Monday November 28, 2016
Have you been noticing any dry, red, or itchy patches on your skin that haven’t been there before? If so, you may be one of the 2% of the population that have psoriasis. Psoriasis is a non-contagious skin condition that often presents as patches of dry, red skin with flaky, silvery scales. Unfortunately, psoriasis is a chronic (long-term) condition with no quick-fix, however, LDC's Private Doctors can advise on how to keep it under control.
Symptoms of Psoriasis
In many people, psoriasis will only present with a rash. People will typically develop dry patches of skin, particularly in the following areas:
- Lower back
Psoriatic skin can sometimes also be itchy and sore; in especially severe cases the dry skin can crack and even bleed.
Psoriasis usually presents as dry, cracked skin, often around the elbows, knees and scalp
While psoriasis is most associated with skin problems, it can also affect other parts of the body. Half of all people suffering from psoriasis will experience painful nail changes, such as pitting or splitting.
Psoriasis can also affect the joints, causing swelling, pain, and stiffness. This is known as psoriatic arthritis or psoriatic arthropathy. Nevertheless, it is important to keep in mind that the severity of psoriasis ranges widely - while psoriasis can have significant impacts on some people, for others it can be no more than an annoyance.
What Causes Psoriasis?
Your skin is made up of several layers, with a layer called epidermis lying at the top. In healthy skin, the cells of this layer are replaced by new skin every 3-4 weeks. In psoriatic skin, the epidermis is attacked by the body’s own immune system, hence Psoriasis being an autoimmune disease. This results in the epidermal cells being replaced every 3-7 days. The rapid turnover of skin cells causes the patches of dry, scaly skin found in psoriasis.
While the exact cause of this condition is still unknown, it can run in families to a degree. Often, the first signs of psoriasis are set off by triggers such as skin injuries, throat infections (‘strep throat’), or even certain prescription medications. These factors can also set off flare-ups of psoriasis, as can stress, alcohol, smoking, and being overweight.
Alcohol can be a trigger for psoriasis, resulting in a flare-up of the condition
Psoriasis Management: Treatment and Medication
There are several topical treatments for psoriasis that your GP can prescribe. These are creams and ointments that can be applied directly to areas of sore, psoriatic skin.
This is the most common treatment that is used to manage psoriasis. It is a moisturising preparation that can help to soothe and soften dry, cracked skin. Mild cases of psoriasis can often be managed with this sort of treatment alone.
Steroid Creams and Vitamin D Analogues
If emollients aren’t enough, then your GP may prescribe creams containing steroids or vitamin D analogues. Steroid creams are only used for short courses to treat flare-ups of psoriasis, as they can have significant side-effects over long-term use, although there is a tendency for psoriasis to rebound once they are stopped.
Other topical treatments used for severe psoriasis include dithranol and coal tar, both of which can be applied by trained nursing staff.
The majority of mild psoriasis can be managed by your GP using the topical treatments already mentioned, but moderate to severe cases will require a specialist referal to a dermatologist.
Emollient creams are first-line treatment for psoriasis, followed by steroid creams
Immunosuppression Treatment for Psoriasis
These specialist doctors can use tablets and injections to help manage psoriasis. These treatments, while potentially more effective, do carry a higher risk of side-effects. The medications used are immunosuppressants, which work by dampening down the inflammation that drives the rapid turnover of new skin cells. However, by suppressing the immune system, and by other effects such as liver dysfuntion, these drugs can put patients at a higher risk of catching infections. Because of these risks, immunosuppressant treatments can only be initiated by a specialist, with monitoring continued by GP's, and patients will often need regular clinic appointments and blood tests.
Phototherapy for Severe Psoriasis
Patients with severe psoriasis may also be offered phototherapy, which uses UV light rays to reduce skin turnover in psoriatic patches. UV rays are naturally found in sunlight – and if you have psoriasis, you may find some improvement after being out and about in the sun! Having said this, sun exposure needs to be balanced with regard to skin cancer risk.
Living With Psoriasis: Support
Although we have focused on the physical symptoms of psoriasis, it is important to recognise the psychological impact of the psoriasis. People living with the condition may struggle to cope, often feeling embarrassed or ashamed. Psoriatic skin disease, especially when visible and not hidden by clothing, can impact your self-esteem – even leading to anxiety and depression. If you do suffer from psoriasis and feel that you are struggling to manage your condition, make sure to contact your GP, who can help you with both your physical and mental health.
You can also contact the Psoriasis Association, which is the national UK charity for people affected by this condition. There you will find support, relevant news articles, and more in-depth information about treatment options. Other good sources of information include the NHS Choices website and the British Association of Dermatologists.
So don't struggle with psoriasis alone - there is plenty of support available out there! Our experienced private GP's are more than happy to work with you to successfully manage the condition, so book a GP appointment today!
By Ankit Mishra