Psoriasis is an inflammatory skin condition that causes thickening, redness and scaling. It can affect the whole of the skin including the scalp and nails. For some, it can be associated with arthritis. Psoriasis affects around 2% of people in the UK; it can start at any age but mainly occurs in adults under 35 years old, affecting men and women equally. The condition causes red, flaky patches to form on the skin, which are crusty and covered with silvery scales.
Alternative names: Chronic plaque, guttate, nummular/discoid, palmoplantar pustular, pustular, annular pustular, generalized pustular] – psoriasis, seborrhoeic dermatitis, sebopsoriasis.
What causes Psoriasis?
It tends to be intermittent in nature and is characterised by remission and ‘flare ups’. The causes of psoriasis remain unknown, but it can run in families and be brought on by illnesses, stresses or even some medications. Although there is no cure, the condition can be well controlled with medication.
What are the symptoms/types of Psoriasis?
The severity of psoriasis varies a great deal from person to person, with some people experiencing it as a minor irritation, whilst for other people it can have a major impact on their quality of life. Severe psoriasis can cause low self-esteem, as well as the discomfort and pain that can occur with flare-ups of the rash. There are several clinical patterns of psoriasis (see pictures):
- Chronic Plaque – The most common variant, it tends to occur on the extensor aspects of the elbows and knees and in the scalp. Skin changes include pink or red inflamed, thickened plaques with copious white scale (see image).
- Sebopsoriasis – Similar to scalp psoriasis but can occur on the face, chest, armpits and groin.
- Flexural – Raw, red areas in the groin, armpits or under the breasts.
- Guttate – Multiple small spots of psoriasis that erupt on the trunk following a sore throat or illness (see image).
- Erythrodermic – Extensive disease covering more than 90% of the body surface area.
- Palmoplantar pustular – Pus-filled inflamed spots and the palms and soles.
- Pustular – The most severe form of psoriasis, skin lesions are red, tender and filled with pus spots.
What Psoriasis treatments are available?
Unfortunately, there is no cure for psoriasis, but there are a number of ways in which you can manage the symptoms and minimise the discomfort that the rash can cause. Our consultant dermatologists can offer you expert treatment with a very good chance of dramatically improving your psoriasis.
Creams include emollients, soap substitutes, vitamin D, tar, steroids.
Phototherapy involves precise doses of ultraviolet light being delivered by a medical UV-machine. Our expert dermatology nurses and physician’s assistant run the phototherapy clinic. Sessions may be 2 or 3 times weekly depending on the type of ultraviolet therapy required.
Systemic medications include tablets such as acitretin, methotrexate and ciclosporin or injectables such as etanercept, adalimumab or ustekinemab. These powerful drugs are reserved for severe or life-limiting psoriasis. (For more information on psoriasis, please see the British Association of Dermatologists website treatment for moderate or severe psoriasis advice leaflet).
The treatment of psoriasis can be divided into three basic strategies depending on severity:
Systemic medication (oral or injectable drugs)
Frequently asked questions
Psoriasis can vary in severity from no more than a minor irritation to being a major problem – in extreme cases, sometimes requiring hospitalisation. Even a small bit of psoriasis in a delicate area such as the face or genitals can cause immense distress. Occasionally it can be itchy or cause painful splitting or fissuring of the skin. As well as the skin being affected, the nails can become abnormally brittle with flaking and pitting. 5% of patients might develop arthritis associated with psoriasis. Although psoriasis is incurable, it can be well controlled with medication.
For more information on psoriasis, please see the British Association of Dermatologists website psoriasis advice leaflet.
In addition to receiving specific treatment for psoriasis flare-ups, it’s also important that you self-manage your skin condition in order to minimise and prevent flare-ups from happening. Maintaining good physical and mental health will ensure that your immune system is strong and will lessen the risk of joint pain and fatigue that can be associated with psoriasis. Stress is often a trigger for flare-ups of psoriasis and other skin conditions, so beneficial for your health if you can avoid stress as much as possible.
If you’d like to find out more about how we can help you to manage your psoriasis effectively in the long term, please contact us and we’ll arrange a consultation with one of our dermatology specialists.