How Does Psoriasis Work?

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 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. 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. 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. 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 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 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 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 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 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.

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

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 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 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 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, 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, 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, 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 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

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

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

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 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 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. 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 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

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

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 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, 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 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

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 to your favorite shows.