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Psoriasis is a chronic, hereditary, noncontagious skin disorder characterized by scaling and inflammation that can develop on virtually any part of the body, even the nails and scalp. Occasionally, doctors may find it difficult to diagnose psoriasis, because it often looks like other skin diseases.
Inverse psoriasis–Smooth, red patches occur in the folds of the skin near the genitals, under the breasts, or in the armpits.
Erythrodermic psoriasis–Widespread reddening and scaling of the skin may be a reaction to severe sunburn or to taking corticosteroids (cortisone) or other medications.
Psoriatic arthritis–Joint inflammation that produces symptoms of arthritis in patients who have or will develop psoriasis. Raised and thickened patches of reddish skin, called “plaques,” which are covered by silvery-white scales. Plaques vary in size and can appear as distinct patches or join together to cover a large area. About 10% of people who get psoriasis develop guttate psoriasis, making this the second most common type.
Appears quickly, usually a few days after a strep throat or other trigger, such as a cold, tonsillitis, chicken pox, skin injury, or taking certain medications. Can first appear as another form of psoriasis, such as plaque psoriasis, and turn into guttate psoriasis. This type of psoriasis occurs in less than 5% of people who develop psoriasis and primarily occurs in adults.
This is a rare and severe form of psoriasis that can be life-threatening, especially for older adults.
Not common, inverse psoriasis also is called “skin-fold,” “flexural,” or “genital” psoriasis. Red and inflamed plaques that only occur in skin folds — armpits, in the genital area, between the buttocks, and under the breasts. Accelerated heart rate due to increased blood flow to the skin — can complicate heart disease and cause heart failure. Natural ultraviolet light from the sun and controlled delivery of artificial ultraviolet light are used in treating psoriasis. Sunlight–Much of sunlight is composed of bands of different wavelengths of ultraviolet (UV) light. Ultraviolet B (UVB) phototherapy–UVB is light with a short wavelength that is absorbed in the skin’s epidermis.
A newer type of UVB, called narrow band UVB, emits the part of the ultraviolet light spectrum band that is most helpful for psoriasis. Psoralen and ultraviolet A phototherapy (PUVA)–This treatment combines oral or topical administration of a medicine called psoralen with exposure to ultraviolet A (UVA) light.
Light therapy combined with other therapies–Studies have shown that combining ultraviolet light treatment and a retinoid, like acitretin, adds to the effectiveness of UV light for psoriasis. Some devices advertised on this website may not be licensed in accordance with Canadian law.


There are five main types of psoriasis (plaque, pustular, erythrodermic, guttate or inverse) with varying symptoms and levels of severity ranging from mild to severe. The immune systems T-cells main purpose is to fight off infection, but a malfunction of the immune system can cause the T-cells to react differently inciting the skin to produce skin cells too rapidly. It may be necessary to confirm a diagnosis by examining a small skin sample under a microscope. Guttate psoriasis is most often triggered by upper respiratory infections (for example, a sore throat caused by streptococcal bacteria). Attacks of pustular psoriasis may be triggered by medications, infections, stress, or exposure to certain chemicals. It can also be caused by a prolonged period of increased activity of psoriasis that is poorly controlled. Guttate psoriasis most frequently develops in children and young adults who have a history of streptococcal (strep) infections.
While most people with this skin condition are able to maintain a high quality of life there is no cure. When absorbed into the skin, UV light suppresses the process leading to disease, causing activated T cells in the skin to die.
Narrowband UVB treatment is superior to broad band UVB, but it is less effective than PUVA treatment (see next paragraph).
The level of severity is determined by the amount of coverage of the patient’s body and how it affects their quality of life (QoL). A mild case of guttate psoriasis may disappear without treatment, and the person may never have another outbreak of psoriasis. Pustular psoriasis can be triggered by infections, sunburn, or medications such as lithium and systemic cortisones. Generalized pustular psoriasis may be triggered by an infection such as strep throat, suddenly stopping steroids, pregnancy, and taking certain medications such as lithium or systemic cortisone. Erythrodermic psoriasis can be life-threatening because the skin loses its protective functions. This process reduces inflammation and slows the turnover of skin cells that causes scaling. Skin affected by psoriasis produces new skin cells every 6 to 8 days thus not allowing enough time for the older cells to dry up and slough off naturally. In severe cases, the discomfort can make it difficult to sleep and focus on everyday activities. The skin may not be able to safeguard against heat and fluid loss nor prevent harmful bacteria and other substances from entering the body.
A UVB phototherapy, called broad band UVB, can be used for a few small lesions, to treat widespread psoriasis, or for lesions that resist topical treatment.
At first, patients may require several treatments of narrow band UVB spaced close together to improve their skin. PUVA is normally used when more than 10 percent of the skin is affected or when the disease interferes with a person’s occupation (for example, when a teacher’s face or a salesperson’s hands are involved).


One combined therapy program, referred to as the Ingram regime, involves a coal tar bath, UVB phototherapy, and application of an anthralin-salicylic acid paste that is left on the skin for 6 to 24 hours. This type of phototherapy is normally given in a doctor’s office by using a light panel or light box. Once the skin has shown improvement, a maintenance treatment once each week may be all that is necessary.
Compared with broad band UVB treatment, PUVA treatment taken two to three times a week clears psoriasis more consistently and in fewer treatments. A similar regime, the Goeckerman treatment, combines coal tar ointment with UVB phototherapy. National Institute of Arthritis and Musculoskeletal and Skin Diseases and National Institute of Health, May 2003. Researchers have found that many people who have psoriatic symptoms come from a family history of psoriasis.
In some cases, guttate psoriasis is severe and disabling, and treatment may require oral medication or injections.
However, it is associated with more shortterm side effects, including nausea, headache, fatigue, burning, and itching. Also, PUVA can be combined with some oral medications (such as retinoids) to increase its effectiveness.
Erythrodermic psoriasis may occur suddenly in a person who has never had psoriasis or evolve from plaque psoriasis. Care must be taken to avoid sunlight after ingesting psoralen to avoid severe sunburns, and the eyes must be protected for one to two days with UVA-absorbing glasses.
People with psoriasis may notice that they experience periods when the condition is worse and then it improves. Triggers include infection, emotional stress, alcoholism, and certain medications such as lithium, anti-malarial drugs, and a strong coal tar preparation.
Long-term treatment is associated with an increased risk of squamous-cell and, possibly, melanoma skin cancers. It also may be triggered by excessive use of potent corticosteroids, which is why it is important to use corticosteroids as instructed.
Phototherapy has long been the option of choice for thousands of physicians and tens of thousands of patients around the globe. Simultaneous use of drugs that suppress the immune system, such as cyclosporine, have little beneficial effect and increase the risk of cancer. Suddenly stopping a psoriasis medication, such as cyclosporine or methotrexate, also can trigger erythrodermic psoriasis.
Whether used independently or in combination with a complementary agent, such as psoralen used with UVA (know as PUVA), phototherapy is the most trusted option available.



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