Everything you need to know about psoriasis, from cause to cure
Psoriasis is a non-contagious condition that causes itchy, dry patches of skin. In the UK alone, it is thought that it affects up to 1.8 million people, yet medical professionals are still not certain of its cause. Psoriasis is a chronic (long-term) condition that can come and go over the years, but there are many ways to manage the symptoms and prevent it from negatively impacting on your life.
What causes psoriasis?
Psoriasis is caused by an over-production of skin cells. Typically, skin cells are made and replaced every 3 to 4 weeks, whereas for those with psoriasis, this process only takes about 3 to 7 days, causing a build-up of skin cells. This is what creates the dry, raised patches of skin. It is not known why this process occurs, but it is thought that the immune systems of people with psoriasis attack healthy skin cells by mistake. The condition can be hereditary, and it may be some comfort to be able to discuss with close relatives what helps them to alleviate their symptoms.
What are the symptoms of psoriasis?
Psoriasis appears as red or pink patches of dry skin with a covering of silver scaling. It is not always painful, but some do experience itchiness and soreness. There are several common types of psoriasis:
Accounting for about 80-90% of cases, plaque psoriasis is the most common form. The red, scaly skin lesions are known as plaques, which usually occur on the elbows, knees and lower back, though they may be found anywhere on the body. These plaques may feel itchy and sore, especially if the dry skin cracks around the joints.
Around half of those with psoriasis will find that the nails are affected by the condition too. The nails may start to yellow and appear thick and dented, with pink discoloured areas under the nail.
This type of psoriasis causes scaly patches of skin that can occur on parts of the scalp or the whole scalp – for some it is very itchy, but others experience no discomfort. It can be addressed with medicated shampoo. Some of these products are available over the counter, but a prescription will be needed for stronger varieties.
Guttate psoriasis is characterised by small, drop-shaped sores (less than 1cm) that appear on the chest, arms, legs and scalp. Thankfully, it’s likely to disappear after a few weeks, although some do go on to develop plaque psoriasis. It is most common in children and teenagers and can occur after a streptococcal throat infection (a bacterial infection that causes the throat and tonsils to become painful and inflamed).
Inverse (flexural) psoriasis
Affecting folds or creases of skin, inverse psoriasis can cause large, smooth red patches in the armpits, groin, under the breasts and between the buttocks. Friction and sweating can exacerbate it, which can be problematic in the summer months.
Much rarer than the previously mentioned types of psoriasis, pustular psoriasis causes pus-filled blisters (pustules) to appear on the skin.
Often causing inflammation, swelling and stiffness in the hands, feet, elbows, neck and spine, psoriatic arthritis is a long-term condition that can develop in those with psoriasis. Doctors may prescribe non-steroidal anti-inflammatory drugs or corticosteroids to help alleviate the pain and swelling.
Sometimes, there are triggers which cause psoriasis to flare up. Cold weather may dry out skin, increasing chances of a flare-up. Certain medications can also be triggering. If you are prescribed beta-blockers, anti-malarial pills or steroidal medicines, be sure to let your doctor know that you have psoriasis. Alternatively, symptoms are often triggered by stress. If this is the case, it is important not to self-medicate with alcohol or nicotine, as these can make symptoms more severe.
Although there isn’t a direct cure, there are a number of ways to manage psoriasis, which may disappear for periods of time. In mild cases, the first treatment you will be offered is likely to be an emollient cream, which covers sore patches with a protective film. This prevents water loss and stops your skin from drying out too much, helping reduce scaling and itching. A prescription topical treatment (something you apply to your skin) may well be all you need to keep symptoms under control. These include corticosteroids and vitamin D analogues, which help reduce inflammation and lower the skin cell turnover. If you are prescribed a topical cream, it will be more effective on properly moisturised skin, so wait at least half an hour after applying an emollient.
Light therapy is another option. While too much sunshine may in fact trigger psoriasis, moderate amounts can help symptoms, so your doctor may use phototherapy – exposing your skin to artificial ultraviolet light – as a treatment. This type of treatment is usually given by a dermatologist in a hospital or specialist centre. If these are ineffective, doctors may resort to systemic medications, which are oral or injected medications that work throughout the entire body by reducing skin cell production or suppressing the immune system.
Good gut health for psoriasis
Maintaining good gut health is one way to help guard against autoimmune diseases, as 60-70% of our immune cells are found in the gut. By introducing a wide range of good bacteria to our guts, we can prepare our cells to respond appropriately to encounters with pathogens. Restoring bacterial balance can reduce inflammation and, by extension, may reduce flare-ups of the skin. In one case study, a woman was given the probiotic Lactobacillus after her pustular psoriasis was unresponsive to conventional treatments. Within a fortnight, her lesions started subsiding. While probiotics alone are not a formal medication for psoriasis, it may be worth taking a multi-strain supplement alongside other treatments to guard against inflammation.
While psoriasis may be distressing, it is important to remember that it is not uncommon and it is not contagious. Symptoms can be managed with appropriate treatment, and it will often disappear of its own accord for stretches of time. Get to know your triggers and remember that while treatments will take time to be effective, they are worth the wait.
More information about the condition can be found on the Psoriasis Association’s website and through the NHS. Liz’s quick guide, Dry Skin & Eczema, is another great resource that details skincare and nutrients that can help address skin complaints, including psoriasis.