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Plaque Psoriasis: Diagnosis, Symptoms, and Treatment

Posted on February 25, 2021
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Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Joan Grossman

  • Plaque psoriasis affects around 90 percent of people with psoriasis.
  • Most people are diagnosed between the ages of 20 and 30 or between 50 and 60.
  • The thick, scaly lesions of plaque psoriasis are caused by the overproduction of skin cells.
  • Treatment includes phototherapy and topical, oral, and injected medications.

Plaque psoriasis is the most common type of psoriasis and affects between 80 percent and 90 percent of people with psoriasis. People with plaque psoriasis may also have another form of psoriasis, such as guttate psoriasis, inverse psoriasis, pustular psoriasis, or erythrodermic psoriasis. Plaque psoriasis may also be associated with psoriatic arthritis.

Plaque psoriasis is a skin condition characterized by thick, red or purple lesions with silvery scales on the skin and scalp. Lesions are formed from an abnormal buildup of skin cells.

Plaque psoriasis is the skin manifestation of a chronic autoimmune condition caused by a dysfunction in the immune system. People with plaque psoriasis have an overactive immune system that causes an inflammatory reaction with T cells, causing skin cells to proliferate at an abnormally high rate.

Plaque psoriasis can have a severe impact on quality of life, but it is not life-threatening. People with plaque psoriasis tend to have higher rates of cardiovascular disease, diabetes, and inflammatory bowel disease, among other comorbidities, which can cause complications that may decrease longevity.

Diagnosing Plaque Psoriasis

The onset of plaque psoriasis can occur at any age, but it commonly first appears between the ages of 20 and 30, or between the ages of 50 and 60. People who present with plaque psoriasis in the earlier onset group tend to have a greater family history of psoriasis and are prone to develop more severe disease.

Plaque psoriasis is typically diagnosed by a clinical evaluation based on a physical examination of skin, nails, and scalp, and a discussion about overall health and medical history. A primary care doctor or dermatologist can diagnose psoriasis. A skin biopsy may be performed, but is usually not needed.

Sometimes a punch biopsy is performed to rule out another condition when lesions are unusual in their appearance. A punch biopsy uses a circular blade, usually 3 millimeters in diameter, that is rotated into the skin as far as the layer of fat just under the skin. The procedure is performed under local anesthesia and requires suturing to close the wound.

Symptoms of Plaque Psoriasis

Plaque psoriasis lesions — or plaques — usually appear as raised patches of skin that become scaly and inflamed. In severe cases, they can sometimes cover large areas of skin. Plaques can appear as red patches on light-skinned people. On people with darker skin, plaques may be thicker and appear purplish or brown. Plaques can occur anywhere on the body, but are more commonly found on knees, elbows, scalp, torso, buttocks, and lower back.

Plaque scales consist of dead skin cells that often turn white, silvery, or gray. The scales frequently flake off. Healthy skin sheds dead skin cells gradually, approximately every 28 days. But for people with plaque psoriasis, dead skin cells adhere to the surface of the skin and quickly become scaly. They can shed every day when the disease is flaring or active. When scales are shedding, they flake off in patches. Talk to your doctor about safe techniques for carefully removing scales.

Plaque psoriasis can be itchy and painful. Other symptoms commonly reported include burning, stinging, cracking, or bleeding skin due to scratching or other forms of irritation, such as clothing rubbing against skin.

Psychological symptoms are also commonly experienced by people with plaque psoriasis. Stress, anxiety, and depression are associated with psoriasis, due to the discomfort of living with the condition. There are also indications that psychological symptoms may be caused by inflammation from the disease itself. Psychological distress is also known to exacerbate the condition and lead to flare-ups.

Treatments for Plaque Psoriasis

Plaque psoriasis treatment is aimed at slowing the overproduction of skin cells. Treatment options include:

  • Topical therapies like creams, ointments, and lotions
  • Phototherapy, also called light therapy
  • Medication taken orally or by injection

Topical Treatments

A range of topical therapies for skin care, such as creams, ointments, lotions, and gels, are often used first to treat plaque psoriasis. Topical treatments include:

  • Topical corticosteroids, which help control inflammatory responses
  • Nonsteroidal topicals with ingredients like vitamin A and synthetic vitamin D
  • Over-the-counter (OTC) topicals, including shampoos and moisturizers with ingredients like coal tar and salicylic acid

OTC products that can be bought without a prescription should be discussed with your dermatologist, in order to avoid ingredients that can irritate plaque psoriasis and risk making it worse. Some topical treatments increase the risk for sunburn.

The National Psoriasis Foundation has a Seal of Recognition and product directory for OTC topicals considered safe for plaque psoriasis.

Phototherapy

Phototherapy, or ultraviolet light therapy, is used when topical treatments are not effective. Phototherapy for the treatment of psoriasis typically uses ultraviolet B (UVB) light or lasers. Light therapy has been shown to decrease itch, slow the production of skin cells, suppress the immune system, and reduce inflammation.

Ultraviolet A (UVA) light is only effective when used with psoralens, plant-based medicines that cause light sensitivity. This procedure is called PUVA, and it can help clear symptoms. Tanning beds are not considered safe for psoriasis and can increase the risk for skin cancer.

Phototherapy is often administered in a clinical setting. Your doctor may also prescribe home phototherapy using a light box or hand-held device.

Medication

A range of medications are used as systemic therapy in the treatment of moderate or severe psoriasis. Medications can have a range of side effects, which should be discussed with your doctor if treatment with medication is warranted. Commonly used medications that are taken orally or by injection include:

  • Soriatane (acitretin) — A synthetic retinoid derived from vitamin A, which should not be taken if pregnant or if one is of childbearing age
  • Methotrexate — A medication that inhibits an enzyme associated with inflammation
  • Cyclosporine — An inhibitor of a protein that activates T cells in the immune system
  • Biologics — A type of medication administered by injection or infusion, including Remicade (infliximab), Humira (adalimumab), and Tremfya (guselkumab)

Certain medications, such as beta-blockers or lithium, may exacerbate psoriasis. Discuss all medications you’re taking for any condition with your doctor or dermatologist.

Lifestyle Interventions

Various lifestyle changes can also be beneficial for people with plaque psoriasis to reduce the risk of flares and other health complications. Healthy lifestyle recommendations for people with plaque psoriasis include:

  • Stopping smoking
  • Lowering or stopping alcohol consumption
  • Maintaining a healthy diet and weight to prevent obesity
  • Getting regular exercise

Your health care provider can help support your lifestyle changes and provide referrals for nutritionists, physical therapists, or mental health counselors that may be covered by insurance.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 88,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with plaque psoriasis? How do you manage your symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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