Plaque psoriasis will look different on different skin tones.
Sometimes, it can be difficult to have conditions such as plaque psoriasis that other people can see. But you are not alone. A study published in JAMA Dermatology in June 2021 found that more than 7.5 million American adults aged 20 and over have the same skin condition.
Psoriasis is known for its frequent red, raised, and flaky appearance on the elbows, knees, and hips, although it can also affect other areas, including the scalp. Adam Friedman, Professor of Dermatology, George Washington College Doctor of medicine and health science, tells health.
He said these common features make it easy for dermatologists to diagnose during the examination.
First, let's talk about why it looks so scaly. The National Psoriasis Foundation stated that the immune system of patients with plaque psoriasis is too active, causing their skin cells to grow rapidly-in only three to four days. However, the cells do not fall off quickly, which means they will accumulate on the surface of the skin.
This dead skin produces plaques and scales. They can vary in size, forming individual patches separated by healthy skin, or groups of patches connected together and covering a large area of skin.
"The plaques are a little elevated. They form a plateau above the surrounding skin. If you close your eyes and touch psoriasis, you will feel it," the University of Mississippi Department of Dermatology, MD, Robert T. Brodell Medical Center, told Health.
He explained that these scales are called "mica" because they are similar to the mineral mica, which splits into very thin elastic plates.
"If you put your finger under one of the [psoriasis] scales, you will fall off a large white scale; unlike some other cases, you may have fine scales, such as dandruff, that will not stick together," he Say.
Related: According to the dermatologist, the cause of psoriasis, plus 7 factors that may cause the onset of symptoms
Depending on the color of your skin, the appearance of psoriasis may vary.
"If you take a biopsy of plaque psoriasis on patients of all races, they are all the same," said Dr. Broder. However, it may look different on the skin," he explained. For example, he said that blacks or African Americans may find their skin darkened in inflamed areas.
"It is not white mica scales, but black, because inflammation causes the production of brown melanin, which drips into the deeper dermis of the skin under psoriasis," said Dr. Broder.
Dr. Friedman agreed, noting that the red and flaky rashes do not include the manifestations of psoriasis on different skin tones. He said that on lighter skin tones, the scales look pink and silvery white. On darker skin tones, the scales look purple and yellower, "they may also look like warts."
However, Dr. Friedman pointed out that certain characteristics of plaques and scales are the same in all forms of psoriasis and all skin types, including the following:
Plaque psoriasis can be very itchy, causing some people to scratch it.
"In patients with a lot of rubbing and scratching, irritant psoriasis becomes inflamed and has chronic eczema characteristics. The more you scratch, the thicker it becomes, etc.," said Dr. Broder.
Although both conditions can cause your skin to become red and inflamed, a dermatologist can tell the difference. The subtle differences in the appearance, location and distribution of the rash and other clues (such as whether the person has joint stiffness) make the diagnosis possible without the need for a biopsy or blood test.
Related: Scalp psoriasis and dandruff: how to distinguish and how to relieve scalp itching
According to the American Academy of Dermatology, plaque psoriasis can occur in any part of the body, but most often occurs in the following areas:
"We believe that one of the causes of psoriasis on extended elbows and knees is because of frictional stress in these areas," said Dr. Broder.
Whether a person has one or more body parts affected varies. The patients with psoriasis that Dr. Brodell saw were only one part of the body, and some parts of the body were affected. "Some of us even had only years of dents on their nails before we discovered psoriasis on their body parts," he said.
Related: Is there a diet for psoriasis? 5 potentially beneficial foods and 5 potentially unhelpful foods
Dr. Friedman said that if there is time for plaque psoriasis, now is the time.
"[The problem] is not how you intend to treat it, but which [treatment] you want to choose because we have many choices," he said.
Dr. Brodell said that once the treatment starts to work after the attack, the plaques may disappear and the skin may flatten. But on lighter skin tones, red may still exist, and on darker skin tones, darkness may still exist.
"There is no scaling, no itching, but it leaves a little redness or darkness, which usually takes months and months to disappear," he said.
Even after a biopsy shows no evidence of inflammation or thickening of the skin, changes in pigmentation may be present. "So even if the inflammation is relieved, the inflammation disappears or is well controlled, it will take a while for the skin to look completely normal," said Dr. Broder.
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