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Psoriasis

Published by Bupa's health information team, June 2009.

This factsheet is for people who have psoriasis, or who would like information about it.

Psoriasis is a common skin condition causing patches of inflamed skin. It isn't contagious. Plaque psoriasis is the most common type.

About psoriasis

In psoriasis, the rate at which your skin is replaced is rapidly increased.

Your skin is constantly shedding old cells and being replaced with new ones from underneath, in a cycle that usually takes about 28 days. In psoriasis, this process speeds up, only taking about three to four days. New skin cells move rapidly to the surface before they have properly matured, and accumulate on the surface of your skin, forming thick patches called plaques. There is also a build-up of a type of white blood cell (called T-cells) under your skin, which causes inflammation.

Psoriasis affects around two in 100 people. Psoriasis can begin at any age, and affects similar numbers of men and women.

Most people with psoriasis have the condition for life. However, it tends to come and go - often for no apparent reason - and the severity of each flare-up can vary. Psoriasis can't be caught from other people and it can't be transferred from one part of your body to another.

Types of psoriasis

  • Plaque psoriasis is the most common type of psoriasis, where you get pinkish-red scaly plaques (patches), especially on your knees and elbows. If you have plaque psoriasis, you may have periods when the symptoms aren't too troublesome.
  • Flexural psoriasis affects areas where your skin is folded - such as your armpits and groin area, where the skin tends to be thinner and more sensitive than other areas of the body. It's also sometimes called inverse psoriasis. Flexural psoriasis is commonest in older people.
  • Pustular psoriasis is a rare, severe form of the condition, in which small pus-filled spots (pustules) develop on your skin. This can be a very serious, life-threatening condition and you may need to be admitted to hospital.
  • Erythrodermic psoriasis is also a rare, severe form of the condition, in which your skin becomes red and inflamed all over. This intense inflammation results in protein and fluid loss, which can lead to a serious illness. It usually needs to be treated in hospital. Erythrodermic psoriasis usually only develops in people who already have another type of psoriasis.
  • Guttate psoriasis is a form of the condition in which small, circular, inflamed patches of skin suddenly appear all over your body, usually after a throat infection. It tends to affect children and young adults.

Symptoms of psoriasis

Psoriasis occurs in different forms, but usually involves the thickening and reddening of patches of skin. Your skin may feel itchy, and can sometimes feel painful or sore.

If you have very mild symptoms, you may not be aware you have it.

Some types of psoriasis can affect your scalp - where it can cause redness and flaking - and your fingernails, which can become pitted and discoloured.

If you think you have these symptoms, see your GP.

Complications of psoriasis

About one in 10 people with psoriasis also develops associated arthritis (inflamed joints). This is called psoriatic arthritis (please see Related topics). Usually the joints at the end of your fingers and toes are affected, although your back, knees and hips may be affected too.

Causes of psoriasis

It's thought that in psoriasis, substances produced by your immune system cause your skin to start producing new cells faster than usual and allow T-cells to build up. What makes your immune system act like this isn't clear.

You're more likely to get psoriasis if you have a family history of the condition. If one of your parents has psoriasis, you have a one in four chance of getting it too. However, in many people, there is no obvious cause.

If you're susceptible to psoriasis, environmental factors may play a role. Triggers include throat infections, cuts, bruises or burns, some medicines, stress or psychological trauma, smoking and high alcohol intake.

Diagnosis of psoriasis

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP can usually diagnose psoriasis from the symptoms you describe and a physical examination.

If your psoriasis is extensive or severe, if it's affecting your education or work, or if your diagnosis is uncertain, your GP may refer you to a dermatologist (a doctor who specialises in skin conditions).

If you have generalised pustular psoriasis or erythrodermic psoriasis, you may need to be admitted to hospital for treatment.

Treatment of psoriasis

Self-help

Your GP will probably advise you to use emollients - creams or lotions that moisten, soften and soothe your skin. He or she will usually prescribe these, but you can also buy them from a shop without a prescription. Discuss this with your GP so that you can get the best results.

Topical treatments

Your GP may prescribe you a medicated cream or ointment. The type and strength of topical treatment will depend on the type of psoriasis you have and include preparations containing:

  • tar - these can reduce inflammation and scaling, and are often used in psoriasis affecting your scalp; however, they can be messy
  • steroids - these are often used for localised psoriasis (eg patches on your elbows or knees), but shouldn't be used if your psoriasis is quite widespread; stronger steroids can be used on your palms and soles, or your scalp
  • vitamin D derivatives (such as calcitriol or tacalcitol) - these can be easier to use than some of the other products, but sometimes irritate the skin

Oral medicines

In certain situations, for example if topical treatments haven't controlled your symptoms, or if your psoriasis is extensive, you may be prescribed oral medicines (medicines that you take by mouth) such as:

  • methotrexate
  • acitretin
  • ciclosporin (cyclosporin)
  • hydroxycarbamide

These medicines work by suppressing your immune system, or by slowing down the production of skin cells, and are prescribed by a dermatologist.

If you're a woman, you will be warned not to become pregnant while taking these medicines or for some time afterwards. With some of the tablets, men will also be advised that they shouldn't get their partner pregnant. This is because these medicines can cause serious damage to an unborn baby.

Biological agents are newer treatments for psoriasis that can be very effective, but tend to be restricted to people with severe psoriasis. They are given as an injection into your skin, or through a drip into a vein in your arm.

Your dermatologist can discuss these treatments with you. You will need to have various pre-treatment tests before you can try these medicines, and you will be monitored with blood tests while you're receiving the treatment.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Light therapy

If your psoriasis is widespread (covers a large part of your body), or if it doesn't respond to the above treatments, your dermatologist may recommend light therapy.

  • Ultraviolet B (UVB) light therapy involves shining artificial UVB light on to your skin. You will usually have the therapy two to three times a week for several weeks. UVB light occurs naturally in sunlight.
  • Psoralen and ultraviolet A (UVA) light treatment (also called PUVA) involves combining a medicine which sensitises the skin to sunlight (psoralen) with a controlled dose of UVA light. You may have psoralen as a tablet or applied directly to your skin. The UVA light is given in a machine that looks similar to a shower cabinet, containing fluorescent tubes. You usually have the treatment twice a week, for several weeks.
  • Sometimes UVB light therapy is used in combination with topical treatments such as steroid creams or tar (see Topical treatments). This combination may be effective at helping to control your symptoms of psoriasis by making your skin more sensitive to UVB light.

Living with psoriasis

Psoriasis is a long-term condition and for many people is usually mild. It can, however, have a profound social and psychological impact on daily living. There is currently no cure, but the range of treatments available is usually effective at relieving symptoms when they occur. It may help to talk to your GP about your treatment options and join a self-help group for support.

Related topics

Further information

Sources

  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:646-647
  • Kumar P, Clark M. Clinical medicine. 6th ed. Amsterdam: Elsevier Science, 2005:1331-1334
  • Psoriasis in sensitive areas. Psoriasis Association. www.psoriasis-association.org.uk, accessed 26 September 2008
  • Pustular psoriasis. Psoriasis Association. www.psoriasis-association.org.uk, accessed 26 September 2008
  • Erythrodermic psoriasis. National Psoriasis Foundation. www.psoriasis.org, accessed 26 September 2008
  • Guttate psoriasis. Psoriasis Association. www.psoriasis-association.org.uk, accessed 26 September 2008
  • What is psoriasis? Psoriasis Association. www.psoriasis-association.org.uk, accessed 26 September 2008
  • Psoriasis - an overview. British Association of Dermatologists. www.bad.org.uk, accessed 26 September 2008
  • Psoriasis advance - time to kick the habit. National Psoriasis Foundation. www.psoriasis.org, accessed 26 September 2008
  • Guidelines for the general management of psoriasis. British Association of Dermatologists. www.bad.org.uk, accessed 26 September 2008
  • Infliximab for the treatment of adults with psoriasis. National Institute for Health and Clinical Excellence (NICE), 2008, Technology Assessment 134. www.nice.org.uk
  • Etanercept and efalizumab for the treatment of adults with psoriasis. National Institute for Health and Clinical Excellence (NICE), 2006, Technology Assessment 103. www.nice.org.uk
  • Treatments for moderate or severe psoriasis. British Association of Dermatologists. www.bad.org.uk, accessed 26 September 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: June 2009

 

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