What is this red, scaly patch on my skin?
8/11/2022 by Hayden Middleton, P.A.-C.
Psoriasis is a chronic inflammatory skin condition with a large genetic component. The exact underlying cause of psoriasis is unknown, but it is largely attributed to an abnormal immune system.
Psoriasis is a cyclical disease process that will flare up for weeks or months at a time, and then disappear or become mild for a period of time. There are several types of psoriasis that can affect the scalp, nails and skin.
Certain risk factors are associated with psoriasis flares, including infection; injury like a cut or burn; heavy alcohol intake; smoking; rapid withdrawal from oral or injected steroids; and stress. The stereotypical psoriasis rash is a red, plaque — raised, scaly, and white and gray — and most often occurs on the elbows and knees. But it can affect any skin area. It most commonly affects adults, being much rarer in the pediatric population.
When to be seen for care
If you have signs or symptoms of psoriasis, you should seek care from your primary care clinician. You should be seen as soon as possible if the rash is widespread, affecting sensitive areas like the palm or groin area, or if there is associated joint symptoms like joint pain, stiffness, redness or swelling. Other associated rash symptoms include itchiness, cracking or peeling with bleeding and burning.
If the rash is mild and limited, it can often be treated in primary care without being seen by a specialist. The appearance of the rash can be distressing to the patient, causing psychosocial distress and further supporting the need for early intervention and treatment.
Treatment largely consists of prescription-strength topical steroids, including creams, ointments or a special shampoo, depending on the location affected. Other helpful treatment tips include daily moisturization with a thick emollient, like petroleum jelly, avoiding triggers, smoking cessation and keeping the skin clean. It is especially important to apply moisturizers after showers or baths to prevent excess loss of skin moisture.
When to see a specialist
Your primary care provider may refer you to specialty care, likely to a dermatologist or rheumatologist, if you have severe or widespread symptoms or certain associated symptoms like joint pain, redness or swelling. These symptoms indicate possible psoriatic arthritis. Other therapy that may be prescribed by a specialist include other topical therapies, light therapy or oral immunosuppressive agents.
Hayden Middleton, P.A.-C.,, M.S., is a primary care physician assistant in Family Medicine in Rochester where he practices in the Baldwin Building. He practices family medicine, with a clinical and research interest in dermatology, LGBTQI medicine and procedural medicine.