Ask the Expert: Psoriasis
Interviewed by Gurminder for Doctify
Leading dermatologist, Dr Adam Friedmann at The Harley Street Dermatology Clinic, has put together some information and advice on this commonly misunderstood skin condition.
What is it?
Psoriasis is an inflammatory skin condition that causes thickening, redness and scaling. It can affect the whole of the skin including the scalp and nails. Occasional it can be associated with arthritis. It tends to be intermittent in nature and is characterised by remission and ‘flare ups’. The causes remains unknown but it can run in families and be precipitated by illnesses, stresses or even some medications. Although there is no cure, the condition can be well controlled with medication.
What does it look like?
There are several clinical patterns of psoriasis:
- Chronic Plaque– The commonest variant, it tends to occur on the extensor aspects of the elbows and knees and in the scalp. Skin changes include pink or red inflamed, thickened plaques with copious white scale.
- Sebopsoriasis – similar to scalp psoriasis but can occur on the face, chest, armpits and groin
- Flexural – raw, red areas in the groin, armpits or under the breasts
- Guttate – multiple small spots of psoriasis that erupt on the trunk following a sore throat or illness
- Erythrodermic – extensive disease covering more than 90% of the body surface area.
- Palmoplantar pustular – pus-filled inflamed spots and the palms and soles
- Pustular – the most severe form of psoriasis, skin lesions are red, tender and filled with pus spots
How might it affect me?
Psoriasis can vary in severity from no more than a minor irritation to being a major problem – in extreme cases, sometimes requiring hospitalisation. Even a small bit of psoriasis in a delicate area such as the face or genitals can cause immense distress. Occasionally it can be itchy or cause painful splitting or fissuring of the skin. As well as the skin being affected, the nails can become abnormally brittle with flaking and pitting. 5% of patients might develop arthritis associated with psoriasis.
What are the treatments?
The treatment can be divided into three basic strategies depending on severity. These are creams, phototherapy (ultraviolet/sunlight) and systemic medication (oral or injectable drugs).
- Creams include emollients, soap substitutes, vitamin D, tar and steroids.
- Phototherapy involves precise doses of ultraviolet light being delivered by a medical UV-machine.
- Systemic medications include tablets such as acitretin, methotrexate and ciclosporin or injectables such as etanercept, adalimumab or ustekinemab. These powerful drugs are reserved for severe or life-limiting psoriasis.
Remember, although psoriasis is incurable, it can be well controlled with medication – there is no need to let psoriasis rule your life.