Understanding psoriasis

Psoriasis – one condition, many treatments

Getting the right treatment

Once you develop psoriasis, the skin condition is likely to come and go in various different forms on your body. However, if you use a medication specifically prescribed for your psoriasis in the correct way, it is possible to manage your condition. This will allow you to focus on feeling confident and getting the most out of your life.

From mild to severe, there are many different treatment options to help control and alleviate psoriasis symptoms. You can discuss your options with your doctor and together find the treatment that is best for you.

What exactly is psoriasis?

Psoriasis is a chronic disease that appears on the skin. It occurs when the immune system sends out faulty signals that make new skin cells grow too quickly. With psoriasis, the normal cycle of skin cells, which usually takes about a month, is sped up to a cycle that is completed in just a matter of a few days. The body does not shed these excess skin cells, so the cells pile up on the surface of the skin and ‘plaques’ form.

There are seven types of psoriasis.The most common form, plaque psoriasis, appears as raised, red patches covered with a silvery white build-up of dead skin cells. Psoriasis can occur on any part of the body and may, in some cases, be associated with other serious health conditions, such as diabetes, heart disease and depression.

Who is affected by psoriasis?

Anyone can develop psoriasis. It is equally common in men and women, and affects approximately 100 million people, about 2-3% of the global population.

Psoriasis can start at any age, but most people develop psoriasis in between the ages of 15-35. Each person’s experience is completely different; similarly, the emotional and psychological impact of psoriasis can affect individuals in different ways.

Everything you need to know about psoriasis treatment

There are many different treatment options to help manage and alleviate psoriasis symptoms. You can discuss your options with your doctor and together find the treatment that is best for you. Treatments range from creams and gels to tablets and injectable medication, and even light therapy. The treatment prescribed will depend on many factors, such as the physical severity of the disease and what will best fit with your lifestyle and personal needs. The following information about treatment options will help you find the most effective way to manage your psoriasis.

Over-the-counter topical treatments

There are many topical treatment options available to you. Topical medications – typically a cream, gel or an ointment applied directly to the skin – are commonly prescribed by your doctor as first-choice, also known as first-line treatments, to manage mild to moderate cases of psoriasis. You may also want to mention to your doctor if you are finding your medication too time-consuming or greasy to apply, as there may be a preferable alternative. The following over-the-counter (without prescription) medications are available:

Steroids (also called corticosteroids) – facilitate slowing down cell growth and reduce inflammation. It is advised that this treatment is only applied to the affected area and used for a short period of time due to the possibility of various side effects, such as thinning of skin. Alternatively, milder options such as hydrocortisone, which can be purchased at your local pharmacist may be a more suitable option.
Moisturisers – moisturising creams and lotions soften and rehydrate the skin and provide a protective barrier, helping to keep the skin comfortable, reducing itching and scaling.
Coal tar – has been used for decades to treat psoriasis due to its anti-inflammatory and anti-scaling properties. Available as lotion, cream, solution and shampoo for scalp psoriasis, as well as oil for use in the bath or shower. Coal tar products should be carefully considered, as they may irritate the skin, making the skin more sensitive to sunlight and even promote skin cancer; It is important to therefore attend regular check-ups and monitor for any changes to the skin when using the substance.
Salicylic acid ointments – used for a variety of different skin conditions, salicylic acid ointments work as a peeling agent to shed the outer layer of the skin. The ointment can benefit patients with psoriasis by softening the skin and reducing the appearance of silvery scales. It is important to note that the ointment can cause skin irritation and may also lead to temporary hair thinning or hair loss.

Prescription topical treatments

More potent topical treatments for psoriasis are available on prescription and include:

Dithranol: a topical treatment that comes in a cream, gel, ointment or paste and is good for chronic scaly psoriasis.

Topical retinoids: these are derived from vitamin A and can reduce the thickness of psoriasis plaques by slowing skin cell growth.
Topical steroids: often come in a cream, gel or ointment formulation, and are measured in strengths of 'mild,' 'moderate,' 'potent' and 'very potent'. They are used to reduce inflammation and may be useful to use on thickened plaques of psoriasis which appear on the palms and soles.
Vitamin D3: topical forms of synthetic chemically produced vitamin D analogue to help slow down the growth of skin cells and remove scales.
Combination fixed-dose products: combine a topical steroid and topical form of vitamin D, coal tar or salicylic acid in one treatment to slow down the development of skin cells as well as to suppress inflammation.

Systemic drugs

If other types of treatment should not deliver the desired results, so-called systemic drugs can be an alternative option. As systemic treatments are typically given as a pill or an injection, they cause an effect to the entire body and therefore are usually prescribed for moderate to severe psoriasis. Some common systemic treatments are:

Biologics: a type of medication that targets specific parts of the immune system that play a major role in developing psoriasis and psoriatic arthritis.

Immunosuppressants: used to treat severe psoriasis and also works to suppress or reduce the body's immune response.

Cytotoxic drugs: work by binding to and inhibiting an enzyme involved in the rapid growth of cells. They also slow the rate of skin cell growth.

Oral retinoids: these are synthetic (chemically-produced) forms of vitamin A that work to re-establish a more normal pattern of cell growth. This can help decrease the scale and thickness of psoriasis plaques, as well as decrease inflammation. Oral retinoids are often used to treat severe psoriasis – including plaque, guttate, erythrodermic and pustular psoriasis.

Phototherapy

Vitamin D, also known as “the sunshine vitamin”, is present in natural light and can benefit individuals with psoriasis thanks to its ability to reduce the thickness of plaques and to make them less scaly. A range of treatments involving ultraviolet (UV) light are used to treat moderate to severe psoriasis that has been resistant to topical treatments.Phototherapy (or light therapy) makes use of skin cells’ ability to absorb the energy from UV light, subsequently using it to power chemical reactions that affect the function of the cells.

The process can be conducted at home or at a dermatologist’s office, however it is imported to note that an indoor tanning machine is not a suitable substitute for a phototherapy unit.Beneficial effects can also stem from exposure to natural sunlight; however, you should take care to protect yourself from sunburn, which can make your psoriasis worse and increase your risk of skin damage and skin cancer.

Natural remedies

While there remains little evidence to prove the effectiveness of natural skin remedies, many individuals chose to use them to help reduce the appearance of psoriasis plaques. The range of natural medicines available to purchase include aloe vera, tree oil shampoo or apple cider vinegar (applied to the scalp), Dead Sea bath salts and consuming turmeric. When incorporating any of the above in a psoriasis treatment plan, it is important to work in partnership with your dermatologist to ensure they are safe to use alongside other medication.

Coping with psoriasis

Everyone copes with psoriasis differently and the choice of therapy should be based on conversations between you and your doctor. A treatment which works well for one person may not work for another. And in some cases, a treatment that has previously worked well for someone may not be the right choice for them in the future. So work with your doctor to find the right treatment for you. Once he has a clear picture of your preferences and lifestyle, he will be able to create a treatment plan that works for you. Your doctor will also be able to help you overcome any issues with the treatment, to keep you on track.

References:

World Health Organization. Global report on psoriasis. 2016. World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/204417/1/9789241565189_eng.pdf NHS Choices. Psoriasis. Available from: http://www.nhs.uk/Conditions/Psoriasis/Pages/Introduction.aspx WebMed. Skin Problems and Treatments ‘The 7 Types of Psoriasis’. Available at: http://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-types#1Psoriasis.org (2017). About Psoriasis. Available from: https://www.psoriasis.org/about-psoriasis Nhs.uk (2017). Topical corticosteroids. Available from www.nhs.uk/Conditions/Corticosteroid-preparations-(topical)/Pages/Introduction.aspx#sideeff

Psoriasis.org (2017). Moderate to severe psoriasis and psoriatic arthritis: biologic drugs. Available from https://www.psoriasis.org/about-psoriasis/treatments/biologics

Psoriasis.org (2017). Over-the-counter (OTC) topicals. Available from https://www.psoriasis.org/about-psoriasis/treatments/topicals/over-the-counter

British Association of Dermatology. Topic treatments for Psoriasis. Available from http://www.bad.org.uk/library-media%5Cdocuments%5CPsoriasis%20-%20topical%20treatments%20Updated%20Nov%202013%20-%20lay%20reviewed%20Nov%202013.pdf

Papaa.org. Retinoids and Psoriasis. Available from http://www.papaa.org/further-information/retinoids-and-psoriasis

Psoriasis.org (2015). How Vitamin D can help psoriasis. Available from https://www.psoriasis.org/advance/how-vitamin-d-can-help-psoriasis

Guenther, L. (2004). Fixed-Dose Combination Therapy for Psoriasis. American Journal Of Clinical Dermatology, 5(2), 71-77. Available from https://www.ncbi.nlm.nih.gov/pubmed/15109271

Papaa (2017). Immunosuppressants and biologics. Available from http://www.papaa.org/psoriasis-treatments/immunosuppressants-and-biologics

Wang, J., Wang, Y., & Ahn, H. (2014). Biological Products for the Treatment of Psoriasis: Therapeutic Targets, Pharmacodynamics and Disease-Drug-Drug Interaction Implications. The AAPS Journal, 16(5), 938-947. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147058/

Psoriasis.org (2017). Systemic Medications: Soriatane (Acitretin). Available from https://www.psoriasis.org/about-psoriasis/treatments/systemics/soriatane

Psoriasis.org (2017). Phototherapy. Available from https://www.psoriasis.org/about-psoriasis/treatments/phototherapy

Choonhakarn, C., Busaracome, P., Sripanidkulchai, B., & Sarakarn, P. (2010). A prospective, randomized clinical trial comparing topical aloe vera with 0.1% triamcinolone acetonide in mild to moderate plaque psoriasis. Journal of The European Academy Of Dermatology And Venereology, 24(2), 168-172. Available from http://dx.doi.org/10.1111/j.1468-3083.2009.03377.x

Ramesh, R.; Subash, Kumar, S. V., & Deepthi, E. (2011). Update and management of psoriasis: A perspective. Journal of Pharmacy Research, 4(6), 1867-1871. Available from https://www.researchgate.net/profile/Vijaya_Kumar3/publication/257712033_psoriasis-_ramesh/links/00463525c16e3dc770000000.pdf

Pazyar, N., & Yaghoobi, R. (2012). Tea tree oil as a novel antipsoriasis weapon. Skin Pharmacology And Physiology, 25(3), 162-163. http://dx.doi.org/10.1159/000337936. Available from https://www.karger.com/Article/Abstract/337936

Abels, D., Rose. T., & Bearman, J. (1995). Treatment of psoriasis at a Dead Sea dermatologic clinic. International Journal of Dermatology, 34(2), 134-137. Available from http://dx.doi.org/10.1111/j.1365-4362.1995.tb03599.x

Shehzad, A., Rehman, G., & Lee, Y. (2012). Curcumin in inflammatory diseases. Biofactors, 39(1), 69-77. Available from http://dx.doi.org/10.1002/biof.1066

Psoriasis.org (2017). Herbs/Natural remedies. Available from https://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/herbal-remedies

UK/IE MAT-09232 Date of prep: May 2017

Psoriasis on different body areas

The symptoms of psoriasis can vary depending on which part of the body is affected.

Discuss your psoriasis with your doctor, who will be able to prescribe an appropriate treatment and help you manage the condition.

Learn more by selecting a body area

Face

Hands & nails

Legs & feet

Scalp

Skin folds

Understanding psoriasis

How to care for psoriasis on the face

Manage psoriasis on the face with some simple techniques

Facial psoriasis most often affects the eyebrows, the skin between the nose and upper lip, the upper forehead and the hairline. It's important to discuss with your doctor which treatments or products are suitable for use on delicate areas such as the face.

What can I do?

In addition to treatments advised by your doctor for psoriasis on the face, there are a number of simple techniques and preventative measures that can help you manage the condition.

Try to use skin care products that have been specifically formulated for sensitive skin. Use an electric razor to shave – it's less harsh on the skin than a manual razor. Also try to get into the habit of patting rather than rubbing when you dry your skin. Once dry, use a moisturising cream to keep the skin rehydrated.

Caring for your skin all year round

The skin on your face is delicate. When you have facial psoriasis it is much more sensitive to the weather than usual and adapts to changes of temperature less easily. Wind and rain in autumn and winter can dry out the skin , so apply a protective cream to your face before going out and wear a hood or scarf.

Always try to use non-irritating and gentle skin care products that have been specifically formulated for sensitive skin.

Heat and sunlight in spring and summer can also increase inflammation, so avoid direct exposure to sunlight in very sunny weather to prevent burning. Use a suitable protective cream, preferably a total sunblock for the face, especially during a flare-up.

Remember that apart from during a flare-up, moderate amounts of exposure to the sun may actually help to clear plaques.

UK/IE MAT-09232 Date of prep: May 2017

Understanding psoriasis

Hand & Nail Psoriasis – What to expect

Psoriasis on your hands and nails can make daily activities or delicate tasks difficult to carry out. Hand and nail psoriasis can be difficult to cope with. The plaques are often more visible than those on the body or scalp, and using your hands is a very important part of interpersonal relationships, like shaking hands in social and professional situations.

A flare-up of psoriasis on the palm of the hand is often accompanied by cracking, blisters and swelling.
In around half of cases, psoriasis on the hands affects the nails.
Holes in the nails – also called pitting – is the most common characteristic.
Nails may become white and thick. As a result of dryness, lines can also appear running across the nail.
When the cuticles are affected they can no longer act as a protective barrier. Inflammation can also spread under the nails.

Psoriasis on hands

Can you get psoriasis on your hands?

Psoriasis on hands is characterised by red, raised, inflamed patches of skin that have a silvery, scaly appearance. The skin may be cracked, itchy, bleeding and sore. Your hands may be swollen, and your joints sore. Nail changes take place in around 50% of those suffering with psoriasis. This usually occurs as thickening of the nails, discolouration, separation of the nail from the nail bed, deformation and pitting. Using the correct treatment, symptoms of psoriasis on hands can be alleviated in some cases or reduced.

Psoriasis on hands

Symptoms of psoriasis on hands

Symptoms of psoriasis on hands include raised, red skin that has a scaly, silvery appearance. Psoriasis patches may feel sore and itchy and there may be cracking, bleeding, swelling and blisters. Nail changes can occur, such as the thickening of the nails, discolouration, separation of the nail from the nail bed, deformation and pitting.

Precautionary measures for psoriasis on the hands

Precautionary measures of psoriasis on hands include wearing cotton gloves to prevent skin injury when undertaking household chores, washing with soap substitutes, reducing stress, eating a healthy, balanced diet and limiting your intake of alcohol. Moisturising your hands will help to keep the skin soft and smooth.

Psoriasis on nails

Fingernail psoriasis is common in around 50% of people suffering from psoriasis. Psoriasis nails are characterised by changes in the nail. Fingernail psoriasis is more common than toenail psoriasis. Symptoms can be mild or severe and the severity does not depend on psoriasis elsewhere on the body.

You can protect your nails by keeping them short and wearing gloves for cleaning chores. Psoriasis on the nails can be a cosmetic problem for many, however, psoriasis and acrylic nails are not always a good combination as the glue used during acrylic nail application can contain chemicals that can cause sensitivity.

Psoriasis nails

Symptoms of psoriasis on nails

Symptoms of psoriasis on nails include changes in the nails. This can be pitting of the nails, discolouration and thickening. Onycholysis may also occur. This is when the nail becomes separated from the nail bed. Sometimes you can get an infection in the gap under the nail.

Precautionary measures of psoriasis on nails

Precautionary measures of psoriasis on nails include keeping your nails as short as possible. Soaking your nails in warm soapy water can help to remove any dirt from under the nail. Also, protect your nails by wearing cotton gloves when doing household chores. Furthermore, rubbing a moisturiser in your nails can be beneficial.

Treatment options and precautions

You should talk to your doctor about hand and nail psoriasis, and the current treatment options available. You can also ask for help with management strategies and simple precautions that you can take.

Some ways to prevent psoriasis from flaring-up and affecting the hands and nails include avoiding movements that cause repeated friction to the hands and keeping nails trimmed and as short as possible. Long and loose nails can continue to be injured as they catch and rub against surfaces.

It is also important to protect nails from damage because any injury or trauma can in some cases trigger or make nail psoriasis worse. Wearing gloves, if possible, while you are using your hands during activities that are likely to damage your nails is the simplest way to help prevent this.

References

http://www.mayoclinic.org/diseases-conditions/psoriasis/basics/symptoms/con-20030838
http://www.papaa.org/further-information/nail-psoriasis
https://www.psoriasis.org/about-psoriasis/specific-locations/hands-feet-nails
http://www.papaa.org/further-information/emollients-and-psoriasis

This content is not intended to advise you about your health. Always seek advice from your doctor or other qualified healthcare professionals.

UK/IE MAT-09232 Date of prep: May 2017

Understanding psoriasis

How to manage psoriasis on the legs and feet

Psoriasis on the legs

If you have psoriasis on the legs, often the skin on your shins and knees can be very itchy. You may find that your ankles can also swell at the end of the day because of poor circulation. Keeping your legs as moisturised as possible and bending your knees from time to time when standing, or elevating your feet when sitting or lying down, can really help reduce swelling and any itchiness.

High temperatures or prolonged periods of standing can cause the veins in your leg to swell, putting more strain on the skin.

Psoriasis on the feet

Certain types of psoriasis can also affect different parts of the foot. When your skin on the toes and heels is inflamed, it can crack, blister and become swollen and painful.

Keeping your feet as clean and fresh as possible is key when trying to manage psoriasis on your feet. Footwear should be light and comfortable and, where possible, you may want to choose shoes that will keep your feet cool and dry and allow the air to circulate freely. You could also try foam, cork or water-filled insoles or use insoles made from polymers which act as shock-absorbers and may protect healing skin.

In winter, feet should be kept warm, particularly if you have poor circulation in the legs and in warmer weather, using a daily footbath may be helpful.

This content is not intended to advise you about your health. Always seek advice from your doctor or other qualified healthcare professionals.

UK/IE MAT-09232 Date of prep: May 2017

Understanding psoriasis

Hair care for scalp psoriasis

Symptoms and how to cope with psoriasis on the scalp

As well as the scalp itself, scalp psoriasis can also affect the ears, the area above and behind the ears, the earlobes, the nape of the neck, the forehead and the hairline. Hair care and psoriasis

It's important to treat your scalp very gently if psoriasis is present. Wash and dry your hair gently. If you use a hair dryer you should use the cool or very low heat setting and hold it at least 30 cm. from your head.

Remember to thoroughly dry behind your ears and on both sides of the earlobes.

Any brushing or combing of the scalp should be done particularly gently to avoid aggravating the existing psoriasis symptoms. Use a hairbrush with natural bristles rather than a hard plastic brush, and avoid using rollers and curlers which can pull the hair and dry the scalp.

Use a hairbrush with natural bristles rather than a plastic brush, and avoid using rollers and curlers which can pull the hair and dry the scalp.

Consider your hairstyle

You may also want to consider what kind of hairstyle is practical. A short haircut could be more comfortable and practical if you have severe psoriasis on your scalp.

Whatever hair style you choose, it may also be best to avoid styles that place tension on the hair, such as back combing or putting it up too tightly. If you are suffering from a flare-up on the scalp, you may want to put off perming or dying your hair until it has healed. Don't be embarrassed about telling your hairdresser about your psoriasis and ask them to treat your scalp gently.

You can always talk to your doctor or healthcare professional

As always, your healthcare professional is the best person to advise you on how to care for your scalp and the different treatment options for the condition. They can also help you with any general concerns about using hair styling products while you are using a treatment, so do make sure you involve them in any decisions you make regarding your psoriasis.

UK/IE MAT-09232 Date of prep: May 2017

Understanding psoriasis

How to manage psoriasis in your skin folds

Common symptoms and how to manage psoriasis in skin folds

The skin in skin folds such as the armpits and under the breasts is more delicate and thinner than in other areas. Rubbing and sweating can be a cause of frequent psoriasis irritation.

It can get hot and damp where the skin has less contact with the air. This increases the likelihood of yeast and fungal infections, especially in areas where you sweat more, such as the armpits, under the breasts, and in the groin and crotch area.

As often as possible, try to wear loose, comfortable clothing. The best materials are cotton or poly-cotton mixes.

Taking precautionary measures

To help manage the condition, try to keep skin folds as dry as possible even after the psoriasis has cleared. You should also take care to wash the gently and dry it carefully afterwards. If necessary, you can use tissues to make sure smaller folds are completely dry.

Try to wear loose, comfortable clothing. The best materials are cotton or poly-cotton mixes. Women may also want to avoid wearing under-wired bras as these can increase perspiration.

Keep dry and comfortable

For psoriasis in the groin and crotch area – around the genitals and anus and between the buttocks – it can be a good idea to have an additional daily wash in warm summer weather. Afterwards, remember to dry your groin and buttock creases thoroughly.

You should wear comfortable cotton underwear. If possible, avoid tight jeans and trousers. It is best not to wear synthetic materials next to the skin as they cause sweating. For men, boxer shorts are better than briefs as they allow air to circulate.

UK/IE MAT-09232 Date of prep: May 2017