| What Is Psoriasis?
(Part 3) Guttate Psoriasis
Guttate Psoriasis
The Latin word gutta, meaning
droplet, describes the physical appearance of the lesions
in this type of psoriasis. In guttate psoriasis, patients
often describe the sudden appearance of small (2-3 mm
in diameter), raised, scaling bumps. Classically, it
can start in childhood or teenage years after streptococcal
infections of the throat (streptococcal pharyngitis)
or tonsillitis. A sudden flare of numerous tiny red,
raised bumps (papules) covering large areas of the body
can arise two to four weeks after the illness. The number
of lesions can increase and spread rapidly over the
trunk, arms, legs, and sometimes the face.
In children, an episode of guttate
psoriasis usually clears up after the initial episode
and does not recur. However, chronic psoriasis can follow.
In adults, it can develop into plaque-type psoriasis.
Phototherapy is particularly effective for guttate psoriasis.
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| Inverse Psoriasis
Inverse psoriasis (also known
as flexural psoriasis) affects areas where the body
folds, such as the skin in the armpits, groin, under
the breasts, and in the perianal location. This type
of psoriasis usually occurs in conjunction with plaque-type
psoriasis but can occur on its own. It differs from
other types of psoriasis because rather than appearing
scaly, the skin is smooth, moist, and salmon colored.
Inverse psoriasis can be confused with a yeast (candida)
or fungal infection (jock itch). People with inverse
psoriasis can be extremely uncomfortable, because their
skin is often raw, tender or itchy—most distressing
for those affected, as scratching these areas in public
is embarrassing. Sweating can irritate the skin further.
Inverse psoriasis can usually be controlled with topical
corticosteroids.
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A mild to mid-potency topical steroid is usually tried
first, as the skin in these locations is thinner and more
likely to develop local side effects from topical steroids
(thinning of the skin, stretch marks). As noted earlier,
a new kind of topical nonsteroidal therapy is now available
and is currently being investigated for use in psoriasis
in these locations. The new therapies are available in
cream formulations.
Erythrodermic Psoriasis
Erythrodermic psoriasis is a severe
form of psoriasis. Also known as exfoliative psoriasis—because
scaly lesions cover all or almost all of the body and
the skin can be scaling and peeling—it is characterized
by widespread, extremely red, itchy and swollen skin.
For some, the skin can be very red with minimal scaling.
In areas of raw skin, pustules might be present and
pus can ooze from these lesions. The eyes, the lining
of the mouth and the inside of the nose can also be
affected.
Erythrodermic psoriasis usually
appears in one of two forms. First, a chronic, longstanding
plaque-type psoriasis may gradually progress so that
increasing areas of skin become involved. Second, erythrodermic
psoriasis can occur in people with unstable psoriasis
and can be triggered by several factors, including illness,
emotional stress, alcoholism and the withdrawal of potent
topical, oral and/or injected corticosteroids.
Those with erythrodermic psoriasis
can be quite sick (possibly with fevers and chills),
are prone to infection in the involved skin, and might
have difficulty maintaining normal levels of fluids
and body temperature. As a result of the increased volume
of blood flowing through severely inflamed skin, the
patient can develop an increased heart rate, particularly
in the elderly or those with prior heart disease, and
this can ultimately lead to heart failure.
Those presenting with erythrodermic
psoriasis should be referred to a dermatologist. Basic
principles of care include maintaining normal levels
of fluids and the liberal use of a moisturizer and/or
topical steroids. In order to restore normal levels
of fluids and nutrients, some cases will require hospitalization.
Once a patient is stabilized, typical treatments such
topical therapy, phototherapy, oral medications or biologic
therapy can be used to control the disease.
Pustular Psoriasis
Pustular psoriasis is characterized
by the appearance of small blister-like areas of non-infected
pus on the skin. Pustular psoriasis can be separated
into two forms: localized (often only the hands and
feet) and generalized (extensive areas of the body).
Localized, or palmoplantar pustulosis (PPP), is the
most common pustular variant. Those with generalized
pustular psoriasis (GPP) are amongst the most seriously
ill and will usually require hospitalization until the
psoriasis is controlled. Pustular psoriasis can be triggered
by infections, stress or certain medications. Smoking
may also play a role.
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