Any condition that affects the skin has the potential to be upsetting and distressing if it affects the way we look. This can, in turn, affect our self-esteem and increase stress levels. Psoriasis is a skin ailment that is relatively common amongst children and adults, which can appear without warning and sometimes for no reason.

There are some common types of Psoriasis which will affect anywhere up to two percent of the population at any one time in their life. There are also some less common types of the condition, which although rare, can produce unpleasant side effects and symptoms. Thankfully, it is easy to spot, diagnose and treat and this informational guide will take you through everything you need to know about Psoriasis, it’s causes, diagnosis, symptoms and treatment.

What is Psoriasis?

Psoriasis is a common skin ailment that causes the skin to become red, flaky and crusty. The skin will often develop silvery looking ‘scales’ over the top of the crusting and redness. It will tend to appear on places such as the elbows, knees and on the lower back. It can also crop up on the scalp too. It might appear on other areas of the body that are particularly prone to dryness. When it does crop up, it tends to do so in small patches. However, these patches have the potential to become very itchy and sore.

The condition can be triggered at any age, but the most common age groups likely to suffer from it are adults under the age of thirty-five. Unlike a lot of skin conditions, Psoriasis affects equal numbers of men and women. Many people who are diagnosed with the condition find that it is simple enough to treat and does not cause them any long-term bother or major issues. However, some people can be greatly affected by it and find that it has a detrimental effect on their day to day life. It is therefore defined as a chronic disease that can sometimes have periods of remission, followed by periods of mild to severe symptoms.

What causes Psoriasis?

The condition is caused when skin cells turnover happens too quickly. At this moment in time, scientists and doctors do not have an explanation as to why this might happen, however, common thinking amongst medics suggest that it may be because of problems with a compromised immune system.

New skin cells are produced in the body in the deepest layer of skin. Over time, these move up until they reach the upper levels of the epidermis. They then die and flake off. In someone who does not have Psoriasis, normal skin cell turnover is anything from three to four weeks. In someone who has the condition, the skin cell turnover happens very rapidly, in three to seven days. Skin cells that aren’t matured properly build up too quickly on the surface of the skin which causes redness, flaking and irritation, plus the ‘silvery’ looking scales.

Medical professionals are in agreement that in many cases a compromised immune system can trigger the condition. Your immune system is the core of your body and is the mechanism that prevents diseases and infections. If it is compromised, you’re more likely to pick up infections and illnesses. One of the main types of cell that the immune system uses to help fight illnesses is called a T-cell.

These travel through the body to fight off bacteria and germs. In cases of Psoriasis, instead of attacking bacteria, they latch onto health skin cells and attack those instead. This means that your skin ends up producing new skin cells much more quickly than is normal, which in turn then makes your immune system produce more T-cells. Whilst it is thought a compromised immune system may play a part in this, it is also believed there are certain genes and environmental factors that can also play a role in the development of the condition.

What are the different types of Psoriasis?

There are a number of different types of Psoriasis, that can occur in various places on the body. These are as follows:

Psoriasis Vulgaris

This is the most common type of the condition, and accounts for up to ninety percent of all diagnosed cases. The rash from this type of Psoriasis will tend to appear on the elbows, knees, scalp or lower back, but it can actually appear anywhere on the body. The lesions from this rash can be very sore and itchy. In some cases, the skin that surrounds joints and pressure points can actually crack and may start to bleed.

Psoriasis of the Scalp

This can affect certain areas of the scalp or sometimes the scalp as a whole. With this type of the condition, there will be red patches of skin that have a white, scaly coating. Some sufferers find that it is persistently itchy, whilst for others it causes no discomfort at all. In a few, rare cases, it can cause hair loss, though this is not common and is only very temporary. Once treatment is used, hair will grow back quickly.

Psoriasis of the Nails

It is believed that round fifty percent of all people who have Psoriasis will go on to develop the condition in their nails. The nails will develop little pits or dents that can sometimes become discolored and grow incorrectly. In some cases, nails will come loose and drop off.

Guttate Psoriasis

This particular form of the condition causes small sores on the chest, arms and legs. It can also form on the scalp too. It is common to find this type of Psoriasis will develop after a strep throat infection. It tends to occur in children, teenagers and young adults.

Inverse Psoriasis

This type of Psoriasis develops in the folds and creases of the skin such as groin, buttocks, armpits or underneath and between the breasts. It causes red patches in these areas that feel smooth to the touch. It is affected by heat, friction and sweat – so is likely to flare up in hot weather.

There are some less common forms of Psoriasis too. We’ll now examine these in more detail:

  • Pustular Psoriasis: This causes blisters that are filled with pus and can crop up anywhere on the body.
  • Generalised Pustular Psoriasis: This causes raised pustules that crop up very quickly on a wider area of skin that is normal for the condition. The pus in them is made up of white blood cells and therefore is not infectious, or a sign that there is any infection in the body. This can come in cycles and can often occur after a period of ill-health.
  • Palmoplantar Pustulosis: A type of Psoriasis in which pustules will form on the palms of hands and on the soles of feet. They will appear and develop into brown spots which peel off after time. The pustules can reappear every few days, or every few weeks or months.
  • Acropustulosis: Here, pustules will appear on the fingers and toes. They often burst and leave areas of skin that are bright red or look scaly. Sometimes this can lead to problems with the nails, causing them to either become deformed or drop off.
  • Erythrodermic psoriasis: This is a rare form of the condition that covers the entire body. Sufferers may find they have intense itching and burning from the sores. In severe cases it can cause loss of fluid and proteins and can ultimately cause infection, dehydration, heart failure, hypothermia and malnutrition.

Considering Genes as a Cause of Psoriasis

It is a skin condition which does tend to run in families. Therefore, if you have a close relative who has it or who has suffered with it in the past, you’re more likely to develop it yourself. However, medical professionals and other scientists are still not one hundred percent clear on how much genetics does play a role in Psoriasis. They believe that there are a great number of different genes that are linked to the development of the condition and that different combinations of these genes contribute to whether or not someone is likely to develop it or not.

More causes of Psoriasis

There can sometimes be a trigger point that will start a flare up of Psoriasis. If you already suffer from the condition, it can be worth noting when your symptoms start and identify anything that may have caused it. Here are just a few of the common triggers for Psoriasis:

  • Excessive consumption of alcohol
  • Smoking
  • Stress or a sudden increase in stress
  • Injury to the skin – this can be something like a cut, or scratch, or even something like sunburn.
  • Immune conditions such as HIV and AIDS can also trigger off Psoriasis in particularly vulnerable patients.
  • In women, it is thought that common hormone changes can trigger the condition. Things like puberty, pregnancy and the menopause can either trigger Psoriasis to start, or conversely, to clear up.
  • Medications can trigger the condition, particularly ones such as Lithium, used to treat bipolar disorder. However, anti-malarial meds, common painkillers like ibuprofen and certain blood pressure medications can also play a part in cases of Psoriasis too.

How is Psoriasis diagnosed?

Psoriasis diagnosis is usually carried out by a trained medical professional such as a Doctor or skin specialist. It can often simply be diagnosed purely by the way it presents on the surface of the skin and is easy to spot.

Sometimes, in rarer cases, a biopsy is taken to make a more accurate diagnosis. This will then be sent off for examination. This is done in cases where the type of psoriasis needs to be diagnosed, and also in cases where other skin conditions may be present, or there is the need to rule out other disorders. Doctors will occasionally refer patients with Psoriasis on to Dermatologists if they are either uncertain about the diagnosis, or if the condition is presenting in a particularly severe manner.

Complications of Psoriasis

In some cases of the condition a complication called Psoriatic Arthritis can occur. This needs to have a separate diagnosis and treatment. In people who are suspected of having this condition their Doctor will refer them onto a Rheumatologist who will be able to diagnose and treat. X-Rays of any affected joints will need to be taken.

Psoriasis Treatments

Unfortunately, there is no cure for Psoriasis, but there are a number of treatments that can be used to help improve symptoms and the appearance of the skin. For most cases, the first line of defense will be the use of topical creams and ointments. These will most likely contain Vitamin D or Steroids. These are applied to skin at regular intervals during the day.

Most cases of Psoriasis should respond to this treatment and clear up or go into remission. In some patients, they might not be enough. For such cases, something called Phototherapy may be prescribed. This involves exposing the affected areas of skin to different types of ultraviolet light. In severe cases, or cases that do not respond to either treatment, medicines that can be taken orally or injected may be prescribed. If you are suffering from Psoriasis of the scalp then a combination of shampoo and ointment may be recommended to be used together.

In most cases, topical treatments are enough to keep the condition at bay. However, these may take anything up to six weeks to have a proper effect, so patience and time is needed to see a result. Here are some of the most common topical treatments used to treat Psoriasis:

Emollient Moisturisers

An emollient is a simple yet very effective moisturising treatment which is applied directly to the skin. It helps to provide a stable barrier to stop moisture loss from the epidermis. In most mild cases, an emollient cream is enough to treat it. Their main benefit is that they will stop itching and flaking of the skin. Some topical treatments work better than others, and some need to be used on skin that has already been moisturised with an emollient barrier. Doctors usually recommend that if you’re going to use a topical treatment on top of an emollient that you wait up to half an hour before you apply it.

Steroid Creams and Ointments

In some cases of Psoriasis steroid creams and ointments are used, either alone, or in conjunction with emollient moisturisers. They are very effective in treating mild to moderate skin issues. They work to reduce inflammation, which in turn slows how quickly skin cells reproduce and stops any itching. Steroid creams vary in strength, and are often only prescribed by Doctors. They should only be used on affected areas of skin or particularly bad patches of the condition. Over time, if they are used for too often they can lead to thinning of the skin.

Vitamin D Creams

This is another alternative cream used to treat Psoriasis. They are used alongside or instead of steroid treatments for cases of mild to moderate Psoriasis. They work in a similar way to steroid creams to slow how quickly skin cells are produced and have a mild anti-inflammatory effect. They have relatively few side effects so long as they are used properly and only under the guidance of a Doctor or Dermatologist.

Calcineurin inhibitors

Calcineurin inhibitors, such as tacrolimus and pimecrolimus, are ointments or creams that reduce the activity of the immune system and help to reduce inflammation. They’re sometimes used to treat psoriasis affecting sensitive areas, such as the scalp, the genitals and folds in the skin, if steroid creams are not effective. These medications can cause skin irritation or a burning and itching sensation when they’re started, but this usually improves within a week.

Coal Tar

This is a thick oil and is one of the oldest successful treatments for the condition. It helps to reduce scales, inflammation and itching. It is often used on the types of Psoriasis that affect the limbs, the trunk of the body and the scalp. However, Doctors will urge you to be careful with its use as it can stain clothes and bedding. It can be used in conjunction with phototherapy.

Dithranol

Dithranol is another treatment that has been used for many years as an effective first treatment for the condition. It helps to stop skin cells reproducing too fast and it doesn’t have many side effects. The only potential problem is getting the dosage and application right as it can burn skin if it is too concentrated. It can only be used and applied by a trained medical professional as it can stain clothes, bedding and fixtures and fittings. It is applied, left to sink in for up to an hour and then washed off. This can also be used in conjunction with phototherapy.

Diagnosis and prevention

If you think you may have Psoriasis or have spotted any signs or symptoms of it on your body, then seek medical attention as soon as possible.

Early diagnosis and treatment is essential to make sure you keep on top of the condition and can easily manage it yourself at home. It may be tempting to look online and try all sorts of natural cures and remedies, but the only way to get an accurate assessment of your condition is to seek help from a medical professional who is trained in skin conditions.

Diet and supplementation can help once you’ve been diagnosed and are being given the correct treatment and it can occasionally be worth looking into specific triggers that could be affecting flare ups. It is not known if there are any specific foods that can trigger off cases of Psoriasis, but in general simply looking at eating a well-balanced, diet with a good selection of high-quality proteins, fruits, vegetables and whole grain carbohydrates is the right start.

It may be worth looking into what personal care products you use on a daily basis. Opting for fragrance free, color free shampoos and soaps may potentially help, as can reducing the number of products you use to clean your home. Always wear gloves for chores like washing up or cleaning room to room to make sure you minimize contact with other potential irritants. Think about changing your laundry detergent too and swapping it for one that is fragrance free with minimal ingredients.

Whilst we all want to live a natural, healthy life it’s important to remember that anything, no matter whether it is a man-made product or something that purports to be natural, has the potential to cause skin irritations. Patch test any new products for twenty-four hours before first use and in cases of Psoriasis, think about avoiding any new products at all until the condition is in remission.

Seeking an accurate diagnosis is important, in order to rule out any other potential illnesses or conditions and to also make sure you’re otherwise in good physical shape with no other underlying health concerns. Treatment is simple, effective and can provide quick, sustained relief. Knowing and understanding how to spot and treat Psoriasis can mean that although it is a recurring condition, you can treat it yourself without worry.

References and Further Reading:

https://commons.wikimedia.org/wiki/Category:Psoriasis#/media/File:Psoriasis_on_back.jpg
https://upload.wikimedia.org/wikipedia/commons/4/48/Guttate_psoriasis.jpg
https://upload.wikimedia.org/wikipedia/commons/b/b3/Luszczyca_paznokcia.jpg
https://upload.wikimedia.org/wikipedia/commons/8/88/Psoriasis_of_the_palms.jpg
https://upload.wikimedia.org/wikipedia/commons/c/ce/Saalmann_Psor_Kamm.jpg
https://patient.info/health/psoriasis-leaflet
https://www.nhs.uk/conditions/psoriasis/
http://www.britishskinfoundation.org.uk/SkinInformation/AtoZofSkindisease/Psoriasis.aspx
https://www.psoriasis-association.org.uk/
http://www.papaa.org/resources/gallery