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What is Psoriasis?

Psoriasis is a common 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. While skin cells are normally made and replaced in about 3 to 4 weeks, an increase in production speeds up this process to about 3 to 7 days, resulting in a build up of skin cells that form red, flaky patches on the skin. The condition is thought to be linked to the immune system and to the activity of T-cells in particular. In addition to detecting ad attacking invading germs, T-cells in sufferers of Psoriasis also attack healthy skin cells, triggering the production of more skin cells and, in turn, more T-cells. While the direct cause of this activity is unknown, Psoriasis is known to be genetic and thus can run in families.

What triggers Psoriasis?

While the exact cause of Psoriasis is unknown, there are certain triggers which can cause a flare up of the problem, or cause it to get worse. Working out your triggers will help you either to avoid them, or anticipate a flare up and seek treatment. 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, the menstrual cycle, or menopause

  • Certain medications, 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 different types of Psoriasis, and suffers of one type are likely to experience another at some point. Common forms of Psoriasis include the following:

  • Plaque Psoriasis is the most common type of Psoriasis and is experienced by most sufferers of Psoriasis, with or without another type of the condition. It can occur anywhere on the body but is most common on the palms and soles, genitals and armpits. It is identifiable as red, sore and often itchy patches of skin which are clearly visible against the normal skin. 

  • Scalp Psoriasis refers to Psoriasis on the scalp, where skin builds up very easily. It causes itchiness and dandruff-like flakes on the scalp and often around the hairline and neck. Some cases can lead to hair thinning, but this is usually temporary and can be reversed with treatment.

  • Guttate Psoriasis is identifiable by the teardrop-shaped pink or red marks it causes on the skin. It is most prominently found on the back, torso and limbs and can be itchy and sore or cause no irritation. It is prominent in children and adolescents and is often triggered by a streptococcal throat infection.

  • Pustular Psoriasis 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 is common amongst Psoriasis sufferers and refers to discolouration, pitting, splitting, thickening or detachment of the finger and toenails. Severity differs between patients, with some suffering from finger restricted movement, and unlike dermatological forms of Psoriasis, treatment can take some time to be effective. 

Treatment

How is Psoriasis diagnosed?

In most cases, a GP will be able to diagnoses Psoriasis following an examination of your skin. Very rarely, a doctor may wish to perform a biopsy to determine the exact type of Psoriasis and rule out other skin disorders. This includes taking a very small skin sample for examination in a laboratory. If your symptoms appear particularly severe, or if your GP is uncertain about their diagnosis, you may be sent to a dermatologist for further consultation. Depending on your symptoms, the severity of your symptoms, and your personal medical requirements, your GP will be able to recommend treatment. It is common to start with topical treatments, before moving onto systemic treatments or phototherapy if symptoms persist. 

Topical treatment

There are a range of creams and ointments available for treatment of dermatological Psoriasis, most of which are applied to the affected area daily and should begin to take effect within a few weeks. Your doctor may recommend starting with an over-the-counter emollient, which reduces itching and scabbing by moisturising the skin, and is often sufficient treatment for mild cases of Psoriasis. 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 the production of skin cells and reducing inflammation. You can purchase Calcipotriol under the brand name Dovonex online from Dr Felix. If these treatments are ineffective, a doctor may chose to prescribe a calcineurin inhibitor, ointments which work by reducing 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.

Alternative treatments include coal tar, which has long been known to reduce itchiness and inflammation. It is occasionally recommended where other treatments have failed, but patients are often put off by its strong smell and tendency to stain clothes and bed sheets. Finally, Dithranol may be used to suppress 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 are ineffective, you may wish to 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 and is carried in 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 refers to 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 in 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 medications which work by slowing the production of skin cells. Methotrexate is usually taken once per week, and can cause nausea and affect the production of blood cells. 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 risks and potential side effects beforehand.

Living with Psoriasis

Psoriasis is often experience 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, minor injuries, streptococcal infection, certain medications, and disorders of the immune system. Furthermore, taking care of yourself mentally and physically can help reduce outbreaks, so take care to eat well, exercise often 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 individual to another through skin to skin contact.

Does Psoriasis scar?

Psoriasis does not usually scar. However, scratching at irritated skin can cause scarring, particularly in cases of severe Psoriasis. You should avoid touching or further irritating your 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 if you think you may have the condition. Psoriasis is not contagious and in many cases, goes away on its own.

Does drinking cause Psoriasis?

While drinking alcohol is not in itself a cause of Psoriasis, drinking too much can be a trigger of recurrent outbreaks. 

Can dietary changes help with Psoriasis?

Dietary changes can be effective in reducing the symptoms of Psoriasis for a number of reasons. Firstly, leading a healthy lifestyle, to which diet is integral, will boost your overall physical and mental wellbeing. A healthy and balanced diet helps to optimise your body’s ability to function and boosts incentive to exercise, which is also proven to reduce stress and anxiety. Whatsmore, this is likely to help you maintain a healthy weight; an increase in BMI (body mass index) and obesity are linked to inflammation and a higher likelihood of experiencing Psoriasis. Losing weight healthily and responsibly where necessary 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. In the long term, these can contribute to reducing inflammation and improving the overall health of your skin. Anti-oxidants, which are present in various plant-based foods like fruits and vegetables, nuts and seeds, and certain spices and herbs, can also contribute to reducing stress and inflammation. To give your skin an overall health boost, try increasing your Vitamin D intake. Moderate exposure to sunlight, a source of Vitamin D, is thought to be good for the skin, and increasing your nutritional intake of Vitamin D can similarly help reduce the impact of conditions such as Psoriasis. Try including more vitamin D-rich foods in your diet, including oily ish, milk and yoghurt and eggs.

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