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Psoriasis

Psoriasis is a skin condition where you get raised patches of inflamed skin. It can vary hugely in severity from person to person. It can also come and go over time. Psoriasis isn’t contagious so you can’t catch it or pass it on to others, and it doesn’t spread over your body.

Psoriasis affects about two in 100 people in the UK. You can get it at any age, but it often develops either between the ages of 15 and 30, or later when you’re over 40. It affects men and women equally.

Although there isn’t a cure for psoriasis, there are lots of treatments to help relieve your symptoms.

Your skin is made up of layers, and the top one 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 increases and can be as short as a few days. New skin cells move to the surface before they have properly matured and build up on your skin in thick patches called plaques. A certain type of blood cell also builds up under your skin, which causes inflammation.

You can have psoriasis for the rest of your life but it tends to fluctuate over time, often for no apparent reason. You may have flare-ups when your symptoms are more severe, but at other times it may be hardly noticeable.

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

Details

  • Types Types of psoriasis

    There are different types of psoriasis, some of which we’ve explained below.

    Plaque psoriasis

    Plaque psoriasis is the most common type and you get pinkish-red plaques (raised patches) with silver scales, often on your back, knees and elbows.

    Flexural psoriasis

    Flexural psoriasis, also called inverse psoriasis, affects areas where your skin folds, such as your armpits and groin. Your skin tends to be thinner here. Flexural psoriasis causes patches of smooth red, shiny skin, which may be itchy or uncomfortable.

    Pustular psoriasis

    This is a rare, severe form of psoriasis in which small, pus-filled spots (pustules) develop on your skin. You may get them just on the palms of your hands or soles of your feet. If it happens all over your body, it’s called generalised pustular psoriasis. This can be life-threatening so you’ll need treatment in hospital.

    Erythrodermic psoriasis

    Erythrodermic psoriasis is another rare and severe form in which your skin becomes red and inflamed all over. This can cause serious complications and you’ll usually need to go to hospital for treatment. Erythrodermic psoriasis usually 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 – they look a bit like rain droplets. It tends to affect children and adults under 30, often after they have had a throat infection.

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  • Symptoms Symptoms of psoriasis

    The symptoms of psoriasis depends on which type you have but you’ll usually have thickened, red patches of skin – these may have silver-white scales. The patches may be different sizes and will look different to your surrounding skin.

    Your skin may feel itchy, and it can sting and feel sore. But if your symptoms are mild, you might not know you have psoriasis – children sometimes don’t have any obvious symptoms at all.

    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. They will probably be able to diagnose psoriasis 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 you have painful joints or back pain too, your GP may refer you to see a rheumatologist. This is a doctor who specialises in identifying and treating conditions that affect your joints and muscles, such as arthritis.

  • Treatment Treatment of psoriasis

    Although there isn’t a cure for psoriasis, there are lots of treatments that can really help to relieve your symptoms. These can vary in how well they work over time so you might need to switch treatments, or take a combination.

    Self-help

    You might find it helps to use emollients. These are creams or lotions that moisten, soften and soothe your skin. You often have to use a fair amount of the product and apply it three or four times a day. Having a warm bath or shower every day may help to soften your psoriasis, particularly if you add bath oil. After your bath, pat your skin dry and apply a thick layer of emollient. Try not to scratch your skin as it may get infected.

    There are other things you can do to ease your symptoms. These include managing stress, not drinking too much and quitting smoking, as these can all make psoriasis worse.

    Light therapy

    If topical treatments don’t work for you, another treatment you might be able to try is ultraviolet (UV) light therapy. You have this in a machine that looks similar to a shower cubicle that contains fluorescent tubes.

    • Ultraviolet B (UVB) light therapy involves shining artificial UVB light onto your skin. UVB light is naturally in sunlight, which is known to help clear psoriasis. You usually have the therapy two to three times a week.
    • Sometimes UVB light therapy is used alongside topical treatments (see below) such as coal tar preparations. This combination might help 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 can take psoralen as a tablet or apply it directly to your skin (probably as a gel or lotion). You usually have the treatment two or three times a week.

    Medicines

    Topical treatments

    These are treatments that you put on your skin. Your GP may prescribe you a medicated cream or ointment. The type of medicine and its strength will depend on what type of psoriasis you have and how severe it is. We’ve listed some examples of topical treatments below.

    • Steroid creams are often used to treat psoriasis that’s just on limited bits of your body, such as on your elbows or knees. You may be able to use stronger steroids on your palms and soles or your scalp, and lower dose ones on your face. You can usually use steroid creams for up to a month. Steroids are sometimes combined with vitamin D treatments as they work better if you take them together.
    • Medicines based on vitamin D (such as calcipotriol or tacalcitol) are used to treat mild or moderate psoriasis for longer periods of time. These may also help psoriasis on your face. They work by slowing down the production of skin cells and ease inflammation.
    • Medicines based on vitamin A (retinoids) can be useful, but they may irritate your skin. You usually take these alongside another treatment.
    • Creams that contain the medicine dithranol can work if you have plaque psoriasis, but they are messy and can irritate healthy skin. They might stain your bath and clothing.
    • Coal tar preparations can reduce inflammation and scaling. They may be an option if you have psoriasis that affects your scalp. But they can be smelly and messy and aren’t used very much now.

    Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

    Oral medicines

    If topical treatments don’t control your symptoms, or if psoriasis covers a lot of your body, your doctor may prescribe you 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 so your doctor will want you to have regular appointments to see how you get on taking them.

    You shouldn’t get pregnant (or get your partner pregnant) while taking some of these medicines as they can potentially harm your baby. So make sure you use contraception while you take them (and for some time after) if necessary. Ask your doctor for more details, and read our FAQ: What medicines should I avoid if I’m pregnant?

    Biological medicines

    Biological medicines are another type of treatment for psoriasis that can be very effective. Your doctor will usually only prescribe you these if you have severe psoriasis, or if other treatments haven’t worked. You have them as an injection into your skin or through a drip into a vein in your arm. There are a number of biological medicines available, which include:

    • etanercept
    • adalimumab
    • infliximab
    • ustekinumab

    Your doctor will talk to you about the best medicines for the type of psoriasis you have and what’s likely to work for you. You’ll need to have regular appointments and blood tests while you take them so your doctor can see if the medicines are working.

    Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your doctor for advice.

  • 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 develop psoriasis aren’t properly understood yet. It’s thought to be genetic because you’re more likely to get psoriasis if other people in your family have it. But just because they have it doesn’t definitely mean you will too.

    Other factors in your life play an important role in triggering psoriasis. These include bacterial throat infections and the effects of certain medicines or stress. Smoking and drinking too much alcohol may also be involved.

    The climate you live in can have an effect on psoriasis too. Most people with the condition find it improves when they are in the sun. Your symptoms may get better in the summer when you spend time in the sun and worse in the winter when there’s less sunlight.

    Both these genetic and other factors in your life lead to immune cells in your skin setting off inflammation. This causes your skin to start producing new cells faster than usual, which leads to psoriatic plaques. What makes your immune system act like this isn’t clear.

  • Complications Complications of psoriasis

    There are a number of possible complications of psoriasis, which include the following.

    • Some people with psoriasis develop pain or stiffness in their joints, which may be a result of psoriatic arthritis. Usually it affects the joints in your hands and feet, although you may also get it in your back, elbows, knees and hips.
    • People who have psoriasis or psoriatic arthritis may be more at risk of cardiovascular disease.
    • People with psoriasis are more likely to be obese or have diabetes.
    • Psoriasis can affect your quality of life and lead to depression.
  • Living with psoriasis Living with psoriasis

    If you have psoriasis, you may not want to do certain things if you’re worried about how your skin looks. You might be reluctant to go swimming, for example, even though there’s no reason why you can’t (psoriasis isn’t contagious). If you swim in the sea, it may help, possibly because you’re exposed to sunlight at the same time. If you swim in a pool, the chlorine may dry out your skin, so have a shower straight after and use a good moisturiser.

    You may find that if you have psoriasis in your armpits, the chemicals and alcohol in deodorants aggravate it or trigger a flare-up. If you don’t want to stop using deodorant, look out for products that are alcohol- and perfume-free as these are more suitable for sensitive skin. Some deodorants also contain moisturisers.

    Some people with psoriasis find the condition affects their personal relationships. Since psoriasis isn’t contagious, there’s no reason why you can’t have sex, even if you have psoriasis in your genital area. Although it can be distressing and might put you off sex, you won’t pass it on to your partner. It can sometimes be uncomfortable if you have psoriasis on your genitals but using a condom and lubricating jelly may help. Some creams and lotions can reduce how well latex condoms work – ask your pharmacist for advice on what’s safe to use.

    You may be concerned about how pregnancy will affect your psoriasis, and it’s hard to predict how the condition will react. For some women it gets better while for others it can get worse. You might need to take different treatments while you’re pregnant too because some may harm your baby. Bear in mind you may need to change your treatment if you get pregnant – for more information, see our FAQ: What medicines should I avoid if I’m pregnant?

  • FAQ: What are the chances I’ll get erythrodermic psoriasis again? FAQ: What are the chances I’ll get erythrodermic psoriasis again?

    Answer

    It's hard to say. Erythrodermic psoriasis is rare but some people seem to be more prone to getting it than others. So although it may get better with treatment it's possible it will keep coming back.

    More information

    Erythrodermic psoriasis is a severe form of psoriasis and your skin becomes red and inflamed all over.

    Erythrodermic psoriasis seems to be more common in people who have plaque psoriasis that gets worse despite having treatment. Other things that can cause a flare-up of the condition include:

    • taking certain medicines
    • stopping steroid treatment
    • an infection
    • drinking too much alcohol

    It's impossible to say what your personal risk is of erythrodermic psoriasis coming back as this varies from person to person. Talk to your doctor if you're worried about it.

  • FAQ: What medicines should I avoid if I'm pregnant? FAQ: What medicines should I avoid if I'm pregnant?

    Answer

    Psoriasis itself won’t harm your baby but some medicines used to treat it could potentially do so. These include acitretin, methotrexate, hydroxycarbamide and ciclosporin. PUVA therapy (psoralen tablets with ultraviolet A light therapy) is also not recommended. Some of these can stay in your body for a long time after you stop taking them.

    More information

    As well as being harmful to a baby, some medicines can affect sperm, so don’t get your partner pregnant while you’re taking them.

    • Acitretin. This can cause severe birth defects. Use at least one method of contraception (ideally two) so you don’t get pregnant while taking acitretin, and for three years after you stop treatment. This will ensure the medicine is completely out of your system.
    • Methotrexate. Use contraception while on methotrexate, and for at least three months afterwards.
    • Hydroxycarbamide. Use contraception while taking this medicine and for two months afterwards.
    • Ciclosporin isn’t a suitable treatment if you’re pregnant or trying to get pregnant as there’s some research that shows it may harm a baby. Ciclosporin isn’t thought to cause severe birth defects though so your doctor may suggest you take it if there’s no alternative.
    • Psoralen tablets and ultraviolet A light therapy (PUVA) aren’t suitable if you’re pregnant.

    There are lots of creams and ointments, such as emollients and steroid creams, that are safe to use when you’re pregnant.

    If you’re considering having a baby, talk to your doctor before you start any medicines. And talk with your GP too about contraception to ensure you’re using an effective method.

  • FAQ: Why do I need check-ups while taking psoriasis medicines? FAQ: Why do I need check-ups while taking psoriasis medicines?

    Answer

    Psoriasis medicines all have the potential to cause side-effects and some of them can be serious. This is why it’s important to have regular check-ups so your doctor can monitor your treatment.

    More information

    You can probably see your GP for check-ups for topical treatments for psoriasis. You’ll need to go to hospital if you’re taking tablets or injected medicines.

    • Both methotrexate and hydroxycarbamide can interfere with your body’s production of different blood cells (your blood count), which can lead to anaemia. Methotrexate can also damage your liver over time. You’ll need regular blood tests to monitor your blood count and check how well your liver is working.
    • Ciclosporin can damage your kidneys and cause high blood pressure over time. You’ll need regular blood pressure checks and blood and urine tests to check your kidney function.
    • Acitretin can damage your liver and can sometimes cause problems with bone growth. It’s important to tell your doctor if you get any joint or back pain while you’re taking this.

    You’ll have regular check-ups when you first start treatment. These may become less frequent when your condition is more stable and you might have a review just once a year.

  • FAQ: Will it help my psoriasis to use a normal sunbed? FAQ: Will it help my psoriasis to use a normal sunbed?

    Answer

    No, using a sunbed won’t help to treat psoriasis.

    More information

    If you’re prescribed ultraviolet (UV) light therapy, the dose to your skin and the strength of the light are carefully controlled. This allows you to receive the most effective light treatment in the safest way.

    Commercial sunbeds provide no control of the exact type or dose of light emitted. Most sunbeds use UVA light, which won’t help to treat psoriasis unless it’s in combination with the medicine psoralen. So you have the risks of UV exposure, without the benefit of treating psoriasis. These risks of UV exposure include skin cancer.

  • Resources Resources

    Further information

    Sources

    • Psoriasis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published September 2014
    • Psoriasis. BMJ Best Practice. www.bestpractice.bmj.com, published 14 November 2014
    • Psoriasis. Medscape. www.emedicine.medscape.com, published 22 January 2015
    • Map of Medicine. Psoriasis. International View. London: Map of Medicine; 2013 (Issue 2)
    • Psoriasis – an overview. British Association of Dermatologists. www.bad.org.uk, published May 2012
    • Chronic plaque psoriasis. PatientPlus. www.patient.info/doctor, reviewed 20 November 2012
    • Psoriasis. National Institute for Health and Care Excellence (NICE), October 2012. www.nice.org.uk
    • Psoriasis. DermNet NZ. www.dermnetnz.org, published August 2014
    • Flexural psoriasis. DermNet NZ. www.dermnetnz.org, published 15 December 2014
    • Guttate psoriasis. Medscape. www.emedicine.medscape.com, published 22 July 2014
    • Tollefson MM. Diagnosis and management of psoriasis in children. Pediatr Clin N Am 2014; 61(2):261–77. doi:10.1016/j.pcl.2013.11.003
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 23 March 2015
    • Phototherapy. British Association of Dermatologists. www.bad.org.uk, published February 2012
    • Enamandram M, Kimball AB. Psoriasis epidemiology: the interplay of genes and the environment. J Invest Dermatol 2013; 133(2):287–89. doi:10.1038/jid.2012.434
    • Frequently asked questions. The Psoriasis and Psoriatic Arthritis Alliance. www.papaa.org, accessed 24 March 2015
    • Psychological aspects of psoriasis. The Psoriasis and Psoriatic Arthritis Alliance. www.papaa.org, accessed 24 March 2015
    • Psoriasis in sensitive areas. The Psoriasis Association. www.psoriasis-association.org.uk, reviewed September 2014
    • Psoriasis fertility, conception and pregnancy. The Psoriasis and Psoriatic Arthritis Alliance. www.papaa.org, accessed 24 March 2015
    • Hydroxycarbamide (formerly known as hydroxyurea). British Association of Dermatologists. www.bad.org.uk, published June 2013
    • Ciclosporin. British Association of Dermatologists. www.bad.org.uk, published December 2013
    • Treatment of psoriasis in pregnancy. DermNet NZ. www.dermnetnz.org, published 15 December 2014
    • Erythrodermic psoriasis. PatientPlus. www.patient.info/doctor, reviewed 28 September 2011
    • Erythrodermic psoriasis. DermNet NZ. www.dermnetnz.org, published 15 December 2014
    • Facial psoriasis. DermNet NZ. www.dermnetnz.org, published 12 August 2014
    • Diagnosis and management of psoriasis and psoriatic arthritis in adults. Scottish Intercollegiate Guidelines Network (SIGN), October 2010. www.sign.ac.uk
    • Ultraviolet light therapy. The Psoriasis Association. www.psoriasis-association.org.uk, published December 2014
    • Sunbeds. British Association of Dermatologists. www.bad.org.uk, published 25 March 2015
    • Sunbeds. World Health Organization. www.who.int, published 25 March 2015
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