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Country music superstar LeeAnn Rimes publicly outed herself a couple of years ago as a person with psoriasis, an immune-related condition that can cause inflammation of the skin.
“I was only 2 years old when I was diagnosed with psoriasis,” Rimes told Glamour magazine in 2020. “By the time I was 6, about 80% of my body was covered in painful red spots — everything but my hands, feet, and face.”
After years of hiding her condition, Rimes found a treatment that successfully suppressed it. That is, until the pandemic hit, and with it social isolation and stress, she said. “Stress is a common trigger for psoriasis, and with so much uncertainty happening, my flare-ups came right back,” she said.
Rimes made the courageous decision not to hide the reality of her condition, baring it all to show her fans and the rest of the world the reality of living with psoriasis. “I want to give a voice to what so many other people are going through,” Rimes said. “This is finally my time to be honest about what psoriasis is and what it looks like.”
Since then, Rimes has been an advocate for people with psoriasis, including partnering with the National Psoriasis Foundation to commemorate National Psoriasis Day. “The more we hide, the more shame and dis-ease builds within,” she posted on her personal blog. “You are worthy just as you are! You are LovEd.”
If you think you may have psoriasis, here’s what to look for.
Psoriasis is an immune-mediated disease that causes inflammation and can result in itchy and painful raised plaques and scales on the skin, according to the National Psoriasis Foundation. It affects as many as 7.5 million U.S. adults, or more than 3 percent of the population.
“The exact cause of psoriasis isn’t known,” says Dr. Emily Shaughnessy, a dermatologist at Hartford HealthCare Medical Group in Connecticut. “We do know it to be an immune-mediated condition that causes our skin to turn over faster than normal skin, which is why you get those scaly plaques.”
“It’s thought to be both due to environmental causes, as well as genetic factors,” Shaughnessy adds. “But it’s really important to know that it’s not contagious, so you can’t give it to anyone, and no one can pass it to you.”
Symptoms often start between age 15 and 25 but can begin at any age, the NPF says. Men, women and children of all skin colors can develop psoriasis.
“The symptoms can be very variable depending on what type of psoriasis you have, but most commonly we see patients with red scaly plaques on the elbows, knees, scalp and sometimes even the other parts of the body,” Shaughnessy says.
Lesions or plaques can also appear on the eyelids, ears, lips, skin folds, hands, feet and nails.
“The most classic form is what we call plaque psoriasis, where people will develop these raised lesions,” says Dr. Ana-Maria Orbai, director of the Psoriatic Arthritis Program at the Johns Hopkins Arthritis Center. She adds: “There’s a rash that’s called guttate psoriasis, which looks like little drops of rain. That’s how it got its name. And it’s just very little patches of rash, but it’s spread over almost the entire body.”
There are five main types of psoriasis: genital; scalp; facial; hand, feet and nail; and skin-fold psoriasis.
“Inverse psoriasis [is] where people tend to develop the rash in the skin fold, and it tends to look different just because the skin in those areas has a different quality,” Orbai says. “It’s not going to scale as much, but it’s going to be red, and it’s going to hurt, and it’s going to ooze fluid, and it’s very uncomfortable.”
Rarer forms include pustular psoriasis, which affects 2 to 4 percent of psoriasis patients. It features pimple-like pustules on the hands and soles of the feet that are itchy and tender.
Erythrodermic psoriasis can involve up to 90 percent of the skin and cover it with a red rash. It is severe enough to result in hospitalization and treatment with potent drugs, Orbai says.
Nail psoriasis can lead to pits on the surface of the nails, and in its extreme form, called onycholysis, can lead to the disintegration of the entire nail.
The most common side effect of psoriasis is joint involvement, called psoriatic arthritis.
“Thirty to 40 years is the peak age where people develop psoriatic arthritis, which is about a decade later than the peak age for psoriasis, for the skin disease,” Orbai says. “People usually take 10 to 20 years to develop psoriatic arthritis. In terms of the disease course, it’s rather unpredictable. People will experience episodes of worsening of the psoriatic arthritis and then episodes of improvement.”
Psoriatic arthritis presents as joint pain, fatigue and stiffness, sometimes years before diagnosis. It is more commonly linked with psoriasis of the scalp, behind the ear, inside the ear and on the perianal skin.
Fortunately, science has developed several effective treatments for the various forms of psoriasis. These include topical steroidal and nonsteroidal creams; ultraviolet light therapy; injectable or intravenous systemic treatments, including biologics; and nutrition and lifestyle changes, the NPF says.
“Topical therapy is still the cornerstone of the treatment of psoriasis,” says Dr. Linda Stein Gold, director of clinical research and division head of dermatology at the Henry Ford Health System in Detroit. Such treatments work best in combination with other therapies, especially for plaque psoriasis, she adds.
“A little bit of it depends on the severity,” Shaughnessy says. “So for more mild cases, we can often do just topical treatments, such as topical steroids. We also have this really cool medical-grade light box that we use ultraviolet rays to treat the skin. That’s incredibly effective for psoriasis.”