Psoriasis Treatment

Psoriasis is a chronic skin condition caused by an over-reactive immune system, which speeds up skin cell turnover and can range from mild to severe. Psoriasis is part of a group of immune-mediated inflammatory diseases, which also includes conditions like inflammatory bowel disease and axial spondyloarthritis.

It is characterised by the rapid production of skin cells, resulting in scaly skin lesions and inflammation. The condition is also known for its genetic links, with hereditary factors playing a significant role in psoriasis, meaning that people with a family history are more likely to develop the condition.

Up to about one-third of people with psoriasis develop psoriatic arthritis, which causes joint pain, stiffness, and swelling. Early recognition and referral are crucial, as they can prevent long-term joint damage and improve outcomes. It’s important to note that people with psoriasis have higher rates of cardiometabolic conditions (e.g., high blood pressure, obesity, type 2 diabetes, high cholesterol), fatty liver disease, and depression.

Psoriasis is a complex condition, influenced by both genetic and environmental factors. Understanding these factors can help you better manage the disease. Genetic factors can contribute to the development of psoriasis, triggering the onset or progression of the disease. Common triggers include streptococcal throat infections (especially in guttate psoriasis), certain medications (e.g., lithium, beta-blockers, antimalarials, interferon), skin injuries (Koebner phenomenon), stress, alcohol consumption, and smoking.

Psoriasis symptoms

Psoriasis causes red, scaly, itchy plaques on the skin; psoriatic arthritis can cause hot, swollen, or stiff joints. Recognising joint pain early is essential to prevent long-term joint damage and improve outcomes, so prompt consultation with a rheumatologist is recommended.

Scalp and nail psoriasis are common conditions; nail changes (such as pitting, lifting from the bed, or thickening) can range from mild to severe and are associated with a higher risk of psoriatic arthritis.

Psoriasis can also lead to flexural psoriasis, which affects skin folds, and guttate psoriasis, characterised by small, dot-like lesions.

Psoriasis is assessed using tools such as the PASI (Psoriasis Area and Severity Index), BSA (Body Surface Area), and DLQI to determine its severity and guide treatment.

Types of psoriasis

Psoriasis is a chronic skin condition that can manifest in various forms, each presenting its own unique set of symptoms and affecting other areas of the body. Understanding the different types of psoriasis is crucial to achieving an accurate diagnosis and developing an effective management plan. Main types of this skin condition include:

• Chronic plaque psoriasis: This is the most common form you’re likely to encounter. Chronic plaque psoriasis develops as raised, red patches that become covered with silvery-white scales on your skin. You’ll typically notice these scaly skin lesions appearing on your elbows, knees, scalp, and lower back, though they can affect virtually any part of your body. Your doctor will often identify this type first, as it represents the majority of psoriasis cases.
• Guttate psoriasis: If you develop guttate psoriasis, you’ll notice small, drop-shaped spots that usually appear quite suddenly on your skin, often following a bacterial infection, such as a streptococcal throat infection. This type is more commonly seen in children and young adults, and it may cover large areas of your trunk, arms, and legs.
• Pustular psoriasis: This represents a more severe form of psoriasis characterised by white pustules (blisters containing non-infectious pus) that appear surrounded by red, inflamed skin. You may experience pustular psoriasis as localised patches affecting specific areas, such as your hands and feet, or, in very severe cases, it can cover most of your body. Generalised pustular psoriasis is rare and may need urgent hospital treatment.
• Erythrodermic psoriasis: This is a rare but extremely severe form that you should consider a medical emergency. Erythrodermic psoriasis causes widespread redness across your skin, severe itching, and extensive shedding. This type can dangerously disrupt your body’s ability to regulate temperature and fluid balance, which is why you may require urgent medical attention if you develop these symptoms.
• Scalp psoriasis: When psoriasis affects your scalp, you’ll likely notice thick, crusted plaques that may extend beyond your hairline onto your forehead, neck, or ears. You might experience significant flaking, intense itching, and sometimes temporary hair loss due to scratching or inflammation. This type can be particularly frustrating as it’s often visible and affects your daily comfort.
• Nail psoriasis: This type specifically targets your fingernails and toenails, and you may notice pitting, discolouration, thickening, and in severe cases, marked nail dystrophy or, rarely, loss of the nail. Nail psoriasis can be particularly challenging for you and your doctor to treat effectively, and it may also serve as an early indicator of psoriatic arthritis, which affects your joints.
• Flexural (inverse) psoriasis: If you develop this type, it will affect your skin folds, such as under your breasts, in your armpits, or around your groin area. You’ll notice that the affected areas are typically smooth and red, and they may be more sensitive to minor irritation due to the natural moisture and friction that occur in these areas.

Each type of psoriasis can range in severity, and it’s common to experience more than one form at the same time.