Psoriasis Stories
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Patient Story: Psoriasis
E.T., 59 YEARS OLD, FEMALE
Nine years ago, I began to experience marked dryness in the area of my elbows and around the cuticles of my nails. Due to the stress of my job and lack of time, I did not visit a specialist, and the rash and dryness gradually spread to the area under my eyes and my knees.
As the months went by, during a casual visit to the beauty salon, while washing my hair, the hairstylist asked me if I had seen the plaques on the back of my neck. To my surprise, I had never seen what I had there, and after taking a picture of the affected area, I was very surprised and decided to visit a dermatologist, since the hairstylist mentioned that it could be psoriasis because she had seen it in another client before.
By that time, almost at the same time, my nails began turning dark green, as if they had a fungal infection, and started splitting. Since I worked with my hands, out of embarrassment, I had to put Band-Aids on all of my fingers to hide them, which made me feel very depressed.
The dermatologist proceeded to biopsy one of my nails, and although the result was not yet definitive, it was leaning toward psoriasis.
In search of a second opinion, I visited another dermatologist, who definitively diagnosed me not only with psoriasis of the skin, but also with psoriatic arthritis. At that point, I understood the constant pain in my knees and chest, and I learned more about my condition and the possible treatments.
As an option, my dermatologist proceeded to educate me about injectable medications and their benefits. Although she explained that they would compromise my immune system, I felt more confident after hearing her say that if she were me, she would inject them herself. That is when my odyssey of trying to obtain that medication began, which is not covered by private insurance. My own private insurance recommended that I apply for the public health insurance plan, which was also denied.
Faced with the frustration of not being able to start treatment, thanks to my daughter, a medical student, I finally obtained a coupon provided by the pharmaceutical company itself, which allowed me to begin using this new treatment. This injectable medication, administered once a month, has been a great help by almost completely reducing the skin manifestations and improving my body pain. It is very effective, especially during the first three weeks after it is administered.
Today, after two years of using the medication, I am grateful that I decided to use it, and although I recognize that during the last week of the month its effectiveness may not be the same, I have adapted to the process and managed to cope with flare ups during the fourth week.
Psoriasis – Clinical Overview
DEFINITION
Psoriasis is a condition that causes the body to make new skin cells in days rather than weeks. As these cells pile up on the surface of the skin, you may see thick, scaly patches. Those thick, scaly patches that develop on the skin are called plaques (placks). About 80% to 90% of people living with psoriasis get plaques, so they have plaque (plack) psoriasis. When someone has plaque psoriasis, you’ll often see raised patches coated with a silvery-white scale.
SYMPTOMS
No matter the size, plaques tend to be itchy. Without treatment, the itch can become intense. Some people notice that their skin stings, burns, or feels painful and tight. Scratching can cause the patches to thicken.
While patches of thickened, dry skin are common, psoriasis can cause many signs and symptoms. What you see and feel tends to vary with the:
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Type of psoriasis you have
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Plaque psoriasis
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Guttate psoriasis
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When someone gets this type of psoriasis, you often see tiny bumps appear on the skin quite suddenly. The bumps tend to cover much of the torso, legs, and arms. Sometimes, the bumps also develop on the face, scalp, and ears. No matter where they appear, the bumps tend to be:
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Small and scaly
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Salmon-colored to pink
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Temporary, clearing in a few weeks or months without treatment
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Guttate psoriasis tends to develop in children and young adults who’ve had an infection, such as strep throat. It’s possible that when the infection clears so does guttate psoriasis.
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Inverse psoriasis
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This type of psoriasis develops in areas where skin touches skin, such as the armpits, genitals, and crease of the buttocks. Where the inverse psoriasis appears, you’re likely to notice:
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Smooth, red patches of skin that look raw
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Little, if any, silvery-white coating
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Sore or painful skin
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Other names for this type of psoriasis are intertriginous psoriasis or flexural psoriasis.
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Pustular psoriasis
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This type of psoriasis causes pus-filled bumps that usually appear only on the feet and hands. While the pus-filled bumps may look like an infection, the skin is not infected. The bumps don’t contain bacteria or anything else that could cause an infection. Where pustular psoriasis appears, you tend to notice:
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Red, swollen skin that is dotted with pus-filled bumps
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Extremely sore or painful skin
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Brown dots (and sometimes scale) appear as the pus-filled bumps dry
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Generalized Pustular psoriasis: serious and life-threatening, this rare type of psoriasis causes pus-filled bumps to develop on much of the skin. Also called von Zumbusch psoriasis, a flare-up causes this sequence of events:
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Skin on most of the body suddenly turns dry, red, and tender.
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Within hours, pus-filled bumps cover most of the skin.
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Often within a day, the pus-filled bumps break open and pools of pus leak onto the skin.
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As the pus dries (usually within 24 to 48 hours), the skin dries out and peels (as shown in this picture).
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When the dried skin peels off, you see a smooth, glazed surface.
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In a few days or weeks, you may see a new crop of pus-filled bumps covering most of the skin, as the cycle repeats itself.
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Anyone with generalized pustular psoriasis also feels very sick, and may develop a fever, headache, muscle weakness, and other symptoms. Medical care is often necessary to save the person’s life.
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Erythrodermic psoriasis
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Serious and life-threatening, this type of psoriasis requires immediate medical care. When someone develops erythrodermic psoriasis, you may notice:
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Skin on most of the body looks burnt
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Chills, fever, and the person looks extremely ill
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Muscle weakness, a rapid pulse, and severe itch
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Most people who develop erythrodermic psoriasis already have another type of psoriasis. Before developing erythrodermic psoriasis, they often notice that their psoriasis is worsening or not improving with treatment. People who develop erythrodermic psoriasis should seek immediate medical attention. Among other dangers, the person may be unable to keep warm, so hypothermia can set in quickly.
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Nail psoriasis
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Many people who have psoriasis see signs of the disease on their nails. With any type of psoriasis, you may see changes to your fingernails or toenails. About half of the people who have plaque psoriasis see signs of psoriasis on their fingernails at some point.
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When psoriasis affects the nails, you may notice:
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Tiny dents in your nails (called “nail pits”)
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White, yellow, or brown discoloration under one or more nails
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Crumbling, rough nails
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A nail lifting up so that it’s no longer attached
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Buildup of skin cells beneath one or more nails, which lifts up the nail
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Psoriatic arthritis
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If you have psoriasis, it’s important to pay attention to your joints. Some people who have psoriasis develop a type of arthritis called psoriatic arthritis. This is more likely to occur if you have severe psoriasis. Most people notice psoriasis on their skin years before they develop psoriatic arthritis. It’s also possible to get psoriatic arthritis before psoriasis, but this is less common.
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When psoriatic arthritis develops, the signs can be subtle. At first, you may notice:
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A swollen and tender joint, especially in a finger or toe
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Heel pain
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Swelling on the back of your leg, just above your heel
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Stiffness in the morning that fades during the day
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Places psoriasis appears on your body
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Amount of psoriasis you have
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TYPICAL PRESENTATION
Plaque psoriasis
About 80% to 90% of people who have psoriasis develop this type. When plaque psoriasis appears, you may see:
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Patches of thick, raised skin called plaques
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Scale (a dry, thin, and silvery-white coating) covers some plaques
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Plaques of different sizes
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Smaller plaques joining together to form larger plaques
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Plaques can appear anywhere on the skin, but you’re most likely to find them on the:
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Knees
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Elbows
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Lower back
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Scalp
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Text from the American Academy of Dermatology (AAD).
Source: https://www.aad.org/public/diseases/psoriasis/what/overview
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Personal narratives provide a vital perspective that clinical data alone cannot capture. By sharing your experience with psoriasis, you contribute to a compassionate medical community of students, professionals, and patients seeking a holistic understanding of dermatological health.