What is psoriasis?

Psoriasis is an autoimmune disease that occurs when the body's immune system mistakes healthy cells for dangerous substances.

It is a common skin condition that causes red patches of inflamed skin with silver-white scales, often on the elbows and knees, but also commonly affects the scalp, face and folds of skin (such as the back of your knees and elbows).

Skin cells typically grow deep inside the skin, and about once a month they rise to the surface. This process is accelerated in those suffering from psoriasis, which causes a build-up of dead skin cells on the surface of the skin.

In some severe cases of psoriasis, dermatologists may recommend medication and injections, which alter the immune response of the body, therefore suppressing the outbreak.

Whatever your personal requirements, you can rest assured that we will provide the leading consultants and techniques for your treatment at our state-of-the-art, purpose-built, central London facility in Chelsea.

What are the symptoms of psoriasis?

The main symptoms of psoriasis are

  • Inflamed, scaly skin 
  • Patches of thick, raised skin
  • Silvery – coloured skin
  • Small, scaly spots 
  • Hair loss (on the scalp)
  • Pitted, crumbly nails 
  • Blisters 

The most common form of psoriasis is plaque psoriasis, and occurs in roughly 80-90% of cases. This manifests in raised, thickened, silvery skin in plaques of various sizes, with smaller plaques joined together to form larger plaques. Itchiness is a common feature of plaque psoriasis. Scratching it will make your symptoms worsen.

The other 10% - 20% of cases can be one of:

  • Guttate psoriasis: characterized by small, scaly pink bumps on the skin, typically on the torso, legs and arms
  • Inverse psoriasis: characterized by smooth red patches of skin that look raw, usually in places where skin touches skin, e.g. armpit, genitals, buttocks 
  • Pustular psoriasis: characterized by sore puss-filled bumps on the feet and the hands
  • Pustular psoriasis (generalized): a very rare life-threatening type of psoriasis where much of the skin’s surface flares up and is affected. Often accompanied by fever, headache, muscle weakness and other symptoms. Immediate medical care is necessary
  • Ethryodermic psoriasis: also life threatening and requiring of immediate medical attention. The skin on most of the body appears burnt, accompanied by fever
  • Nail psoriasis: characterized by pitted, crumbly nails and discolouration. Also nail lifting
  • Psoriatic arthritis: when the psoriasis affects the joints, again requiring immediate medical management

Where does psoriasis form on the body?

Most commonly psoriasis forms in the following areas of the body:

  • Elbows
  • Knees 
  • Scalp
  • Lower back 

That said, depending on which type of psoriasis is present, psoriasis can appear almost anywhere in the body and even be generalised across the entire surface of the body's skin.

How can you treat psoriasis?

Psoriasis is a chronic disease that flares up and subsides intermittently. While there is no cure for psoriasis (the condition cannot be eradicated completely) there are many ways to manage the symptoms.

Treatments to manage symptoms include:

  • topical creams and gels 
  • Light Therapy 
  • oral and injected medications

Topical treatments and light therapy are typically reserved for milder instances of psoriasis. Medication is typically used in the strongest cases, when psoriasis has not responded adequately to these first two treatments.

A bespoke treatment plan will be devised by your consultant dermatologist at your consultation to most effectively combat and control your condition.

What are the benefits of psoriasis treatment?

The benefits of treatment for psoriasis include:

  • Controlled or reduced symptoms 
  • Improved self confidence and self-esteem
  • Reduced stress, anxiety and unhappiness 

What causes psoriasis?

Psoriasis is common and affects roughly 2% of the population.

The exact causes of psoriasis are not fully known or understood. That said, genetics, the immune system and environmental factors are all known to play a part.

The following factors are understood:

  • Most people who get psoriasis have white, Caucasian skin
  • Psoriasis does run in families
  • Psoriasis is not contagious
  • The immune system plays a part in psoriasis, as the body’s skin cells are attacked by overactive white blood cells, causing the over production of new skin cells that pile up on the surface of the skin as psoriasis
  • Certain genes do indicate a higher likelihood of getting psoriasis

The following environmental triggers are also indicated for psoriasis flare-ups:

  • Stress 
  • Skin injury, e.g. sunburn
  • Infection
  • Some medications, e.g. lithium, prednisone, hydroxychloroquine
  • Cold, dry weather
  • Tobacco usage
  • Alcohol usage

What to expect during your psoriasis consultation at the Cadogan Clinic?

You will meet with one of our highly trained dermatologists at the Cadogan Clinic on Sloane Street, Chelsea for an in-person assessment of your skin.

Your consultant will discuss the following with you at this consultation:

  • The best options for treatment for you given your psoriasis condition, and the results that you would likely achieve with each treatment
  • An explanation of the treatment or treatment plan 
  • Go through your past medical history
  • Answer any questions you may have

3 Easy Steps

  • Visit the Clinic on Sloane Street, Chelsea for your in-person consultation with one of our dermatologists 
  • Start your treatment plan 
  • Return to the Clinic to see your dermatologist - if required - to monitor the progress of treatment 

Why choose the Cadogan Clinic for your psoriasis treatment?

  • We treat hundreds of psoriasis cases each year 
  • Our team of 9 highly experienced specialist dermatologists have been handpicked to form one of the best independent dermatology units in the country
  • Our purpose build dermatology clinic is conveniently located off Sloane Square  

What can cause Psoriasis to flare up?

  • Stress
  • Lack of adequate sunlight or too much exposure to the sun (sunburn)
  • Bacteria or viral infections, such as strep throat and upper respiratory infections
  • Dry air or dry skin
  • Injury to the skin, including cuts, burns, and insect bites
  • Certain medicines, including anti-malaria drugs, beta-blockers, and lithium
  • Excessive alcohol consumption

Dermatology Gallery

Skin Lumps and Warts

Benign Dermatofibroma - Persisting asymptomatic nodule. Recommend excision on cosmetic grounds as will never go away spontaneously.

Benign vascular nodule - Developed at site of minimal trauma; needs surgical removal as bleeds easily.

Benign vascular nodule - On face of elderly lady, for surgical removal.

Warty benign basal cell papilloma (seborrhoeic keratosis) - Slowly growing on trunk of 70 year old man; removed by curettage.

Warty benign basal cell papilloma (seborrhoeic keratosis) - Flesh-coloured growth on trunk of 75 year old man

Seborrhoeic warts / keratoses - On a patient

Seborrhoeic warts / keratoses - On a patient

Solar keratoses - Extensive scalp solar keratoses suitable for PDT

Rapidly growing nodule - Below left eye in 70 year old man. Needs excision for cure and for histology to differentiate between a keratoacanthoma and a basal cell cancer

Hand warts - Can be treated with Cryotherapy

Plantar warts - Potentially suitable for cryotherapy

Melanomas

Lentigo maligna - Black discolouration on background brown lentigo on nasal bridge–needs excision to prevent spread.

Melanoma - Melanoma on a patient

Lentigo maligant melanoma - Slowly growing brown stain on cheek of elderly lady

Malignant melanoma - Well demarcated black plaque on sun damaged trunk of 35 year old

Malignant melanoma - Well demarcated black plaque on sun damaged skin

Melanoma - Change in the pigmentation of a previously brown mole

Nodular melanoma - A large pigmented nodule

A nodular melanoma - Enlarging pigmented plaque

Subungual melanoma - Persisting black toenail originally thought due to trauma

A nodular melanoma - Persisting oozing nodule with pigmentation

Amelanotic melanoma - Vascular nodule on the foot

Large malignant melanoma - On upper back of very sundamaged skin

Other Skin Cancers

Basal cell cancer - Slowly growing nodule on sun exposed skin of 68 year old man showing telangiectasia (blood vessels) diagnostic of a basal cell cancer

Multiple cancers - Multiple scaly patches consistent with multiple cancers on sun-exposed neck of elderly woman

Basal cell cancer - Scaly area which never heals on right side of forehead of 72 year old. Need excising to prevent further enlargement.

Basal cell cancer - Slowly growing area on sun damaged facial skin of 35 year old surfer. Basal cell cancer needing Mohs and reconstruction to prevent further growth.

Pigmented basal cell cancer - On sun exposed skin of 72 year old. Could be mistaken for a melanoma due to the black pigment.

Squamous Cell Cancer - Sore ear thought to be infection in 78 year old man but due to a squamous cell cancer

Bowen’s disease on the hand - An early skin cancer

Psoriasis

Psoriasis - Symmetrical well defined erythematous plaques on the knees

Psoriasis - Well demarcated scaly plaques on elbows of a 4 year old

Psoriasis - Scaly itchy scalp with well demarcated edge due to psoriasis

Psoriasis - Well demarcated scaly rash of psoriasis in a child on an unusual location

Small Plaque Psoriasis - Widespread rash with well demarcated pink scaly patches

Psoriasis - Psoriasis on the forehead and scalp

Moles

Large congenital mole - Atypical pigmentation in a child - needs monitoring

Protruding benign mole - Excise on cosmetic grounds

Hair bearing benign flesh coloured facial naevus -

Halo naevus - This is benign and occurs more frequently in patients with vitiligo

Large naevi with irregular pigmentation - Dysplastic naevi which need monitoring /excision to prevent progression

Unusual mole on sole of foot - For dermoscopic monitoring

Halo - Less intense pigmentation surrounding a normal mole

Benign Mole - Benign mole on a patient

Benign Mole - Benign mole on a patient

Acne

Acne Scarring - Acne Scarring

Acne - Acne on a male patient

Acne - Acne on the forehead

Acne - Acne on the cheek

Autoimmune

Alopecia - Alopeca areata

Allergies

Urticaria - Urticaria or hives

Pigmentation

Vitiligo - On a patient

Actinic Lentgines - On the patient's hand

Sun Damage - On the patient's chest

Actinic Lentgines - On the patient's hand

Extensive Actinic Lentigines - Forehead with extensive actinic lentigines sun freckling

Vascular

Vascular Papule - Vascular papule on patients face

Superficial Leg Vessels - Close up of superficial leg vessels amenable to sclerotherapy or laser.

Eczema

Dry Eczematous Skin - Dry eczematous skin on a patient

Flexural Eczema - Flexural eczema on a patients arm

Frequently Asked Questions

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. Whilst symptoms may go into remission of their own accord, without proper treatment and control, it is unlikely that they will go away permanently

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

It is often difficult for an untrained eye to tell the difference between the two conditions.

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

The Cadogan Clinic is based at 120 Sloane Street in Chelsea, just off Sloane Square and the Kings Road.

Our address is 120 Sloane Street, Chelsea, London, SW1X 9BW.

We are accessible by all major bus routes that pass through Sloane Square and Sloane Street, as well as Sloane Square tube station.

Local pay parking is available just around the corner from the Clinic on Cadogan Gate, Cadogan Square and Cadogan Gardens. Our local residential parking zone is the Royal Borough of Kensington & Chelsea.

How to find us

The Cadogan Clinic is based at 120 Sloane Street in Chelsea, just off Sloane Square and the Kings Road.

We are accessible by all major bus routes that pass through Sloane Square and Sloane Street, as well as Sloane Square tube station.

We are just a 5 minute walk northwards up Sloane Street once you have arrived at Sloane Square.

Local pay parking is available just around the corner from the Clinic on Cadogan Gate, Cadogan Square and Cadogan Gardens. Our local residential parking zone is the Royal Borough of Kensington & Chelsea.

Address: 120 Sloane Street, Chelsea, London, SW1X 9BW

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