Psoriasis is a chronic skin condition characterised by red, scaly patches that can appear anywhere on the body. It is an autoimmune disorder, meaning the immune system mistakenly attacks healthy skin cells, causing them to multiply rapidly. This overproduction of skin cells leads to the formation of thick, itchy plaques that can sometimes crack and bleed.
Although psoriasis affects around 2% of the UK population, its severity and impact vary widely from person to person. Some individuals experience mild irritation, while others may struggle with painful, widespread plaques that affect daily life and self-confidence. The condition can also influence mental health, contributing to anxiety, depression, and social isolation.
Understanding the causes of psoriasis and exploring the available treatment options can help manage symptoms effectively. While there is currently no cure, a combination of medical treatments, lifestyle adjustments, and skincare practices can significantly reduce flare-ups and improve quality of life for those living with psoriasis.
Common Causes and Triggers of Psoriasis
Psoriasis is a complex condition influenced by a combination of genetic, immune system, and environmental factors. While the exact cause of psoriasis is not fully understood, research indicates that certain triggers can initiate or worsen flare-ups in individuals who are genetically predisposed.
Genetic Factors
- Family History: Having a parent or sibling with psoriasis increases the likelihood of developing the condition. Approximately one-third of psoriasis sufferers have a close relative with the condition.
- Genetic Mutations: Specific genes associated with the immune system, such as HLA-Cw6, have been linked to higher risks of psoriasis, particularly early-onset types.
Immune System Responses
- Autoimmune Reaction: Psoriasis is an autoimmune disorder, where the immune system mistakenly attacks healthy skin cells. This triggers an accelerated skin cell production cycle, causing new skin cells to form within days instead of weeks. The excess skin cells build up, creating thick, scaly patches.
- Inflammation: The inflammatory response involved in psoriasis can also affect other parts of the body, which is why people with psoriasis are at a higher risk for psoriatic arthritis and other inflammatory conditions.
Environmental and Lifestyle Triggers
| Trigger | Description | Impact on Psoriasis |
|---|---|---|
| Stress | High levels of stress can weaken the immune system. | Can lead to psoriasis flare-ups. |
| Infections | Conditions such as streptococcal throat infections can trigger guttate psoriasis. | Particularly affects children and young adults. |
| Skin Injuries | Cuts, scrapes, insect bites, or sunburn can cause the Koebner phenomenon. | Leads to new psoriasis plaques at the injury site. |
| Medications | Certain drugs like beta-blockers, lithium, and antimalarials may worsen symptoms. | Can trigger or exacerbate psoriasis. |
| Weather | Cold, dry weather dries out the skin, while sunlight may improve symptoms. | Can worsen or alleviate symptoms depending on exposure. |
| Lifestyle Factors | Smoking and excessive alcohol reduce treatment effectiveness and worsen symptoms. | Linked to more severe psoriasis. |
Understanding these environmental and lifestyle triggers can help manage psoriasis more effectively, with targeted treatments and lifestyle changes.
Types of Psoriasis and How They Affect the Skin
Psoriasis is not a one-size-fits-all condition; it presents in various forms, each with unique symptoms and treatment approaches. Identifying the type of psoriasis is important for choosing the most effective treatment and managing flare-ups.
1. Plaque Psoriasis (Psoriasis Vulgaris)
- Appearance: The most common type, causing raised, red patches covered with silvery-white scales.
- Location: Often appears on the scalp, elbows, knees, and lower back.
- Symptoms: Patches can be itchy, painful, and may crack or bleed.
- Treatment: Usually managed with topical treatments, phototherapy, and systemic medications for moderate to severe cases.
2. Guttate Psoriasis
- Appearance: Characterised by small, drop-shaped spots on the skin.
- Location: Common on the torso, arms, and legs, and can appear on the face and scalp.
- Symptoms: Often triggered by a bacterial infection, such as streptococcal throat infection, particularly in children and young adults.
- Treatment: Often responds well to topical treatments, light therapy, and antibiotics if triggered by an infection.
3. Pustular Psoriasis
- Appearance: Manifests as white pustules (blisters of non-infectious pus) surrounded by red skin.
- Location: Can be localised to certain areas, such as the hands and feet, or generalised across the body.
- Symptoms: May cause fever, chills, and severe itching.
- Treatment: Requires specialist care, often involving topical therapies, systemic medications, and close monitoring.
4. Inverse Psoriasis
- Appearance: Shows as red, shiny, and inflamed skin in body folds, such as the armpits, groin, under the breasts, and around the genitals.
- Symptoms: Worsened by friction and sweating, often associated with fungal infections.
- Treatment: Often managed with topical steroids, calcipotriene, and antifungal treatments.
5. Erythrodermic Psoriasis
- Appearance: The rarest and most severe form of psoriasis, causing widespread redness and shedding of the skin.
- Symptoms: Can cause intense itching, pain, and extreme discomfort. It often requires immediate medical attention.
- Treatment: May involve hospitalisation, with treatments including systemic medications and supportive care to manage symptoms and prevent complications.
Each type of psoriasis presents differently, and understanding the specific symptoms can guide treatment choices and help maintain healthy skin.
Treatment Options for Psoriasis
Psoriasis treatment aims to reduce symptoms, manage flare-ups, and improve skin health. The treatment approach depends on the type and severity of psoriasis, as well as the individual’s overall health. Effective treatment plans often combine medical therapies with lifestyle adjustments for long-term management.
Topical Treatments
- Corticosteroids: The most common topical treatment, helping to reduce inflammation and itching. Mild steroids are used for sensitive areas, while stronger formulations may be needed for thick plaques.
- Vitamin D Analogues: Such as calcipotriene and calcitriol, these slow skin cell growth and are often used in combination with corticosteroids.
- Topical Retinoids: These vitamin A derivatives help reduce inflammation and promote healthy skin turnover.
- Coal Tar: An older treatment option that reduces scaling, itching, and inflammation. Often used in shampoos for scalp psoriasis.
- Moisturisers and Emollients: Hydrating the skin can prevent dryness, reduce scaling, and maintain the skin barrier.
Phototherapy (Light Therapy)
- Ultraviolet B (UVB) Therapy: Exposes the skin to natural or artificial UVB light, slowing skin cell growth. Can be used alone or with topical treatments.
- PUVA Therapy: Combines psoralen medication with UVA light exposure, suitable for severe or widespread psoriasis.
- Excimer Laser Therapy: Targets specific areas of the skin, delivering high-intensity UVB light to minimise damage to healthy skin.
Systemic Medications
For moderate to severe psoriasis, systemic medications may be prescribed to control the immune system response:
- Methotrexate: Reduces inflammation and slows skin cell production. Often used for psoriatic arthritis as well.
- Ciclosporin: An immunosuppressant that can quickly reduce symptoms, suitable for short-term use.
- Oral Retinoids: Such as acitretin, help reduce skin cell turnover but are not recommended for pregnant women.
Biologic Treatments
- How Biologics Work: Target specific parts of the immune system that trigger psoriasis, such as TNF-alpha inhibitors or interleukin inhibitors.
- When Biologics Are Used: Typically prescribed for severe psoriasis or when other treatments are ineffective. Administered by injection or intravenous infusion.
- Examples of Biologics: Include adalimumab (Humira), etanercept (Enbrel), and ustekinumab (Stelara).
When to See a Dermatologist
It is important to consult a dermatologist or specialist if:
- Psoriasis symptoms worsen or do not respond to over-the-counter treatments.
- The condition interferes with daily activities or quality of life.
- Joint pain or stiffness occurs, as this may indicate psoriatic arthritis, requiring specialist care.
Specialists like Dr Andreea Anton provide expert advice and treatment plans, tailoring approaches to individual needs. Professional care ensures effective management of psoriasis, improving symptom control and skin health.
Managing Psoriasis Symptoms at Home
While medical treatments play a crucial role in managing psoriasis, lifestyle changes and home care strategies can also help reduce symptoms and prevent flare-ups. Adopting a consistent skincare routine, maintaining a healthy lifestyle, and avoiding common triggers are essential steps in psoriasis management.
Skincare Tips and Hydration
- Moisturise Regularly: Use thick creams and ointments to lock in moisture and prevent dry, flaky skin. Apply moisturiser immediately after bathing to maintain hydration.
- Avoid Harsh Skincare Products: Choose gentle, fragrance-free products to minimise irritation. Soaps and cleansers with added moisturisers are beneficial.
- Bathe with Care: Use lukewarm water rather than hot water, which can dry out the skin. Adding colloidal oatmeal or Epsom salts to the bath may help soothe inflamed skin.
- Protect the Skin: Avoid scratching or picking at psoriasis plaques to reduce the risk of infection and scarring.
- Use Humidifiers: Keeping the air moist, especially during winter months, can prevent dry skin and reduce flare-ups.
Diet and Lifestyle Adjustments
- Maintain a Balanced Diet: Incorporate anti-inflammatory foods, such as fruits, vegetables, and omega-3-rich fish, into the diet. Avoiding processed foods and excessive sugar can help manage inflammation.
- Stay Hydrated: Drinking plenty of water supports skin health and prevents dryness.
- Exercise Regularly: Engaging in low-impact activities, such as walking, swimming, or yoga, can boost circulation and reduce stress, which may help manage psoriasis symptoms.
- Limit Alcohol Consumption: Excessive alcohol intake can trigger flare-ups and reduce the effectiveness of psoriasis treatments.
- Avoid Smoking: Smoking is a known trigger for psoriasis and may worsen symptoms, particularly for plaque and palmoplantar psoriasis.
Reducing Stress and Avoiding Triggers
- Practice Stress Management Techniques: Engage in relaxation methods, such as deep breathing, meditation, and mindfulness practices, to lower stress levels.
- Identify Personal Triggers: Keep a symptom diary to track flare-ups and identify potential triggers, such as certain foods, stress, or skin injuries.
- Protect the Skin from Injuries: Take precautions to avoid cuts, scrapes, or sunburn, as skin trauma can lead to the Koebner phenomenon, where new psoriasis plaques form at the site of injury.
By incorporating these home care practices into a daily routine, individuals with psoriasis can help reduce symptom severity, extend periods of remission, and improve overall skin health. When combined with professional treatments, these lifestyle adjustments can provide a comprehensive approach to managing psoriasis effectively.
