move rapidly to the surface before they have properly matured, and accumulate on the surface of the skin, forming thick patches called plaques. There is also a build-up of a type of white blood cell (called T-cells) under the skin, which causes inflammation. Plaque psoriasis is a chronic condition. A chronic illness is one that lasts a long time, sometimes for the rest of the affected person's life. Although most people who get plaque psoriasis will have the condition for the rest of their life, about 80 percent will get remissions (periods when the symptoms decrease). Symptoms of plaque psoriasisThe plaques in plaque psoriasis are usually pinkish-red and disc shaped, with well-defined clear edges. They will be covered with silvery white scales. They may be itchy, and sometimes, may bleed. The plaques are not contagious. Plaque psoriasis can affect any area of your body, but it is most common to get plaques on your:
You may also notice changes in your nails, such as:
If you think you have any of these symptoms, you should see your GP. Complications of plaque psoriasisUp to 10 percent of people with psoriasis also develop associated arthritis (inflamed joints). This is called psoriatic arthritis. Usually the joints at the end of the fingers and toes are affected, although the back, knees and hips may be affected too. For more information on psoriatic arthritis, please see related topics. Anyone with psoriasis is potentially at risk of developing a more severe form of the condition, such as pustular or erythrodermic psoriasis (see related topics), although this is rare. Your psoriasis can also become unstable. This means that you start to develop new plaques and your plaques become bigger, losing their clear-cut edges and sometimes even joining up. In unstable psoriasis, the creams and ointments that you usually use to treat your plaques may start to make your psoriasis even worse. However, it is important that you seek the advice of your doctor before changing your treatment. Causes of plaque psoriasisIt is thought that substances produced by your immune system cause your skin to start producing new cells faster in psoriasis, as well as causing the build-up of T-cells. But what makes the immune system act like this isn't clear. You are more likely to get psoriasis if you have a family history of the condition. If one of your parents has psoriasis, you have a one in four chance of getting it. In many people, however, there is no obvious cause. If you have psoriasis, certain factors can cause new lesions to develop. These include:
Diagnosis of plaque psoriasisYour GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Usually, your GP will be able to tell whether you have psoriasis just by looking at the areas of affected skin. He or she will assess the extent of your psoriasis and how severe it is. If your psoriasis is extensive or severe, if it's affecting your education or work, or if your diagnosis is uncertain, your GP may refer you to a dermatologist (a doctor specialising in conditions affecting the skin). Treatment of plaque psoriasisThere is no cure for psoriasis, but a lot can be done to help control your symptoms. Your GP will discuss your treatment options with you. It is possible that you may decide you don't need any treatment at all for your psoriasis. Self-helpCutting down on alcohol and smoking may help to reduce your symptoms. Your GP will probably advise you to use emollients. He or she will usually prescribe these, but you can also buy these products from a shop without a prescription. They are very effective at keeping your skin moist, softening scaling and reducing irritation. It's worth discussing the choice of treatment with your doctor so that you can get the best results. Topical therapiesYour GP can also prescribe a medicated topical preparation (a treatment that is applied directly to your skin, such as a cream or ointment). These are usually the first type of treatment tried. Topical treatments for plaque psoriasis include creams and ointments containing:
Light therapyLight therapy can only be given by a dermatologist in a hospital. Your dermatologist may recommend light therapy if the above treatments haven't worked. Light therapy includes the following.
Oral medicinesYour dermatologist may prescribe you one of the following medicines if topical treatments and light therapy haven't controlled your symptoms; your psoriasis is extensive; or if you have psoriatic arthritis:
You take these medicines by mouth, and they work by suppressing your immune system, or by slowing down the production of skin cells. If you are a woman, you will be warned not to become pregnant while taking these medicines or for some time afterwards. Men may also be advised they shouldn't get their partner pregnant for some time after taking some of the medicines. This is because they can cause serious damage to an unborn baby. Biological agentsBiological agents are newer treatments for psoriasis that can be very effective, but tend to be restricted to people with severe psoriasis. They are given as an injection into your skin, or through a drip into a vein in your arm. Your dermatologist can discuss these treatments with you. You will need to have various pre-treatment tests before you can try these medicines, and will be monitored with blood tests while you are receiving the treatment. Further information
Related topicsSources
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Mike Ardern-Jones, BSc, MBBS, MRCP, DPhil, Consultant Dermatologist, Southampton University NHS Trust and Spire Southampton Hospital, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: August 2008.
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