Comprehensive Guide to Plaque Psoriasis: Types and Treatment Options

Understanding the Types and Management of Plaque Psoriasis

Plaque psoriasis is a common chronic skin condition characterized by rapid skin cell growth, leading to thick, red, scaly patches called plaques. These patches can be itchy, uncomfortable, and vary in size from small spots to large areas. The condition often fluctuates, with flare-ups lasting weeks or months followed by remission phases.

Different forms of plaque psoriasis include:

Nail psoriasis
Causes pitting and discoloration in nails, potentially leading to loosening or crumbling of the nails.

Guttate psoriasis
Primarily affects young people, presenting as small, drop-shaped spots often triggered by infections like streptococcal throat.

Other variants include:

Inverse psoriasis
Appears as smooth, inflamed red patches in skin folds such as armpits and groin, often worsened by friction or sweating.

Pustular psoriasis
Uncommon form characterized by white, pus-filled blisters on hands, feet, or fingertips.

Erythrodermic psoriasis
Severe, widespread redness, peeling, and burning sensations over most of the body.

Psoriatic arthritis
Involves joint pain, swelling, and skin symptoms, which can lead to joint damage if untreated.

The primary goals of treatment are reducing inflammation and clearing skin lesions. Approaches include:

Topical therapies—ointments and creams for mild to moderate cases, often combined with phototherapy or systemic medications in severe cases. Common options are:

Topical corticosteroids
Help decrease inflammation and itching; used short-term to prevent side effects.

Anthralin
Assists in slowing skin cell proliferation and removing scaling, though it can cause irritation and staining.

Salicylic acid
Over-the-counter agent that helps peel away dead skin, often combined with other treatments, especially for scalp psoriasis.

Phototherapy involves exposing affected skin to controlled ultraviolet light. Techniques include:

UVB phototherapy
Uses narrowband UVB light multiple times weekly, generally safe with minor side effects like redness or dryness.

Goeckerman therapy
Combines UVB exposure with coal tar application to enhance treatment efficacy.

Excimer laser
Targets mild to moderate plaques precisely, requiring fewer sessions but may cause temporary redness or blistering.

Systemic medications are reserved for severe psoriasis and include drugs like retinoids, methotrexate, and cyclosporine. These suppress immune responses but are used cautiously due to potential side effects, including increased infection risk.