Psoriasis is a dermatological disease that causes red, scaly patches of an itchy nature on the skin.. It is a chronic inflammatory pathology with a strong genetic predisposition and clinical pictures mediated by the patient’s immune response. The prevalence of this condition is estimated to be 0.2 to 4.8% of the world population, with an average of 2% in many of the countries consulted.
Psoriasis can appear de novo in the family environment, but if one of the parents has it, the probability that the offspring will develop this condition is 10%. If both parents manifest symptoms of this disease, the probability of developing it in children is 50%. In general, 1 in 3 patients with psoriasis have a family history. Up to 25 regions of the genome have been identified that could be associated with this pathology, although the causes have not yet been fully elucidated.
The pathophysiology of psoriasis involves the infiltration of immune T-lymphocytes into the skin, which promotes the proliferation of keratinocytes (epithelial cells). This results in the formation of dense plaques, inflammation and localized itching.This results in the formation of dense plaques, inflammation and localized itching, as the epidermal cells are not able to properly secrete the lipids necessary to keep the skin hydrated, firm and healthy. If you want to know everything about the types of psoriasis and their particularities, read on.
What are the types of psoriasis?
As mentioned above, in general terms, psoriasis is described as a skin condition that causes silvery scales to form, psoriasis is described as a skin condition that causes silvery scales, redness and irritation of the skin.. In a person with this condition, dead keratinocytes (epidermal cells) accumulate in the skin, resulting in the appearance of the characteristic scales.
Although the lesions are similar in all its variants, psoriasis is a medical entity with great variability at the clinical and evolutionary level. Therefore, here are the 5 types of psoriasis, their causes and possible approaches. Do not miss it.
1. Guttate psoriasis
Corresponds to approximately 8% of all patients with guttate psoriasis. of all patients with psoriasis. In this variant, red, scaly patches with silvery crusts in the form of “tears” appear on the trunk and extremities of the patient. (Guttata = in drops). It is frequent, above all, in children and young adults.
Interestingly, this type of psoriasis has an abrupt onset, usually after a streptococcal upper respiratory tract infection. Other types of infections, the use of certain medications, inflammation of the tonsils, mechanical injuries to the skin and continued stress may also be other possible triggers of the condition.
Since many cases of guttate psoriasis are related to infectious conditions, antibiotic treatment may sometimes be necessary, initial antibiotic treatment may sometimes be necessary.. However, milder forms can be treated at home with topical solutions containing cortisone, which acts as an anti-inflammatory and also reduces the aggressiveness of allergic conditions. Complete recession of symptoms is expected to be achieved after appropriate treatment.
2. Pustular psoriasis
This variant is much less common than the previous one, affecting approximately 3% of all patients with psoriasis. This type of psoriasis is considered a severe complication of the diseaseIn this type of psoriasis, sterile pustules (non-infectious pus grains) appear on the previously described plaques. Depending on its form of presentation, there are several sub-variants:
- General pustular psoriasis (PPG).General pustular psoriasis (PPG): affects different areas of the patient’s body. This variant usually develops suddenly and is accompanied by chills and fever, among other things.
- Palmoplantar pustular psoriasis (PPP)is a difficult-to-treat psoriasis, which mainly affects middle-aged women. In this case, the pustules appear on the palms of the hands and feet.
- AcropustulosisPPG affects only the tips of the fingers and toes.
PPG has historically been considered as the most severe possible pole of the spectrum in psoriasis, however, recent genetic and immunological studies seem to show that its etiology is different from that of other variants. In PPG, the inflammatory component is much more pronounced and, as a result, the erythema and burning sensation are worse than in psoriasis vulgaris. It is believed that a mutation of the IL36RN gene (which codes for a cytokine) could be the cause of this severe clinical picture.
This pathology is treated with phototherapy (using electromagnetic radiation) and specific topical and systemic treatment, always in a hospital environment.always in a hospital environment. If you think you may be suffering from pustular psoriasis (especially the generalized variant), go to the emergency department quickly, because without treatment and monitoring, this disease can cause anything from extracutaneous manifestations to death.
3. Plaque psoriasis
It is the most common variant, since 80 to 90% of patients with psoriasis manifest it.. For this reason, it is known medically and socially as “psoriasis vulgaris”, the typical one we think of when naming this clinical picture.
In this variant, the aforementioned reddened and itchy plaques appear, which arise due to the interaction of the immune system with the cutaneous keratinocytes. T-lymphocytes infiltrating the skin promote their proliferation, causing dead skin cells to accumulate in the form of dense plaques. The skin appears with reddened “patchy”, inflamed, dry, torn and itchy cores.
Again, infections, consumption (or discontinuation) of certain medications, skin lesions, dry air, stress or too much exposure to sunlight can cause these plaques to appear. It is usually addressed with soothing topical creams (corticosteroids, retinol and others), oral or systemic injectable treatments (steroids, cyclosporine or biologic medications) and/or phototherapy. As you can see treatment is usually multidisciplinary.
4. Erythrodermic psoriasis
The rarest variant in this list, occurring in only 2% of cases. only occurs in 2% of patients included in the psoriatic included in the psoriatic picture. In this case, psoriasis affects practically the entire body of the patient, presenting with severe reddening of almost the entire epidermis, very aggressive exfoliation, severe pain and itching and even an increase in heart rate. Put more informally, patients with erythrodermic psoriasis appear to have severely burned their entire body.
As you can imagine, severe erythrodermic psoriasis puts the patient’s life at risk, to a lesser or lesser extent. Therefore, as with the generalized pustular variant, its initial treatment is only conceivable in a hospital setting. The first thing in severe patients is hydration, recovery of water balance and normalization of body temperature parameters: this can be life-saving if done quickly.
This type of psoriasis requires treatment with specific drugs that are not sold freely, moist dressings with restorative medication and topical steroids. Once the worst symptoms have passed, the approach can be varied and adapted to the patient’s stay at home..
5. Reverse psoriasis
This variant is more common than the first two, but less common than typical psoriasis. Approximately 20-30% with normal psoriasis will eventually develop inverse psoriasis during their lifetime. This clinical entity causes the appearance of smooth, inflamed patches on certain areas of the skin, which appear reddened. They arise mainly in the armpits, groin, genitals and under the breasts (places with skin folds). (places with skin folds).
This type differs from the common type in that, on this occasion, the reddened patches do not have a dry “flaky” conformation. This is because the lesions appear in areas protected from environmental dryness, such as the skin folds that form between the breasts and the trunk. As you can imagine, inverse psoriasis is more common in people who are overweight or obese.
As these areas of affected skin are prone to fungal and bacterial infections, psoriasis inversa is more common in people who are overweight or obese.In some cases, certain treatments may be necessary to dry out the vulnerable area, however counter-intuitive this may seem. The patient is also usually advised to avoid covering the lesions, in addition to the clinical approaches already mentioned in the other variants.
As you have seen, there are 5 main types of psoriasis, some with their own sub-variants. Plaque psoriasis is the most common and harmless type, but unfortunately, generalized pustular psoriasis (PPG) and erythrodermic psoriasis can even lead to death if not treated in time. In any case, it should be remembered that these variants affect less than 3% of patients, so they are exceptional clinical pictures that should not be feared.
Generally, topical corticosteroids are the treatment of choice for sustained symptom management. If these are sustained or worsen over time, phototherapy and other newer approaches may be used.