Psoriasis: Online Diagnosis and Treatment

Psoriasis is a chronic, systemic, non-contagious, immune-mediated, inflammatory skin condition. While itchy, raised skin plaques with a silver scale are the most common manifestation of psoriasis, excess inflammation can impact other organs and tissues in the body. Approximately 75% of people with psoriasis have at least one comorbid condition, including arthritis, cardiovascular disease, metabolic syndrome, and depression.¹

While the exact cause of psoriasis is unknown, environmental, genetic, and immune factors contribute to this complex disease. Psoriasis cannot be cured, but the disease can be controlled with an ever-expanding array of medications used to temper the immune response.²

Psoriasis affects about 3% of the U.S. adult population or more than 7.5 million people.³ Psoriasis can develop at any age, but there are two peaks for psoriasis onset risk. These are between the ages of 20 and 30 and between 50 and 60. There is typically a two-year delay between psoriasis onset and diagnosis.⁴  

Approximately 80% of people with psoriasis have mild-to-moderate disease, and 20% have moderate-to-severe disease.⁵

Scheduling a consultation with a virtual doctor on the Telegra MD telehealth platform for psoriasis diagnosis and treatment is simple and convenient. You will receive a diagnosis, a treatment protocol, and an appropriate online prescription to treat psoriasis. Telehealth for psoriasis treatment makes it easy to consult with a virtual doctor and receive prescription medication to treat your psoriasis quickly and easily, even if you don’t have insurance. Schedule an appointment today to learn whether you might have psoriasis and receive a personalized treatment plan.

What Is Psoriasis?

Psoriasis is an immune-mediated inflammatory skin disease. The immune system in a susceptible person becomes overactive, which results in chronic inflammation throughout the body. Once the immune response is stimulated, positive feedback loops make it difficult to shut down.

A ramped-up immune system releases cytokines, and other chemicals, and T-cells (specialized immune cells) migrate to the skin. The immune system triggers new skin cells to accumulate faster than the old ones can be shed. Other signs of inflammation are increased redness, swelling, pain, and warmth.

What Are The Common Symptoms Of Psoriasis?

Psoriasis plaques are typically well-demarcated, red, and scaly. This means the borders are distinct and easily differentiated from surrounding tissue. A plaque is a raised lesion that is greater than 1 cm in size. Psoriasis plaques are red with silver scales.

Symptoms associated with psoriasis include the following:

• Severe itching
• Pain
• Scaly skin patches
• Nail changes
• Pustules
• Shiny, reddened areas in skin folds
• Dry eyes
• Eye redness
• Joint pain
• Skin cracking that may bleed

Can Psoriasis Be Treated Through Telehealth?

Yes, consulting a medical professional via telehealth is a convenient way to diagnose and treat psoriasis. You can schedule an online medical consultation appointment with a virtual doctor using the Telegra MD platform and receive a personalized treatment plan. Your virtual doctor can give you tips on managing your symptoms and call your online prescription to a local pharmacy.

Online doctors who prescribe psoriasis treatment medications provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Are Some People at Increased Risk for Psoriasis?

While the underlying cause of psoriasis is unclear, researchers have identified several risk factors.

Potential risk factors for psoriasis include:^2,6

• Family history, genetic predisposition; approximately 30% of people with psoriasis have a first-degree relative with the disease; gene variants contribute to 28% of a person’s psoriasis risk
• Smoking
• Heavy alcohol consumption
• Overweight or obesity
• Medications: angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), antimalarials, lithium, nonsteroidal anti-inflammatory drugs (NSAIDs)
• Infections: streptococcal, human immunodeficiency virus (HIV)
• Skin trauma
• Chronic emotional stress

How Do You Diagnose Psoriasis?

Psoriasis is a clinical diagnosis. Your doctor will ask about your medical, past medical, immunization, surgical, and family history. They will then examine your rash to determine whether it is consistent with psoriasis. If the diagnosis is uncertain, your doctor may suggest a skin biopsy or skin scraping be sent to the lab for evaluation.

Psoriasis can be categorized into six types.²

Plaque psoriasis

This type of psoriasis is the most common, accounting for 80% to 90% of all cases. Characteristics of plaque psoriasis include:

• Symmetrical distribution on the body
• Well-defined borders
• Plaques vary in size
• Most common locations are the scalp, knee, extensor surface of the elbows, and the intergluteal cleft
• Worsens in the winter
• Auspitz sign- removing the silver scale causes a small amount of bleeding
• Varies from mild-to-moderate disease (involves less than 10% of the body surface area) to moderate-to-severe disease (10% of more body surface area)

Guttate psoriasis

With smaller plaques over the body, guttate psoriasis affects about 8% of people with psoriasis. More commonly found in children and young adults, characteristics of guttate psoriasis include:

• Sudden onset
• Usually preceded by a group A beta-hemolytic streptococcal infection
• Most commonly found on the trunk, shoulders, upper arms, and thighs
• Lesions are generally less than 1 cm in diameter and covered with a fine scale
• The rash may resolve without treatment, and some people develop chronic guttate or plaque psoriasis

Erythrodermic Psoriasis

Generalized redness from head to toe that may be life-threatening, erythrodermic psoriasis is a rare disease that affects only about 1% of people with psoriasis. Characteristics of erythrodermic psoriasis include:

• Inflamed, red, scaly skin over the entire body
• Desquamation (skin shedding) and loss of skin barrier integrity
• Associated with increased infection risk, temperature control problems, and dehydration due to lack of skin protection
• May be triggered by antimalarial drug use, the rapid discontinuation of corticosteroids, overexposure to sun or ultraviolet light, and infections

Inverse psoriasis

Psoriasis is localized to skin folds; inverse psoriasis affects between 3% and 7% of people with psoriasis. Characteristics of inverse psoriasis include:

• Found in skin folds, including the eyelids, neck, armpits, under the breasts, and genitals
• No visible scaling due to increased moisture in the skin folds
• Have a shiny, red appearance
• May develop cracking and secondary infections

Generalized Pustular psoriasis

Pustular lesions on a reddened skin base that may be life-threatening. This type of psoriasis affects less than 1% of people with psoriasis. Characteristics of generalized pustular psoriasis include:

• May have a milder, chronic disease course or a sudden, severe disease course
• May be triggered by certain medications such as lithium or nonsteroidal anti-inflammatory (NSAID) drugs
• May be triggered by infection or withdrawal of glucocorticoids
• May involve the whole body, including the mouth and other mucosal membranes
• Loss of skin protection due to skin shedding increases the risk of infection, fluid loss, and difficulties with temperature control

Palmoplantar Pustular psoriasis

Pustular psoriasis is localized to the palms and soles. It most commonly develops in women between the ages of 30 and 40. Hand lesions typically come before feet lesions.

Characteristics of palmoplantar psoriasis include:

• Recurrent eruptions of pustules
• A very painful, debilitating condition
• Highly associated with a smoking history

Palmoplantar psoriasis

Psoriasis localized to the palms and soles. Characteristics of palmoplantar psoriasis include:

• Scaling and redness of the fingertips
• May cooccur with plaque psoriasis

Nail Psoriasis

Psoriasis that affects the nail and can occur with any psoriasis type. About half of people with psoriasis develop fingernail changes, and one-third develop toenail changes. Characteristics of nail psoriasis include:

• Nail pitting, discoloration, tenderness, and nail bed separation
• Can come before or after other forms of psoriasis
• More common in people with psoriatic arthritis

How Do You Treat Psoriasis?

Depending on your psoriasis type and severity, your doctor may suggest one of the following treatment options:^5,7

Topical therapies are typically used for mild-to-moderate disease or in combination with other options for more severe disease.

• Topical corticosteroids: used alone or in combination with other treatment options; have the potential to cause skin atrophy.
• Retinoids: tazarotene; may cause skin irritation; used with topical corticosteroids; teratogen; should not be used when there is a possibility of pregnancy.
• Vitamin D3 analogs: calcipotriene, calcipotriol, and calcitriol; first-line treatment options; reduce excess skin cell proliferation; can be used with topical corticosteroids; can cause mild irritant rash.
• Calcineurin inhibitors: tacrolimus and pimecrolimus are immune modulators that may be used to treat inverse psoriasis by reducing inflammation.
• Aryl hydrocarbon receptor agonists: tapinarof; FDA-approved steroid-free option.

Other options

• Phototherapy: lasers and other devices that deliver ultraviolet radiation to the skin; used to treat limited skin areas that are resistant to topical treatments or more severe disease
• Retinoids: acitretin, used to treat moderate-to-severe disease; potent teratogen; should not be used in women planning pregnancy within the next three years
• Calcineurin inhibitor: cyclosporin, an immune modulator used for treating moderate-to-severe disease; significant side effects
• Antimetabolites: methotrexate inhibits enzymes involved in rapid skin growth
• Biologics: etanercept, adalimumab, infliximab, ustekinumab, deucravacitinib, and ixekizumab; these disease-modifying drugs blunt the immune response that causes damaging inflammation
• Phosphodiesterase-4 inhibitors: apremilast; control inflammation, but the way they do it is not fully understood

When Should You See a Doctor for Psoriasis?

In the Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey, approximately one in every three people with psoriasis rated their disease as severe. This increased to one in every two for people with both psoriasis and psoriatic arthritis. Despite the severity of their symptoms, nearly half of the people surveyed had not seen their doctor in over a year.⁸

Telehealth for psoriasis is the perfect diagnosis and treatment option. You can schedule an online appointment with a virtual doctor using the Telegra MD platform and receive a diagnosis based on your psoriasis symptoms and the appearance of your skin rash. Your virtual doctor can give tips on reducing flares and call in a prescription to a local pharmacy. Online doctors who treat psoriasis provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Obtaining a psoriasis treatment plan after seeing a doctor online through telemedicine is similar to seeing your local doctor. In both cases, you would:

• Make an appointment: Typically, appointments to see virtual doctors through telehealth are much easier to make and are more convenient than in-person appointments, as many telemedicine companies provide online telehealth services for psoriasis treatment at any time, day or night.
• Provide a medical history: Whether completing forms in your local doctor’s office or online before consulting with your virtual doctor, you will need to provide a medical history.
• Consult with your doctor: After reviewing your medical history forms, your virtual doctor will discuss your psoriasis treatment options.
• Treatment: After deciding on an optimal and personalized treatment plan for psoriasis, your virtual doctor will transmit your prescriptions to your local pharmacy.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Lebwohl MG, Kavanaugh A, Armstrong AW, Van Voorhees AS. US perspectives in the Management of Psoriasis and Psoriatic Arthritis: patient and physician results from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Am J Clin Dermatol. 2016;17:87–97.

2. Kimmel GW, Lebwohl M. Psoriasis: Overview and diagnosis. Evidence-Based Psoriasis. 2018:1-16. doi:10.1007/978-3-319-90107-7_1

3. Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis Prevalence in Adults in the United States. JAMA Dermatol. 2021 Aug 1;157(8):940-946. doi: 10.1001/jamadermatol.2021.2007. PMID: 34190957; PMCID: PMC8246333.

4. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377–85.

5. American Academy of Dermatology (AAD) Work Group, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137-74. doi: 10.1016/j.jaad.2010.11.055

6. Adışen E, Uzun S, Erduran F, Gürer MA. Prevalence of smoking, alcohol consumption and metabolic syndrome in patients with psoriasis. An Bras Dermatol. 2018;93(2):205–211. doi:10.1590/abd1806-4841.20186168

7. Kim WB, Jerome D, Yeung J. Diagnosis and management of psoriasis. Can Fam Physician. 2017 Apr;63(4):278-285. PMID: 28404701; PMCID: PMC5389757.

8. Lebwohl MG, Bachelez H, Barker J, Girolomoni G, Kavanaugh A, Langley RG, Paul CF, Puig L, Reich K, van de Kerkhof PC. Patient perspectives in the management of psoriasis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey. J Am Acad Dermatol. 2014;70(5):871–881.e871–830.