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PsoriasisPublished by BUPA's health information team, healthinfo@bupa.com, March 2007. This factsheet is for people who have psoriasis or who know someone who does. Psoriasis is a chronic (prolonged) inflammation of the skin. Often there are red patches (plaques) on the skin covered by silvery scales of dead skin. The condition is not infectious and is not usually severe enough to affect general health.
Who gets psoriasis?Psoriasis is quite common, affecting around two percent of the UK population, although people with very mild symptoms may not be aware they have it. Psoriasis can begin at any age, but it most commonly starts between the ages of 11 and 45. It often starts in the late 20s. The underlying cause of psoriasis isn't known, but it tends to run in families. If both of your parents are affected, you have a 60 percent chance of developing the condition. Environmental triggers are important too, stimulating the development of the condition if you are susceptible to it. Triggers include throat infections, skin trauma such as cuts, bruises or burns, some medicines, stress or psychological trauma, smoking and high alcohol intake. And although psoriasis is much more likely if you have a family history of the condition, others may still get it. Symptoms of psoriasisPsoriasis occurs in different forms, but it usually involves the thickening and reddening of patches of skin. Patches of psoriasis typically occur on the elbows, knees, scalp and lower back, but it can sometimes affect the whole body. These patches have a thick silvery-white scale of dead skin on the top, and may be itchy (see The main types of psoriasis). Most people with psoriasis have the condition for life. However, it tends to comes and go, often for no apparent reason, and the severity of each flare-up can vary. The main types of psoriasis
Psoriasis can also occur on the scalp (scalp psoriasis), where it can cause redness and flaking, or smooth patches may appear on the soles of the feet and palms of the hands. Fingernails can also be affected by pitting like on a thimble, discolouration or breakage. Around 10 percent of people with psoriasis also have associated arthritis (inflamed joints) called psoriatic arthritis. This can range from being very mild to severe. Usually the joints at the end of the fingers and toes are affected, although the back, knees and hips may be too. For more information, please see the separate health BUPA factsheet Psoriatic arthritis. Causes of psoriasis skin changesIn areas affected by psoriasis, there seems to be a rapid increase in the speed at which skin cells are replaced. Skin usually takes about 28 days to replace itself, but in areas affected by psoriasis it only takes three or four days. New skin cells move rapidly to the surface before they are properly mature, forming the thick psoriatic patches. There is also a build up of a particular kind of white blood cell (called T-cells) under the skin, which causes inflammation. It's thought that substances produced by the immune system may cause both the build up of T-cells and the abnormal turnover of skin cells - but what makes the immune system act like this isn't clear. Diagnosis of psoriasisYour doctor can usually diagnose psoriasis from the symptoms you describe and a physical examination. In some cases, a small skin sample may be taken to be tested in a laboratory (biopsy) to help confirm the diagnosis. Treatment of psoriasisSelf-care action planThere are several common-sense ways to help minimise psoriasis flare-ups.
Medicines and light treatmentsThere are many treatments available for psoriasis. Psoriasis creams and ointments are usually the first tried, followed by tablets and treatment with ultraviolet light. Some of the main treatments are listed below.
Complementary therapyIt is unusual for conventional medicine to cure psoriasis, or to relieve the symptoms completely. For this reason, many people turn to complementary therapies such as homeopathy, acupuncture and herbal remedies. Whether they are of any benefit is unclear, partly because people often use steroid creams at the same time as the complementary therapies, and also because of the way psoriasis naturally comes and goes. Relaxation methods such as meditation, yoga and the Alexander Technique may well be beneficial because they reduce stress, a trigger for psoriasis. PhysiotherapyIf you have psoriatic arthritis, physiotherapy, certain exercises, and occupational therapy - where you learn to carry out daily tasks as easily as possible - can be helpful. What is the outlook?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. However, you should look out for possible complications such as infections (shown by skin becoming more painful, swollen, red or tender than usual) or arthritis and, if worried, see your GP. Further information
Sources
Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre. Publication date: March 2007. Expected review date: March 2009.
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