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In this section you can find out more information regarding Plaque Psoriasis (PsO)

Psoriasis is a common, chronic condition that causes flakey, scaly patches on the skin. Plaque psoriasis is the most common form of psoriasis. On brown, black and white skin the patches can look pink or red, and the scales white or silvery. On brown and black skin, the patches can also look purple or dark brown, and the scales may look grey.

It can occur on any part of the body, but most commonly on the knees, elbows, central part of the body (trunk/torso) and scalp.

Psoriasis affects around 2 in 100 people in the UK. It can start at any age, but most often develops in adults between 20 and 30 years old and between 50 and 60 years old. It affects men and women equally.

There are several types of psoriasis, each of which varies in its signs and symptoms.

What is Plaque Psoriasis (PsO)? 1

What is Plaque Psoriasis (PsO)? 2

References
1. Mayo Clinic. Psoriasis. Available at https://www.mayoclinic.org/diseasesconditions/psoriasis/symptoms-causes/syc-20355840 Accessed October 2022
2. National Psoriasis Foundation. About Psoriasis. Available at https://www.psoriasis.org/about-psoriasis Accessed October 2022
3. NHS. Psoriasis - Overview. Available at https://www.nhs.uk/conditions/psoriasis/ Accessed October 2022

Causes

Psoriasis occurs when skin cells are replaced more quickly than usual - the exact cause is unknown. Research suggests it's caused by a problem with the immune system.

New skin cells are produced in the deepest layer of skin which gradually move up through the layers of skin until they reach the outermost level, where they die and flake off. This whole process normally takes around 3 to 4 weeks. In people with psoriasis, this process only takes about 3 to 7 days. As a result, cells that are not fully mature build up rapidly on the surface of the skin, causing flaky, crusty patches covered with scales.

Psoriasis is not contagious - it cannot be spread by person-to-person contact.

Risk Factors

Factors that may increase the risk and symptoms of PsO include:

Genetics

PsO runs in families.

Smoking

Increases the risk of PsO but also may increase the severity of the disease.

Immune system problems

T-cells which are used to fight infection attack healthy skin cells by mistake.

Triggers

  • Injury to the skin to skin – e.g. a cut, scrape, insect bite or sunburn – this is called the Koebner response
  • Drinking excessive amounts of alcohol
  • Stress
  • Hormonal changes, particularly in women e.g. menopause
  • Medication – lithium, some antimalarial medicines, anti-inflammatory medicines including ibuprofen, and ACE inhibitors (used to treat high blood pressure)
  • Throat infections – guttate psoriasis develops after a streptococcal throat infection

References
1. NHS. Psoriasis - Causes. Available at https://www.nhs.uk/conditions/psoriasis/causes/ Accessed October 2022
2. Mayo Clinic. Plaque Psoriasis. Available at https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840 Accessed October 2022

PsO causes dry, itchy, raised skin patches (plaques) covered with scales. There may be few or many on the body.

They usually appear on the elbows, knees, lower back and scalp. The patches vary in colour, depending on skin colour. The affected skin might heal with temporary changes in colour (post inflammatory hyperpigmentation), particularly on brown or black skin.

The plaques can be itchy or sore, or both. In severe cases, the skin around the joints may crack and bleed.

References
1. NHS. Psoriasis - Symptoms. Available at https://www.nhs.uk/conditions/psoriasis/symptoms Accessed October 2022
2. Mayo Clinic. Plaque Psoriasis. Available at https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/syc-20355840 Accessed October 2022

A GP can often diagnose psoriasis based on the appearance of the skin.

A referral to a specialist in diagnosing and treating skin conditions (dermatologist) may be made if the condition is severe.

In rare cases, a small sample of skin called a biopsy will be sent to the laboratory for examination under a microscope.

Psoriatic arthritis is a complication of psoriasis, if this is suspected a referral may be made to a specialist in arthritis (rheumatologist). Read more about psoriatic arthritis.

Blood tests may be taken to rule out other conditions like rheumatoid arthritis. Read more about rheumatoid arthritis.

References
1. NHS. Psoriasis - Diagnosis. Available at https://www.nhs.uk/conditions/psoriasis/diagnosis Accessed October 2022
2. Mayo Clinic. Plaque Psoriasis. Available at https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845 Accessed October 2022

There are a variety of treatments available for PsO. There is no cure, but treatments can can improve symptoms and the appearance of skin patches.

There are three main ways to treat PsO:

  1. Topical – creams and ointments applied to the skin
  2. Phototherapy – skin is exposed to certain types of ultraviolet (UV) light
  3. Systemic – oral and injected medications that work throughout the entire body

Often the different types of treatment are used in combination.

Topical

  • Usually the first treatments for mild to moderate psoriasis
  • Creams and ointments include emollients, steroid creams, vitamin D analogue creams, calcineurin inhibitors, coal tar and dithranol

Phototherapy

  • Uses natural and artificial light – these include ultraviolet B (UVB) phototherapy, psoralen plus ultraviolet A (PUVA) and combination light therapy

Systemic

In moderate to severe cases of PsO, there are two main groups of medications that are used:

  1. Non-biological medications – including methotrexate (decreases the production of skin cells and suppresses inflammation), ciclosporin (suppresses the immune system) and acitretin (reduces the production of skin cells).
  2. Biological treatments – reduce inflammation by targeting specific components of an overactive immune system.

References
1. NHS. Psoriasis - Treatment. Available at https://www.nhs.uk/conditions/psoriasis/treatment Accessed October 2022
2. Mayo Clinic. Plaque Psoriasis. Available at https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845 Accessed October 2022

Lifestyle changes can help with managing PsO and include:

Diet and exercise – eating a healthy, well balanced diet and exercising regularly can also relieve stress, which may improve the symptoms of PsO.

Triggers – infections, injuries to the skin, smoking and intense sun expose can all worsen PsO.

Skin health – daily baths, gentle washing, application of moisturisers, controlling sunlight and avoiding scratching can all help controlling the condition.

Mental health – the physical appearance of PsO can have an effect on mental health – healthcare professionals understand the emotional impact of the condition and will listen to anxieties and concerns.

References
1. NHS. Psoriasis – Living With Psoriasis. Available at https://www.nhs.uk/conditions/psoriasis/living-with/ Accessed October 2022
2. Mayo Clinic. Plaque Psoriasis. Available at https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845 Accessed October 2022

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