HEALTHPLAN MAGAZINE

What is Psoriasis?

The word Psoriasis comes from the Greek word 'psora' meaning 'itch' which usefully sums up exactly what Psoriasis is. Psoriasis is a chronic skin disease that causes red, flaky, crusty patches of skin to appear which become covered in silvery scales. The patches can appear on elbows, knees and scalp and anywhere on your body. They can be itchy and sore. Most people are usually affected in small patches. Attacks of Psoriasis can be mild or severe. At its worst Psoriasis is socially disabling and in some rare cases it is life-threatening. Early on-set Psoriasis is seen in 16 to 22-year-olds and late-onset Psoriasis is generally seen in people aged between 50 and 60. At any one time, 2% of the population has Psoriasis but it is not contagious.

What are the Symptoms of Psoriasis?

In most instances Psoriasis is cyclical, so it will cause problems for a few weeks and then ease or stop altogether. In Psoriasis vulgaris, the most common form, the first signs of an outbreak are red spots or patches that then become larger and scaly. The upper scales fall off in large quantities, while the lower layers of scales are firmly fixed. If the scales are scraped off then a number of small, bleeding areas can be seen underneath.

Different forms of Psoriasis

There are a number of different types of Psoriasis. Usually people suffer with one type although more than one type can occur. Some kinds of Psoriasis change into another type or become more severe.

Plaque Psoriasis

Plaque Psoriasis is the most common form, accounting for approximately 90% of Psoriasis cases. The plaques can be itchy, sore or both. In severe cases, the skin around your joints may crack and bleed.

Scalp Psoriasis

Scalp Psoriasis causes red patches of skin covered in thick silvery-white scales. Some people find scalp Psoriasis extremely itchy, but others suffer no discomfort. In rare cases it can cause temporary hair loss.

Nail Psoriasis

Psoriasis can cause nails to develop tiny dents or pits that become discoloured. They may grow abnormally, become loose and separate from the nail bed.

Guttate Psoriasis

Guttate Psoriasis, common among children and teenagers, causes small drop-shaped sores on the chest, arms, legs and scalp. It usually clears up quickly although some people go on to develop plaque Psoriasis.

Inverse (flexural) Psoriasis

This type of Psoriasis is found in the folds or creases in your skin, such as the armpits, groin, between the buttocks and under the breasts. Inverse Psoriasis is irritated by friction and sweating, so it can be extremely uncomfortable in warmer weather. The plaques are often infected by the yeast-like fungus candida albicans.

Pustular Psoriasis

Pustular Psoriasis causes pus-filled blisters (pustules) to appear on the skin. Different types of pustular Psoriasis affect different parts of the body. Generalised pustular Psoriasis or von Zumbusch Psoriasis for example, causes pustules on a wide area of skin to develop very quickly.

The pus consists of white blood cells and is not a sign of infection. The pustules may reappear every few days or weeks in cycles. During the start of these cycles, von Zumbusch Psoriasis can cause fever, chills, weight loss and fatigue. It is very rare.

Palmoplantar pustular Psoriasis

This causes pustules to appear on the palms of your hands and the soles of your feet. The pustules gradually develop into circular brown scaly spots, which then peel off. Pustules may return every few days or weeks.

What are the Causes of Psoriasis?

Psoriasis seems to occur when skin cells are replaced more quickly than usual. It is not known exactly why this happens. The body produces new cells in the deepest layer of the skin level and these move up to the surface gradually over three or four weeks. Once at the surface they die and flake off. In people with Psoriasis, this process is speeded up and takes just three to seven days. The skin cells are not fully mature and cause red, flaky, crusty patches covered with silvery scales.

It may be that these skin cells are replaced too quickly because of a problem with the immune system. The immune system use T-cells to help fight infection. In people with Psoriasis T-cells attack healthy skin cells by mistake. This triggers the immune system to produce new skin cells more quickly than usual, as well as more T-cells.

Other factors include genetics because Psoriasis runs in families. One in three people with Psoriasis has a family member with the condition.

Psoriasis Triggers

The symptoms of Psoriasis can be triggered and produce flare ups. Common triggers include:

• Drinking too much alcohol
• Smoking
• Stress
• Hormonal changes
• Throat infections
• Some drugs such as antimalarial treatments, anti-inflammatories, beta blockers
• Damage to the skin

Treatment for Psoriasis

Depending on your age and state of health your GP will recommend a number of treatment options.

Moisturisers are useful for mild Psoriasis to reduce the dryness of the skin and alleviate cracking and scaling. Creams and ointments containing coal tar, dithranol, tazarotene (Zorac) or vitamin D-related compounds, e.g. calcipotriol (Dovonex), calcitriol (Silkis) or tacalcitol (Curatoderm) are often recommended. Sometimes, corticosteroid-containing ointments will be used for a short time. Meanwhile, special lotions are available for scalp treatment and these will often contain salicylic acid, coal tar, sulphur or corticosteroids.

In some instances phototherapy (ultraviolet B, UVB) and photochemotherapy (psoralent ultraviolet A, PUVA) will be used. Many patients find that natural sunlight also helps.

There is no cure for Psoriasis, but treatment helps to keep the condition under control.

Image courtesy of Wikimedia Commons