Psoriasis

Psoriasis is a skin condition that results in red, flaky, crusty patches of skin covered with silvery or whitish ‘scales’.

Overview

Psoriasis is relatively common and affects 2-3% of the U.K. population. Typically, psoriasis is considered to be a long-term issue, which means it’s what’s known as a chronic condition.

While the presentation of the condition is different in each individual, psoriasis patches commonly appear on the knees, elbows and scalp. It can be itchy and painful, and can also cause joint problems, known as psoriatic arthritis.

As a result of the chronic, uncomfortable and sometimes unpredictable nature of the condition, many patients find that it negatively impacts their quality of life and self-confidence. For these reasons, as well as its unsightly presentation, it is common for patients suffering from psoriasis – especially in its more severe forms - to also experience psychological issues, such as depression and anxiety.



While psoriasis cannot be cured, with medical help the condition is manageable, and there are some techniques that patients may find helpful in identifying triggers and reducing their flare-ups.



Symptoms of Psoriasis

The presentation of psoriasis is varied, and thus it may be confused with other skin conditions.

This is why it’s important to be diagnosed by a doctor, to ensure the proper treatment course can be advised and monitored.

Common signs and symptoms of psoriasis include:

  • Red patches covered with thick, silvery scales
  • Small scaly spots (often seen in children)
  • Itchy, ‘burning’ sensations or soreness at the site
  • Dry, cracked skin that may bleed
  • Thickened, pitted or ridged nails
  • Swollen and stiff joints

The severity of psoriasis is also varied, and patches can present either as a few areas that shed dandruff-like scales, or as skin eruptions that cover large areas.

Most types of psoriasis go through cycles, causing flare-ups that last a few weeks or months, and then subside for a time, or can go into remission.

There are several types of psoriasis. These include:

80% of psoriasis sufferers experience this form, which presents as dry, raised, red skin lesions (also called plaques) covered with silvery scales. Plaques may be itchy or sore, and can present anywhere on the body, including in the genital area.
When the condition affects the fingernails or toenails, it can cause pitting (tiny depressions in the flat surface of the nails), abnormal nail growth and discoloration. Psoriatic nails can also loosen and separate from the nail bed, which is known as onycholysis. In more severe cases, psoriasis may cause the nail to crumble.
This form usually affects younger people, and presents as small, water-drop-shaped scaly lesions on the upper part of the body.
This form causes smooth patches of red, inflamed skin which is worsened by friction and sweating. Typically, it affects the skin in the armpits, under the breasts, and in the groin or genital area.
This rarer form of psoriasis may occur in widespread patches (also called generalized pustular psoriasis) or in smaller areas, such as the hands, feet or fingertips. It typically develops quickly, with pus-filled blisters appearing in the hours after skin becomes red and tender. Blisters may come and go frequently, and will sometimes be accompanied by fever, chills and severe itching.
The rarest form of the condition covers the entire body with a red, peeling rash that is likely to itch or burn intensely. This usually occurs in the setting of known worsening or unstable psoriasis and can be fatal.
Presenting alongside inflamed, scaly skin, the condition causes swollen, painful joints that are typical of arthritis. Joint symptoms may be the first or only manifestations of the condition, and at times only changes in the nails are evident. The condition varies in severity and can affect any joint. While it is not typically as severe as other forms of arthritis, it can cause stiffness and progressive joint damage.

Scratching or otherwise interfering with psoriasis may cause infection or other complications, so it is important to seek medical advice if the condition persists or worsens.

Causes of Psoriasis

The causes of psoriasis aren't fully understood, but experts think it’s related to a problem in the immune system problem involving T cells (a type of white blood cell) and other white blood cells, which are called neutrophils.

While normally, T cells travel throughout body to defend against viruses or bacteria, in patients with psoriasis, the T cells malfunction and attack healthy skin cells as though fighting an infection or foreign substance.

The process becomes an ongoing cycle, in which new skin cells move to the outermost layer of skin too quickly — in days, rather than weeks. Skin cells build up in thick, scaly patches on the skin's surface, continuing until treatment stops the cycle.

There are few ‘proven’ triggers for psoriasis, although patients often report flare-ups associated with stress, alcohol, infections and certain medications.

The condition is seen as likely to be influenced by genetics, so it is possible that if an individual’s parents have experienced problems with psoriasis, they may be more likely to have the same trouble.

Different types of psoriasis may have different causes, for example:

This is typically triggered by a bacterial infection, such as a streptococcal throat infection.
Fungal infections may trigger this type of psoriasis.
Overactive T cells may also trigger increased production of healthy skin cells, and white blood cells, especially more T cells and neutrophils. When they travel into the skin, this can cause pustular lesions.
The exact cause is rare, but it may be brought on by suddenly stopping treatment for a more common or less serious type of psorsiasis.
As the immune system begins to attack healthy cells and tissue, it causes inflammation in the joints as well as overproduction of skin cells.

Some patients find it helpful to keep a record of changes in their condition - whether it improves or worsens – in order to look for commonalities, such as environmental or psychological factors, over time.

Some common psoriasis triggers include;

  • Emotional stress
  • Cold, dry weather conditions
  • Consuming alcohol or caffeine
  • Injury to the skin, such as scratches or vaccination
  • Irritation to the skin from shaving or exfoliation
  • Bacterial infections
  • Medications (commonly antimalarial drugs and painkillers)
  • Consuming fatty meats

While smoking is harmful to individuals as well as to those around them, it can also trigger psoriasis outbreaks – making it another reason to quit.

Treatment of Psoriasis at Derma

Your appointment will begin with a skin check and medical history, followed by recommended treatment options.

Together with the dermatologist, you will discuss the latest and most effective treatments and explain all potential side-effects, enabling you to select the best option for you.

Mild to moderate forms of psoriasis may be controlled using topical treatments available from chemists, but depending on your condition, prescription creams may be necessary. The dermatologist will let you know whether it is beneficial to continue with any over-the-counter treatment, or if it is advisable to stop.


Additionally, Derma offers Narrow-band phototherapy, which uses Ultraviolet (UV) light to treat psoriasis, and is often effective in managing the condition. A course of treatment requires 3 visits to the hospital each week for around 8 weeks, but the results last several weeks. It may be helpful during periods where the condition is more prone to flare-ups, such as during the dry, cold winter months.

You may be a candidate for treatment using medication that works to suppress the immune system, however this treatment requires you to be closely monitored.

Depending on the treatment and the severity of your condition, further tests and follow-up appointments may be required to manage your treatment.

Book your consultation

For more information, or to book an appointment with Derma, please call the clinic or contact us.

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