Five Forms of Psoriasis

4 out of 5 people have Psoriasis

Psoriasis is an inflammatory skin disease in which skin cells replicate at an extremely rapid rate. New skin cells are produced about eight times faster than normal--over several days instead of a month--but the rate at which old cells slough off is unchanged. This causes cells to build up on the skin's surface, forming thick patches, or plaques, of red sores (lesions) covered with flaky, silvery-white dead skin cells (scales).

Rarely life-threatening, at its mildest, psoriasis can be itchy and sore. At its worst, it's painful, disfiguring, and debilitating. About two-thirds of the people with psoriasis have a mild form of the disease, says the NPF. About one-third have moderate or severe psoriasis. Psoriasis can affect people at any age, but it most often strikes those between the ages of 15 and 35.

There are five forms of psoriasis. Plaque psoriasis is the most common--affecting 4 out of 5 people who have psoriasis, says the NPF. Plaque psoriasis may start with small red bumps and progress to larger lesions.

The plaques of psoriasis occur most frequently on the elbows, knees, other parts of the legs, scalp, back, face, palms, and soles of the feet. Psoriasis can also affect the fingernails and toenails, causing pitting, discoloration, or tissue buildup around the nails. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, about 15 percent of people with psoriasis also get psoriatic arthritis, which can be progressively disabling if untreated.

Wayward White Blood Cells

Scientists believe that certain white blood cells called T lymphocytes (T cells) play an important role in psoriasis. "And the disease has a genetic component," says Lindstrom. In about one-third of psoriasis cases, there is a family history of the disease.

T cells circulate throughout the body, orchestrating the immune system's response to foreign invaders like bacteria or viruses. In people with psoriasis, the defective T cells are overactive and migrate to the skin as if to heal a wound or ward off an infection. This process leads to the rapid growth of skin cells, triggering inflammation and the development of lesions.

Both the environment and genetics may play a role in the development of psoriasis. "In genetically predisposed children, psoriasis can be triggered by a strep or other infection," says Lindstrom. That's what happened to author John Updike. After an attack of measles at the age of 6, Updike developed psoriasis "in all its flaming scabbiness from head to toe," as he later described it in his memoir, Self-Consciousness.

Remission and Reactivation

While the disease never goes away, the symptoms of psoriasis subside for a while (remission) and then return (flare-up, or reactivation). Remission can last for years in some people; in others, flare-ups occur every few weeks. Certain triggers, such as stress and seasonal changes, can reactivate psoriasis. "Certain drugs may also exacerbate it," says Lindstrom, including lithium, prescribed for bipolar disorder (also called manic-depressive illness), beta-blockers used to treat high blood pressure, and antimalarial drugs.

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