Psoriasis

Psoriasis is a non-contagious auto-immune condition, which causes symptoms on the skin, nails and sometimes the joints, and currently affects around 2% of people in the UK. It can start at any age, but often first develops in adults aged under 35, affecting both men and women equally. Psoriasis is more than just a skin condition and can affect people psychologically as well as physically due to the potentially extensive, uncomfortable and unsightly skin changes it creates.

People with psoriasis have a much faster skin replacement process. Usually, skin takes 21-28 days to replace itself, however psoriasis sufferers will have a process taking only a few days, which results in the formation of raised, crusty or flaky patches on the skin, covered with a silvery scale. These are referred to as psoriatic “plaques”. Plaques can form anywhere on the body, including the scalp, hands, feet and genitals. Psoriasis affects everyone differently and can vary greatly in severity. Some people find they can manage their condition at home or with support from their GP. Unfortunately, for some people their psoriasis may occasionally become severe (known as a ‘flare’) and this can greatly affect their quality of life.

Selfcare and more information

Childhood psoriasis

Approximately 4% of all skin conditions diagnosed in children under 16 are attributed to psoriasis. All types of psoriasis seen in adults can also occur in children, and treatment options tend to be similar to those available to adults.

If you would like more information about psoriasis in children PAPAA, the psoriasis and psoriatic arthritis alliance, have a great resource with more information about childhood psoriasis. They discuss types of psoriasis, potential causes, common symptoms and alongside this, general advice on living with the condition.

Causes of psoriasis

Recent research into the condition has found that the changes in the skin that cause psoriasis begin in the immune system when certain immune cells (T cells) are triggered and become overactive.

The T cells behave in the same way that they would if they were fighting an infection, or healing a wound, which triggers them to produce inflammatory chemicals. This leads to the rapid growth of skin cells and can causes the psoriatic plaques to form. This is why you may hear psoriasis being referred to an “auto-immune disease” or “immune-mediated condition”.

Despite research, it is still unclear as to why the immune system is triggered to act in such a way in the first place. It has been thought that injury to the skin, or a throat infection, may trigger the initial stages of psoriasis, but this is not currently confirmed. We know that about 3 in 10 people with psoriasis have a close relative with it too, so there may also be a genetic factor involved too.

Potential causes of psoriasis ‘flares’

Whilst psoriasis is a long term (chronic) condition, most people’s experience of psoriasis can include periods of relief; with fewer symptoms, but also unfortunately harder times, when their psoriasis becomes severe. For most people, there is no obvious reason as to why a psoriasis flare happens. For some people, however, psoriasis can get more severe in certain situations, as highlighted in the sections below.

During times of stress

Whilst it is difficult to prove a relationship between stress and psoriasis, it is thought that stress may contribute to a flare up with the condition. There is some evidence to suggest that patients with psoriasis may see an improvement in symptoms if they are treated for stress. You can find out more about managing stress by clicking here.

During an infection

Certain types of infection may cause a psoriatic flare. In particular, a sore throat caused by the germ (bacterium) streptococcus can cause a flare-up of guttate psoriasis or chronic plaque psoriasis.

Whilst taking certain medications

Some medications have been seen to possibly trigger or worsen plaque psoriasis, such as beta-blockers, anti-inflammatory painkillers as well as some antibiotics. In some cases, a flare-up may not appear until the medication has been taken for weeks or months. Medications will not cause flare ups in everyone who has psoriasis. You should talk to your doctor if you feel that your medications are influencing your skin.

If you are a smoker

In some cases, smoking may trigger the first appearance of psoriasis. Toxins in cigarette smoke may also aggravate existing psoriasis. For support to help you quit smoking, you can visit NHS Smokefree, or you can download the NHS Smokefree app; for iPhone click here, for Android click here.

You can read more information about smoking and the skin from DermNet NZ by clicking here.

After an injury to the skin

An injury to the skin, or even excessive scratching of the skin, may trigger patches of psoriasis to develop. Plaques appearing where an injury or scratch took place is known as Köbner’s phenomenon.

The amount of sunlight you are getting

Many people with psoriasis find that exposure to sunlight helps ease their symptoms and clear their psoriasis, with many finding their condition easier to manage in the warmer summer months. Others, however, notice the opposite; for some, strong sunlight can make their psoriasis worse. A severe sunburn (which is classed as a skin injury) can also lead to a psoriatic flare.

A change in hormone levels

Psoriasis in women tends to be worse during puberty and during the menopause. This is because of changes in hormone levels. Some pregnant women who have psoriasis find that their symptoms improve during pregnancy but can flare up in the months after having a baby which again is thought to be related to the changes in hormone levels.

If you are drinking large amounts of alcohol

Drinking large amounts of alcohol may also cause a psoriatic flare in some people.

What other problems can be associated with psoriasis?

Joint problems

Around 1 or 2 in 10 people with chronic plaque psoriasis also develop inflammation and pains in some joints (arthritis). This is known as psoriatic arthropathy (or psoriatic arthritis). Any joint can be affected, but it seen most in the joints of the fingers and toes. The cause for this is not yet clear.

You should see your GP if you have psoriasis and are developing joint pains or swelling.

Risk factors for cardiovascular disease

People who have psoriasis are more likely to have some of the risk factors for developing cardiovascular disease (heart disease and stroke) such as high levels of cholesterol and other fats in the blood (known as hyperlipidaemia), high blood pressure (hypertension) and diabetes. You are more likely to have these risk factors if you have severe psoriasis. You can take a heart age test, to identify your current risk and have a look at resources for keeping your heart healthy. You can also download a resource about this from the British Heart Foundation.

You may wish to speak to your practice nurse about ways in which you can lower your cardiovascular risk if you have concerns.

Obesity

Psoriasis also seems to be more common in people who suffer from obesity.

Depression and Anxiety

Living with psoriasis can make some people feel embarrassed or low in confidence, and some may develop a negative body image. Certain activities may be avoided because of this, such as swimming, for fear of uncovering skin. Sometimes, even daily life can be affected when it comes to deciding what to wear or worrying that flakes of skin may be visible to others. This may lead to anxiety at work or to personal relationships becoming affected by psoriasis. For these reasons, some people may go on to develop anxiety or depression.

Types of psoriasis & diagnosis

Types of psoriasis

There are several different types of psoriasis. You can find more information on this at NHS choices, or from the Psoriasis Association.

Diagnosing psoriasis

If you have itchy ‘plaques’ on your body, but are not certain that you have psoriasis, you may wish to visit your GP. Often, your doctor will be able to advise you if the condition is psoriasis just from looking at your skin.

In cases of doubt a small sample of skin (biopsy) can be sent to the laboratory for further examination. This determines the exact type of psoriasis and rules out other skin disorders, such as seborrheic dermatitis , lichen planus, lichen simplex or pityriasis rosea.

Managing psoriasis

Whilst there’s no cure for psoriasis, there are a range of treatments available that can improve symptoms and the appearance of skin patches.

Treatment options

Topical treatment

In most cases, the first treatments suggested are ‘topical’ treatments – which means creams or ointments that are applied to the skin. These are most suitable for people who have mild to moderate psoriasis.

If you suffer with scalp psoriasis, your doctor may recommend using Olive Oil on your scalp to help remove thickened skin, which can be washed off after a few hours using a tar-based shampoo.

Some people find that topical treatment is all that is needed to control their condition, although it may take up to 6 weeks of use before there is a noticeable effect.
You can read more about topical treatments on the NHS website.

Further treatment

If you have tried topical treatments, your GP may decide to refer you to a skin specialist (dermatologist). This may be because your doctor is uncertain about your diagnosis, or because your condition is severe.

When seeing a skin specialist for the first time, it is best to bring a list of any creams and ointments that you have tried. The dermatologist will want to know about your skincare regime, both the creams that you have been prescribed by your doctor, and items bought at your local pharmacy. Your dermatologist will also want to know how and when you are applying these; so, it will be helpful to have all this information written down prior to your appointment.

Based on your examination, the skin specialist will discuss with you your options for further treatment. They may offer advice on different creams and emollients or on making changes to your existing skin care routine.

If you have tried creams without any relief of your symptoms, or your psoriasis is more severe, a treatment called phototherapy may be used. Phototherapy is a type of ultraviolet light treatment that usually takes place in a local dermatology unit.

If the above treatments are ineffective, systemic treatments may be used. These are oral or injected medicines that work throughout the whole body.

Your dermatologist will be able to discuss the options that are available to you and discuss possible risks and benefits of these options.

Psoriatic arthritis treatment

If your doctor suspects that you have psoriatic arthropathy, which can sometimes be a complication of psoriasis, your GP may wish to refer you to a specialist in arthritis (rheumatologist). You may need to have blood tests to rule out other conditions such as rheumatoid arthritis, and X-rays of the affected joints may be taken. Your rheumatologist will discuss any treatment options with you.

The appearance of psoriasis

Having psoriatic plaques on visible areas of the body, such as the face and chest, can often impact upon a person’s self-esteem, potentially leading on to depression or anxiety.

If you feel that you would benefit from learning more about cover products, in order to help camouflage distressing psoriasis patches, you can visit the changing faces website and find your nearest clinic by clicking here. The team will help you find the best colour match and teach you how to self-apply the specialist products.

The products that will be recommended to you are sometimes available on prescription, but this will be down to local NHS policies. Changing faces will therefore not be able to guarantee that everyone will receive a prescription.

Useful information about my psoriasis

Videos about my psoriasis

Psoriasis | https://www.nhs.uk

NHS | published on 22 April 2008

Treating scalp psoriasis | https://www.guysandstthomas.nhs.uk

Guy’s and St Thomas’ NHS Foundation Trust | published on 28 June 2017

How to use topical steriods | https://www.guysandstthomas.nhs.uk