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Managing Psoriasis in the Elderly


Caregiver managing psoriasis in elderly patient
Topical Psoriasis Cream
Psoriasis Infographic
Psoriasis Infographic

What is Psoriasis?

Psoriasis is an immune-mediated skin disease. It is a skin condition where the body makes new skin cells at an abnormally fast rate. Scientists have discovered that the T-cells in a person has psoriasis attack the body's skin cells. Once the T-cells start to attack, they continue to do so. People with psoriasis see thick, scaly patches forming on the body's skin because skin cells are generating in days rather than weeks. Knees, elbows, lower back, nails, and the scalp area are the most common places for psoriasis to appear. Psoriasis is one of the most common chronic (long-term) skin diseases affecting the elderly. There are seven different types, and it is possible to have more than one type at a time.




Seven Types of Psoriasis in the Elderly

1. Plaque Psoriasis

  • Plaque psoriasis is the most common form and accounts for roughly 80 - 90% of people with psoriasis

  • Plaque is patches of thick, raised skin on the body

  • Plaque psoriasis can appear in different sizes (smaller plaques may overlap to form one large plaque)

  • Silver scales will appear on top of patches of plaque

2. Guttate Psoriasis

  • Young adults and children are more susceptible to getting guttate psoriasis

  • Strep throat or any bacterial infection can trigger guttate psoriasis

  • Guttate psoriasis appears as small (drop-shaped), scaly, pinkish (salmon-like color) lesions

  • Most likely to see these lesions on your arms, legs, or torso

  • Guttate psoriasis is temporary and will typically clear up within a few weeks to a couple of months

3. Inverse Psoriasis

  • Triggered by fungal infections

  • Areas of skin on skin contact (armpits, genitals, etc.) are likely places to develop inverse psoriasis

  • Appears as smooth, red patches of skin that look raw

  • Red patches of skin may have a slight silver-white coating

4. Pustular Psoriasis

  • Is rare

  • Mainly seen in adults, it is very uncommon to see it in children

  • There are two types of pustular psoriasis, generalized and localized

  • Localized pustular psoriasis develops on the fingers, toes, and nails, palms, and soles

  • Lesions appear as yellowish pustules (pus-filled bumps)

  • Typically lasts a couple of days, the pustules dry up and will improve without needing treatment

Pustular Psoriasis (Generalized)

  • This type is not very common

  • Pustular psoriasis is a severe form of psoriasis and develops quickly

  • Pustular psoriasis can appear in cycles from every few days to weeks

  • Will appear as white pus-filled bumps

  • Sometimes pus-filled bumps will be inside red blotches

  • Typically develops on the palms, feet, and sometimes your fingers and toes

  • Pustular psoriasis can cause soreness, itchiness, muscle weakness, and be painful

  • Can lead to having a fever, chills, pain in your joints, and headaches

5. Erythrodermic Psoriasis

  • Erythrodermic psoriasis is the least common type affecting roughly 2% of people who have psoriasis

  • Erythrodermic psoriasis is a very severe form that often covers the entire body and is described as, resembling a bad rash or burn on the skin

  • The skin will appear red and slightly discolored and start to shed in large quantities rather than in smaller scale-like pieces

  • Increased heart rate, fluctuations in body temperature, and severe itching and pain are signs to look for if you think you may have erythrodermic psoriasis


If you have any type of psoriasis, you should seek medical care right away. If you think you have erythrodermic psoriasis, get immediate medical care as this is a very serious and maybe a life-threatening situation.


6. Psoriasis in Nails

  • Roughly 50% of plaque psoriasis patients also see signs of psoriasis on their nails at some point

  • The nails appearance will start to change color (turning yellow, white, or brown), shape (developing grooves and ridged on the ends), and show small red or white spots on the nail

  • Psoriasis can cause the nail to become thick, brittle, or break if you get a fungal infection

  • Nails sometimes may loosen and detach from the skin

  • Psoriasis may impair patients ability to use their fingers and toes because of the changes to the nails it can be painful or tender to the touch

7. Psoriatic Arthritis

  • Only some people with psoriasis are affected by psoriatic arthritis later on in life

  • Because psoriasis affects people differently, you may notice problems in your joints like swelling, tenderness, stiffness, and pain before any visual indicators appear

  • Elderly patients with psoriatic arthritis will have red patches with silvery scales on the body's skin

  • Any part of the body, fingers, feet, knees, etc., can be affected

  • Unusual swelling may appear in the heel area or on the back of the legs

  • Some psoriasis patients experience morning stiffness, where the joints feel tighter than normal first thing in the morning, but after moving around a little, the stiffness will subside

  • Most commonly develops in fingers and toes but can occur wherever ligaments and tendons connect to the bone

Causes

There are still unknown factors as to why people get psoriasis. Research has shown that genes can play a role in triggering the onset of psoriasis; however, some people do develop psoriasis even if it does not run in the family.


If one parent has psoriasis, there is a 10% chance the child will develop psoriasis later on in life. If both parents have psoriasis, the chances of the child having psoriasis increase to 50%.


Psoriasis in the elderly can appear different and affect people differently. Other triggers for psoriasis include a weekend immune system, stress, cold, dry weather, alcohol and tobacco use, infections, and damage to the skin.

Anyone can develop psoriasis at any time. It most often occurs between the ages of 15 to 50. Once you get psoriasis, there is a higher risk of developing psoriatic arthritis, usually between ages 30 and 50.


Treatment for Psoriasis in the Elderly

Unfortunately, there is no cure for psoriasis in the elderly, and it can lead to developing other health conditions like heart disease, obesity, diabetes, and depression. There are very effective treatments available to treating psoriasis in the elderly and lowering the risk of other health conditions that may arise later on. Treating psoriasis in elderly patients can be difficult and should be treated with caution.


Types of Treatment


Topical Treatments

Topical treatments come in gels, ointments, or creams and are applied directly to the skin. Topicals help to slow the rate of growth of skin cells. Inflammation and the build-up of plaque may decrease as well. This treatment is usually the favored option when treating psoriasis in the elderly. Elderly patients may need assistance when applying topical ointments to hard-to-reach places and should be applied delicately.


Phototherapy/PUVA Therapy

Similar to topical treatments, phototherapy helps to slow down the growth rate of skin cells but, instead of using a cream, phototherapy or light therapy emits UV rays. The UV ray (lasers) is focused directly onto the areas of plaque and silvery scales to reduce the reproduction rate of skin cells.

This treatment plan costs a few thousand dollars a year, but Medicaid, Medicare, or insurance, can help to cover in-office treatment. If you prefer at-home treatment, you can rent or purchase a UVB unit.

Choosing this treatment plan for elderly patients should be carefully considered and proceeded with caution. Elderly patients who have had psoriasis for a long time may develop solar keratosis. The lasers can worsen the symptoms of solar keratosis in elderly patients, so this treatment may or may not be recommended.


Medication

Medication is usually a last resort when treating elderly patients with psoriasis. There is a higher risk of complications. Elderly patients are often on other medications which, can increase the risk of having an adverse drug interaction. Some medications can lead to other health conditions or severe side effects.


Elderly patients with psoriasis should consult with their dermatologist first to identify which type(s) of psoriasis they have, provide them with information and treatment plans, and help decide which treatment plan is right for them. Patients with psoriasis should also consult with a medical professional(s). They can help prevent possible side effects and interactions that may occur during the treatment process.

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