Monday 29th of October is World Psoriasis Day and to mark it we would like to increase awareness of the condition, dispel some myths and make people aware of different treatments available for it.
What is Psoriasis?
Psoriasis is a chronic skin problem characterized by a scaly rash in the skin. A picture of the typical rash of psoriasis is shown here although it can look different in some cases. Psoriasis often appears on the elbows and knees, around the tummy button and ears and may also affect the nails and scalp. It can be very itchy and areas with psoriasis are prone to bleeding. If you think you may have psoriasis you should take the opportunity to see your GP.
For individuals who develop psoriasis it can be a disfiguring and embarrassing condition. Many patients report that psoriasis has a very negative impact on their quality of life, limits their social and professional activities and often leaves them feeling isolated. Indeed it is recognized that patients with psoriasis are at a higher risk of developing anxiety and depression than the general population.
Phototherapy uses the portion of light known as UVA and UVB. These are two different types of UV or ultraviolet light, which is at a wavelength beyond the range that humans can see. You might be familiar with the terms UVA and UVB from sunscreen labels as these are the types of light that can burn or damage the skin.
How do you know if your psoriasis is severe?
The impact of psoriasis on a patient’s life along with the physical evidence of psoriasis are used to determine how severe psoriasis is. Increasing severity is associated with very thick/red areas of psoriasis that cover a large amount of the body.
Why do we develop it?
We all inherit multiple genes from our parents and a proportion of us inherit a set that makes it likely they will develop psoriasis at some stage in their life. Known triggers of psoriasis include throat infections, obesity, stress and even some prescribed medications. In some cases no trigger is found. Psoriasis cannot be passed from person to person (i.e. it is not an infection), it is nothing to do with personal hygiene and it is not an allergy.
The consequences of psoriasis are not just confined to the skin
Psoriasis can be much more than a simply a persistent rash. In some cases, especially in severe cases, the inflammation of psoriasis is not confined solely to the skin and affects multiple sites in our body. In the skin we can see the inflammation as a red rash and associated dryness of the skin. Inflammation at other sites is not possible to see in the same way but nevertheless has consequences. For example inflammation in blood vessel puts patients with psoriasis at elevated risk of developing high blood pressure, strokes and heart attacks. In addition it is thought that they are also at an increased risk of developing indigestion (reflux) and certain types of bowel inflammation (Crohn’s disease). I must stress that most patients with psoriasis do not develop such complications but it is important for all of us to be aware of them.
How can we treat it?
If it is partly determined in our genes and triggers that we can’t avoid in everyday life what can we do about it? Having a healthy lifestyle with no smoking, balanced diet and moderate alcohol intake all help.
Recent research has identified of the importance of weight loss, especially in obese patients with psoriasis; fat tissue can worsen inflammation in the skin and elsewhere in the body. If you are above your ideal body weight losing weight will help to treat your psoriasis.
The majority of people use steroid creams and moisturizers to control the skin condition but they need to be given the right one at the right time. Some creams are stronger than others. In more severe cases treatment such as UV light therapy (phototherapy), tablets or injections. Interestingly it is thought that up to 40% of patients who use creams have psoriasis that is severe enough to need UV light therapy, tablets or injections.
What is the right treatment for you?
Psoriasis is a disease with different forms and various impacts on life. The right treatment partly depends on the severity of psoriasis. For mild psoriasis a combination of creams may be sufficient. We use many creams for psoriasis but the most common ones have steroid, vitamin D, salicylic acid or anti-inflammatory called tacrolimus. In more severe cases we consider phototherapy, tablet treatments (usually with immunosuppressants) and injection treatments (so-called biologic treatment).
The right treatment for you will depend on how active your psoriasis is, what your lifestyle is, what other conditions you may have and of course what your goals for treatment are.
After a consultation we endeavour to provide an individualized effect treatment plan that suits our patient. Come to see me in our London or Canterbury clinics for an expert opinion regarding your skin!