How Does Psoriasis Work?

Psoriasis is a condition where an overactive immune system causes discomfort and discoloration of the skin. Learn what we know (and don't know!) about how psoriasis works in this episode of BrainStuff.

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Episode Transcript

Speaker 1 (00:01):
Welcome to Brainstuff, a production of iHeartRadio. Hey brain Stuff,
Lauren Vogelbaum here. You may have heard that your body
replaces and replenishes all of its cells every seven years.
This isn't quite true. It's catchy, but our bodies are complicated,
and your rate of cellular renewal depends person to person

(00:25):
and organ to organ. Your skeletal cells might change out
every ten to fifteen years or so. Some of the
cells in your brain and heart will stay with you
for your entire life. On the flip side, the cells
in your liver get replaced every three years, and the
ones in your gut turnover within a few months. But
if it were a race, your skin would win. Under

(00:48):
normal conditions, the cells in your epidermis, your skin's outermost layer,
replace themselves in just four weeks. That's because the outer
layer of the epidermis is actually made up of tough,
dead cells that help protect us from germs and rough
surfaces and everything else in the world around us. We're
constantly sloughing off the old ones as they wear out.

(01:11):
We shed some forty thousand dead skin cells every minute.
That adds up to about one and a half pounds
of skin around seven hundred grams shed every year, but
that's assuming that everything is working properly. Sometimes, for reasons
that we don't entirely understand, your skin can go into overdrive.

(01:33):
In a condition called psoriasis, your skin tries to replace
its outermost layer every four days or so. This leads
to a build up of skin cells that can cause discolored,
uncomfortable patches on your skin that are annoying at best.
It's caused by your immune system being way overactive. So
it's not contagious, but there's no cure, not yet anyway.

(01:58):
But what's going on here? How could a process that's
supposed to be good, the maintenance of our body's first
line of defense turn against us today? Let's talk about
what we know and don't know about psoriasis. First off,
not allsrisis looks the same. The symptoms and their severity

(02:18):
can really differ, and they come and go over time
in flares. Very basically, soriasis usually manifests as patches of
irritated skin that are tender, itchy, or even painful. The
patches are often reddish or purplish in color, sometimes with
scales or flakes coming off. They could occurb anywhere on

(02:39):
the body, though they're most common around the elbows and knees,
hands and feet, around the torso and scalp, and anywhere
the skin folds, like under the arms. The finger and
toenails can also be effected, showing pitting, discoloration, or other
deformation of the nail, along with pain or tenderness. Psorisis
can pop up in anyone at any age. People usually

(03:02):
see their first flare between the ages of fifteen to
twenty five, but it can happen earlier or later. We
know that genetics has something to do with it. You're
more likely to develop psoriasis if someone in your family
has it. Researchers are investigating a number of associated genes
but haven't really pinned any down yet. About a tenth
of the population may be genetically predisposed to psoriasis, but

(03:26):
only two to three percent of people will actually develop it.
It seems that something has to trigger your immune system
to start acting up. That something might be an injury
to the skin or a seemingly unrelated illness like a
strep infection. It can be a change in the weather
or just stress, and once a flare happens, the condition

(03:47):
is chronic, meaning it'll usually keep recurring and resolving and
recurring throughout your life. And unfortunately, researchers aren't exactly sure
why this happened. It seems like a combination of genetic
predisposition and some environmental trigger causes your skin to stress out.

(04:09):
Your skin and your immune system try to work together
to protect you, which is good, but in this case,
researchers think that some kind of feedback loop happens, a
sort of perfect storm where your skin produces more and
more replacement cells and your immune system is really gearing
up for a fight, getting extra blood flow and defensive
cells to the area, and nothing comes of it, so

(04:32):
you're left with patches of flaky, inflamed skin. It doesn't
help that this perfect storm that is psoriasis can present
in a number of ways. Let's talk more about those
different symptoms. Researchers divide them into five basic types of psoriasis.
The most common by far is called plaque soriasis because

(04:53):
it causes raised scaly patches on the skin known as plaques.
On light colored skin, they often look red with white scales.
On darker colored skin, they often look purple with gray scales.
They usually appear on the elbows, knees, torso, and scalp,
but can show up anywhere and can be puffy and
itchy or painful. Plaques show up on about eighty percent

(05:17):
of people with psoriasis. What's called inverse psoriasis is a
little less common. It causes dark red to purple, sort
of shiny patches in places where our skin folds, like
under the arms, around the groin, and under the breasts.
The patches aren't usually scally, but they can be really
itchy and tender. Around twenty five percent of people with

(05:40):
riasis experience these more rarely, like less than ten percent
of the time. The condition can cause what's called gut
tape csoriasis, which is sort of like plasoriasis, but the
scally spots are smaller and more numerous, often spread over
the entire arms, legs, or torso. It's a lot of small,

(06:01):
thin patches of irritation rather than a few big ones.
This one often shows up in adolescence rarely, in about
three percent of cases. Psoriasis can cause pustules to develop
a rash of painful, pus filled bumps across the palms
or souls, or sometimes other areas. Of the body. That's
called pustular psoriasis. Also, rarely, in about two percent of cases,

(06:27):
you find really widespread discoloration and irritation over large areas
of the body. This is called erythrodermic psoriasis, and it's
a more severe version that can be accompanied by flu
like symptoms like fever, chills, and fatigue. If this happens
to you or a loved one, definitely call a doctor
right away because it counts as a medical emergency. Generally speaking,

(06:50):
if you have any of these symptoms, getting in touch
with a healthcare professional is the best thing to do
because well, a, you're probably uncomfortable, and b they'll be
able to help with the diagnosis and figure out from
there how best to manage and reduce those symptoms and
any others that may come up. All forms of psoriasis

(07:10):
are tricky to treat because, again, it's not caused by
some germ that medicine can help you fight. It's an
instance of your own body turning against you. A healthcare
provider will evaluate your symptoms and do a skin biopsy,
that is, take a small sample of skin to look
at under a microscope to tell whether you're experiencing psoriasis

(07:31):
or a different condition. Well, once you have a diagnosis,
there are lots of treatment options for relieving discomfort and
reducing the severity and occurrence of skin patches. There are
topical treatments, creams, and other products that you apply directly
to your skin. Some can be bought over the counter
from drug stores or grocery stores, but others, like topical

(07:52):
steroids and some strong alternatives, need a prescription. Topicals are
great because, depending on the product, they're non invasive ways
to reduce inflammation, or control skin growth or smooth rough patches.
Then there's phototherapy. This is a category of also non
invasive treatments that use ultraviolet light to slow down skin

(08:15):
growth on an ongoing basis. Basically, a dermatologist will prescribe
a consistent schedule for you to either go into a
medical office or use a machine at home that exposes
affected areas of your skin to a specific amount of
ultraviolet light for a specific amount of time. Consistency is key,
but home photo therapy especially can be a convenient and

(08:37):
affordable treatment. Those are the first two categories of treatment
that healthcare providers will usually try, but if they're not
working or for whatever reason you need something different. There's
what's called systemic treatments. They're called systemic because they're not
applied to a particular topical area. Instead, these are prescripts

(09:00):
medications that help control immune or skin activity throughout your body.
Some can be taken orally and work to moderate your
immune response or your skin growth in specific ways. Others,
called biologic drugs, have to be given by either injection
or IV. Biologics are super targeted drugs that block particular
activity in your immune system. Systemics are powerful tools against soriasis.

(09:26):
All of these treatments can come with risks and side effects.
A health care provider can help you figure out which
ones are right for you and manage any side effects
that do occur. And it is important to treat psoriasis
because first of all, it is uncomfortable and having skin
problems can be embarrassing and you don't need to live
with that. But also, untreated csoriasis is associated with greater

(09:50):
risk of what's called comorbidities, which are other conditions that
often occur alongside a health issue. In the case of psoriasis,
they're often inflamma related and can include things like diabetes,
inflammatory bowel disease and cardiovascular disease. It also includes a
real specific one called syriatic arthritis. Around a third of

(10:13):
people with psoriasis will experience this. It's a condition that
causes swelling and stiffness or pain in the joints and
places where connective tissues attached to the bones, but especially
in the outer joints of the fingers and toes. As
with psoriasis, the symptoms really vary. They can be mild
or severe, and can flare up, then resolve, then flare

(10:36):
up again over time. It's distinct from other kinds of
arthritis for a few reasons, including where it occurs, and
because it's often accompanied by the nail symptoms of psoriasis.
Researchers aren't exactly sure what's going on here either, but
it seems that the inflammation from that overactive immune system

(10:56):
you see in psoriasis isn't just skin deep. If that
inflammation reaches the joints, you get discoloration and discomfort there too.
This can also damage the joints over time, so it's
especially important to talk to a healthcare professional if you
experience these symptoms. They might use different tests like X rays, MRIs,

(11:18):
ultrasounds and blood tests to help rule out other conditions
and make sure that you get the right diagnosis and treatment.
Those treatments include the systemics we talked about a minute ago,
oral medications or biologics that help control your immune system
unlessen inflammation throughout your body. I don't have personal experience
with psoriasis, but just as a human whose job it

(11:41):
is to explain how things work, it's frustrating that this
is such a complex condition that we don't entirely understand
it and can't cure it. But research is ongoing and
the treatments available are improving all the time. Our bodies
are weird and wonderful. They can do amazing things and
can also behave in very strange ways. Please take care

(12:05):
of yours. Today's episode is an original written by me.
Brain Stuff is production of iHeart Radio and is produced
by Tyler Klang. For more podcasts from my heart Radio,
visit the iHeartRadio app, Apple Podcasts, or wherever you listen
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