Psoriasis

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The word psoriasis is derived from the Greek word ‘psora’ which means ‘to itch’

What is it?
Psoriasis is a chronic skin condition which tends to come back from time to time.  A flare up can occur at any time. The skin becomes inflamed and typically develops as patches which can be described as salmon pink plaques bearing large adherent silvery centrally attached scales.  Psoriasis is not infectious.

It can present itself in a mild form where the patient is unaware that they have psoriasis so there are few small patches or it can be very severe where there are many patches of varying size rendering the patient socially disabled and in rare instances be life threatening.  However, in many people the degree of severity is somewhere between these two extremes. It’s no surprise that psoriasis can have a major impact on the patient’s quality of life.

What causes it?
The precise cause of psoriasis is unknown although it is apparent that there is a genetic predisposition and sometimes obvious environmental stimuli, for e.g exposure to certain stimuli such as streptococcal infection in the throat, alcohol, medicines, and local irritation or damage to skin can cause an outbreak in a person who has a genetic predisposition.

Who is affected and most at risk?
2% of the population are affected in the UK. It can start at any age but usually early onset is between 16-22 years of age and late onset strikes between 50-60 years. People most as risk will have a family member with psoriasis especially if they are exposed to stress, alcoholism, infections, medical treatment or events such as divorce, bereavement or moving house.

 What are the symptoms?
There are 2 main types of psoriasis, psoriasis vulgaris (plaque psoriasis) and psoriasis pustulosa (pustular psoriasis). These can be further divided into subgroups according to severity, duration and location on body including the appearance of lesions. Approx 6% of psoriasis sufferers will also have psoriatic arthritis in the joints.

Most cases of psoriasis go through cycles causing problems for a few weeks or months before easing or even stopping. People tend to have 1 form of psoriasis at a time although 2 types can occur together. One type may change into another type or become more severe.

Plaque psoriasis
This is the more common form of psoriasis as 80% of sufferers have this type of psoriasis. Lesions are well defined and can range from a few mm to several cm in diameter. Lesions are pink or red with large dry silvery white scales (like candle grease). They tend to cover elbows, knees, lower back and scalp although can appear elsewhere. The plaques can be itchy, sore or both.

Flexural psoriasis occurs in the skin folds (flexures). Red itchy patches appear in armpits, under breasts or stomach, groin or buttocks. Plaques can often become infected by yeast like fungus candida albicans.

Guttate psoriasis, usually seen in children and adolescents, may be the first sign of disease. It is often triggered by streptococcal tonsillitis.

Numerous small round red patches appear suddenly over the entire body and in many cases the condition disappears by itself.

Psoriasis of scalp The scalp is often involved. Areas of the scalp are interspersed with normal skin, their lumpiness are more easily felt than seen. It frequently overflows just beyond the scalp margin. Hair loss is rare.

Pustular psoriasis (PP)
is a rare variant but very serious condition where the inflammation is so severe that in addition to usual lesions, blisters and pustules containing fluid appear on the skin. The severity of this condition varies.

How is it diagnosed?
Careful physical examination of the skin is the method of diagnosis. If the doctor is in any doubt a biopsy or a very small section of the skin is taken and sent away for examination.

What is the treatment and is there any special advice?
Psoriasis can be treated effectively although the treatment is not a cure. Treatment focuses on ensuring a better quality of life. The treatment depends on the patient’s age, state of health and on the nature of the psoriasis. Treatments tend to focus on the following:

Moisturisers: help to reduce dryness, cracking and scaling of the skin. Sometimes in mild cases moisturisers are all that is needed.

Creams, lotions, ointments: These treatments can be effective as they contain coal tar, dithrnol, tazarotene (Zorac) or vitamin D related compounds e.g calcipotriol (Dovonex)  calcitriol(Silkis)or tacalcitol (Curatoderm).

Corticosteroid containing ointments are used for a short time. Combining corticosteroid with another topical treatment either as separate products used at different times of the day or as a combination product e.g (Dovobet (calcipotiol and betamethasone) or Alphosyl HC (coal tar and hydrocortisone) may be beneficial for chronic psoriasis vulgaris.

Oral treatment or injections with immunosuppresants can be admininstered in severe cases.

Intensive research is being carried out to find better treatments and new treatments are regularly introduced

Special lotions are available for scalp treatment. These often contain salicyclic acid, coal tar, sulphur or corticosteroids.

Special light therapy and very potent medication can be options for severe cases where creams and ointments have not worked well.

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