01.07 Nursing Care and Pathophysiology for Psoriasis

Psoriasis is a common skin condition that typically shows as scaly patches on the skin. Psoriasis is actually an autoimmune disorder. Let’s explore what that means.

What happens is a stressor such as infection, smoking, alcohol, cold/dry air, obesity, or just stress in general occurs, and the body reacts inappropriately to that stress by going into an inflammatory response where the T cells begin attacking the healthy cells. This results in the overproduction of skin cells, which then build up on the skin. The layers of skin aren’t able to sufficiently be supplied with oxygen and nutrients that they need, so they die. This leaves those itchy, white, flaky patches on the skin. Now, psoriasis is a also genetic disorder that is more likely to happen in people with family members that have it.

Living with psoriasis can be stressful. If a patient can manage their stress and care for the skin lesions well, the psoriasis may go into remission. Unfortunately, it very easily flares back up with any of those stressors we talked about. Next, let’s talk about the different types of psoriasis that there are.

Plaque psoriasis is the most common type, and it’s probably what you think about when you hear the word psoriasis. These patients have thick patches of red skin with white scales on them.

Inverse psoriasis is located in the armpits, groin, and skin folds. This type of psoriasis worsens with friction, which is difficult to avoid in those areas of the body.

Guttate psoriasis looks more like pinkish/reddish spots. This type is usually comes about after an upper respiratory infection.

Pustular psoriasis shows as pus filled blisters with red skin. Chemicals, medication, and infections may bring about this type of psoriasis. For example, it’s been found that the chemicals in cigarettes can trigger pustular psoriasis in people.

Erythrodermic psoriasis is the most rare, and the most dangerous form of the disease. It appears as a very red rash that covers large areas of the body. The lesions aren’t defined like in the other types. You might actually see systemic effects in these patients. The patient may have variations in their temperatures, and may become deficit in fluid and protein because of the dysregulation of the skin. This type of psoriasis may occur after the sudden withdrawal of treatment.

Whenever you have a new patient, you should assess their skin. Check all areas of the body, including the scalp. Remember, psoriasis usually shows as red patches with dry skin, or cracked itchy skin. The patient with psoriasis may complain of painful joints, and may be at risk for psoriatic arthritis. This is a disease that a rheumatologist would have to address with the patient as it is more complicated than just skin lesions.