What is psoriasis?
Psoriasis is a common skin problem affecting about 2% of the population. It occurs equally in men and women, at any age, and tends to come and go unpredictably. It is not infectious and does not scar skin. It is generally characterised by symmetrical, well-defined, red plaques with a thick silvery scale but there are a number of other variants of the disease. It is sometimes associated with disorders of the joints and nails. The sites most commonly affected by psoriasis are the scalps and extensor surfaces of the elbows, knees, sacrum and the limbs, but psoriasis may occur anywhere on the skin including the genitalia.
What causes psoriasis?
One third of patients recall a family history, so genetics do play a part. However, the trigger for psoriasis to appear is often an outside event, such as a throat infection, stress or an injury to the skin.
The skin is a complex organ made up of several different layers. The outer layer of skin (epidermis) contains cells which are formed at the bottom and then move up towards the surface gradually changing as they go, finally dying before they are shed from the surface. This process normally takes between 3 and 4 weeks. However in patients with psoriasis the rate of turnover in skin is dramatically increased within the affected skin so that cells are formed and shed in as little as 3 to 4 days. This leads to the typical appearance of psoriasis red, raised plaques with superficial scale.ents recall a family history, so genetics do play a part. However, the trigger for psoriasis to appear is often an outside event, such as a throat infection, stress or an injury to the skin.
For most patients who develop psoriasis, or for whom it clears and then comes back, no obvious cause can be detected. Usually, sunlight improves psoriasis, although occasionally makes it worse (especially if the skin gets burned). A high alcohol intake and smoking can worsen psoriasis too, as can medicines used for other conditions- such as lithium, malaria tablets, and beta-blockers. There is no proven relationship between diet and psoriasis.
How can psoriasis be treated?
It is important to remember that psoriasis can be treated but not cured.
Emollients (moisturisers): Emollients help to moisturise dry skin and probably the most important factor in managing any dry skin condition. Proper use of emollients relieves itching, reduces scaling, softens cracked areas and helps the penetration of other topical treatments. They can be used as often as needed. There is a wide variety of emollients available. A soap substitute like aqueous cream is widely available and cheap, and emulsifying ointment is a good moisturiser although it may be too greasy for daytime use.
Tar: Tar preparations come in the form of creams, ointments or shampoos. These help most patients but can be quite messy.
Steroids: Topical steroids are sometimes helpful, but only on localised lesions. Weaker steroids generally are not effective on thick plaques and potent steroids appear to work well but long term or inappropriate use is associated with side effects. It may be appropriate to use potent or super potent steroids for a short course under a doctor’s supervision.
Vitamin D analogues: Preparations based on variations of vitamin D have been introduced with considerable success. They can be mixed with a steroid at the start of treatment to get troublesome psoriasis under control. They are not used during pregnancy or breast feeding. They are helpful safe and cosmetically acceptable.
Topical retinoids: A vitamin A gel can be used once daily to patches of psoriasis. It should not be use don the face or skin folds or on large areas of the body, where it can cause irritation. It should not be used in pregnancy or during breast feeding.
Dithranol: Dithranol is applied, sparingly, only to affected areas of skin affected by the psoriasis. It should be rubbed in gently until fully absorbed and hands should be washed after use. The dithranol should be removed after a period of time depending on your doctor’s instructions.
Ultraviolet light: This is available through the hospital specialist. It is best used for troublesome psoriasis or for widespread guttate psoriasis that fails to clear with topical treatment or comes back quickly after seeming to clear. Guttate psoriasis is a common disease of teenagers that can present after a throat infection.
Systemic therapy: The decision to use systemic therapy is always difficult, because there are side effects with the drugs used and the patients require constant supervision. The disease will also generally return to its previous state on cessation of therapy. This decision is generally best made by the hospital specialist along with the patient and family.
What should I do now?
Make an appointment to see us. Your skin will be assessed during a Dermatology Consultationand you will be advised on the best treatments to use. There will then be a review visit after a few weeks. The cost of a Dermatology consultation with Adare Cosmetics Clinic is €80.00 Consider contacting others who have psoriasis through a support group.
If possible, cut down your alcohol and smoking consumption.
Stress management may be helpful.
Always use the treatments prescribed for you.