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Virginia Chachati

Reviewed by Virginia Chachati MPharm
(2013, University College London)
GPhC Registration number: 2087654

Information last reviewed 26/06/2021

About

What is psoriasis?

Psoriasis is a skin condition that causes red, flaky patches to appear on the skin. The condition is usually chronic, but its severity differs from person to person.

What causes psoriasis?

Psoriasis occurs due to an increase in the production of skin cells. Skin cells are normally made and replaced every 3 to 4 weeks. With psoriasis, you produce new skin cells every 3 to 7 days. This leads to a buildup of skin cells that form red, flaky patches on the skin. Psoriasis is thought to be linked to the immune system and to the activity of T-cells. T-cells normally attack invading germs. But T-cells in people who have psoriasis also attack healthy skin cells, which triggers the production of more skin cells and, in turn, more T-cells. Scientists are currently researching to find out why this happens. Psoriasis is genetic and can run in families.

What triggers psoriasis?

While the exact cause of psoriasis is unknown, there are some triggers which can make it worse or flare up. Working out your triggers will help you avoid flare ups. Known triggers of psoriasis include:

  • An injury to the skin, such as a scratch, cut, burn or bite - this is known as a Koebner response
  • Smoking
  • Stress
  • Drinking too much alcohol
  • Hormonal changes, such as during puberty, periods, or menopause
  • Certain medicines, including lithium, antivirals, anti-inflammatories such as ibuprofen, and ACE inhibitors
  • Throat infections - a known cause of guttate psoriasis is streptococcal throat infection
  • Immune disorders such as HIV

Symptoms

What are the different types of psoriasis and their symptoms?

There are many types of psoriasis and you may experience more than one. Common forms of Psoriasis include the following:

  • Plaque psoriasis - this is the most common type of psoriasis. It mostly comes up on your hands, feet, genitals and armpits. Patches of skin are red, sore and itchy.
  • Scalp psoriasis - this causes itchiness and dandruff-like flakes on the scalp, often around the hairline and neck. Sometimes it can lead to hair thinning, but this is usually temporary and can be reversed with treatment.
  • Guttate psoriasis - this looks like teardrop-shaped pink or red marks on the skin. It is most common on the back, torso and limbs and can be itchy or sore. Young people are more likely to get it and it’s often triggered by a streptococcal throat infection.
  • Pustular psoriasis - this causes white or yellow pustules to develop on patches of dark red skin, which can be flaky or cracked. The pustules sometimes burst, but often dry up and disappear on their own.
  • Nail psoriasis - this refers to discolouration, pitting, splitting, thickening or detachment of the finger and toenails. Treatment can take some time to be effective.

Treatment

How is psoriasis diagnosed?

In most cases, a doctor will be able to diagnose psoriasis by looking at your skin. Very rarely, a doctor may request a biopsy to find out the exact type of psoriasis and rule out other skin disorders. A biopsy involves taking a very small skin sample for testing in a laboratory. If your symptoms appear severe, or if your doctor is uncertain about their diagnosis, you may be referred to a dermatologist. It is common to start with topical treatments like creams. You may need systemic treatments or phototherapy if your psoriasis does not improve.

Topical treatment

There are a range of creams and ointments available for treatment of psoriasis, most of which are applied to the affected area daily and should begin to take effect within a few weeks. For mild psoriasis, your doctor may recommend starting with an over the counter emollient, which reduces itching and scabbing by moisturising the skin. For mild to moderate cases of psoriasis, a doctor may prescribe a steroid cream, or corticosteroid, which should be used daily but sparingly for a short period of time. 

Alternatively, vitamin D analogues can be used instead of or in combination with corticosteroids, and work by slowing down the production of skin cells and reducing inflammation. You can purchase a vitamin D analogue called calcipotriol, under the brand name Dovonex, online from Dr Felix. 

If these treatments don’t work, a doctor may prescribe a calcineurin inhibitor. These ointments reduce the activity of the immune system and are commonly used to treat psoriasis in sensitive areas such as the scalp, genitals and folds of the skin. For psoriasis of the scalp, a doctor may recommend a combination of ointments and special shampoos.

An alternative treatment for psoriasis is coal tar, which has long been known to reduce itchiness and inflammation. It is occasionally recommended where other treatments have failed, but it does have a strong smell and can stain clothes or bed sheets. Finally, Dithranol may be used to suppress the production of skin cells but is generally only applied under hospital conditions and for a short period of time.

Phototherapy

If you find that topical treatments like creams are ineffective, you could try a form of phototherapy, which uses natural and artificial light to slow down the production of skin cells. Phototherapy takes place in a hospital or specialist clinic, under the supervision of a dermatologist. You need to have regular sessions over a few weeks. Types of phototherapy include ultraviolet (UVB) therapy, psoralen plus ultraviolet A (PUVA), and combination light therapy. A doctor will be able to advise you on whether phototherapy is the right option for you, and which type you should choose.

Systemic treatment

Systemic treatment includes tablets, capsules and injections which can be used to treat psoriasis. The two main types are non-biological, which are usually administered as tablets or capsules, and biological, given as injections. While these treatments are very effective at treating psoriasis, they can have potentially serious side effects, so it is important to discuss the potential benefits and risks with a doctor.

Methotrexate and acitretin are both medicines which work by slowing the production of skin cells. Methotrexate is usually taken once per week. Acitretin is taken once daily and is generally only prescribed as a last resort where other treatments have failed. Neither are suitable for use in pregnant women. 

Alternatively, ciclosporin is an immunosuppressant, most commonly used to prevent rejection during transplants. It is a proven treatment for psoriasis, but requires kidney function and blood pressure to be monitored during treatment. 

Other systemic treatments for psoriasis include biological therapies which can be injected. The most common biological therapies are anti-TNF drugs, such as etanercept, adalimumab, infliximab and ustekinumab. All of these options require monitoring throughout treatment, and you should speak to your doctor about the risks and potential side effects beforehand.

Living with psoriasis

Psoriasis is often experienced as a recurrent, long term condition, so it is worth making some changes to reduce its impact on your daily life. Where possible, working out what factors trigger your psoriasis can help you avoid or anticipate outbreaks. Common triggers include stress, smoking, drinking too much alcohol, minor injuries, streptococcal throat infections, certain medicines and disorders of the immune system. Taking care of yourself mentally and physically can help reduce outbreaks. You can do this by eating well, exercising regularly and, where possible, reduce the impact of stress in your life. If you are prescribed treatment for your psoriasis, make sure to follow your treatment plan as directed by your doctor, and check in for regular reviews to discuss symptoms and concerns.

Q&A

Is psoriasis contagious?

Psoriasis is not contagious and cannot be passed from one person to another through skin to skin contact. Psoriasis is genetic, so if someone in your family has it then you are more likely to have it too.

Does psoriasis scar?

Psoriasis does not usually scar. However, scratching irritated skin can cause scarring. You should avoid touching patches of skin affected by psoriasis, as this can also slow down the healing process.

Can psoriasis be cured?

Currently, psoriasis cannot be cured. However, it can be effectively managed with the appropriate treatment, so it is well worth a visit to your doctor. Psoriasis is not contagious and in many cases, goes away on its own.

Does drinking cause Psoriasis?

While drinking alcohol does not cause psoriasis, drinking too much alcohol can be a trigger which causes psoriasis outbreaks.

Can dietary changes help with psoriasis?

Dietary changes can help with psoriasis. Having a healthy balanced diet will help maintain your overall physical and mental well-being. Staying at a healthy body weight will reduce the chances of inflammation triggering psoriasis. By making dietary changes, you can lose weight if you need to. This can reduce the severity and frequency of your psoriasis. 
 
You may also wish to try increasing your intake of anti-inflammatory foods, such as oily fish, fruits and vegetables, nuts, seeds and legumes, and fibre. Try including more vitamin D-rich foods in your diet, including oily fish, milk, yoghurt and eggs. Or you can take a daily vitamin D supplement.

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