Psoriasis

Psoriasis is a chronic inflammatory condition of the skin which affects 2% of the population and causes an increase in the rate of the cell turnover.

The normal rate of cell turnover is around a month but in psoriasis, it can be as little as 3-4 days. This causes a build-up of skin cells which cannot be shed normally and typically presents as well-demarcated pink or red plaques with a superficial silvery scale.

The plaques tend to be symmetrical and most often occur on the knees, elbows and shins but can occur anywhere on the body. The scalp and flexures of the axillae (armpits) and groin may also be affected. Psoriasis can also affect the nails which classically have tiny depressions or pits and with separation of the distal nail margin from the underlying nail plate and may be associated with arthritis (joint pains).

Psoriasis is due to an immune system dysfunction and is not something you can catch nor is it contagious. It is mediated by T-cells, a class of white blood cells which usually fend off attacks from viruses and bacteria, but with psoriasis the T-cells attack the healthy skin stimulating the increased production of new skin cells and causing inflammation.

The cause of the T-cell malfunction is thought to be a genetic predisposition and environmental factors. There is often a positive family history of psoriasis and the environmental causes include:

• Infection: especially a streptococcal sore throat which can trigger the onset of psoriasis and precede subsequent flares
• Stress: this can trigger or aggravate psoriasis
• Medication: prescribed medication for high blood pressure such as beta blockers can be associated with psoriasis as can
• Lithium and stopping strong oral or topical steroids
• Alcohol: excess alcohol intake is associated with bad psoriasis.
• Obesity
• Smoking
• Trauma: psoriasis plaques localize to areas of skin trauma such as a scar. The medical term for this is called
• Koebnerisation.

Psoriasis is a chronic disease that flares and subsides intermittently over life. While there is no cure for psoriasis (meaning the condition cannot be eradicated completely so a future flare-up never occurs), there are many ways to manage the symptoms.

Topical treatment is best suited for mild to moderate cases of psoriasis and consists of creams, ointments or gels. Sometimes topical treatment will be used as a supplement to a larger medical plan for severe psoriasis.

These can include:

• Emollients or moisturizers to moisturize dry skin, reduce scaling and relieve itching. These are first-line treatment and can be used with other psoriasis treatments.
• Topical steroids work by reducing skin inflammation. Mild strength topical steroid creams can be useful for flexural and facial psoriasis but their use needs to be monitored as they can cause skin atrophy (thinning ) if overused.
• A topical steroid with a Vitamin D analogue such as Dovobet is a good treatment for plaque psoriasis on the body
• Vitamin D analogues such as calcipotriol can be used on the face and for flexural psoriasis, help regulate the immune response to slow down the rate of cell turnover
• Coal Tar slows down the rate of cell turnover and has been a treatment for psoriasis for many years but has a distinctive smell, stains clothes and is now mostly used for widespread small plaque psoriasis or guttate psoriasis characterized by widespread small patches of inflamed skin.
• Dithranol is another well-established treatment for thick plaques of psoriasis on the limbs. It is now mostly used with a short contact regime of gradually increasing concentrations of Dithrocream. It also stains clothes.
• Calcineurin inhibitors such a Tacrolimus or Pimecrolimus originally developed to treat eczema and used on the face and for flexural psoriasis.

Psoriasis often improves in the summer and on exposure to sunlight.

Light Therapy, also known as phototherapy, harnesses the power of ultraviolet light often in combination with topical treatment if topical treatment alone has not been effective.

Types of light therapy for psoriasis include:

• Narrowband ultraviolet B
• Psoralens plus ultraviolet A or PUVA which combines a light-sensitizing medication with ultraviolet light treatment.

Systemic treatment for psoriasis through medication is typically reserved for severe cases or those which have not responded to topical treatments with phototherapy. This is because medication to treat psoriasis are accompanied by potentially severe side effects.

Your doctor may prescribe a psoriasis medication for a short burst and supplement with other treatment types. It is important to discuss a medication plan thoroughly with your doctor.

Psoriasis medications are either taken orally via pill or by injection. Types of these medications include

• Methotrexate (oral pill)
• Cyclosporin(oral pill)
• Biologics (injections)

Research indicates that drinking alcohol is a common trigger for psoriasis, and can increase the likelihood of a flare-up in an individual disposed to psoriasis.

This is not always the case, however, and psoriasis can be triggered by a variety of other emotional, environmental and medical factors.

It is also true that people who do not drink alcohol can suffer from psoriasis.

There is evidence that psoriasis is genetic and it is common that psoriasis sufferers also have family members who suffer from the condition.

This is a very common disorder, however, impacting roughly 2% of the population and variety of other causes are also known to be associated beyond genetics, including an array of environmental and medical causes.

Psoriasis is not contagious. It is caused by an over active immune system, so cannot be given to somebody else.

Typically psoriasis is not dangerous when experienced in mild form.

That said, psoriasis can be a very dangerous condition, particularly when symptoms are generalised (as opposed to localised) and very severe.

If you suffer from psoriasis you should seek a professional medical opinion.

Psoriasis is a chronic condition, which in some cases can severely impact upon a person’s quality of life. If left untreated, it is unlikely that psoriasis will disappear permanently of its own accord.

The goal of psoriasis treatment is to reduce the symptoms and end the flare up. If treatments are successful, psoriasis may go into remission.

However it is worth remembering that psoriasis is highly unpredictable. Remission can be a lengthy process and symptoms may be absent for months or years. But it can also be short-lived and symptoms may return within a few weeks.

Psoriasis is more likely to go into remission if it is treated. One of our psoriasis specialists will be able to advise on which treatment will be best for you.

Psoriasis is a chronic condition. There is no cure for psoriasis. Some treatments can control the condition permanently, or even prompt long remissions.

But since psoriasis is linked to genetic makeup, we do not have a permanent cure for the disease.

Whilst your results may essentially prove permanent, treatments are only able to control the disease and are not able to fully cure it.

It will not be known at the outset whether your treatment is able to deliver permanent results for you

Psoriasis and eczema are common skin conditions, but it is often difficult for the untrained eye to tell the difference between the two conditions.

Eczema makes the skin red and inflamed, it may be scaly, oozing, or crusty and some sufferers may find that they have rough, leathery patches on the skin. Psoriasis can also cause red patches, which may also be silvery, scaly and raised. The skin is thicker and is more inflamed in a person with psoriasis.

You will need to seek a professional medical opinion from a trained dermatologist to understand your skin condition if you are unsure.