Psoriasis is a common skin condition, but there can sometimes be misleading information or total myths about it online. Vhi consultant dermatologist, Dr Rebecca Hellen, explains the facts about psoriasis, including causes, treatments and dealing with itching.

The basics: what is psoriasis and what causes it?

Psoriasis is a chronic (meaning something lasting a long time or recurring often) skin disorder that causes areas of thickened and inflamed skin. The affected skin is covered by scales that can appear silvery in colour. Psoriasis commonly affects the elbows, knees and scalp, but it can present in various areas and ways.

Psoriasis is caused by:

• Immune system issues: The body’s defence system attacks healthy skin cells and causes them to grow too quickly.
• Genetics: Psoriasis can run in families. Up to 40% of people with psoriasis will have a family member that’s affected by it too.

Psoriasis flare-ups can be triggered by:

• Stress: High levels of stress can make psoriasis worse or trigger a flare-up.
• Infections: Strep throat can cause psoriasis to flare, particular guttate psoriasis.
• Skin injuries: Cuts, scrapes or even severe sunburns can trigger psoriasis as the skin tries to heal.
• Medications: Certain medications can make psoriasis worse.
• Lifestyle factors: Smoking is a risk factor for psoriasis. Heavy alcohol intake can flare psoriasis and reduce response to treatment.  

The types of psoriasis

There are several types of psoriasis, including:

Chronic plaque psoriasis: This is the most common form of psoriasis, and it tends to affect the elbows and knees, but it can appear anywhere on the body. The affected skin will have thickened, dry, red plaques with silvery scale and can be itchy and sore.

Guttate psoriasis: This causes small, droplet-shaped plaques dotted all over the skin. It tends to affect younger people more commonly than adults. It can sometimes appear after a throat infection.  

Inverse psoriasis: Affects the parts of the body with folds, like under the arms, breasts, or groin. The rash can look shiny, smooth, and red. These plaques are not as thick or scaly as those found in typical psoriasis and are sometimes mistaken for fungal skin infections.

Palmoplantar psoriasis: Appears on the palms of your hands and soles of your feet with redness and scaling and a clearly defined border. It is similar to a condition called palmoplantar pustulosis, which has pustules (small yellow, pus-filled bumps) within the rash.

Nail psoriasis: Causes your nails to develop small dents or pits. It can also change the colour and shape of your nails.

Severe variants: Erythrodermic psoriasis occurs when psoriasis covers over 90% of the body surface. Generalised pustular psoriasis is similar to this, however, there are pustules (small pus-filled bumps) within the rash. These more severe types of psoriasis require urgent treatment with your healthcare provider.

If you think you might have any of the above, speak to your healthcare provider for a diagnosis.

Treatment and management of psoriasis

You may come across various treatment options online, but it’s best to follow the treatment plan that your healthcare provider suggests. Psoriasis can be difficult to treat because there are so many different types and there might be various sites on the body involved; treatment will vary depending on both, so it’s vital that you’re guided by your healthcare provider. Once you receive a diagnosis from a healthcare provider and know exactly what type of psoriasis you’re dealing with, you can focus on your treatment options. Mild psoriasis can be treated with topical treatments (treatments that are applied directly to the skin), which will vary depending on which parts of your body are affected. This is directed by your GP or a dermatologist. There are numerous prescription creams, gels, lotions and sprays that can be helpful. For psoriasis on the scalp, treatment can be trickier, and may involve some tar-based ointments to descale the scalp. Following this, topical steroids might be used on the scalp. It might seem overwhelming to hear about all the treatment options, but your healthcare provider will guide you and answer any questions you have.

Self-care is really important when you have psoriasis or any other chronic condition. Taking care of your wellbeing, with the support of your healthcare providers, can help you manage your symptoms and protect your mental health. Your healthcare provider will advise on lifestyle factors you can adjust or try out, such as exercise, diet, and sleep tips. Always pay attention to your mental health too and keep your healthcare provider informed―there are lots of options available to help you take care of your emotional wellbeing too.

Facts about psoriasis

Let’s dive into some facts about psoriasis that it’s important we know:

Fact #1: Although there is no cure for psoriasis, there are highly effective treatments available now, particularly for moderate-to-severe psoriasis. Your GP or dermatologist can help you to find treatments that work best for you.

Fact #2: Psoriasis increases your risk for cardiovascular disease, such as heart attack and stroke. The risk is highest in patients with severe psoriasis and psoriatic arthritis (an autoimmune disease and form of inflammatory arthritis). If you have psoriasis and psoriatic arthritis, it’s important to get regular cardiovascular screening to manage your risk factors.

Fact #3: About one third of people with psoriasis develop psoriatic arthritis. If you have nail psoriasis, your risk of psoriatic arthritis is greater. If you have psoriasis and symptoms of joint pain, stiffness and/or swelling, it is important to discuss these with your healthcare provider.

Fact #4: Psoriasis can have a big impact on mental health and wellbeing. This is particularly true for people with extensive psoriasis, psoriasis in visible areas or genital psoriasis. If your psoriasis is affecting your mental health, don’t hesitate to speak to your healthcare provider for guidance.

Fact #5: It’s possible to have more than one type of psoriasis at a time. There is also a wide spectrum of severity with psoriasis; from mild cases that can be managed with creams to severe cases that require treatment in hospital, but fortunately this is rare.

Fact #6: Psoriasis can occur at any age, but the peak ages are 15-25 and 50-60. Many people are surprised that they can develop psoriasis for the first time later in life.

Myths about psoriasis

Just as important as knowing the facts about psoriasis, is knowing the myths we commonly hear:

Myth #1: Psoriasis is an infection of the skin.

The fact: Psoriasis is a skin condition, not a skin infection. The skin is not infected; it’s simply a build-up of skin cells (caused by the immune system, genetics or environmental factors listed above) that create the plaques we’re familiar with seeing on people with psoriasis. 

Myth #2: Psoriasis is contagious.

The fact: Psoriasis is not contagious and cannot be spread from person to person.

Myth #3: Psoriasis is caused by your diet.

The fact: Genetics, the immune system and environmental factors cause psoriasis; it is never caused by what you eat.

Myth #4: You can self-treat psoriasis by using sunbeds.

The fact: Phototherapy is one type of treatment for psoriasis, but it’s completely different to using sunbeds. Sunbeds emit high levels of UVA light and are known to dramatically increase the risk of skin cancers, including melanoma. Dermatologists administer phototherapy using specific wavelengths of UVB light at controlled doses, which minimise the risk of burning and skin cancer.

Avoiding the itch

It can be tempting to scratch your skin when it’s dry and itchy from psoriasis, however, scratching at itchy skin can often keep the itch-scratch cycle going. If you have psoriasis, you can follow the general skincare advice for anyone with dry and itchy skin:

• Avoid harsh soaps and cleansers
• Use gentle products designed for eczema-prone or psoriasis-prone skin
• Moisturise once or twice a day
• Avoid scrubbing your skin as much as possible

If your symptoms are bothering you, always chat to your healthcare provider. There are many treatment options available for mild-to-moderate psoriasis and moderate-to-severe psoriasis

Understanding flare-ups

For some people with psoriasis, their condition doesn’t change much over time. For others, certain things might trigger a flare-up, such as sore throats, stress, or alcohol; different things will act as triggers for different people. When you’re prone to psoriasis flare-ups, we don’t always expect them to go away on their own―with your healthcare provider or dermatologist, you’ll figure out a treatment plan that works best for you long-term.

Hopefully, this blog has dispelled some myths you might have heard about psoriasis and reassured you that you don’t need to feel alone with your condition. Your healthcare provider will help you find the most suitable treatments for your skin so your day-to-day is impacted as little as possible.   

This content is for information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Always seek advice from your GP or an appropriate medical professional if you have concerns about your health, or before commencing a new healthcare regime. If you believe that you are experiencing a medical emergency call 999 / 112 or seek emergency assistance immediately.

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