Psoriasis: all bases covered

Statistics demonstrate that psoriasis affects around 2 in 100 people in the UK, often leaving sufferers feeling ashamed and embarrassed about the condition of their skin. Acclaimed consultant dermatologist Dr Emilia Duarte Williamson discusses everything you need to know about the condition, including causes and treatment options.

What is psoriasis and what does it look like?

Psoriasis is an inflammatory chronic skin condition that can appear at any age from childhood to old age. However, it occurs more commonly in younger adults. It appears as red or pink, flat or raised patches. They tend to be symmetrical on both sides of the body.

The condition commonly affects elbows, knees and scalp, but can be spread all over the body, and can look like little dots.  This is guttate psoriasis or small plaque psoriasis. It can affect the whole-body surface, as it's called erythrodermic psoriasis.

It can affect the nails and very importantly, it can affect the joints, producing inflammation and destruction of the joints. It is very important to keep this in mind for patients with psoriasis.

What are the symptoms and how is it diagnosed?

Some patients suffer from extensive psoriasis but do not show any obvious symptoms. However, if the symptoms are evident, patients feel embarrassed about people staring at them, due to their “scaly” skin. The skin can feel itchy at times and when patients scratch, they can spread the psoriasis, causing pain.

Frequently, individuals with psoriasis may not experience significant symptoms, distinguishing it from eczema where intense itchiness is common. Psoriasis tends to be less itchy and less problematic. However, some individuals with this condition may feel embarrassed or even depressed, particularly when psoriasis is prominently visible on the scalp or face.

 Is psoriasis caused by stress? Are there any other reasons it may occur?

We believe that psoriasis is multifactorial. The triggers for psoriasis are not well identified, but it is recognised that stress can exacerbate the condition.

Genetics can also play a part in the likelihood of a patient suffering from psoriasis: Some patients have a family history of the condition, while others do not. We believe that psoriasis is an immunological condition, provoked by an overreaction of the immune system.

Inflammation and certain medications, such as beta-blockers, antimalarials, or lithium, can potentially induce psoriasis. However, the exact cause is often unknown, and psoriasis is a chronic condition. Diagnosis is primarily clinical due to the distinctive nature of the disease. In rare instances, a small punch biopsy may be required for clarification, but in the majority of cases, general practitioners or dermatologists can easily diagnose it.

How is psoriasis treated?

Mild psoriasis is treated with topical treatments, such as mean creams and lotions. Currently. the most popular treatments are topical steroids. When used properly, these treatments can be both safe and effective. However, if the condition is extensive, patients may choose to undergo light treatment.

In my clinic, we use Naroban UVV, which is a similar device to sunbeds, but is a safer medical device where the dose of the light is very well controlled. In cases where proves ineffective or in cases of more severe conditions the light doesn't help, we have systemic treatments, immunosuppressants, type, methotrexate, and cyclosporin.  Although these are serious drugs, they are extremely safe.

In cases of severe disease or if systemic treatments prove ineffective, biologics are employed. These targeted treatments act specifically on the immune system, demonstrating high effectiveness and safety.

There are numerous treatments available. Unfortunately, the disease is not curable, but there are multiple, extremely effective treatments used to control it.

Can psoriasis come and go? How can people manage their symptoms?

As soon as patients begin a treatment plan for symptoms, they will begin to notice an improvement in their symptoms.

Psoriasis, as previously mentioned, is a long-life disease. However, certain individuals may experience periods of remission, during which the symptoms and lesions diminish.

Patients often notice improvement in the summer, due to the benefits brought on by sunlight. However, this improvement is not universal. Treatment challenges may arise for some patients, making management variable and, at times, difficult.

If you are suffering from psoriasis and would like to book a consultation with Dr Williamson, do not hesitate to do so by visiting his Top Doctors profile today.