Signs and symptoms of psoriasis may include the following [7]:

• Family history of similar skin condition
• Pruritus (mostly seen in eruptive, guttate psoriasis)
• Cutaneous erythematous plaques, pustules or small papules
• Erythema and scaling
• Joint pain
• Pain (mostly seen in erythrodermic psoriasis and in some instances of traumatized plaques or in the joints affected by psoriatic arthritis)
• Dystrophic nails
• Recent streptococcal throat infection, immunization, viral infection, use of antimalarial drug, or trauma
• Eye related findings are seen in around 10% of patients and conjunctivitis or blepharitis are the most common ocular symptoms.

• Pain

  Signs and symptoms of psoriasis may include the following: Family history of similar skin condition Pruritus (mostly seen in eruptive, guttate psoriasis) Cutaneous erythematous plaques, pustules or small papules Erythema and scaling Joint pain Pain (mostly [symptoma.com]

  If psoriasis affects the hands and feet, painful fissures (cracks) can develop and these can affect use of the hands and walking. Severe psoriasis on the body can also develop cracks which are painful and can bleed. [britishskinfoundation.org.uk]

  Plaque psoriasis appears as red, thick, scaly, raised-up areas on the skin that are itchy, painful, and can flake and bleed. [jamanetwork.com]

  The tophi decreased in size peripherally with marginal improvement in back pain. From this study, we want to bring to the attention of physicians that gout can lead to back pain with inflammatory changes on MRI. [ncbi.nlm.nih.gov]

  For other patients, psoriasis can be quite disabling; they may develop extensive patches or patches that are painful or itch. In some, psoriasis causes joint pain and arthritis. Everyone is different. There is no cure for psoriasis. [cuimc.columbia.edu]

• Fever

  Fevers and chills may accompany this form of psoriasis. [aocd.org]

  Von Zumbusch psoriasis can cause fever, chills, weight loss and fatigue. Palmoplantar pustulosis This causes pustules to appear on the palms of your hands and the soles of your feet. [www2.hse.ie]

• Asymptomatic

  Furthermore, the rose bengal and ocular surface disease tests were more abnormal in patients with psoriasis (p CONCLUSIONS: Patients with psoriasis should undergo regular eye exams, regardless of risk factors, to monitor for the progression of symptomatic or asymptomatic [ncbi.nlm.nih.gov]

  It may be located on the scalp, elbows, knees, and lower back, and it may be itchy or asymptomatic. Read full article about psoriasis. [healthline.com]

  Non-resection versus resection for an asymptomatic primary tumour in patients with unresectable Stage IV colorectal cancer. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD008997. DOI: 10.1002/14651858.CD008997.pub2 [cochrane.org]

  Although it is known that the most frequent association is with throat infection, it is emphasized that urinary tract infections should be considered as a triggering factor due to improvement of psoriatic lesions after treatment of active or asymptomatic [go.gale.com]

  […] especially beta-blockers, chloroquine, lithium, angiotensin-converting enzyme inhibitors, indomethacin, terbinafine, and interferon-alfa) Emotional stress Alcohol consumption Tobacco smoking Obesity Symptoms and Signs of Psoriasis Lesions are either asymptomatic [msdmanuals.com]

• Nail Abnormality

  Fawcett RS, Linford S, Stulberg DL (2004) Nail abnormalities: clues to systemic disease. Am Fam Physician 69(6):1417–1424 PubMed Google Scholar 7. [dx.doi.org]

  This patient has extensive psoriasis, nail involvement, and joint pain. See 15 Fingernail Abnormalities: Nail the Diagnosis, a Critical Images slideshow, to help identify conditions associated with various nail abnormalities. [emedicine.com]

• Arthritis

  Merola and Sara Davin, The psychosocial burden of psoriatic arthritis, Seminars in Arthritis and Rheumatism, 47, 3, (351), (2017). [doi.org]

  A decrease in skin microbiome flora diversity seems to be a sign that a patient with psoriasis is at elevated risk for developing arthritis. [ncbi.nlm.nih.gov]

  If you have symptoms of psoriatic arthritis, it is important to see your doctor soon because this is one of the most destructive forms of arthritis. The symptoms of psoriasis tend to come and go. [niams.nih.gov]

  Psoriatic arthritis. Semin Arthritis Rheum. 1973;3:55-78. [ Links ] Hukuda S, Minami M, Saito T, Mitsui H, Matsui N, Komatsubara Y, et al. [dx.doi.org]

• Joint Deformity

  Some of those who suffer from the disease develop chronic, inflammatory arthritis (psoriatic arthritis) that leads to joint deformations and disability. [who.int]

  The symptoms of psoriatic arthritis are joint pain and joint deformity. For psoriatic arthritis, we recommend patients see a rheumatologist, who can prescribe systemic therapies for this disease. [cuimc.columbia.edu]

  Similar to rheumatoid arthritis, PsA can cause pain, disability, and permanent joint deformities. [ajmc.com]

  It’s a painful form of arthritis which causes red, stiff, swollen joints and can eventually result in joint deformity if not properly treated. Symptoms may be mild to severe and any joint can be affected. [advancedderm.com]

• Arthralgia

  In this case, the skin tightening was successfully improved and ustekinumab was more effective, even though oral prednisolone (9-12 mg/day) had some effect on skin tightening and arthralgia. [ncbi.nlm.nih.gov]

  Treatment and Course of Henoch-Schönlein Purpura NSAIDs may alleviate arthralgias but can aggravate gastrointestinal symptoms, and should be avoided in any patient with renal disease. [hopkinsvasculitis.org]

  […] use to look for Henoch-Schonlein purpura because elevated levels of IgA are normally not found in the blood, but also you can find immune complexes, and these immune complexes formed in the blood travel down to joints and can cause joint pain known as arthralgias [khanacademy.org]

  Patients may have a preceding history of psoriasis, although this is not a requirement. [11] Constitutional signs and symptoms include headache, fever, chills, arthralgia, malaise, anorexia, and nausea. [emedicine.com]

• Joint Stiffness

  If you experience joint stiffness or pain, NYU Langone dermatologists and rheumatologists, who specialize in conditions that cause painful swelling in joints and muscles, collaborate to determine if you have psoriatic arthritis. [nyulangone.org]

  Psoriatic arthritis usually involves the knees, ankles, and joints in the feet. There may also be a loss of range of motion of the involved joints as well as joint stiffness. [onhealth.com]

• Blepharitis

  An elderly male with palmoplantar psoriasis developed periocular psoriasis in the form of blepharitis and conjunctivitis following an external dacryocystorhinostomy as a manifestation of Koebner phenomenon. [ncbi.nlm.nih.gov]

  […] or in the joints affected by psoriatic arthritis) Dystrophic nails Recent streptococcal throat infection, immunization, viral infection, use of antimalarial drug, or trauma Eye related findings are seen in around 10% of patients and conjunctivitis or blepharitis [symptoma.com]

  […] including: Psoriatic arthritis, which causes pain, stiffness, and swelling in and around the joints Temporary skin color changes (post-inflammatory hypopigmentation or hyperpigmentation) where plaques have healed Eye conditions, such as conjunctivitis, blepharitis [mayoclinic.org]

  […] which the patient may have high fever) Dystrophic nails, which may resemble onychomycosis Long-term, steroid-responsive rash with recent presentation of joint pain Joint pain (psoriatic arthritis) without any visible skin findings Conjunctivitis or blepharitis [emedicine.medscape.com]

• Eczema

  Eczema and psoriasis, pityriasis, impetigo, and porrigo decalvans are forms of skin eruption seen. In psoriasis it is a fairly good remedy, but inferior to crysarobin in P. inveterata. [thesaurus.com]

  Eczema Eczema (also known as atopic dermatitis) can develop at any age, even during infancy. It usually begins before age 5. About 40 percent of children "grow out" of their eczema, but others experience flare-ups throughout their lives. [verywell.com]

  Skin conditions such as psoriasis and eczema negatively impact the patient's quality of life; the primary goal of topical treatments is to minimize the disease-specific symptoms. [ncbi.nlm.nih.gov]

  Eczema As for the differences between psoriasis and eczema, Dr. Mason says the types of psoriasis aren’t the same as types of eczema. [unitypoint.org]

  — Jessica Cruel, SELF, "Dandruff Scraping Videos Are the New Pimple Popping Videos," 19 July 2018 In some cases, chronic skin conditions like eczema or psoriasis are to blame, Dr. [merriam-webster.com]

• Erythema

  A 33-year-old female (Case 1) and a 37-year-old male (Case 2) presented at the clinic with symptoms of itching, erythema, and scaliness. [ncbi.nlm.nih.gov]

  The erythema response is assessed before the next phototherapy session and can be graded as no erythema, mild and barely perceptible erythema (grade 1), moderate and well-defined asymptomatic erythema (grade 2) and severe painful erythema persisting for [doi.org]

  [citation needed] Types[edit] Erythema ab igne Erythema chronicum migrans Erythema induratum Erythema infectiosum (or fifth disease) Erythema marginatum Erythema migrans Erythema multiforme (EM) Erythema nodosum Erythema toxicum Erythema elevatum diutinum [en.wikipedia.org]

  Generalized Rash: Conditions Associated with Pruritus Common Variable Absent or rare Atopic dermatitis Drug eruption* Fifth disease (i.e., erythema infectiosum)* Contact dermatitis Erythema multiforme HIV acute exanthem* Insect bites Folliculitis Keratosis [web.archive.org]

• Dry Skin

  That therapy produced only 1 adverse effect (dry skin near the lesions on the patient's arms and legs) and was relatively inexpensive. [ncbi.nlm.nih.gov]

  Moisturizers have been shown to significantly improve skin conditions and quality of life for psoriasis patients. They are a valuable first-line treatment, as dry skin is common and adds to the irritability of the diseased skin. [doi.org]

• Pruritus

  BACKGROUND: Psoriasis is a chronic and prevalent disease, and the associated pruritus is a common, difficult-to-control symptom. The mediators involved in psoriatic pruritus have not been fully established. [ncbi.nlm.nih.gov]

  These result in erythema and in some cases, pruritus. If left untreated, acute erythrodermic psoriasis and generalised psoriasis may become life threatening. [symptoma.com]

  Pruritus The pathophysiology of itch is still being elucidated, and the mechanism by which UV light reduces pruritus is not well defined. [doi.org]

  Area of involvement Severity Morphology, pruritis and thickness Mild Mild erythema, scaling and pruritus Minimal thickness Moderate Moderate erythema, and scaling Mild to moderate pruritus Moderate thickness Affects >50% of the scalp Severe Severe erythema [omicsonline.org]

• Koebner Phenomenon

  Thus, the authors report the first case of Koebner phenomenon in ophthalmic literature, with a review of previously published postsurgical cases of Koebnerization in psoriasis patients. [ncbi.nlm.nih.gov]

  Additionally, some patients with psoriasis will develop lesions on areas that are not normally affected by the condition – a development known as the Koebner phenomenon. [phillyvoice.com]

  phenomenon: occurrence of lesions in areas of trauma. [clinicaladvisor.com]

  This occurrence was first described by a doctor named Koebner in 1872, and was subsequently called the Koebner phenomenon. [irishskin.ie]

• Withdrawn

  However, the drug was withdrawn due to massive viral warts development and loss of efficacy. Afterwards, the girl was treated with etanercept in short 10 week and long 24 week courses with excellent response. [ncbi.nlm.nih.gov]

  With the exception of efalizumab, which has been withdrawn from both the European and U.S. markets due to long‐term safety concerns, these biologics are generally well tolerated in long‐term studies, and offer a viable alternative to conventional non‐biologic [doi.org]

  As lesions resolve, acitretin can be withdrawn, and maintenance phototherapy with PUVA or narrowband UV-B can be continued as needed. [emedicine.com]

  Efalizumab (which has been withdrawn from the market) is a chimeric monoclonal anti-CD11a antibody. [dx.doi.org]

The diagnosis of psoriasis is mostly clinical. Laboratory findings are useful in differentiating between psoriatic arthritis and rheumatoid arthritis and a typical laboratory finding showing psoriasis will produce the following results: [8].

• Negative test result for rheumatoid factor (RF) 
• Normal Erythrocyte sedimentation rate (ESR) (except in pustular and erythrodermic psoriasis)
• Elevated Uric acid level may be in psoriasis (especially in pustular psoriasis)
• Fluid from pustules is sterile with neutrophilic infiltrate

In cases of hands and foot psoriasis where the use of topical steroids appear to be worsening the situation, fungal studies should also be performed.

• Hyperuricemia

  Therefore, it is important to periodically investigate uric acid levels in order to treat changes triggered by hyperuricemia. [ncbi.nlm.nih.gov]

  Tin Lok Lai, Cheuk Wan Yim, Pui Yan Wong, Man Chi Leung and Woon Leung Ng, Hyperuricemia in Asian psoriatic arthritis patients, International Journal of Rheumatic Diseases, 21, 4, (843-849), (2018). P. Gisondi, G. Altomare, F. Ayala, A. Conti, P. [doi.org]

• Hypoalbuminemia

  4 weeks. 49 Any abnormality (>3-fold the upper limit of normal) in liver function testing necessitates a temporary reduction of MTX and repeat of tests within 2 to 4 weeks. 49 If there are persistent elevations in serum aspartate aminotranferase and hypoalbuminemia [doi.org]

  Other possible complications in pustular psoriasis include the following: Secondary bacterial skin infections, hair loss ( telogen effluvium ), and nail loss Hypoalbuminemia secondary to loss of plasma protein into tissues Hypocalcemia Renal tubular necrosis [emedicine.com]

  Medical complications (e.g., secondary infection, septicemia, hyperparathyroidism with hypocalcemia, hypoalbuminemia) may occur. 1 Figure 6. Impetigo herpetiformis on the leg. [aafp.org]

• HLA-Cw6

  Ikaheimo I, Tiilikainen A, Karvonen J, Silvennoinen-Kassinen S (1996) HLA risk haplotype Cw6, DR7, DQA1*0201 and HLA-Cw6 with reference to the clinical picture of psoriasis vulgaris. Arch Dermatol Res 288:363–365 PubMed CrossRef Google Scholar 30. [dx.doi.org]

  This illness is closely linked with some human leukocyte antigen alleles (HLA alleles) especially the human leukocyte antigen Cw6 (HLA-Cw6). Psoriasis is an autosomal dominant trait in some families. [symptoma.com]

  Polygenic disorder with strong HLA-association, mainly with HLA-Cw6. With both parents affected, risk for offspring is 65%; if in addition a sibling is affected, the risk rises to 83%. [clinicaladvisor.com]

Management of psoriasis may involve drugs, light therapy, stress reduction, climatotherapy, and various adjuncts such as sunshine, moisturizers, and salicylic acid [9].

Expert dermatologists from across the globe released a consensus report on treatment optimization and transitioning for moderate-to-severe plaque psoriasis. The recommendations are covered below:

• Methotrexate may be used for as long as it remains effective and well-tolerated.
• Cyclosporine is generally used intermittently for inducing a clinical response with one or several courses over a 3–6 month period.
• Transition from conventional systemic therapy to a biological agent may be done directly or with an overlap if transitioning is needed because of lack of efficacy, or with a treatment-free interval if transitioning is needed for safety reasons.
• Combination therapy may be helpful.
• Continuous therapy for patients receiving biologicals is recommended.

Psoriasis is generally not life threatening in most cases but it causes some inconvenience [6]. It is a however, a chronic disease and may reoccur is some cases. The peeling, splitting of skins can bring about pain and self-esteem issues. Therefore, psoriasis affects a patient’s quality of life as the individual will have to deal with embarrassment about appearance and self-consciousness. This is not forgetting the cost of remedy.

The major causes of keratinocyte turnover remain unknown till date. However, it has been proven that environmental, immunologic and genetic factors all seem to play different roles in the development of the condition [2].

Environmental factors

Stress has been postulated as a major cause but apart from this, other factors have equally been known to trigger the exacerbation of the condition. The factors include trauma, infections, alcohol and drug use. Evidence also exists towards the increased incidence of psoriasis in patients that have been diagnosed with chronic gingivitis. With treatment of the gingivitis came improved control of the psoriasis, however, the long term incidence was not affected. This gives further proof to the fact that there is a multifactorial and genetic influence as far as the disease etiology is concerned.

Genetic factors

The gene locus has been determined therefore, patients with psoriasis definitely have a genetic predisposition for the condition. It is not yet clear what the triggering event maybe for most cases but there is a high possibility that the event is immunologic. The first lesion arising from the condition is seen often after an upper respiratory infection.

This illness is closely linked with some human leukocyte antigen alleles (HLA alleles) especially the human leukocyte antigen Cw6 (HLA-Cw6). Psoriasis is an autosomal dominant trait in some families [3].

According to evidence, there is a high level of dermal and circulating TNF-α suggesting that Psoriasis is an autoimmune condition. This may be why treatment with TNF-α inhibitors has proven successful in some cases. The psoriatic lesions are linked with increased T-cell activity beneath the underlying skin area.

Another important factor to keep in mind is the fact that 2.5% of people with HIV see worsening cases of psoriasis as CD4 continues to decrease.

There are 970-2300 cases of psoriasis for every 100,000 people around the world, an incidence of 1% to 3%.

Psoriasis can be seen at any age but it is most common in adults aged 20-30 years [4]. There is no sexual predilection and the condition is rarely seen in people of African descent. One out of 3 patients has a positive family history suggesting familial clustering. Risk of getting affected with the condition increases with a first degree relative being affected but the risk increases to 60% when both parents are either affected now or where affected in the past.

As pointed out earlier, psoriasis is multifactorial and complex and it appears to be influenced by immune mediated as well as genetic components. This is of course supported by the fact that psoriasis has been treated successfully in the past with biologic medications and immune mediating medications.

The pathogenesis of the disease is still open to debates till date. There are varying theories as to what causes the disease and thus far, traumatic insult, stressful life events and infection have been mooted. In many patients however, no obvious triggers exist. As soon as the condition is triggered, there is substantial leukocyte recruitment to the dermis and epidermis and this is what causes the rather characteristic psoriatic plaques.

Keratinocyte proliferation arises when the epidermis gets infiltrated by an increased number of activated T-cells [5]. This fact is supported by histologic examination and immunohistochemical staining of psoriatic plaques which have shown large T cell populations within psoriatic lesions.

Finally, a hyper-inflated deregulated inflammatory sequence begins, followed by a strong production of different kinds of cytokines.

There is no way to prevent psoriasis.

Psoriasis is a chronic disorder that is relatively common. It is characterised by excessive proliferation of keratinocytes which lead to the forming of thickened skin, inflammation and scaly plaques [1]. These result in erythema and in some cases, pruritus.

If left untreated, acute erythrodermic psoriasis and generalised psoriasis may become life threatening. Affected patients often need examination by a dermatologist and may be admitted to the hospital in some cases. Due to the sporadic course of the disease, it is often difficult to treat.

Psoriasis is skin disorder that is relatively common. It is a condition that changes the life cycles of skin cells. In doing so, it makes the cells to build up faster than normal on the skin's surface. The extra skin cells formed produce thick scales that are itchy and dry. The red patches that form may be  painful in some cases.  

This disease is chronic (long lasting) and the symptoms fluctuate in appearance. The symptoms may get better at certain times and at other times it may worsen. 

In treating the condition, the focus of the treatment is to stop the cells of the skin from growing rapidly. Although there is no cure for this condition treatment often offers significant relief. 

Exposure to small amounts of sunlight and the use of cortisone and other nonprescription creams can also help in the improvement of symptoms. 

1. Catsarou-Catsari A, Katambus A, Theodorpoylos P. Ophthalmological manifestations in patients with psoriasis. In: Acta Derm Venereol (Stock). 64. 1984:557-559.
2. Huynh N, Cervantes-Castaneda RA, Bhat P, Gallagher MJ, Foster CS. Biologic response modifier therapy for psoriatic ocular inflammatory disease. Ocul Immunol Inflamm. May-Jun 2008;16(3):89-93.
3. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol. Sep 2009;61(3):451-85.
4. Mrowietz U, de Jong EM, Kragballe K, Langley R, Nast A, Puig L, et al. A consensus report on appropriate treatment optimization and transitioning in the management of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol. Feb 26 2013.
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7. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol 2014; 70:512.
8. Icen M, Crowson CS, McEvoy MT, et al. Trends in incidence of adult-onset psoriasis over three decades: a population-based study. J Am Acad Dermatol 2009; 60:394.
9. Tollefson MM, Crowson CS, McEvoy MT, Maradit Kremers H. Incidence of psoriasis in children: a population-based study. J Am Acad Dermatol 2010; 62:979.
10. Armstrong AW, Harskamp CT, Dhillon JS, Armstrong EJ. Psoriasis and smoking: a systematic review and meta-analysis. Br J Dermatol 2014; 170:304.