Clinical Immunology focuses on the immune system’s health. Learn about the diagnosis and treatment of allergies, autoimmune diseases, and immunodeficiencies.
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Recognizing the symptoms of psoriasis requires looking beyond simple skin irritation. The clinical presentation is diverse, ranging from small, scaling spots to significant eruptions that cover large areas. The symptoms are the direct result of immune system dysfunction. When the immune system sends out faulty signals, it speeds up the growth cycle of skin cells. This immune disorder aspect is critical because it links the visible dermatological symptoms with potential internal systemic issues, particularly joint pain and stiffness associated with psoriatic arthritis.
The most common symptom is the presence of plaques. These are distinct patches of red, raised skin covered with thick, silvery scales. They frequently appear on elbows, knees, the lower back, and the scalp.
Sensations
Symptoms often include intense itching, burning, or soreness around the patches. The skin may become dry and cracked, sometimes bleeding, particularly if located on joints where movement stretches the skin.
The immune disorder manifests internally before it appears externally. Overactive T-cells and neutrophils migrate to the dermis and epidermis, releasing cytokines like Tumor Necrosis Factor-alpha (TNF-alpha).
Joint Symptoms
A significant symptom of the immune disorder is joint involvement. Stiffness, swelling, and pain in the joints can be early signs of psoriatic arthritis, which affects a portion of psoriasis patients.
Nails are often an early indicator of the disease. Tiny dents or pits in the nail plate are common.
Onycholysis
The nail may crumble or separate from the nail bed. Yellow-brown discoloration, resembling a drop of oil under the nail plate, is a specific symptom known as the oil drop sign.
This type manifests differently due to location. It appears in skin folds such as the armpits, groin, and under the breasts.
Lack of Scaling
Unlike plaque psoriasis, inverse psoriasis lesions are smooth and shiny red. They lack the traditional scale due to moisture and friction in these areas, but can be painful and prone to fungal infections.
Often triggered by a bacterial infection like strep throat, this form presents as small, water-drop-shaped, scaling lesions on the trunk, arms, or legs.
Acute Onset
Symptoms usually appear suddenly, distinct from the slow progression of plaque psoriasis. It is more common in children and young adults.
This rare form is characterized by white pustules (blisters of non-infectious pus) surrounded by red skin.
Systemic Reactions
Symptoms can be severe and include fever, chills, severe itching, and fatigue. It requires immediate medical attention as it indicates a massive inflammatory response.
This is the least common but most severe form. The entire body is covered in a peeling rash that can itch or burn intensely.
Barrier Failure
The skin loses its ability to protect against heat loss and fluid loss. Symptoms include shivering, fluctuating body temperature, and rapid heart rate. This is a medical emergency.
A distinctive symptom is the swelling of an entire finger or toe, giving it a sausage-like appearance.
Enthesitis
Pain occurs where tendons and ligaments connect to bone, commonly affecting the heel (Achilles tendon) or the sole of the foot. This is a direct result of the immune system attacking connective tissue.
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The first signs often include small scaling spots, dry and cracked skin that may bleed, or itching and burning sensations in specific areas like the scalp or elbows.
Yes, stress is a significant trigger for the immune system. High stress levels can cause the release of chemicals that increase the inflammatory response, worsening symptoms.
The immune system mistakenly attacks healthy skin cells, causing the body to produce new skin cells too quickly. These excess cells pile up on the surface, creating the thick, silvery scales.
Yes, people with psoriasis, especially those with psoriatic arthritis, may experience eye inflammation conditions like conjunctivitis or uveitis.
Not always. Joint pain is a symptom of psoriatic arthritis. While many people develop skin symptoms first, some experience joint pain before any skin lesions appear.
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