Psoriasis

Psoriasis is a skin condition that results in red, flaky, crusty patches of skin covered with silvery or whitish ‘scales’.

Psoriasis is relatively common and affects 2-3% of the U.K. population. Typically, psoriasis is considered to be a long-term issue, which means it’s what’s known as a chronic condition.

While the presentation of the condition is different in each individual, psoriasis patches commonly appear on the knees, elbows and scalp. It can be itchy and painful, and can also cause joint problems, known as psoriatic arthritis.

As a result of the chronic, uncomfortable and sometimes unpredictable nature of the condition, many patients find that it negatively impacts their quality of life and self-confidence. For these reasons, as well as its unsightly presentation, it is common for patients suffering from psoriasis – especially in its more severe forms – to also experience psychological issues, such as depression and anxiety.

Enquire

Psoriasis

While psoriasis cannot be cured, with medical help the condition is manageable, and there are some techniques that patients may find helpful in identifying triggers and reducing their flare-ups.

Symptoms of Psoriasis

The presentation of psoriasis is varied, and thus it may be confused with other skin conditions.

This is why it’s important to be diagnosed by a doctor, to ensure the proper treatment course can be advised and monitored.

Common signs and symptoms of psoriasis include:

Red patches covered with thick, silvery scales
Small scaly spots (often seen in children)
Itchy, ‘burning’ sensations or soreness at the site
Dry, cracked skin that may bleed
Thickened, pitted or ridged nails
Swollen and stiff joints

The severity of psoriasis is also varied, and patches can present either as a few areas that shed dandruff-like scales, or as skin eruptions that cover large areas.

Most types of psoriasis go through cycles, causing flare-ups that last a few weeks or months, and then subside for a time, or can go into remission.

There are several types of psoriasis. These include:

Plaque Psoriasis

80% of psoriasis sufferers experience this form, which presents as dry, raised, red skin lesions (also called plaques) covered with silvery scales. Plaques may be itchy or sore, and can present anywhere on the body, including in the genital area.

Nail Psoriasis

When the condition affects the fingernails or toenails, it can cause pitting (tiny depressions in the flat surface of the nails), abnormal nail growth and discolouration. Psoriatic nails can also loosen and separate from the nail bed, which is known as onycholysis. In more severe cases, psoriasis may cause the nail to crumble.

Guttate Psoriasis

This form usually affects younger people, and presents as small, water-drop-shaped scaly lesions on the upper part of the body.

Inverse Psoriasis

This form causes smooth patches of red, inflamed skin which is worsened by friction and sweating. Typically, it affects the skin in the armpits, under the breasts, and in the groin or genital area.

Pustular Psoriasis

This rarer form of psoriasis may occur in widespread patches (also called generalised pustular psoriasis) or in smaller areas, such as the hands, feet or fingertips. It typically develops quickly, with pus-filled blisters appearing in the hours after skin becomes red and tender. Blisters may come and go frequently, and will sometimes be accompanied by fever, chills and severe itching.

Erythrodermic Psoriasis

The rarest form of the condition covers the entire body with a red, peeling rash that is likely to itch or burn intensely. This usually occurs in the setting of known worsening or unstable psoriasis and can be fatal.

Psoriatic Arthritis

Presenting alongside inflamed, scaly skin, the condition causes swollen, painful joints that are typical of arthritis. Joint symptoms may be the first or only manifestations of the condition, and at times only changes in the nails are evident. The condition varies in severity and can affect any joint. While it is not typically as severe as other forms of arthritis, it can cause stiffness and progressive joint damage.

Scratching or otherwise interfering with psoriasis may cause infection or other complications, so it is important to seek medical advice if the condition persists or worsens.

Causes of Psoriasis

The causes of psoriasis aren’t fully understood, but experts think it’s related to a problem in the immune system involving T cells (a type of white blood cell) and other white blood cells, which are called neutrophils.

While normally, T cells travel throughout the body to defend against viruses or bacteria, in patients with psoriasis, the T cells malfunction and attack healthy skin cells as though fighting an infection or foreign substance.

The process becomes an ongoing cycle, in which new skin cells move to the outermost layer of skin too quickly — in days, rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.

There are few ‘proven’ triggers for psoriasis, although patients often report flare-ups associated with stress, alcohol, infections and certain medications.

The condition is seen as likely to be influenced by genetics, so it is possible that if an individual’s parents have experienced problems with psoriasis, they may be more likely to have the same trouble.

Different types of psoriasis may have different causes, for example:

Guttate Psoriasis

This is typically triggered by a bacterial infection, such as a streptococcal throat infection.

Inverse Psoriasis

Fungal infections may trigger this type of psoriasis.

Erythrodermic Psoriasis

The exact cause is rare, but it may be brought on by suddenly stopping treatment for a more common or less serious type of psoriasis.

Psoriatic Arthritis

As the immune system begins to attack healthy cells and tissue, it causes inflammation in the joints as well as overproduction of skin cells.

Treatment of Psoriasis at Derma

Your appointment will begin with a skin check and medical history, followed by recommended treatment options.

Together with the dermatologist, you will discuss the latest and most effective treatments and explain all potential side-effects, enabling you to select the best option for you.

Mild to moderate forms of psoriasis may be controlled using topical treatments available from chemists, but depending on your condition, prescription creams may be necessary. The dermatologist will let you know whether it is beneficial to continue with any over-the-counter treatment, or if it is advisable to stop.

Additionally, Derma offers Narrow-band phototherapy, which uses ultraviolet (UV) light to treat psoriasis, and is often effective in managing the condition. A course of treatment requires 3 visits to the hospital each week for around 8 weeks, but the results last several weeks. It may be helpful during periods where the condition is more prone to flare-ups, such as during the dry, cold winter months.

You may be a candidate for treatment using medication that works to suppress the immune system; however, this treatment requires you to be closely monitored.

Depending on the treatment and the severity of your condition, further tests and follow-up appointments may be required to manage your treatment.

Further reading: Patient leaflet from the British Association of Dermatologists

Psoriasis – an overview

Frequently Asked Questions

Is psoriasis contagious?

No, psoriasis is not a contagious skin condition. It cannot spread from person to person. Psoriasis is a chronic skin condition that can run in families and results in red, scaly patches and plaques on the skin. It tends to persist lifelong but fluctuates in extent and severity.

Is psoriasis itchy?

Psoriasis can be itchy and it usually causes mild symptoms but can be severe in some patients which can make the skin thicken (lichenification) and then painful cracks can increase the risk of infection.

Does psoriasis go away on its own?

Psoriasis is a chronic skin condition which can fluctuate so it can clear spontaneously but has a tendency to recur at some point in the future.

Is psoriasis genetic?

Genes are certainly important in the cause of psoriasis as it often runs in families. The exact relationship between the genes and how they interact with the environment is complex and not fully understood as yet but a lot of research is being undertaken in this field.

Is psoriasis hereditary?

Psoriasis can run in families although the exact role that genetics plays is unclear. There will be patients who have no family history that they are aware of and still develop psoriasis. If both parents have psoriasis then the risk of their children developing psoriasis is thought to be around 75%, but if only one parent has psoriasis then the risk is around 15%.

What is the difference between eczema and psoriasis?

Psoriasis and eczema are both chronic inflammatory skin conditions that can cause considerable distress. Generally speaking, eczema tends to be itchier and affect the flexures whereas psoriasis causes a milder degree of itching and is commoner on the extensor surfaces of the joints. Occasionally psoriasis can affect the joints and cause psoriatic arthropathy whereas there is no direct joint involvement with eczema.

Can psoriasis spread?

Psoriasis is caused by a complex interaction between your genes and the environment. The condition can range from mild with only a few patches to severe where most of the body is involved. There are several factors that may cause a flare-up which can allow the psoriasis to spread. These triggers include infection, smoking, injury to the skin such as a cut or a burn, stress, excess alcohol, certain medications such as beta-blockers, obesity and vitamin D deficiency.

Enquire