Psoriasis Treatment

About Psoriasis

We all get rashes and blotches and marks from time to time, but some of us get them more than others. Psoriasis is an auto-immune condition, which causes symptoms on the skin, including red, flaky, itchy patches, and the joints. A chronic skin disease that usually involves periods of no or mild symptoms, followed by periods when symptoms are more severe; the severity of psoriasis varies greatly from person to person.

 

Treatments for Psoriasis

There's no cure, but a range of psoriasis treatments can improve symptoms and the appearance of skin patches. The treatment recommended will be determined by the type and severity of your psoriasis and the area of skin affected, your age and your state of health. Psoriasis is unique to each individual, and a treatment that works for one person doesn’t necessarily work for another, because of this, treating psoriasis can be a process of trial and error.  Often, different types of treatment are used in combination.

Types of Psoriasis Treatment

There are three main forms of treatment for psoriasis: topical, phototherapy and systemic. Your dermatologist will recommend which treatment is right for you based on your type of psoriasis and the reaction to any previous treatments. 

Topical

In most cases, the first treatment used will be a topical treatment, in the form of creams and ointments applied to the skin. Some people find that topical treatments are all they need to control their condition, although it may take up to six weeks before an effect is noticeable. There are six main forms of topical treatment:

  • Emollients: are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. The main benefit of emollients is to reduce itching and scaling. Emollients are ideal for treating mild psoriasis.
  • Steroid creams or ointments (topical corticosteroids): work by reducing inflammation, thereby slowing the production of skin cells and reduces itching. Steroid creams or ointments are ideal for treating mild to moderate psoriasis
  • Vitamin D analogues creams: commonly used along with or instead of steroid creams on the limbs, trunk or scalp. They dual purposed, they slow the production of skin cells and also have an anti-inflammatory effect. Vitamin D analogues are ideal for treating mild to moderate psoriasis.
  • Calcineurin inhibitors: these ointments or creams are often used when steroid creams aren't effective. They reduce the activity of the immune system and help to reduce inflammation. They are ideal for treating psoriasis in sensitive areas such as the scalp, the genitals and folds in the skin; however they can cause skin irritation.
  • Coal tar: possibly the oldest treatment for psoriasis, it works by reduce scales, inflammation and itchiness. It is used to treat the limbs, trunk or scalp if other topical treatments aren't effective. 
  • Dithranol: works by suppressing the production of skin cells and has few side effects. However it can only be used as a short-term treatment and under hospital supervision as it can burn if too concentrated.

 

Phototherapy

If topical treatments aren't effective, or your condition is more severe, a treatment called phototherapy may be used. Phototherapy involves exposing your skin to certain types of natural and artificial ultraviolet light which reduces inflammation in the skin and slows the production of skin cells. Ultraviolet A (UVA) and Ultraviolet B (UVB) light in the sun’s rays is widely recognised as an effective treatment for psoriasis, however this is not the same as using a sun-bed, which cannot be used as a substitute.

  • PUVA: a combination of the UVA part of the spectrum and a chemical called psoralen. UVA light is not useful in treating psoriasis on its own, and so psoralen is needed to make the skin more sensitive to light. The light penetrates the skin more deeply than UVB light and may be used if UVB therapy has not worked i.e. severe psoriasis, or for treating hands and feet that experience thicker plaques of psoriasis.
  • UVB: using a wavelength of light that is invisible to human eyes the treatment slows down the production of skin cells. Ideal for treating psoriasis that hasn’t responded to topical treatments. It is often used to treat guttate or plaque psoriasis or as part of a combination therapy with coal tar, as the coal tar makes the skin more receptive to light

 

Systemic

Systemic treatments are oral or injected medicines that work throughout the entire body, rather than targeting one specific area. They used in severe cases where topical and phototherapy treatments have been ineffective, or as a way to treat psoriatic arthritis. While they are highly effective at treating psoriasis they have potentially serious side effects and safety concerns, which the dermatologist will explain.  There are two main types of systemic treatment, called biological and non-biological.

  • Biological: usually given as injections, they are specifically designed to mimic chemicals that are naturally found within the human body, and act to correct something that is going wrong. They work by blocking the body's immune system and targeting the overactive cells. The main biological drugs for psoriasis are Etanercept, Adalimumab, Infliximab and Ustekinumab
  • Non-biological:  usually given as tablets or capsules; they work by suppressing the immune system (immunosuppressant) and slowing down the skin cell production and reducing inflammation.  The main non-biological drugs for psoriasis are Methotrexate, Ciclosporin, Acitretin

Untreated, extremely severe psoriasis can be dangerous. It happens very rarely, but if lesions cover enough of the body, the immune system can become overwhelmed. Seek medical advice immediately if your psoriasis spreads to cover large parts of your body or if you show signs of infection, such as fever.

 

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Causes and Symptoms of Psoriasis

What is Psoriasis?

Psoriasis is a characterised by an accumulation of skin cells that build up to form raised ‘plaques’ on the skin, which can be red or darker, flaky, itchy crusty patches covered with silvery scales. The redness is caused by Blood vessels increase their flow to the skin in an attempt to nourish this skin, leading to redness and swelling. Long-term psoriasis does not cause scarring, but it can cause a temporary increase or reduction in skin pigmentation. Although psoriasis usually appears as a skin condition, recent discoveries show that its real cause is a problem with the immune system; psoriasis is therefore categorised as an auto-immune disorder. The body’s immune system malfunctions and attack normal body tissues, thereby increasing production of skin cells. Skin cells are normally made and replaced every three to four weeks, but in psoriasis this process only lasts about three to seven days. The outer layer of skin (the epidermis) contains skin cells which are continuously being replaced; the resulting build-up of skin cells is what creates the patches associated with psoriasis.

psoriasis | Harley Medical Group
 

It is thought to affect around 2% of the UK population, affecting both men and women equally. While it is not contagious, i.e. it cannot be passed from person to person and it does not spread it from one part of your body to another by touch, psoriasis does affect members of the same family. It can occur at any age, although there seem to be two ‘peaks’; early-onset form of the disease is mostly seen in 16 to 22-year-olds and the late-onset form strikes those between the ages of 50 and 60.

Psoriasis occurs on any area of the body but is most commonly found on the scalp, elbows, knees and lower back. It can also affect joints, body folds and nails; fingernails and toenails are affected in about 50% of active psoriasis cases. Psoriasis tend to come and go unpredictably, and the location of irritation frequently depends on the type of psoriasis experienced, and the severity can range from mildly annoying to truly debilitating.


Causes of PSORIASIS

The cause of psoriasis is not fully understood, but genetic and immune system abnormalities are believed to play key roles in the condition.

  • Genetic factors: One Research studies have shown many different genes are linked to the development of psoriasis, and one in three people with psoriasis has a close relative with the condition. While psoriasis is known to run in families, having these genes doesn't necessarily mean you'll develop it.
  • Immune system malfunction: Your immune system is your body's defence against disease and it helps fight infection. One of the main types of cell used by the immune system is called a T-cell. T-cells are triggered and become overactive attacking healthy skin cells by mistake, this causes the deepest layer of skin to produce new skin cells more quickly than usual, which in turn triggers the immune system to produce more T-cells. It's not known what exactly causes this problem with the immune system, although certain genes and environmental triggers may play a role.

Many people's psoriasis symptoms start or become worse because of a certain event, known as a "trigger". 

  • Injury to the skin: injury to the skin, such as a skin infection, skin inflammation, sunburn or even excessive scratching can trigger, and has been associated with plaque psoriasis.
  • Smoking: Cigarette smokers have an increased risk of chronic plaque psoriasis.
  • Alcohol: Alcohol is considered a risk factor for psoriasis, particularly in young to middle-aged males.
  • Weather: while sunlight is generally considered beneficial for their psoriasis for a small minority it sunlight and/or dry weather sunlight aggravates their symptoms.
  • Emotional stress: Many people see an increase in their psoriasis when they are suffering from emotional stress including divorce, bereavement or moving house.
  • Drugs: A number of medicines have been shown to aggravate psoriasis, such as beta blockers and tablets used to treat malaria.
  • Streptococcal infections: there is some evidence suggests that infections that involve the streptococcal bacteria may cause a type of plaque psoriasis.
  • HIV: Psoriasis typically gets worse after an individual has been infected with HIV. However, psoriasis often becomes less active in advanced HIV infection.
  • Hormone changes: The severity of psoriasis may fluctuate with hormonal changes. Disease frequency peaks during puberty and the menopause.

 

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Types of PSORIASIS

There are two main types of psoriasis: psoriasis vulgaris (plaque psoriasis) and psoriasis pustulosa (pustular psoriasis); 80-90% of all cases of psoriasis are plaque psoriasis. These can be divided into subgroups based on severity, duration, location on the body and appearance of the lesions. Many people have only one form of psoriasis at a time, although two different types can occur together. Alternatively one type may change into another type, or become more severe. In most cases psoriasis goes through cycles, causing irritation and discomfort for a few weeks or months before easing or stopping.

psoriasis | Harley Medical Group

 

Plaque Psoriasis

Plaque psoriasis is the most common form, and is characterised by red skin plaques that are formed by the raised build-up of dead cells. The redness is caused by increased blood flow to the area, required for the speed in which the skin cells are being replicated. Psoriasis plaques normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body. 

 

Pustular Psoriasis

Pustular psoriasis is the rarer form and can be quite painful and prone to flaring.There are two different types of pustular psoriasis: Palmoplantar pustular (also known as Acropustulosis) and Generalised Pustular Psoriasis (also known as von zumbusch psoriasis). Palmoplantar pustular appears the palms of the hands, fingers and/or the soles of the feet and toes, it can also cause nail deformities. Generalised Pustular Psoriasis looks similar to Palmoplantar pustular psoriasis, but is usually widespread across the body rather than confined to a particular area. Pustules develop very quickly and may reappear every few days or weeks in cycles; during the start of these cycles the sufferer can experience fever, chills, weight loss and fatigue. This type of psoriasis is quite rare, but is a serious condition that requires urgent medical attention.

 

Subdivisions of Psoriasis

  • Scalp psoriasis

It is very common for plaque psoriasis to occur on the scalp, either on the whole scalp or in patches. Some people find scalp psoriasis extremely itchy, while others have no discomfort. In extreme cases it can cause hair loss, although this is usually only temporary. Shampoo treatments can be bought over the counter, however, if your scalp is covered with thick scale or doesn’t clear up, consult a dermatologist.

  • Erythrodermic psoriasis

Erythrodermic psoriasis is a rarest form of psoriasis that affects nearly all the skin on the body. This condition can evolve from other forms of psoriasis or be triggered by psoriasis treatment. It can also be triggered by withdrawal from drugs such as corticosteroids. Erythrodermic psoriasis can cause your body to lose proteins and fluid, leading to further problems such as infection, dehydration, heart failure, hypothermia and malnutrition.

  • Guttate Prosiasis

Also known as ‘tear drop’ or ‘rain drop’ psoriasis due to the small raindrop shaped spots on the skin. It often appears after a bacterial infection, such as streptococcal throat infection like tonsillitis. Guttate psoriasis is usually widespread across the torso, back and limbs, and clears up after several weeks or months. Some people may find it evolves into one of the other types of psoriasis, but others will never have another bout of psoriasis.

  • Inverse (flexural) psoriasis

Inverse psoriasis occurs in folds in the skin, such as under the breasts, in the armpits, the groin and between the buttocks. It is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather; obesity can exacerbate this psoriasis. Flexural psoriasis is often be mistaken for a fungal infection or other skin condition.

  • Nail Psoriasis

Nail psoriasis affects up to half of all people with psoriasis and can be found in the fingernails and / or toenails. It is possible for a person to just have psoriasis of the nails, with no other skin involvement. In moderate to severe cases, nail psoriasis can be painful and restrict movement and finger and toe function. This form of psoriasis is easy to misdiagnose as a fungal infection.


Symptoms of PSORIASIS

Psoriasis doesn't have any set way of progressing. It develops differently depending on the person and the type of psoriasis. Some people may only have occasional and minor symptoms for their entire lives. Others may have to cope with severe symptoms on a regular basis.

  • Plaque Psoriasis:  characterised by skin plaques that are formed by the raised build-up of dead cells. These plaques can be very red, itchy and sore, with white or silvery scales; in severe cases, the skin around your joints may crack and bleed. The redness is caused by increased blood flow to the area, required for the speed in which the skin cells are being replicated. Psoriasis plaques normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body.
  • Pustular Psoriasis: characterised by small white or yellow pus-filled blisters (pustules) that appear on top of very red or darkened skin. These pustules may then dry up and turn brown or crusty after they have burst; the pus itself is made up of white blood cells, is not a symptom of infection or bacteria, and it is not contagious.
  • Scalp psoriasis: occurs either on the whole scalp or in patches. It usually looks similar to plaque psoriasis on other areas of the body, but can be prone to quite a thick build-up of scaly skin, which may cause dandruff-like flakes to fall. Some people find scalp psoriasis extremely itchy, while others have no discomfort. In extreme cases it can cause hair loss, although this is usually only temporary.
  • Erythrodermic psoriasis:  characterised by fiercely red and scaly skin over large areas of the body which itches or burns. Erythrodermic psoriasis can cause your body to lose proteins and fluid, leading to further problems such as infection, dehydration, heart failure, hypothermia and malnutrition.
  • Guttate Prosiasis: characterised by small raindrop shaped spots on the skin. Fair skin types experience bright pink or red patches, whilst people with darker skin types may notice less redness and more darkening. There may be some fine scaling and itchiness but symptoms are unique among individuals. Guttate psoriasis is usually widespread across the torso, back and limbs, and clears up after several weeks or months.
  • Inverse (flexural) psoriasis: characterised by large smooth red patches in some or all of these areas, it is made worse by friction and sweating.
  • Nail Psoriasis: the symptoms can range from mild to severe and include: Discolouration of the nail; ‘Pitting’ (small dents) across the surface of the nail’ Nails that split or crumble easily Thickening of the nail Nails that lift or detach themselves from the nail bed- known as onycholosis

 

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Psoriasis Treatment Benefits

psoriasis | Harley Medical Group

    The benefits of psoriasis treatments

    Psoriasis is more than just a skin condition, and it can affect people physically and psychologically.

    Treatment of psoriasis can:

    • Increase in self-esteem and reduce anxiety: many people feel very self-conscious about their skin’s appearance which impacts their confidence levels.
    • Address feelings of isolation and depression
    • Remove barriers of physical intimacy: there is the mistaken belief psoriasis is contagious making many people eschew physical contact with others.
    • Increased energy levels: many sufferers find that coping with psoriasis can be exhausting and frustrating
    • Reduced risk of serious long-term illness: moderate to severe psoriasis increases the risk of heart disease and stroke and treatment of psoriasis may reduce this risk.
    • Ease of physical discomfort: it is common to develop tenderness, pain and swelling in the joints and connective tissue.
    • Encourage a healthier lifestyle: combining exercise and losing weight with treatments has been proven beneficial

    Although there is no cure for psoriasis, it is important to remember that it can be managed. With the right treatment and advice, many people live comfortably with psoriasis.

     

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    OUR Experts

    Our dermatology experts

    Dermatology | Harley Medical GroupFrom the beginning aimed and succeeded in establishing The Harley Medical Group as a leader in the field of Laser & Skin Treatments and Dermatology, with clinics throughout the UK. Our fully qualified medical team are specially selected for their experience, expertise and approachability as well as their friendliness. This means our clients know that they are not meeting with sales people but trained experts, who have the time and the expertise to explain procedures in detail and answer all of your questions. In fact, we’re happy to say that our team is amongst the best.

    We are committed to continually improving and refining our services, while researching the latest advances, thereby provide the highest standard of treatment that the medical profession can offer. Our dermatological treatments are performed in our own clinics, all of which are registered with The Care Quality Commission and the HIW in Cardiff. And following your meeting with our Dermatologist you will receive full aftercare instructions and will continue to receive any support you need. 

    Prices

    Psoriasis Treatment Prices

    There is no set price for Psoriasis treatments as every single client is different and treated on an entirely individual, case-by-case basis. 

    Prices start from £140 and will depend on the bespoke treatment plan recommended by your dermatologist.

     

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    FREQUENTLY ASKED QUESTIONS

    How can I find out if I have psoriasis?

    If you have a rash that is not healing, seek medical advice for evaluation of the rash to determine if it is psoriasis.

    Untreated, extremely severe psoriasis can be dangerous. It happens very rarely, but if lesions cover enough of the body, the immune system can become overwhelmed. Seek medical advice immediately if your psoriasis spreads to cover large parts of your body or if you show signs of infection, such as fever.

    Can psoriasis be treated at home?

    ‘Treated’ is the right word as it is important to understand and accept that psoriasis is a chronic, long-lasting condition that cannot be cured. It is a disease that is characterised by alternate good periods and periods with outbreaks. For more persistent psoriasis we recommend speaking with a dermatologist to establish a long-term treatment plan to manage symptoms. For very mild, less persistent and scalp psoriasis over-the-counter treatments are available. 

    How psoriasis is diagnosed?

    A dermatologist can often diagnose psoriasis, and the type, based on the appearance of your skin following a careful examination. If there is any doubt about the diagnosis, a biopsy will be taken and a small portion of the skin which will be sent to a specialist for examination under a microscope.

    If your dermatologist suspects you have psoriatic arthritis, which is sometimes a complication of psoriasis, you may be referred to a rheumatologist (a doctor who specialises in arthritis). You may also have blood tests and a screening questionnaire to rule out other conditions. 

    Is psoriasis just a skin condition?

    The short answer is no, not at all.

    Psoriasis is often misdiagnosed as a skin condition however it is actually an autoimmune disease. T Cells, which play a role in the immune system, become overactive and attack health skin cells. This in turn causes new skin to be produced creating patches of red, flaky, itchy or painful skin on the limbs, torso and head.

    It can have wider reaching health implications as people with untreated psoriasis are at increased risk of heart disease and stroke. In the most severe cases the body’s immune system can become overwhelmed causing serious illness.

    Beyond the biological explanation psoriasis, the effects run much deeper. People with psoriasis often suffer with low confidence and self esteem, anxiety and depression which in turn impacts on their relationships and social lives. 

    Is there a cure for psoriasis?

    There is no cure for psoriasis; it is a long-term chronic condition. However the symptoms can be managed with a variety of treatments, your dermatologist will advise which is the most suitable for you based on the type of psoriasis and your medical background. It is important to be aware that everybody is different, and so it can be a process of trial and error to find a treatment or combination of treatments which work well for you.

    Due to the nature of the condition, some people find areas of psoriasis clear up on their own in time. Some people may experience just a handful of psoriasis 'flares' in a lifetime, whereas others might have some stubborn patches which are almost always there.