What can I do about my psoriasis?
In this article we will describe what you can do about your psoriasis. Let’s start with the basics.
1. What is psoriasis?
Psoriasis is a chronic (long-term) skin disease that causes red, scaly skin that may be painful, swollen or hot.
There are periods when you have no symptoms or mild symptoms, followed by periods when symptoms are more severe.
Typical (plaque) psoriasis on back of elbow
The severity of psoriasis varies greatly from person to person. For some it is just a minor irritation, but for others it can have a big impact on quality of life.
2. Who gets psoriasis?
Psoriasis is very common and affects 2% of people in the UK.
It can start at any age, but most often develops in adults between 20 and 30 years old and between 50 and 60 years old. It affects men and women equally. The severity of psoriasis varies greatly from person to person.
Certain genes have been linked to psoriasis, so you are more likely to get it if someone else in your family has it. It is not contagious.
3. What is psoriasis linked to?
If you have psoriasis, you are more likely to acquire other conditions, including:
- Psoriatic arthritis, a condition that causes joint pain and swelling
- Cardiovascular problems, which affect the heart and blood circulation system
- Obesity
- High blood pressure
- Diabetes.
4. Causes
Psoriasis is an autoimmune disease, which means that your body’s immune system – which protects you from diseases – starts over-reacting and causing problems. If you have psoriasis, a type of white blood cell called T cells become overactive, and trigger other immune system responses, including swelling and fast turnover of skin cells.
Your skin cells grow deep in the skin and rise slowly to the surface. This is called cell turnover, and it usually takes about a month. If you have psoriasis, though, cell turnover can take only a few days. Your skin cells rise too fast and pile up on the surface, causing your skin to look red and scaly.
What causes a flare-up of psoriasis?
Some things may cause a flare, meaning your psoriasis becomes worse for a while, including:
- Stress
- Infection
- Weather changes
- Medication
- Cuts, scratches or sunburn.
5. Different types
- Plaque psoriasis – is the most common type of psoriasis. About 80-90% of people with psoriasis have plaque psoriasis
- Inverse psoriasis– appears in your skin folds. It causes thin plaques without scales
- Guttate psoriasis – may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots and often affects children and young adults
- Pustular psoriasis – has small, pus-filled bumps on top of plaques
- Erythrodermic psoriasis – is a severe type of psoriasis that affects a large area (more than 90%) of your skin. which causes red and scaly skin over much of your body. This can be a reaction to a bad sunburn or taking certain medications, such as corticosteroids. It can also happen if you have a different type of psoriasis that is not well controlled. This type of psoriasis can be very serious, so if you have it, you should see a doctor immediately
- Nail psoriasis – causes skin discoloration, pitting and changes to your fingernails and toenails.
6. What does psoriasis look like?
It depends on the type.
The common (plaque) type causes well-defined patches of thick, red skin with silvery scales that itch or feel sore. These patches can show up anywhere on your body, but usually occur on the back of the elbows, and front of the knees.
They can also occur on the legs, scalp, lower back, buttocks and genitals, face, inside of mouth, and palms and soles of your feet.
In 50% people with psoriasis it can also affect the finger nails (and/or toenails), causing pitting or even to loosen and separate them from the nail bed.
You may find that your skin gets worse for a while, which is called a flare-up, and then improves.
Eczema and psoriasis are different. Psoriasis is white and flaky, and tends to affect the back of the elbows. Eczema is red and itchy, and affects the front
7. Diagnosis
Psoriasis is usually diagnosed by the typical appearance of the rash. No tests are usually needed.
But in a few cases, psoriasis can be hard to diagnose because it can look like other skin diseases.
If there is uncertainty, your GP may refer you to a skin specialist doctor at the hospital (called a consultant dermatologist). They may do a skin biopsy, which means taking a small sample of your skin, and looking at it under the microscope.
8. Treatment
There is no cure for psoriasis, but it can be treated and managed.
Psoriasis is unique to each individual, and a treatment that works for one person doesn’t necessarily work for another. Because of this, treating psoriasis can be a process of trial and error, and it can be frustrating.
There are several different types of treatment for psoriasis. You may need one of these or a combination of them:
- Moisturisers and emollients (topical, which means putting cream on your skin)
- Topical vitamin D
- Topical steroids
- Coal tar preparations
- Dithranol preparations.
Treatments from a dermatologist
If psoriasis is severe, or if various types of topical treatments do not work, your GP will refer you a hospital specialist called a dermatologist. They may treat you with:
- Ultraviolet light therapy
- Systemic treatments – tablets and injections that suppress the immune system. These include calcineurin inhibitors such as ciclosporin, and methotrexate
- Biological agents – are used for both psoriasis and psoriatic arthritis. They work by interfering with specific components of the immune system. Unlike general immunosuppressants that suppress the entire immune system, biologicals fight more selectively and target only those chemicals causing psoriasis.
9. Psychological impact
The effect that psoriasis can have on physical appearance means low self-esteem and anxiety are common among people with the condition. This can lead to depression, especially if the psoriasis gets worse.
Your GP or dermatologist will understand the psychological and emotional impact of psoriasis. So talk to them about your concerns or anxieties. Referral to a psychologist or psychiatrist may be necessary.
Joining a support group may help you to cope with this disease.
10. Psoriatic arthritis
Some people with psoriasis develop a complication called psoriatic arthritis. This shows itself as tenderness, pain and swelling in the joints. It can affect any joint in the body but often affects the hands, feet, knees, neck, spine and elbows.
Most people develop psoriatic arthritis after psoriasis, but some people develop it before they are diagnosed with psoriasis.
Psoriatic arthritis can present in different ways
If your GP thinks you have psoriatic arthritis, you will usually be referred to a hospital specialist called a consultant rheumatologist; so you can be treated with anti-inflammatory or anti-rheumatic medication.
Summary
We have described what you can do about your psoriasis. We hope it has been helpful.
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