Psoriasis can have a significant negative impact on a person’s quality of life. Those affected by the condition can suffer from low self-esteem and confidence issues because of how their skin looks and feels. Psoriasis is common and affects around 2% of the UK population[i].
In this article, we will discuss:
- What is psoriasis?
- What does psoriasis look like?
- Managing the condition
What is psoriasis?
Psoriasis is a long-lasting, chronic skin disease which can affect anyone at any age but usually develops before the age of 35.
Psoriasis is caused by the over production of skin cells and usually presents itself with flaky, crusted patches of skin that have a silver, scale-like appearance. The severity of the condition varies from person to person, with some people only having a few patches to others having a large percentage of their body covered in psoriasis.
Psoriasis is not contagious and is thought to be linked to the immune system and genetics meaning that if a family member such as a parent has psoriasis you are more likely to develop the condition. The cause of psoriasis can vary from person to person but when a person has ‘flare-ups’ of their condition it will usually be triggered by things such as the weather, stress, being unwell, allergies etc.
What does psoriasis look like?
Each type of psoriasis looks different. The images below show what common types of psoriasis look like.
There is no definitive cause for psoriasis, but the following factors are believed to be responsible for its development[ii].
Immune System Problems
It is believed that the main cause of psoriasis is linked to problems with the immune system, which lead to skin cells reproducing faster than they should do. It is not known precisely why this happens. Bouts of psoriasis can be triggered when the immune system is compromised through illness.
Learn more about the immune system by reading our guide here.
The role genetics play in psoriasis is not completely understood. Research shows that certain combinations of genes have been found in some people with the condition – so if psoriasis runs in your family, you are genetically at higher risk of having or developing it. However, someone in your family having psoriasis does not mean you will automatically develop it.
A trigger is a particular event that causes a flare-up of psoriasis. Triggers for psoriasis vary from person to person. Common, but generally unavoidable, triggers are:
- Hormone changes – for women, this can include menopause
- Some medicines – anti-inflammatory medications, ACE inhibitors and lithium have been known to trigger the condition
- Immune disorders (such as HIV)
- Streptococcal throat infections (a common trigger for guttate psoriasis)
- Skin injuries such as cuts and insect bites
Environmental triggers which can be avoided or limited to lessen their impact include:
- Stress and/or high levels of emotion
- Excessive alcohol consumption
- Weather (especially dry and cold conditions)
Types of psoriasis
Different types of psoriasis can develop, often affecting various parts of the body and presenting in different ways.
Plaque (vulgar) psoriasis
Plaque psoriasis accounts for 90% of cases in England[iii]
Plaque psoriasis is the most common form of psoriasis and can often be accompanied by nail psoriasis. Guttate psoriasis can develop into plaque psoriasis in some cases.
Changes to the skin include ‘plaques’, which are inflamed, crusted, scaly and raised patches of skin that can appear anywhere on the body although they often appear on the elbows, knees, scalp or torso. These plaques can often be painful and itchy, and the severity of this can range from being relatively mild to extreme. The plaques can appear grey, purple or dark brown in colour, but this can vary depending on skin colour.
Whilst many people only have a few plaques, they can also cover a large percentage of the body. When large areas of the skin are affected, the condition can be very uncomfortable, painful and impact on a person’s quality of life.
Scalp psoriasis only affects the scalp, forehead, hairline, skin around the ears and the back of the neck. The severity of it can range from causing extreme itchiness and discomfort to no discomfort at all. Scalp psoriasis can occur on its own but usually happens when someone has plaque psoriasis affecting other areas of the body.
Classic symptoms of scalp psoriasis can include crusted, thick plaques which cover the whole scalp and often surrounding areas of fine like crusting which can appear like dandruff. These plaques can cause itchiness and can last for a long time once they are present. The plaques have a silvery, powdery appearance. Scalp psoriasis can also be linked to psoriatic arthritis. Therefore, is you think you have scalp psoriasis you should see you GP as you may need referring to a dermatologist and a rheumatologist.
In some severe cases, this form of psoriasis can cause temporary hair loss – though this is not common.
Many treatments are available for scalp psoriasis, but it can take some time to find the right one.
8-10% of people experiencing psoriasis have guttate psoriasis[iv]
Guttate psoriasis commonly affects the chest, legs, arms and scalp but can also develop in the ears, on the face or scalp. This is most common in teenagers and children and usually disappears after a few weeks.
Guttate psoriasis present as small spots also referred to as papules. This can develop into plaque psoriasis, but often it goes away after a few weeks. Guttate psoriasis can sometimes be triggered by and infection. It has been linked to the streptococcal throat infection which may present no symptoms and therefore it would be recommended you see your GP if you think you may have Guttate psoriasis.
Around half of the people diagnosed with psoriasis have nail psoriasis
Nail psoriasis rarely occurs on its own, and usually happens alongside plaque or guttate psoriasis. It is common amongst people with psoriatic arthritis.
Read more about psoriatic arthritis on the NHS website here.
Nail psoriasis can cause pits, dents and ridges in the nail surface. Affected nails may become yellow and thick or have salmon-pink areas of discolouration underneath them.
In worse cases, nails may crumble or separate from the nail bed.
Inverse psoriasis usually appears where the skin creases and folds. Some of the most common areas being armpits, under breast and genital areas and buttocks. Inverse psoriasis can be aggravated by sweating, friction and irritation. Unlike plaque psoriasis, which worsens in cold weather, inverse psoriasis tends to worsen when it is hotter – making summer months very uncomfortable.
Inverse psoriasis appears as smooth red patches[v]. Inverse psoriasis can cause severe itchiness and discomfort.
Other less common types of psoriasis include:
- Pustular psoriasis – an aggressive form of psoriasis which flares up quickly and can require hospital treatment. Instead of typical plaques, the skin is affected by small, yellow, pus-filled spots on the limbs and torso.
- Erythrodermic psoriasis – a severe form of the condition which affects the entire body, causing the skin to burn and itch intensely. This type of psoriasis can be life threatening as it can lead to infection, heart failure, dehydration. Medical attention should be sought immediately if a person has a flare up of Erythrodermic psoriasis.
- Palmoplantar psoriasis – causes pustules on the hands and feet which, over time, turn into brown, circular spots that fall off.
- Acropustulosis – this type of psoriasis causes pustules that burst. The affected areas can become scaly or ooze.
Treatment for psoriasis does not cure the condition but helps to keep it under control. You should not attempt to treat the condition by yourself – what works for one person won’t necessarily work for another. Instead, seek help from your GP, who will help you find the best treatment for your individual needs.
GPs will generally start with milder treatments such as creams to see if these help before referring you for stronger treatments. If your condition does not improve then your GP may refer you to a dermatologist who will have access to a wider range of expertise and treatments.
Some of the main treatments for psoriasis are[vi]: –
Topical treatments involve a range of ointments and creams which will be applied topically (to your skin). This is usually sufficient for most patients, but it can take around 6 weeks to see some improvement. Topical treatments include:
- Steroid creams/ointments
- Calcineurin inhibitors
- Vitamin D analogues
- Dithranol (can be used to complement phototherapy treatment)
If the psoriasis is difficult to control with topical treatments alone, your GP may refer you for a course of phototherapy treatment at your local hospital. This involves being exposed to controlled levels of UV (ultraviolet) light, and generally takes place over 8-10 weeks.
Systemic (tablets and injections)
If treatments that focus on the affected area do not work, you might be prescribed a systemic treatment that will work for the whole body. Other treatments will usually be offered before systemic treatments as they often have potentially serious side effects.
Find out more about psoriasis treatment by reading the NICE guidelines here.
Managing the condition
As well as following your prescribed treatments and regularly reviewing this with your GP, there are simple steps you should follow that will help you manage the condition.
- Avoid triggers. If you have a known trigger, do your best to avoid or limit your exposure to it.
- Stay fit and eat healthily. Exercising and eating the right foods will put your body in the best position to manage the condition, as well as preventing other health problems.
- Talk to people. Any level of psoriasis can impact on your confidence and self-esteem, so it is vital to stay open about your feelings towards the condition.
- Use the right skincare products. You should make sure any other skincare products you use alongside prescribed topical ointments and/or shampoos won’t cause irritation to your psoriasis. Be gentle when cleaning affected skin.
The above information is only general guidance. You should always consult with your GP if you think you may have psoriasis or for there the general management of your psoriasis.
Take a look at HARTMANN Direct’s range of skincare products here – formulated to be gentle on fragile and broken skin.
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NHS, n.d. Overview. [Online]
Available at: https://www.nhs.uk/conditions/psoriasis/
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NHS, n.d. Symptoms. [Online]
Available at: https://www.nhs.uk/conditions/psoriasis/symptoms/
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NHS, n.d. Treatment. [Online]
Available at: https://www.nhs.uk/conditions/psoriasis/treatment/
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NICE, n.d. Ixekizumab for treating moderate to severe plaque psoriasis. [Online]
Available at: https://www.nice.org.uk/guidance/ta442/documents/final-scope
[Accessed March 2020].