Psoriasis 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 affecting the scalp, face and folds of skin (such as the back of your knees and elbows). It is an autoimmune disease, which is not contagious, and occurs when the body’s immune system mistakes healthy cells for dangerous substances.

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. Among the factors that can trigger a psoriasis attack are 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; as well as excessive alcohol consumption.

In some severe cases of psoriasis, our dermatologists may resort to pills 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.

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.

 

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

Of the three main types of treatments for psoriasis -topical, light therapy (phototherapy) and medication, medication is the strongest and used for the most severe cases of psoriasis or those which have not responded satisfactorily to topical treatment +/- phototherapy.

Medication is either oral or by injection and although very effective at treating psoriasis, it comes with potential major side effects and is therefore reserved for the more serious cases. The majority of patients find that the gentler topical and light therapy treatments control their psoriasis satisfactorily.

Topical Treatments for psoriasis include:

•    Emollients and Moisturizers: regular use of emollients and moisturizers help soften psoriasis scale and increase moisturization of the skin, improving the scaly, dry and irritating feeling of psoriasis.

•    Keratolytic Agents: these can be used to treat thicker scale psoriasis and psoriasis on the feet They may contain ingredients such as urea (5-40%), salicylic acid (0.5-10%) and propylene glycol (up to 20%).

•    Topical Steroids: these are generally safe and help with the treatment of plaque psoriasis, scalp psoriasis, sebopsoriasis and flexural psoriasis, as well as psoriasis that affects the palms and soles. Topical steroids can be used in combination of other compounds such as calcipotriol, salicylic acid or antifungal agents.

•    Vitamin D Compounds: these can be used once or twice per day to reduce the redness and thickness of scaling, and include compounds such as calcipotriol, calcitriol and tacalcitol.

•    Tar: coal tar is used in many variations to treat psoriasis. It can be applied as a cream, shampoo, lotion, ointment or gel.  It is most suitable for small plaque and guttate psoriasis when used on the body. It can be irritating to the skin and messy, causing staining to body, clothes and hair, so care is to be taken when selecting and using tar for treatment.

•    Dithranol: is also called anthralin, is now mostly prescribed as Dithrocream and can be effective for the treatment of chronic plaque psoriasis. It does temporarily stain the skin and permanently stain clothes.

•    Calcineurin Inhibitors: these are used off-license to treat psoriasis, as their main treatment is for atopic dermatitis.

•    Tazarotene: this is a topical retinoid which can be applied once daily to plaque psoriasis. A common side effect is local irritation.

•    Light therapy (phototherapy) is noninvasive but there is a limit on the number of treatments one can have over a lifetime as excess sun exposure is known to be associated with certain skin cancers.

Types of light therapy for psoriasis include:

•    Narrowband Ultraviolet B: concentrated ultraviolet B light that treats psoriasis with multiple short exposure three times weekly treatments over six weeks.

•    Psoralens Plus Ultraviolet A: this treatment combines a medication (psoralens) which increases light sensitivity with UVA light exposure in a twice-weekly treatment regime often used for more severe cases or those who have not responded satisfactorily to UVB.

•    Controlled Sunlight Exposure: the goal of controlled light exposure is to reduce inflammation and slow new skin cell production; this is the easiest and most basic form of light therapy for psoriasis, but should not be taken on without direction and guidance from a doctor.

Psoriasis is a chronic disease that flares and subsides intermittently. While there is no cure for psoriasis (meaning the condition cannot be eradicated completely so it can be guaranteed there will never be a future flare ) there are many ways to manage the symptoms.

There are three main types of treatment for psoriasis:

       1.Topical

       2. Light therapy

       3. Medication

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.

Types of topical treatments for psoriasis 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.

 

Phototherapy

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.

Your doctor always chooses the most appropriate treatment for you in consultation and taking into account your wishes.

 

Systemic Medication

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)

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, can be treated with Roaccutane.

Acne - Acne on the cheek, can be treated with Roaccutane.

Autoimmune

Alopecia - Alopeca areata

Allergies

Urticaria - Urticaria or hives

Pigmentation

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

Vitiligo - On a patient

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

 

 

ENQUIRE NOW

To enquire about a consultation with a Psoriasis specialist, please complete the form below.

I have read and understand Cadogan Clinic's Privacy Notice

From time to time we may wish to keep you up-to-date with information, offers and promotions we feel will be of interest to you. If you do not wish to receive such information, please uncheck this box.

Submitting your request

Related News

Why Cadogan Clinic?

Book a Consultation