Plaque psoriasis is the most common form of psoriasis (1). It affects millions of people worldwide. Among the different types of psoriasis, this chronic skin condition creates thick, red, scaly patches that can appear anywhere on your body. They most commonly affect the elbows, knees, scalp, and lower back.
Table of Contents
What Is Plaque Psoriasis?
Plaque psoriasis is also called psoriasis vulgaris. It’s a chronic inflammatory skin disease where your immune system mistakenly speeds up skin cell production, causing cells to build up on the skin’s surface.
The condition involves complex interactions between your genes, immune system, and environment. In psoriasis, inflammatory proteins like IL-17 play a key role in causing skin inflammation (2).
Symptoms and Appearance
Plaque psoriasis creates distinctive patches on your skin. These are easy to recognize once you know what to look for.
What Plaque Psoriasis Looks Like
The characteristic appearance includes thick, red patches covered with silvery-white scales. These plaques have clear borders and can range from small spots to large areas covering significant portions of skin.
When doctors examine psoriatic lesions closely, they see regularly distributed red dots. These appear as tiny blood vessels called capillary bushes when looked at more closely. The background color is usually reddish or pinkish with white or yellowish scales (3).
Common Locations
While plaque psoriasis can appear anywhere on your body, certain areas are more commonly affected. The elbows, knees, scalp, and lower back are classic locations. Nearly 8 out of 10 people with psoriasis (79%) have scalp involvement, which is often the first area to show symptoms (4).
Some people also develop nail changes. Nail psoriasis can cause significant physical and functional problems. A systematic review examined treatments for nail involvement in psoriatic diseases (5).
Who Gets Plaque Psoriasis?
Plaque psoriasis can affect anyone. But certain patterns exist in who develops the condition and when.
Age and Gender Patterns
Psoriasis shows two peak times when people typically develop it. The first peak occurs around 30-39 years of age, and the second happens at 60-69 years. Women tend to develop it slightly earlier than men (6).
Geographic Differences
Where you live affects your psoriasis risk. Adult psoriasis rates range from 0.51% to 11.43% of the population. The condition becomes more common with advancing age and is more common in countries farther from the equator (7).
Causes and Risk Factors
Understanding what causes plaque psoriasis helps explain why some people develop it while others don’t.
Genetic Factors
Your genes play a big role in psoriasis risk. Large genetic studies have found 63 specific locations on chromosomes linked to psoriasis. These genetic factors explain about 28% of why psoriasis runs in families (8).
One gene variant called HLA-Cw*0602 strongly increases psoriasis risk. People who carry this gene variant are about 4.5 times more likely to develop psoriasis than those without it (9).
Environmental Triggers
Several environmental factors can trigger psoriasis in people who are genetically at risk.
Smoking significantly increases psoriasis risk. Smokers are almost twice as likely (1.88 times) to develop psoriasis, and the more you smoke, the worse your psoriasis tends to be (10).
Body weight also affects psoriasis risk. For every 5 points your BMI increases, your psoriasis risk goes up by 19%. The higher your BMI, the greater your risk (11).
Impact on Quality of Life
Plaque psoriasis affects much more than just your skin. It can significantly impact physical comfort, emotional wellbeing, and daily activities.
Physical and Emotional Effects
People with psoriasis face many challenges including physical discomfort, problems with emotional functioning, negative body image, and limitations in daily activities. Social contacts and work are also affected. More severe psoriasis is linked to lower quality of life (12).
The psychological impact can be severe. About 28% of psoriasis patients experience depressive symptoms and have 57% higher odds of experiencing depression compared to people without psoriasis (13).
Daily Life Challenges
Psoriasis creates practical challenges in everyday life. People often change their clothing choices to hide plaques. They avoid certain activities that might trigger flares. They also deal with treatments that take a lot of time.
Psoriasis affects many areas of life including daily and social activities, intimate relationships, and work productivity. Overall quality of life is significantly impacted (14).
Diagnosis
Getting an accurate diagnosis is the first step toward effective treatment.
How Doctors Diagnose Plaque Psoriasis
Most dermatologists can diagnose plaque psoriasis just by looking at it. The distinctive appearance of thick, red, scaly patches with clear borders usually makes diagnosis straightforward.
Doctors use several tools to assess how severe psoriasis is. The Psoriasis Area and Severity Index (PASI) is the most widely studied measure (15).
Severity Classification
Doctors classify psoriasis as mild, moderate, or severe. This is based on how much of your body is affected and how symptoms impact your life. However, current measurement methods may not fully capture how psoriasis affects patients. Research shows that many patients with lower scores still experience significant quality of life problems (16).
Treatment Options for Plaque Psoriasis
Managing plaque psoriasis requires finding the right treatment approach for your specific situation. Many treatment options are available. These range from topical creams to advanced biologic medications.
Topical Treatments
Medications applied directly to the skin are usually the first treatment approach. Treatments containing potent corticosteroids work best, either alone or combined with vitamin D products. Very potent corticosteroids also ranked highly for effectiveness (1).
Corticosteroids work at least as well as vitamin D products and cause fewer local side effects like burning or irritation (17).
Combination treatments often work better than single medications. Studies show that combining vitamin D with corticosteroids works significantly better than vitamin D alone, with marginal additional benefit over corticosteroids alone (18).
Phototherapy
Light therapy remains an important treatment option for widespread plaque psoriasis. Narrowband UV-B (NB-UVB) phototherapy works very well. It clears or nearly clears psoriasis in 6 to 9 out of 10 patients (60-90%). This usually takes 20 to 40 treatment sessions (19).
PUVA tends to clear psoriasis more reliably with fewer sessions and provides longer lasting clearance. However, NB-UVB is often preferred as first-line phototherapy because it’s easier to administer and has fewer long-term safety concerns (20).
Systemic Treatments
For moderate to severe plaque psoriasis that doesn’t respond to topical treatments or phototherapy, medications that work throughout the body may be necessary.
Traditional systemic medications include methotrexate, cyclosporine, and acitretin. About 45% of patients achieve 75% improvement (PASI 75) with methotrexate at 12-16 weeks of treatment (21).
Newer oral medications like apremilast offer different options. In a study of patients with moderate plaque psoriasis (affecting 5-10% of body surface), apremilast worked significantly better than placebo. Disease severity decreased by 48.1% with apremilast compared to only 10.2% with placebo at week 16 (22).
Biologic Medications
Biologic medications have transformed treatment for moderate to severe plaque psoriasis. These targeted therapies work by blocking specific proteins involved in inflammation.
A large analysis of 179 studies with 62,339 participants compared different treatments. It found that infliximab, bimekizumab, ixekizumab, and risankizumab were the most effective. These medications helped the most patients achieve 90% improvement (PASI 90) compared to placebo (23).
Newer biologics targeting IL-17 and IL-23 consistently work better than TNF inhibitors, achieving more 75%, 90%, and 100% improvement in PASI scores at week 12 compared to older biologics (24).
Living with Plaque Psoriasis
Managing plaque psoriasis requires a comprehensive approach. This goes beyond just treating skin symptoms.
Lifestyle Modifications
Certain lifestyle changes can help improve psoriasis symptoms and overall health. Weight loss in overweight patients can significantly improve psoriasis. Lifestyle weight loss programs lead to greater reduction in PASI scores, with more participants achieving 75% reduction in psoriasis severity (25).
Diet may also play a role in managing psoriasis. The National Psoriasis Foundation Medical Board strongly recommends dietary weight reduction. They specifically recommend a low-calorie diet for overweight and obese patients with psoriasis (26). Some people also explore specific dietary approaches or consider vitamins and minerals that may support skin health.
Treatment Adherence
Sticking to your treatment plan is crucial for managing plaque psoriasis effectively. However, many people don’t follow their treatment plans, especially with topical treatments.
Psychological factors strongly influence treatment adherence. The relationship between healthcare provider and patient is important. Treatment concerns, depression, and practical barriers to treatment are consistently linked with not following treatment plans (27).
Support from healthcare providers improves adherence to topical treatments. A good patient-healthcare provider relationship is considered crucial (28).
Complementary Approaches
While medical treatments are the foundation of psoriasis care, some people find additional relief through complementary approaches. These might include stress management techniques or home remedies. Some explore dietary supplements and herbal options under medical supervision.
Special Considerations
Certain groups require special attention when managing plaque psoriasis.
Children with Plaque Psoriasis
Childhood psoriasis presents unique challenges. Most topical and systemic therapies used in children are effective, though most conclusions aren’t based on randomized controlled trials. The proposed treatment approach suggests starting with calcipotriene with or without topical corticosteroids, followed by dithranol. Methotrexate is considered the systemic treatment of choice for children (29).
Older Adults
Psoriasis in older adults requires careful treatment selection due to potential interactions with other medications. Older adults may also be more sensitive to side effects. There is very little evidence on the safety of conventional systemic and biologic medications for older adults with psoriasis, highlighting an important gap in our knowledge (30).
Conclusion
Plaque psoriasis is a chronic condition that affects millions of people worldwide. While it can significantly impact quality of life, many effective treatments are available. Treatment options continue to expand and improve. These range from topical medications to advanced biologics.
Success in managing plaque psoriasis comes from working closely with your healthcare team. Together, you can find the right combination of treatments for your specific situation. This may include medications, lifestyle changes, and attention to both physical and emotional wellbeing.
Remember that psoriasis affects each person differently. What works well for one person may not work for another. Be patient as you and your healthcare provider find the best approach for managing your plaque psoriasis. With proper treatment and self-care, most people with plaque psoriasis can achieve good control of their symptoms. They can also maintain an excellent quality of life.