What are the Different types of Psoriasis?

Psoriasis is a chronic immune mediated relapsing disease of skin and there are several different clinical types of psoriasis. Different types of psoriasis may show different clinical manifestations/symptoms. In general psoriasis is the types of psoriasis are non-pustular, pustular and other types of psoriasis.

Non-pustular psoriasis:

This is further subdivided into Psoriasis vulgaris (also known as chronic stationary psoriasis and plaque-like psoriasis) and erythrodermic psoriasis.

Psoriasis vulgaris:

This is the most common form of psoriasis, which accounts for up to 90% of individuals with psoriasis. In this form of psoriasis there plaque formation occurs, which appears as raised areas of inflamed skin, which have silver color scales.

Erythrodermic psoriasis:

This form of psoriasis causes widespread inflammation and exfoliation of the skin, which can cover large area of body surface. There may be itching, pain and swelling in the area of the skin where inflammation and exfoliation occurs. Sometimes erythrodermic psoriasis may occur due to exacerbation of Psoriasis vulgaris, especially upon abrupt withdrawal of systemic treatment. Rarely this form of psoriasis (erythrodermic psoriasis) can cause death, as there is disruption of temperature regulation of the body due to extreme inflammation and exfoliation of skin, which can not function normally.

Pustular psoriasis:

The skin in pustular psoriasis shows multiple raised bumps that are filled with noninfectious pus (known as pustules). The area surrounding the pustules is red and tender. This pustules commonly occurs hands and feet, but can be generalized and occur randomly at any part of the skin. There are several varieties of pustular psoriasis, such as generalized pustular psoriasis (also known as pustular psoriasis of von Zumbusch), palmoplantar pustulosis, annular pustular psoriasis, impetigo herpetiformis etc.

Other types of psoriasis:

There are several other types of less common psoriasis.

• Drug induced psoriasis.
• Napkin psoriasis.
• Inverse psoriasis: may occur in skin folds, such as genitals, inframammary folds (under the breasts), armpits, abdominal folds in obese individuals etc. This type of psoriasis may be infected by fungus and may get irritated by friction and sweating.
• Nail psoriasis: occurs in nails (finger nails and toe nails) and produce changes in the appearance of finger and toe nails such as discoloration of under the nail plate, pitting of the nails, thickening of the skin under the nail, and the loosening/crumbling of affected nails.
• Psoriatic arthritis: as the name suggest, it affect and cause inflammation of joints and connective tissues. Most commonly joints of the fingers and toes are affected and cause swelling of fingers. Sometimes hips, knees and spine may be involved. Approximately 10% of all psoriasis patients have joints and connective tissues involvement (psoriatic arthritis).
• Guttate psoriasis: the skin lesions (scales) are red or pink, teardrop-shaped and large in number and commonly occur in the trunk, but can also occur in the limbs and scalp.

Different Treatment Options For Psoriasis

Psoriasis is a chronic immune mediated skin disease. It is a fairly common skin disease and affects large number of people. The main pathology in psoriasis is speeding up of the growth cycle of skin cells and as a result skin turn over is increased (i.e. normal skin turn over time of approximately 28 days become less than that) and there is also plaque formation occurs.

There are various treatment options available for treatment of psoriasis. If a disease does not have specific and effective treatment, number of different treatment options is generally available for that particular disease and unfortunately none of the treatment options can cure the disease and none of these generally give high satisfaction. The same is true in case of psoriasis too, as it is a chronic disease without any cure; hence there are several treatment options available. Some of the treatment modalities can be helpful and can improve quality of life.

The options available for treatment of psoriasis include use of topical agents, use of systemic agents, phototherapy, use of alternative therapy etc.

Topical agents for treatment of psoriasis:

Several different topical agents are available for treatment of psoriasis, such as petroleum jelly, coal tar, moisturizers, mineral oil, dithranol, salicylic acid, corticosteroids, vitamin D etc. Different preparations act in a different way, for example petroleum jelly, moisturizers etc. act by soothing effect on skin and reduce the dryness. Medicated creams and ointments (containing corticosteroids, dithranol etc.) applied directly to psoriatic plaques reduce inflammation, remove built-up scale, reduce skin turn over, and clear affected skin of plaques.

Phototherapy in treatment of psoriasis:

Wavelengths of 311–313 nm are most effective and special lamps are available which produce this wavelength. PUVA (psoralens and ultraviolet A) phototherapy combines psoralens (oral or topical) and ultraviolet A. But long term phototherapy may cause skin cancer (squamous cell carcinoma but not melanoma).

Systemic agents for treatment of psoriasis:

When topical agents and phototherapy fail to elicit any response, systemic agents are used for treatment of psoriasis. The systemic agents are toxic and need regular blood and liver function tests to monitor side effects. There are three systemic agents used for treatment of psoriasis, which are methotraxate, cyclosporine and retinoids. The first two (methotraxate and cyclosporine) are immunosuppressant drugs and retinoids are synthetic forms of vitamin A.

There are other systemic agents which are also used for treatment of psoriasis, such as efalizumab (monoclonal antibody), Ustekinumab, TNF-alpha (tumor necrosis factor-alpha) etc.

Alternative medicine in treatment of psoriasis:

Various agents are used for treatment of psoriasis, such as cod liver oil, vitamin E etc.