Distinguishing between the five main subtypes of psoriasis

Dr. Jaggi Rao discusses the main subtypes of the skin condition as well as markers that may indicate psoriatic arthritis. (805 words, 3 min)

Though psoriasis has been found to occur at the highest rates in individuals of European ancestry, Black and Hispanic patients make up the second and third most affected racial/ethnic groups, according to recent research. In a study comparing psoriasis subtypes, among Asians, Hispanic/Latios and Caucasians, researchers noted that plaque psoriasis was the most common subtype across the ethnicities.

In a presentation at Skin Spectrum Summit in Vancouver, Dr. Jaggi Rao outlined the basic characteristics of psoriasis as well as the differences between the five main subgroups of the skin condition.

“Nail changes may indicate psoriatic arthritis as nails are an extension of the skin itself,” said Dr. Rao.

Dr. Rao described psoriasis as an immune-mediated chronic inflammatory skin condition that impairs the physical and emotional aspects of an individual’s life. He states that “nothing is destroying or attacking the skin; it has to do with the in- fluence of the immune system to create the reaction we see.”

Dr. Rao lists the five main types of psoriasis as psoriasis vulgaris, guttate psoriasis, pustular psoriasis, inverse psoriasis and erythrodermic psoriasis. Psoriasis vulgaris is the most common as it is seen in 80 to 90 per cent of all psoriasis cases. Guttate psoriasis is caused by the presence of group A streptococcus. Pustular psoriasis, identified through the studded pustules commonly found on palms and soles, and erythrodermic psoriasis, which involves blood vessel dilation (which can change thermal regulation), are both types that require emergency urgent care.

Psoriatic arthritis can be identified through the change in the appearance of the nails. Dr. Rao explained that nails “do not have blood vessels but have keratin and different forms of skin cells.”

Some changes that occur can be pits and grooves, white-yellow discolouration, separation of the nail from the nail bed, a thickened plate, scales of the nail bed, splinter hemorrhages, pustules and more fungal infections. He reported that these symptoms are usually not unilateral and would be visible on the hands and feet. 

With psoriatic arthritis, Dr. Rao advised that topical treatments do not work particularly well as the nail functions as a barrier to the treatment. Instead, Dr. Rao suggested injection-based or oral treatments. 

Dr. Rao said that in the past, psoriasis would be treated with a series of topical, systemic and phototherapy treatments; however, he now believes in using more aggressive therapies earlier, as long as they’re safe. He cautioned that patients need to qualify for these more extreme treatments, which he does by first using systemic treatments plus light therapy. “If that fails, they qualify to move on to the more in- tensive treatments,” said Dr. Rao.

The takeaway: As with any treatment process and plan, Dr. Rao emphasized that the main goal is patient satisfaction. 

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FROM THE LITERATURE ON PSORIASIS

A cross-sectional study of Latino patients screened for psoriasis clinical trials at the University of California–Irvine

  • A recent research letter outlined evidence that psoriasis presentation in Latinos may be notably different than other ethno-racial populations. The study indicated that additional research is necessary to determine the unique clinical characteristics of the skin condition in the Latino population.

    From “JAAD”

Late-onset development of psoriasis in Japan: a population-based cohort study

  • In a large study of Japanese patients, researchers identified a number of factors that influence late-onset development of psoriasis. These factors included age, being male, having a higher body mass index, smoking, low physical activity, weight gain, and others.

    From “JAAD International”

Dermoscopic characterization of guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica in dark skin phototypes: An observational study

  • A recent study found that the known dermoscopic criteria for psoriasis subtypes, including guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica, also apply to dark skin phototypes. 

    From “Dermatol. Ther.”

VIDEO: Brain-skin connection in psoriasis pathogenesis strengthened by a new study

AT THE INTERSECTION OF SKIN AND SOCIETY

This Week

Something to think about during the week ahead…

Next Week

Dr. Monica Li discusses topical clindamycin-tretinoin as an effective Tx option for acne for all skin types.

Thank you to our panellists and delegates for making the Indigenous Skin Spectrum Summit a great success. As always, we welcome your questions and comments on topics in Ethnodermatology.

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