What is psoriasis?
Psoriasis affects about two in every 100 people in the UK. You can get it at any age. But you’re more likely to get psoriasis if you’re between 15 and 30, or later when you’re over 40. Psoriasis affects men and women equally. It isn’t contagious so you can’t catch it or pass it on to anyone else.
If you have psoriasis, you’re likely to have red, flaky, crusty patches of skin. Your skin is made up of different layers. The top layer (your epidermis) constantly sheds old cells and replaces them with new ones. This usually happens in a cycle that takes around 23 days. If you have psoriasis, your cells are replaced much more quickly than this, sometimes every few days. New skin cells build up on your skin in thick patches called plaques. Dead skin cells may build up on the plaques, causing a silvery scale. Blood cells also build up under your skin, causing inflammation.
There’s no cure for psoriasis, but lots of treatments can help to relieve your symptoms. You have psoriasis for the rest of your life, but it tends to flare up and down over time. Even when your symptoms are mild, it can make you feel self-conscious and affect your daily life.
Types of psoriasis
There are several different types of psoriasis.
Plaque psoriasis is the most common type of psoriasis. You get pinkish-red plaques (raised patches) with silver scales, often on your back, knees and elbows. The plaques are usually shaped like discs and may be itchy.
Flexural psoriasis (inverse psoriasis) affects areas where your skin folds, such as your armpits and groin. It causes patches of smooth red, shiny skin. These may be itchy or uncomfortable.
Pustular psoriasis is a rare, serious form of psoriasis. Small, pus-filled spots (pustules) appear on your skin. If you have localised pustular psoriasis, you may just have these spots on the palms of your hands or soles of your feet. If you have generalised pustular psoriasis, the spots will affect your whole body. This can be life-threatening so you’ll need to be treated in hospital.
Erythrodermic psoriasis is another rare form of psoriasis. 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 affects people who already have another type of psoriasis. See our FAQ on Erythrodermic psoriasis.
In guttate psoriasis, small, scaly, inflamed spots of skin suddenly appear all over your body. They look a bit like rain drops. Guttate psoriasis tends to affect children and young adults, often after they’ve had a throat infection. It usually disappears after three to four months.
Symptoms of psoriasis
Your symptoms will depend on which type of psoriasis you have. But you’ll usually have thickened, red patches of skin. These may be covered with silver-white scales. The patches may be different sizes and will look different to your surrounding skin. Some people have lots of plaques and others only have a few of them.
It’s common for your skin to feel itchy. Itching is more common in people who already have dry skin, which can particularly be the case for older people. Your skin may also bleed.
Some types of psoriasis can affect your scalp, causing redness and flaking. The plaques on your scalp can be very thick. Scalp psoriasis can look like dandruff. You may notice some hair loss.
Nail psoriasis can affect your fingernails and your toe nails. Your nails can become pitted, thickened or loosened from the nail bed.
If you have erythrodermic psoriasis or generalised pustular psoriasis, you may feel unwell. You may have a high temperature, fast heart rate and feel ill.
If you have any of these symptoms, make an appointment to see your GP.
Diagnosis of psoriasis
Your GP will ask about your symptoms and examine you. They may be able to diagnose psoriasis by looking at your skin and nails. But they may want to rule out other possible causes, such as an infection or eczema.
They’ll ask about the size of your plaques and where they are on your body. This will help your GP decide which type of psoriasis you have. They may ask if you have a high temperature and feel unwell. They may also ask you whether your symptoms are affecting your daily life and your mood, even if your psoriasis is mild.
If your GP isn’t sure you have psoriasis, or your symptoms are bad, they may refer you to a dermatologist. A dermatologist is a doctor who specialises in identifying and treating skin conditions. If you have painful joints or back pain, 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 of psoriasis
There’s no cure for psoriasis. But there are lots of treatments that may help to relieve your symptoms. Some may work better for you than others, so you may need to switch treatments after a while or try a combination. You can try some treatments through your GP, but others are only available from specialist psoriasis clinics.
The choice of treatment will depend on your individual needs. It will depend on which type of psoriasis you have and whether your symptoms are mild or serious. Your doctor will discuss the treatments with you so that you can choose the right one for you. Your doctor will explain when and how to treat your symptoms, and how to use any prescribed treatments properly and safely.
Self-help for psoriasis
You may find your psoriasis gets better if you use emollients, especially if your symptoms are mild. Emollients are creams, lotions or ointments that moisten, soften and soothe your skin. They can help reduce scaling and itching. They may also help other psoriasis skin treatments work better. Your doctor can prescribe emollients. But you can also buy emollients over the counter from a pharmacy.
You should apply emollients to your skin regularly and in large quantities, whenever your skin feels dry. You may find you’re using them three or four times a day, or more often when you’re having a flare-up. Emollients work best when your skin is damp, such as after a bath or shower. Use a combination of an emollient bath oil, soap substitute and emollient cream, lotion or ointment.
Having a warm bath or shower every day may help to soften your psoriasis, especially 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.
You may be able to ease your symptoms if you avoid anything that could make your psoriasis worse. So try to manage your stress levels, don’t drink too much alcohol and quit smoking, or at least cut down. Some people find that sunlight makes their psoriasis better. But you shouldn’t expose your skin to the sun if you’re using some psoriasis medicines. Too much sunlight can also increase your risk of developing skin cancer.
Light therapy for psoriasis
If topical treatments don’t work for you, your doctor may suggest you try ultraviolet (UV) light therapy. This is also called phototherapy. You have light therapy in a machine that looks similar to a shower cubicle and contains fluorescent lights. It’s important to note this is very different from using a sunbed in a high-street tanning shop, which doctors don’t recommend. Instead, light therapy is a controlled medical treatment that your doctor arranges.
Ultraviolet B (UVB) light therapy involves shining artificial UVB light onto your skin. UVB light is found naturally in sunlight, which may help to clear up psoriasis. You usually have light therapy two to three times a week. UVB light therapy can irritate inflamed psoriasis, so discuss this with your dermatologist.
Sometimes you’ll have UVB light therapy with topical treatments such as coal tar or dithranol. This may make your skin more sensitive to UVB light so you don’t need to have so many sessions of light therapy.
UVA light therapy (PUVA) involves making your skin more sensitive to UVA light with a medicine called psoralen. This is only available from specialist centres in the UK. You can take psoralen as a tablet or put it on your skin. You usually have the treatment two or three times a week.
Higher doses of PUVA can make you more prone to skin ageing and skin cancer. You’ll also be more likely to have skin cancer once you’ve had more than 150 doses of PUVA. Your dermatologist will make sure light therapy is right for you. You’re unlikely to be offered PUVA if you’re at a high risk of developing skin cancer. This may be because skin cancer is more common in your family.
Medicines for psoriasis
Your doctor can prescribe many different medicines for psoriasis, depending on your type of psoriasis, symptoms and lifestyle.
You put topical treatments directly onto your skin. Your GP may prescribe you a medicated cream or ointment.
Corticosteroid creams are often used to treat psoriasis that’s just on limited parts of your body, such as on your elbows or knees. You may be able to use stronger corticosteroids on your palms and soles or your scalp, and lower dose ones on your face. You can usually use corticosteroid creams for up to a month. Stop using them once your skin is clear or nearly clear. Your doctor will show you how much and what strength of corticosteroid to put on your skin each time.
Your doctor may recommend you use a corticosteroid with a vitamin D treatment. If you do this, use the two types of topical medicines at different times of the day. So use the corticosteroid product in the morning and the vitamin D product in the evening. There are also ointments, gels and foams that combine corticosteroids with vitamin D, which are used once a day. Your doctor can tell you more about these and how to use them.
If you have mild or moderate psoriasis, you may be given a medicine based on vitamin D (such as calcipotriol or tacalcitol). You can use these for longer periods of time than topical corticosteroids. These may also help psoriasis on your face. They work by slowing down how quickly your body makes skin cells and reduce inflammation.
Medicines based on vitamin A (retinoids) can be useful for psoriasis, but they may irritate your skin. You usually use these with a topical corticosteroid. Apply vitamin A products to the plaques only and avoid the surrounding skin. You’ll need to wash your hands after using a vitamin A treatment and avoid exposing your skin to sunlight. These medicines shouldn’t be used if you’re pregnant or are planning to get pregnant as they could harm your baby.
Creams containing dithranol may work if you have plaque psoriasis. But they’re messy and can irritate healthy skin. They may also stain your bath and clothing. Your doctor can show you how to use dithranol products carefully to reduce the risk of side-effects. Wear disposable gloves when you’re using these treatments and wash your hands afterwards.
Coal tar products can reduce inflammation and scaling. They are available as creams and shampoos, and may be an option if you have psoriasis that affects your scalp. But they can be smelly and messy and can stain skin and clothing, so 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.
If topical treatments don’t control your symptoms, or your psoriasis covers a lot of your body, your doctor may prescribe tablets. The choice of tablets will depend on various things, including your age, type of psoriasis, symptoms and whether you have arthritis as well.
Oral medicines for psoriasis include:
- dimethyl fumarate
These medicines work by dampening down your immune system or slowing down your production of skin cells. They can have serious side-effects so your doctor will want you to have regular check-ups. Read our FAQ on Check-ups.
You shouldn’t get pregnant (or get your partner pregnant) if you’re 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 afterwards) if necessary. Ask your doctor for more details, and read our FAQ on Medicines during pregnancy.
Biological medicines can be very effective for psoriasis. They block chemicals in your body that cause inflammation. Your doctor will usually only prescribe you a biological medicine if you have bad psoriasis, or if other treatments haven’t worked. You can only have the treatment at a specialist psoriasis centre. Biological medicines include:
Your doctor will talk to you about the best medicines for your type of psoriasis and what’s likely to work for you. You can discuss all of the pros and cons of the different treatments. You’ll need to have regular appointments and blood tests while you take biological medicines so your doctor can see if the medicines are working. If one biological medicine doesn’t help your psoriasis, you may be able to try another one after a short gap between them.
Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your doctor for advice.
Causes of psoriasis
Why some people have psoriasis and others don’t still isn’t clear. Certain genes have been linked to psoriasis. So you’re more likely to get psoriasis if other people in your family have the condition. But just because they have psoriasis doesn’t mean you definitely will too.
It seems there are certain triggers that can lead to psoriasis starting or getting worse in people who are predisposed to the condition. These triggers may include throat infections, an injury to your skin, certain medicines or stress. Smoking and drinking too much alcohol may also be involved. Psoriasis also seems to be triggered by problems with your immune system, which triggers inflammation in your skin.
Complications of psoriasis
Everyone gets psoriasis differently. Some people have it very mildly with only a few symptoms. But others have much more serious symptoms, which can cause complications.
Some people with psoriasis have inflamed joints too, causing pain, swelling and stiffness. This is called psoriatic arthritis. It usually affects the joints in your hands and feet. But you may get it in your back, elbows, knees and hips too. If you have arthritis with your psoriasis, your doctor will refer you to a rheumatologist. Your skin and joint symptoms will usually be treated together with the same medicines.
Having psoriasis may mean you are more likely to have inflammatory bowel disease, especially Crohn’s disease. It can also mean you are more likely to have a certain type of skin cancer, called non-melanoma skin cancer.
People who have psoriasis or psoriatic arthritis may be more prone to heart disease and problems with blood circulation. You may be more likely to have high cholesterol levels or high blood pressure. You may also be more likely to have blood clots in your legs (deep vein thrombosis), especially if your psoriasis is very bad. Your doctor will tell you how to reduce your risk of blood clots, especially if you’re having surgery.
Psoriasis can affect your quality of life and lead to depression, even if your symptoms are only mild. It can affect your social life, ability to work and daily activities.
Living with psoriasis
If you have psoriasis, you may not like how your skin looks. This can affect how you view your whole body and may make you feel down. Even people with very mild symptoms say that psoriasis has a big effect on their daily life. Some people with psoriasis have anxiety and/or depression too. This can affect their social life, work and relationships. If you’re feeling down, depressed or anxious, speak to your doctor, as they may be able to recommend further advice and support. You may be able to see a counsellor or join a local self-help group.
Having psoriasis may stop you taking part in certain activities. You may be reluctant to go to a hairdresser, use communal showers or do certain sports. You may also be reluctant to go swimming, but there’s no reason why you can’t. You can’t pass your psoriasis onto someone else.
Keeping up with treatment
Treating your psoriasis can take up a lot of your time. You may need someone to help you apply your creams and ointments. Some of the medicines are also smelly or messy to use. If you need to leave these on overnight, they can stain your nightwear or bedding. If you’re struggling to use your psoriasis treatments, speak to your doctor or the practice nurse at your GP surgery. They may be able to arrange for someone to help you, or another treatment may be more suitable for you.
Some skincare and make-up products may make your psoriasis worse. If you have scalp psoriasis, hair dye may make your symptoms flare up. But there’s no reason why you can’t use some of these products. Try a tiny amount of the product first, called a patch test, to see if it irritates your skin. You may need to try several products before you find the one that’s suitable for you. Don’t apply make-up or skincare products to open sores or inflamed patches of skin.
Some people with psoriasis find their condition affects their sex life. But there’s no reason why you can’t have sex, even if you have psoriasis in your genital area. You can’t pass psoriasis on to your partner. Sex 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 worry that being pregnant could affect your psoriasis. It’s hard to know how getting pregnant will affect you, as every woman experiences psoriasis differently. Some women find their psoriasis gets better during pregnancy, but others find theirs gets worse. You may need to take different treatments while you’re pregnant because some may harm your baby. So if you’re pregnant, or are thinking of getting pregnant, speak to your doctor. For more information, see our FAQ on Medicines during pregnancy.
Coping in different weather
A change in climate may affect your psoriasis. Most people with the condition find their symptoms improve when they’re in the sun. Your symptoms may get better in the summer and flare up in the winter. But some people find sunlight makes their psoriasis worse. Sunburn can cause plaque psoriasis to flare up. Don’t use sunbeds to treat your psoriasis. Using fake tans and bronzers are the safest way to tan. See our FAQ on Sunbed use.
Having psoriasis can make you more likely to have high blood pressure or high cholesterol levels. This can make you more prone to heart disease. Try to eat a healthy diet and get as much exercise as you can. Stop smoking if you smoke and, ideally, lose some weight if you’re overweight.
FAQ: Can I get erythrodermic psoriasis again?
Erythrodermic psoriasis is a serious form of psoriasis. Your skin becomes red and hot all over and you may feel very unwell. This form of psoriasis tends to affect people who already have plaque psoriasis that isn’t responding to treatments. So if your plaque psoriasis is well treated, you’re less likely to get erythrodermic psoriasis again. But it’s difficult to say that it won’t ever come back.
It’s important that you and your doctor keep your psoriasis stable. Erythrodermic psoriasis often develops gradually, but may also flare up suddenly, even in people with mild symptoms. It can be triggered by stopping corticosteroid treatments, taking certain medicines such as lithium or an infection.
Erythrodermic psoriasis can have serious complications. It needs immediate hospital treatment. If you’re worried about getting it again, speak to your doctor.
FAQ: Which psoriasis medicines should I avoid during pregnancy?
Some medicines used to treat psoriasis could potentially harm your baby during pregnancy. So you won’t be able to take them if you’re pregnant or want to get pregnant. You shouldn’t take some psoriasis medicines if you’re breastfeeding either.
Medicines to avoid include acitretin, methotrexate and hydroxycarbamide. PUVA therapy (psoralen tablets with ultraviolet A light therapy) also isn’t recommended during pregnancy. Ciclosporin isn’t usually recommended as some research shows it may harm the growing baby. But it isn’t thought to cause serious problems in pregnancy so your doctor may suggest you take it if it’s the best medicine for you.
Some of these medicines can stay in your body for a long time after you stop taking them. So you need to make sure the medicines are completely out of your system before you get pregnant. If you take acitretin, you’ll need to use an effective type of contraception during treatment and for three years afterwards. Don’t use barrier contraception, such as condoms on their own – speak to your GP about using another form of contraception too. If you take methotrexate, you’ll need to use effective contraception during treatment and for at least three months afterwards.
Men’s fertility may be affected by psoriasis medicines they’re taking. Some medicines, such as methotrexate, can affect sperm production. So men shouldn’t get their partner pregnant while taking methotrexate or for three months afterwards.
If you and your partner are considering having a baby, talk to your doctor about your psoriasis treatments. Also talk to your doctor about the best forms of contraception.
FAQ: Why do I need regular check-ups for psoriasis?
Psoriasis medicines can cause side-effects. Some of these can be serious. So it’s important that you have regular check-ups so your doctor can monitor you. You can probably see your GP for check-ups if you’re using treatments that you put on your skin. But you’ll need to go to hospital if you’re taking tablets or injected medicines.
Methotrexate can damage your liver over time. It can also affect your body’s production of red blood cells, which can cause anaemia. So you’ll need regular blood tests to check your blood cell count and see how well your liver is working. You may need to have blood tests every one to two weeks at first and then every two to three months.
Acitretin can damage your liver and affect bone growth. Ciclosporin can damage your liver and kidneys and may cause high blood pressure over time. So you’ll need to have regular blood tests and check-ups when you’re taking these medicines too.
If you start a new treatment, your doctor will probably arrange a check-up around four weeks later. At your check-up, they’ll make sure your treatment is working well and that you’re using it properly. They’ll also discuss any side-effects. If there’s little or no improvement, or your treatment is causing side-effects, your doctor will usually suggest you try something else.
FAQ: Will using a sunbed help my psoriasis?
Your doctor may prescribe ultraviolet (UV) light therapy (phototherapy) for your psoriasis. Using a sunbed isn’t a safe alternative. If you have phototherapy, the dose and strength of the ultraviolet light are carefully controlled. This makes sure you get the best treatment in the safest way.
Most hospital-based light therapy for psoriasis uses UVB rays. Some light therapy uses UVA rays with a special medicine called psoralen instead. But this is only available from specialist centres. Commercial sunbeds don’t have any control over the exact type and dose of ultraviolet light you receive. Most commercial sunbeds use UVA light. UVA rays won’t treat psoriasis on their own.
If you have too much exposure to UVA and UVB rays, this can cause skin ageing and increase your risk of skin cancer. So using a sunbed may mean you’re exposed to the risks of too much sun, without any benefits to your psoriasis. Doctors recommend that people avoid using sunbeds.
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Reviewed by Graham Pembrey, Lead Health Editor, Bupa Health Content Team, December 2017 Expert reviewer, Dr Anton Alexandroff, Consultant Dermatologist Next review due December 2020
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