The 5 types of psoriasis (causes, symptoms and treatment)

Psoriasis is a dermatological disease that causes red, scaly patches of an itchy nature on the skin.. It is a chronic inflammatory disease 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 presents it, the probability that the offspring will develop this condition is 10%. If both parents show symptoms of this disease, the probability of developing it in children is 50%. In general, 1 in 3 psoriasis patients have a family history. Up to 25 regions of the genome that could be associated with this pathology have been detected, although its causes have not yet been fully elucidated.

The pathophysiology of psoriasis includes 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., 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 peculiarities, keep reading.

• We recommend you read: "What is Psoriasis and how to alleviate its symptoms?"

What are the types of psoriasis?

As we have already said in previous lines, in general, 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 on the skin, resulting in the appearance of the characteristic scales.

Although the lesions are similar in all their variants, psoriasis is a medical entity with great variability at the clinical and evolutionary level. Therefore, below we will tell you the 5 types of psoriasis, its causes and possible approaches. Do not miss it.

1. Guttate psoriasis

Corresponds to about 8% of all patients with psoriasis. In this variant, red, scaly patches with silver crusts in the form of "tears" appear on the trunk and extremities of the patient. (Guttata = in drops). It is common, especially in children and young adults.

Interestingly, this type of psoriasis has a sudden onset, usually after a streptococcal infection in the upper respiratory tract. Other types of infections, the use of certain medicines, inflammation of the tonsils, injuries mechanical stress on the skin and ongoing stress could also be other possible triggers for condition.

As many of the pictures of guttate psoriasis are related to infective pictures, sometimes initial antibiotic treatment may be necessary. However, the milder forms can be treated at home, with topical solutions that contain cortisone, which acts as an anti-inflammatory and, in addition, reduces the aggressiveness of the symptoms allergic. A complete recession of symptoms is expected after appropriate treatment.

2. Pustular psoriasis

This variant is much less frequent than the previous one, since it affects approximately 3% of all patients with psoriasis. This type of psoriasis is considered a serious complication of the disease, in which 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): 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): it is a psoriasis that is difficult to treat, which mainly affects middle-aged women. In this case, pustules appear on the palms of the feet and hands.
• Acropustulosis: affects only the tips of the fingers and toes.

PPG has historically been considered the most severe possible end 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, therefore, the erythema and burning sensation are worse than in psoriasis vulgaris. It is believed that a mutation in the IL36RN gene (which codes for a cytokine) could be the cause of this serious clinical picture.

This pathology is treated with phototherapy (using electromagnetic radiation) and a specific topical and systemic treatment., always in a hospitable environment. If you think you may suffer from pustular psoriasis (especially in the generalized variant), go to the emergency room with quickly, since without treatment and monitoring, this disease can cause 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 at a medical and social level as "vulgar psoriasis", the typical one we think of when naming this clinical picture.

In this variant, the already named red and itchy plaques appear, which arise from the interaction of the immune system with skin keratinocytes. T lymphocytes infiltrated into the skin promote their proliferation, causing dead skin cells to accumulate in the form of dense plaques. The skin is shown as red, “patchy”, inflamed, dry, ragged, and itchy nuclei.

Again, infections, taking (or stopping) certain medicines, skin lesions, Dry air, stress, or too much exposure to sunlight can cause these plates. It is usually approached with topical soothing creams (corticosteroids, retinol, and others), systemic oral or injectable treatments (steroids, cyclosporine, or biologic medications), and / or phototherapy. As you see, treatment is usually multidisciplinary.

4. Erythrodermic psoriasis

The rarest variant on the entire list, since only occurs in 2% of patients included within the psoriatic picture. On this occasion, psoriasis affects practically the entire body of the patient, presenting with severe redness of almost the entire epidermis, a very aggressive exfoliation, severe pain and itching and even an increase in the frequency cardiac. Put more informally, patients with erythrodermic psoriasis appear to have severely burned their entire bodies.

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 conceived in a hospital environment. Hydration, recovery of fluid balance and normalization of body temperature parameters are the first in critically ill patients: this can save lives if done quickly.

This type of psoriasis requires treatment with specific drugs that are not sold freely, wet dressings with repairing medication, and topically applied steroids. Once the worst symptoms have passed, the approach can vary and adapt to the patient's stay at home.

5. Reverse psoriasis

This variant is more common than the first two, but less than the typical one. Approximately 20-30% with normal psoriasis end up developing the reverse type throughout their lives. This clinical entity causes the appearance of smooth and inflamed spots in certain areas of the skin, which appear red. They arise mainly in the armpits, groin, genitals and under the breasts (places with skin folds).

This type differs from the common one 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.

What these areas of affected skin are prone to fungal and bacterial infections, certain treatments may be necessary to dry out the vulnerable area, as counterintuitive as this may seem. The patient is also usually recommended to avoid covering the lesions, in addition to the clinical approaches already mentioned in the rest of the variants.

Resume

As you have seen, there are 5 main types of psoriasis, some with their own sub-variants. Plaque psoriasis is the most common and innocuous type, but unfortunately, the generalized pustular (PPG) and erythroderma can even cause the death of the patient if they are not treated weather. In any case, it is necessary to remember that these variants affect less than 3% of patients, so they are exceptional clinical pictures, which should not be feared.

Generally, topical corticosteroids are the treatments of choice for sustained symptom management. If these persist or worsen over time, phototherapy and other newer approaches can be used.