What is Psoriasis?
Psoriasis is a common life-long inflammatory disease. The condition is not infectious. It does not scar the skin but can sometimes cause an increase or reduction in skin pigmentation. The condition can affect the nails and joints as well as the skin, in fact almost half of people with psoriasis have psoriasis affecting the nails. The outer layers of your skin contain skin cells which are constantly being replaced. It often takes around 3-4 weeks for this process of skin cell replacement to take place but with psoriasis, this process is accelerated with cells being shed in just 3-4 days.
What causes Psoriasis
The actual cause of psoriasis is unknown. Environmental factors can trigger psoriasis and inherited factors have also been found to increase the likelihood of triggering psoriasis. Psoriasis is more common where a family member suffers from the condition. Psoriasis causes also include infections and stress. Smoking and excess alcohol may cause psoriasis to be worse. Certain medications such as beta blockers, lithium and anti-malaria tablets can also cause psoriasis to become more severe.
Who is at risk of psoriasis?
Psoriasis occurs in all races in both men and women at any age affecting about 2% of the population.
What are the symptoms of Psoriasis
Skin affected by psoriasis tends to be pink or red with silvery-white scales. Some people may suffer from several plaques covering large areas of the body. The condition can be itchy and painful, particularly if it affects the scalp and groin areas. It often affects the nails too and it can be painful lifting the nail from the nail bed. Painful cracks may develop on hands and feet if they are affected by psoriasis. Psoriatic arthritis sufferers may experience pain, swelling and stiffness in joints.
There are four patterns of the condition that are recognised including:
Chronic plaque psoriasis which affects the knees, elbows, torso and scalp.
Guttate psoriasis which are small plaques of the condition scattered over the torso and limbs.
Palmoplantar psoriasis which affects the hands and feet.
Pustular psoriasis which affects the torso and limbs with tiny pus spots.
How is psoriasis diagnosed?
A Dermatologist will often diagnose the condition by visually examining the appearance and distribution of the scales and plaques on the skin. A Rheumatologist may be involved in diagnosing psoriatic arthritis.
How do you treat Psoriasis
There is no cure for psoriasis so psoriasis treatment aims to manage the condition. There are many effective treatments to clear the lesions and control symptoms. Psoriasis treatment depends on your individual circumstances and severity of your condition. Topical treatments include creams, ointments, gels and lotions such as corticosteroids, calcipotriol, tazarotene, coal tar and dithranol, which your Dermatologist will prescribe you. For those with more extensive psoriasis, phototherapy (a light treatment), systemic (tablet) treatment or biologics (injectable treatment) may be required.
Ultraviolet (UV) phototherapy is a treatment using two types of ultraviolet light (narrowband UVB and PUVA) in a way to treat psoriasis effectively. The treatment will usually take about 8-10 weeks with frequent sessions each week. Phototherapy will keep psoriasis away for a period after treatment.
There are systemic (tablet) treatments such as methotrexate, acitretin, ciclosporin which are prescribed by a Dermatologist and monitored often with blood tests required on a regular basis.
Biologics (injectable treatment) are a newer form of treatment that while expensive, can give excellent results as a treatment for managing psoriasis. These are either administered by injection from a Dermatologist or Dermatology nurse, or there are home injection versions available. Blood tests are often required to monitor during treatment. Current available biologics include etanercept, adalimumab, infliximab, ustekinumab, secukinumab and ixekizumab.
You can discuss treatment options in a consultation with a Dermatologist to determine the most suitable options for you.
The Dermatologist will encourage you to adopt a healthy lifestyle, exercise regularly, stop smoking and reduce excess alcohol as these can all help manage the severity of the psoriasis.
As Psoriasis effects the physical appearance, patients can suffer from depression and anxiety and patients may avoid activities such as swimming or outdoor sports from embarrassment, so it is important that the psychological and emotional impacts of psoriasis are also addressed. There are a number of very good patient support groups that a Dermatologist can direct you to for support.
Where can I get patient support for Psoriasis?
Psoriasis and Psoriatic Arthritis Alliance. For independent support, advice and a positive approach. http://www.papaa.org/
Psoriasis association. The Psoriasis Association aims to raise awareness of psoriasis; to provide information, advice and support to those affected by psoriasis; and to promote and fund research into psoriasis. https://www.psoriasis-association.org.uk/
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