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Psoriasis

Psoriasis is a common skin condition that causes raised patches of inflamed skin. It varies in severity from person to person and can come and go over time. You can’t catch psoriasis or pass it on to other people.

Your skin is made up of several layers, the top one of which constantly sheds old cells and replaces them with new ones from underneath. This happens in a cycle that usually takes about 28 days. If you have psoriasis, the rate at which your skin is replaced in the affected area increases and the cycle can be as short as two to six days. New skin cells move to the surface before they have properly matured and build up on your skin in thick patches called plaques. There is also a build-up of a type of blood cell (called T-cells) under your skin, which causes inflammation.

Psoriasis affects about two in 100 people. It can begin at any age, but commonly develops either in early adult life between the ages of 15 and 30 or later between 50 and 60. It affects similar numbers of men and women.

Psoriasis is a life-long condition and it’s unlikely that you will ever be completely free of it. However, it tends to fluctuate in severity over time, often for no apparent reason. This means that you may have flare-ups when the symptoms are more severe, but at other times the condition may hardly be noticeable.

Psoriasis isn't contagious, so you can't catch it from other people and it doesn't spread from one part of your body to another.

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An image showing a close-up of plaque psoriasis on the skin

Details

  • Types Types of psoriasis

    There are a number of different types of psoriasis.

    Plaque psoriasis

    Plaque psoriasis is the most common type of psoriasis, where you get pinkish-red, scaly plaques (raised patches), especially on your knees and elbows.

    Flexural psoriasis

    Flexural psoriasis is also known as inverse psoriasis. It affects areas where your skin folds, such as your armpits and groin area. Your skin tends to be thinner and more sensitive in these areas. Flexural psoriasis causes patches of bright red, shiny skin – these may be slightly itchy or uncomfortable. You may have flexural psoriasis at the same time as having plaques elsewhere on your body.

    Pustular psoriasis

    This is a rare, severe form of the condition in which small pus-filled spots (pustules) develop on your skin. If this happens all over your body, it's called generalised pustular psoriasis. This can be a life-threatening condition and you’re likely to need to be treated in hospital.

    Erythrodermic psoriasis

    Erythrodermic psoriasis is another rare and severe form of the condition in which your skin becomes red and inflamed all over – it looks like sunburn. The inflammation can result in serious complications and usually needs to be treated in hospital. Erythrodermic psoriasis usually only develops in people who already have another type of psoriasis.

    Guttate psoriasis

    In this form of psoriasis, small, scaly, inflamed spots of skin suddenly appear all over your body – their appearance is sometimes described as looking like rain droplets. It tends to affect children and young adults, often after a throat infection.

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  • Symptoms Symptoms of psoriasis

    Psoriasis occurs in different forms, but you will usually have thickened, red patches of skin, which may have silver/white scales. The patches can vary in size and are clearly defined from the surrounding skin. Your skin may feel itchy, painful or sore. If you have mild symptoms, you may not be aware that you have psoriasis.

    Some types of psoriasis can affect your scalp and cause redness and flaking. It can also affect your fingernails, which can become pitted, thickened or loosened from the nail bed.

    If you have any of these symptoms, see your GP.

  • Diagnosis Diagnosis of psoriasis

    Your GP will ask about your symptoms and examine you. He or she will probably be able to diagnose psoriasis from your symptoms and by looking at your skin and nails. Your GP may refer you to a dermatologist (a doctor who specialises in identifying and treating skin conditions) if a definite diagnosis can’t be made or if your psoriasis is:

    • extensive or severe
    • affecting your education or work
    • not responding to treatment

    If you have generalised pustular psoriasis or erythrodermic psoriasis, you may need to go to hospital for urgent treatment.

  • Treatment Treatment of psoriasis

    Although there is no cure for psoriasis, there are a number of treatments that can help relieve your symptoms. Treatments vary in how effective they are for different people and you may need to try several before you find one that works for you.

    Self-help

    Your GP will probably advise you to use emollients – creams or lotions that moisten, soften and soothe your skin. Having a warm bath may help to soften your psoriasis – your GP may suggest adding bath oil.

    Medicines

    Topical treatments

    These are treatments that you apply to your skin. Your GP may prescribe you a medicated cream or ointment – the type and strength will depend on your psoriasis, but common treatments include the following.

    • Coal tar preparations can reduce inflammation and scaling, and are often used to treat psoriasis affecting your scalp. However, they can be smelly and messy.
    • Creams that contain dithranol can be very effective, but they are messy and can irritate healthy skin, so they aren’t often prescribed.
    • Steroid preparations are often used for localised psoriasis (for example, on your elbows or knees). You may be able to use stronger steroids on your palms and soles, or your scalp. Generally, steroid creams are only used short-term.
    • Vitamin D derivatives (such as calcipotriol or tacalcitol) can be easier to use than some of the other products, but may irritate your skin.
    • Vitamin A derivatives (retinoids) can be useful, but they are prone to causing skin irritation.

    Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    Oral medicines

    If topical treatments don't control your symptoms, or if your psoriasis is extensive, you may be prescribed medicines that you take as tablets, such as:

    • methotrexate
    • acitretin
    • ciclosporin
    • hydroxycarbamide

    These medicines work by suppressing your immune system, or by slowing down the production of skin cells. They can have severe side-effects and need to be prescribed by a doctor.

    Women will be warned not to become pregnant while taking these medicines and, in some circumstances, for some time afterwards. With some of the tablets, men will also be advised that they shouldn't get their partner pregnant. This is because these medicines can cause serious damage to an unborn baby.

    Biological medicines are newer treatments for psoriasis that can be very effective, but tend to be restricted to people with severe psoriasis, or if other treatments haven’t worked. They are given as an injection into your skin, or through a drip into a vein in your arm. These medicines include:

    • etanercept
    • adalimumab
    • infliximab
    • ustekinumab

    Your doctor can discuss these treatments with you. You will need to have various pre-treatment tests before you can try these medicines and you will be monitored with blood tests while you're receiving the treatment.

    Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

    Light therapy

    Depending on the type and extent of your psoriasis, your doctor may recommend that you have ultraviolet (UV) light therapy.

    You have the light therapy in a machine that looks similar to a shower cubicle, containing fluorescent tubes.

    • Ultraviolet B (UVB) light therapy involves shining artificial UVB light on to your skin. UVB light occurs naturally in sunlight. You will usually have the therapy two to three times a week for up to eight weeks.
    • Sometimes UVB light therapy is used in combination with topical treatments such as coal tar preparations. This combination may be effective at helping to control your symptoms by making your skin more sensitive to UVB light.
    • Psoralen and UVA light therapy (PUVA) involves combining a medicine (psoralen) that sensitises your skin to sunlight with a controlled dose of UVA light. You may have psoralen as a tablet or applied directly to your skin. You usually have the treatment twice a week for up to 10 weeks.
  • Dermatology treatment

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including dermatology treatment.

  • Causes Causes of psoriasis

    The exact reasons why you may develop psoriasis aren’t fully understood at present. It appears that your genes are the most important factor in causing the condition because you're more likely to get psoriasis if other people in your family have it. However, this doesn’t mean you will definitely get the condition.

    Environmental factors also play an important role in triggering psoriasis. These include a bacterial throat infection, the effects of certain medicines or stress. For many people, there is no obvious cause.

    The genetic and environmental triggers lead to immune cells in your skin setting off inflammation. This causes your skin to start producing new cells faster than usual, leading to psoriatic plaques. What makes your immune system act like this isn't clear.

  • Complications Complications of psoriasis

    Some people with psoriasis develop pain or stiffness in their joints, which may be a result of a condition called psoriatic arthritis. Usually the joints in your hands and feet are affected, although you may also get it in your back, knees and hips.

  • FAQs FAQs

    Can I go swimming if I have psoriasis?

    Answer

    Yes. You may feel reluctant about swimming if you have psoriasis. However, the condition isn’t contagious so there is no reason why it should stop you from swimming.

    Explanation

    Many people find that swimming in a pool or the sea, or using a hot tub, can help their psoriasis. You may find that lengthy bathing increases itching and irritation.

    It’s possible that swimming in the sea will help if you have psoriasis. This is probably mainly because of the associated exposure to sunlight.

    Can I still have sex if I have genital psoriasis?

    Answer

    Yes, you can still have sex if you have psoriasis in your genital area. Psoriasis isn't contagious, so you won't transmit it to your partner by having sex.

    Explanation

    Psoriasis that affects your genital skin can be very distressing and can put some people off having a sexual relationship. However, there is no medical reason why you can’t have sex. You and your partner may find it helpful to seek reassurance from your doctor.

    You may find that having sex is uncomfortable if you have psoriasis in your genital area. Using a condom and lubricating jelly can help to ease this. However, certain topical preparations can reduce the contraceptive effectiveness of latex condoms. Use condoms made from another material instead.

    Can I use deodorant if I have psoriasis in my armpits?

    Answer

    If you have active psoriasis in your armpits, deodorants can aggravate the condition. Different products are available that you may find you can tolerate if you don’t want to stop using deodorant completely.

    Explanation

    Deodorants can sometimes trigger a flare-up of flexural psoriasis in your armpits. This is because deodorants contain chemicals and alcohol that can irritate the skin. You can buy deodorants that contain fewer chemicals and are alcohol- and perfume-free, making them more suitable for sensitive skin. Some also contain moisturisers.

    You may need to try several products before you find one that suits you. Your doctor may be able to give you advice on which products to try.

    How long will I have to wait after taking psoriasis treatment until I can try for a baby?

    Answer

    Certain medicines for psoriasis are harmful to an unborn baby. Some of these can stay in your body for a long time after you stop taking them, so you will need to take your doctor's advice on when it's safe to start trying to get pregnant.

    Explanation

    The following medicines may cause harm to an unborn baby. Some may also affect a man's sperm, so men taking them will be advised not to get their partner pregnant.

    • Acitretin. This can cause severe birth defects. You must use effective contraception so you don’t get pregnant while taking this medicine and for three years after stopping treatment.
    • Methotrexate. You must not become pregnant or get your partner pregnant while on methotrexate and for at least six months afterwards.
    • Hydroxycarbamide. You must not get pregnant or get your partner pregnant while taking hydroxycarbamide and for two months afterwards.
    • Ciclosporin isn't recommended if you are already pregnant or are trying to get pregnant. There is limited evidence about the harm ciclosporin may cause to an unborn baby, but it isn't thought to cause severe birth defects. Therefore, your doctor may advise you to take this medicine if there is no alternative.
    • Oral psoralen and ultraviolet A light therapy (PUVA) isn’t used during pregnancy.

    It's important to discuss contraception with your GP to ensure you're using an effective method.

    How will my psoriasis be affected if I become pregnant?

    Answer

    Pregnancy can make your psoriasis better or worse. In addition, your treatment may need to be altered because you can’t take certain medicines for psoriasis while you're pregnant.

    Explanation

    You may find that your psoriasis improves if you become pregnant, although there is a possibility that the condition will be more severe after your baby is born. It’s also possible that being pregnant will cause your psoriasis to get worse.

    Psoriasis itself won’t harm your baby. However, some medicines for psoriasis can cause severe damage to an unborn baby. If you're planning on trying to get pregnant, talk to your doctor who will advise you if it's safe for you to go ahead.

    Your doctor may gradually reduce your treatment before you try to get pregnant, but don’t stop taking any medicines without talking to your doctor first. He or she may also adjust your treatment to try to control your psoriasis better before you try to become pregnant.

    You can use many creams and ointments, such as emollients and steroid creams, safely during pregnancy, but ask your doctor for advice first. If you have more severe psoriasis, it’s safe to have ultraviolet (UV) B light therapy. Ciclosporin or azathioprine may also be used if absolutely necessary. However, you won’t be able to have oral psoralen and UVA (PUVA) light therapy during pregnancy.

    All medicines for psoriasis work differently, so it's important to work with your doctor to determine what treatment is appropriate for you during pregnancy.

    If I've had erythrodermic psoriasis once, what are the chances I will get it again?

    Answer

    It's uncommon for erythrodermic psoriasis to come back (reoccur).

    Explanation

    Although it’s rare for you to develop erythrodermic psoriasis more than once, some people do seem to be more prone to getting it than others.

    Erythrodermic psoriasis seems to be more common in people who have unstable psoriasis (a form of the condition in which your plaques suddenly become bigger or new plaques form), or in those for whom treatment isn’t very effective. Other things that can cause a flare-up of the condition include:

    • taking certain medicines
    • stopping treatment
    • infection

    It’s impossible to say what your personal risk is of erythrodermic psoriasis coming back, as this varies considerably from person to person. Talk to your doctor if you're worried about getting a flare-up of erythrodermic psoriasis.

    My psoriasis seems to be affected by the weather – is this usual?

    Answer

    Yes, sunlight, humidity and temperature can all have an effect on psoriasis.

    Explanation

    Changes in the weather affect everyone with psoriasis differently. However, in general, most people with the condition find that it improves when they have more exposure to sunlight.

    When it's humid (there is more moisture in the air) your skin is less likely to dry out, which can also help psoriasis. In the winter, however, a combination of dry air, less exposure to sunlight and colder temperatures can all contribute to psoriasis getting worse.

    What can I do to help psoriasis on my face?

    Answer

    Some treatments are specifically designed to treat psoriasis on your face. It may also be possible to use special camouflage make-up to cover up your psoriasis.

    Explanation

    Your facial skin is more sensitive than that on the rest of your body, so some treatments that are designed for use on your body may irritate the skin on your face.

    Your doctor will recommend treatments you can try that are specifically designed to be used on your face. These may include creams containing a lower dose of steroids than would be used on the rest of your body. You may also find that treatments containing vitamin D derivatives help psoriasis on your face. Using a moisturiser can help to reduce scaling.

    You may be able to use camouflage make-up to cover up psoriasis on your face. Some charities offer a service that involves checking if the make-up will be suitable for you and ensuring that it won’t irritate your skin, or interfere with the effectiveness of creams and ointments prescribed for treating your psoriasis. They will help you to find a tone that matches your skin and show you how to apply the make-up yourself. Your GP may be able to give you more information about skin camouflage services.

    Why do I need to have check-ups while taking medicines for psoriasis?

    Answer

    All of the medicines used to treat psoriasis have the potential to cause side-effects and some of them are serious. For this reason, it's important that you attend regular check-ups so your doctor can monitor your treatment.

    Explanation

    You will probably see your GP for check-ups for topical treatments for psoriasis. You will need to have regular hospital check-ups if you're taking oral or injected medicines.

    • Methotrexate can interfere with your body’s production of blood cells (your blood count), which can lead to conditions such as anaemia. Methotrexate can also cause liver damage over the long term. You will need regular blood tests to monitor your blood count and check how well your liver is working.
    • Ciclosporin can cause damage to your kidneys and produce high blood pressure over the long term. You will need regular blood pressure checks, and blood and urine tests to check your kidney function.
    • Hyrdroxycarbamide can interfere with your production of blood cells – you will need regular blood tests to check your blood count.
    • Acitretin can cause liver damage and, rarely, problems with bone growth, so it's important to tell your doctor about any joint or back pain that develops while you’re taking this medicine. You may find your psoriasis gets worse at first and it can lead to your eyes, nose and lips becoming drier.

    You will usually need to have weekly check-ups when you first start treatment. These may become less frequent when your condition is more stable.

    Will it help my psoriasis to use a normal sunbed?

    Answer

    No, sunbeds are of limited or no value in psoriasis.

    Explanation

    If you’re prescribed ultraviolet (UV) light therapy, the dose to your skin and the wavelength of the light are carefully controlled. Both of these factors will be recorded as your treatment is gradually increased. This allows you to be given the most effective light treatment in the safest manner.

    Commercial sunbeds provide no control of the exact type or dose of light emitted. The amount of UVA and UVB light varies considerably between appliances depending on a number of things including the type and how old it is. Therefore, there is no way of knowing how much of each type of UV light you’re being exposed to when you use a sunbed – you may only be getting UVA, which, when used on its own, doesn’t help psoriasis. Alternatively, you may be exposed to dangerous levels of UVB light, which can increase your risk of skin cancer.

    This lack of information about the levels of each type of UV light emitted means that if you’re using sunbeds, your doctor won’t be able to accurately work out what dose of UV light you should be prescribed if you need light therapy.

  • Resources Resources

    Further information

    Sources

    • Psoriasis – an overview. The British Association of Dermatologists. www.bad.org.uk, published May 2012
    • Psoriasis. eMedicine. www.emedicine.medscape.com, published June 2012
    • Psoriasis: signs and symptoms. American Academy of Dermatology. www.aad.org, accessed 13 June 2012
    • Guttate psoriasis. eMedicine. www.emedicine.medscape.com, published May 2012
    • Plaque psoriasis. The Psoriasis Association. www.psoriasis-association.org.uk, accessed 13 June 2012
    • Psoriasis. DermNet NZ. www.dermnetnz.org, published May 2012
    • About psoriasis. The Psoriasis Association. www.psoriasis-association.org.uk, accessed 13 June 2012
    • Psoriasis. Prodigy. www.prodigy.clarity.co.uk, published May 2010
    • Etanercept and efalizumab for the treatment of adults with psoriasis. National Institute for Health and Clinical Excellence (NICE), 2006. www.nice.org.uk
    • Infliximab for the treatment of adults with psoriasis. National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk
    • Ustekinumab for the treatment of adults with moderate to severe psoriasis. National Institute for Health and Clinical Excellence (NICE), 2010. www.nice.org.uk
    • Ultraviolet light therapy. The Psoriasis Association. www.psoriasis-association.org.uk, accessed 14 June 2012
    • Personal communication, Dr M Ardern-Jones, Consultant Dermatologist/Senior Lecturer, Sir Henry Wellcome Laboratories, Southampton General Hospital, June 2012
    • Psoriasis – a simple explanation. The Psoriasis and Psoriatic Arthritis Alliance. www.papaa.org, accessed 14 June 2012
    • Frequently asked questions. The Psoriasis and Psoriatic Arthritis Alliance. www.papaa.org, accessed 14 June 2012
    • Ebetrex 10mg/ml solution for injection, pre-filled syringe. electronic Medicines Compendium. www.medicines.org.uk, published March 2012
    • Hydrea 500mg hard capsules. electronic Medicines Compendium. www.medicines.org.uk, published June 2012
    • Neoral soft gelatine capsules, Neoral oral solution. electronic Medicines Compendium. www.medicines.org.uk, published February 2012
    • Neotigason 10mg capsules. electronic Medicines Compendium. www.medicines.org.uk, published July 2011
    • Condoms (male and female): your guide. The Family Planning Association. www.fpa.org.uk, published March 2011
    • Sunbeds. The British Association of Dermatologists. www.bad.org.uk, accessed 15 June 2012
    • Exposure to artificial UV radiation and skin cancer. International Agency for Research on Cancer, 2006, Working Group Report 1. www.iarc.fr
    • What is skin camouflage? Skin Camouflage Network. www.skincamouflagenetwork.org.uk, accessed 18 June 2012
    • Find out about the skin camouflage team. Changing Faces. www.changingfaces.org.uk, accessed 18 June 2012
  • Related information Related information

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    Produced by Polly Kerr, Bupa Health Information Team, August 2012.

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