About 2% of the UK population has it, but many fail to be correctly diagnosed. The condition runs in families. The scalp, elbows and knees are the commonest places on the skin affected with red, dry, scaly and thickened skin that looks unsightly.
Most cases of psoriasis are mild – but it still can cause personal psychological and social problems. Most cases can be treated with the correct topical preparation but severe disease may require regular tablet or injection treatment. Phototherapy is also a very popular management for psoriasis. Occasionally psoriasis can affect the joints and require additional medical management from a rheumatologist.
Psoriasis is characterized by patches of thick, red, inflamed skin and dry, silvery flakes of skin known as scales. Symptoms range in severity from barely noticeable to outbreaks of lesions that cover most of the body, and psoriasis even causes a form of arthritis in some people. The condition is not contagious, so it cannot spread from person to person. A better understanding of psoriasis causes, symptoms, and treatment will help both afflicted and non-afflicted people cope with the physical and emotional challenges of living with the condition.
While the actual cause of psoriasis is unknown, it is believed to result from genes that influence the immune response in the skin, possibly causing areas in which the immune system is inadvertently directed against the body’s own cells. Some people have a genetic makeup that makes it more likely to develop psoriasis than others, and about one third of the people with psoriasis also have a family member with the condition. Psoriasis can flare up at any time without any apparent cause, but it is often initiated or aggravated by specific triggers. Some examples of triggers that may aggravate psoriasis symptoms are listed on your screen.
Researchers believe psoriasis results from inflammation and excessive skin cell production. In particular, T-cells, which are a particular type of white blood cell that aid the normal immune response, are activated unnecessarily. The T-cells are activated to such an extent that they influence a series of reactions that cause and maintain the inflammation while accelerating proliferation of skin cells. Skin cells normally take about a month to develop, mature, and move to the skin’s surface, where they are continually shed. During the heightened immune response that causes psoriasis, the skin cells mature in less than a week and move to the surface, where they accumulate, resulting in the formation of scales among the red, inflamed tissues.
Psoriasis can affect all age groups, but it primarily affects adults. About three-quarters of people with the condition develop it before the age of 40, and only about one in ten develop it in their childhood years. Males and females are affected about equally. Psoriasis is most common in people of northern European descent, varies among other ethnicities, and is rare in Native Americans. More than half of the psoriasis cases are mild, covering less than 3 percent of the body, with fewer moderate cases. Severe cases that cover more than 10 percent of the body are the least common. Although people may inherit the genes that make them more likely to develop the disease, they may or may not develop psoriasis due to a wide variability in triggers, environment, and personal health factors.
The inflamed, irritated areas – or lesions – linked with psoriasis are often associated with itching, pain and bleeding between the cracks in the skin around affected areas. The degree of itching and pain can vary from minimal to extreme, which may cause problems sleeping and carrying out everyday tasks. Psoriasis patches can occur anywhere on the body, but they are found predominantly on the scalp, face, back, elbows, palms, legs, knees, and soles of the feet. Psoriasis may also cause pitting, discoloration, and deformation of fingernails and toenails. In about one in ten people with psoriasis, inflammation in the joints causes symptoms of arthritis, which can affect them at any age.
There are five main types of psoriasis that are commonly identified. Plaque psoriasis is the most common and accounts for about 80 percent of psoriasis cases. People typically have only one of the five types at a time, but some of the types will occasionally occur together.
A dermatologist may take a small portion of skin, called a skin biopsy, for microscopic evaluation to help diagnose the type of psoriasis in order to determine the best treatment option. The variability in the disease means that each patient may respond to treatment differently, so a unique treatment may be chosen based on the type, location, severity of psoriasis, and medical history. In general, treatments fall into one of four general categories shown. Antibiotics are also used against secondary infections that may occur in open skin lesions. There is no cure for psoriasis, but the right combination of avoiding triggers and the correct use of a wide variety of treatment options may help alleviate symptoms between outbreaks.
Biologics for psoriasis preceptorship program, Dept Dermatolgy, Exeter 2009-13.
This program was clinical teaching program aimed and up-skilling UK Consultant Dermatologist not familiar with prescribing biologic agents in clinical practice.
Downs AMR. Overnight application of dovobet ointment is a highly effective treatment for resistant scalp psoriasis.
Acta Dermato-Venereol 2006; 86:66-67. Laws PM, Downs AMR et al. Practical experience of ustekinumab in the treatment of psoriasis: experience from a multicentre, retrospective case cohort study across the UK & Ireland. Br J Dermatol 2012; 166:189-95.
Downs AMR Topical immunomodulators in dermatology. Pulse July 2005
Downs AMR Psoriasis – the scale of the problem. Chemist & Druggist Feb 2006
Downs AMR The use of biologics for psoriasis in a district general hospital. Dermatology in Practice 2007;15:8-10
Downs AMR Biologics in chronic psoriasis MIMS Winter 2008
Downs AMR, Dunnill MGS. Exacerbation of psoriasis induced by interferon-alpha treatment for hepititis C. Clin Exp Dermatol 2000; 25: 351-52.
Downs AMR. Etanercept vs. Adalimumab in the treatment of psoriasis Clin Exp Dermatol 2007; 32:593.
Downs AMR. Switching between anti-tumour necrosis factor biologic agents - is patient weight an important consideration? Brit J Dermatol 2009; 160:1123-24.
Downs AMR. Observational case series on a group of psoriasis patients who failed to respond to anti TNF alpha biologics and switched to ustekinumab. Brit J Dermatol 2010; 163:433-44
Bewley A, Boorman J, Cliff S, Domanne E, Downs AMR, et al. Interim results from a UK real world study to assess the impact of treatment with adalimumab on the physical and psychological manifestations and quality of life in patients with psoriasis. EADV, Istanbul 2013
Downs AMR, Bower CP. Psoriasis integrated care clinics: a novel approach to healthcare delivery. EADV, Istanbul 2013.
Bewley A, Boorman J, Cliff S, Domanne E, Downs AMR, et al. Results from a UK real world study to assess the impact of treatment with adalimumab on the physical and psychological manifestations and quality of life in patients with psoriasis. AAD San Fransisco 2015
Downs AMR. Scalp psoriasis. Korean Society of Dermatologists May 2010
Downs AMR. Integrated Care Clinics in psoriasis. NAPC Commissioning Conference London June 2011
Downs AMR. The Touch program interim data: improving compliance in psoriasis. 3rd World psoriasis and psoriatic arthritis conference Stockholm 2012.
Downs AMR. Managing scalp psoriasis Kuala Lumpor. Malaysian Dermatology Society May 2013
Downs AMR. Coping with Psoriasis – Patient/Physician challenges and the role of Emollients in psoriasis. Dubai 2103
Downs AMR, Biologics for severe psoriasis. Amman, Jordanian Dermatology Society September 2014
Williams P, Savanovic-Abel O, Haigh R, Winfield W, Batchelor R, Downs A. Successful treatment of Dermatomyositis-Associated Calcinosis with Adalimumab. Clin Exp Derm 2016.
Our Consultant Dermatologist have been managing psoriasis since 2000. We offer the management of all types of psoriasis and related conditions.