Solutions for Psoriasis
Living with psoriasis can be challenging, but becoming familiar with the condition and exploring available treatments can improve your quality of life. As a dermatologist specialising in skin care, Dr Dalia can offer insights into causes and treatment for psoriasis.
What is Psoriasis?
Psoriasis is a chronic autoimmune condition that affects the skin, causing rapid cell turnover and inflammation. This results in the formation of thick, scaly patches on various parts of the body. While psoriasis is not contagious, it can be uncomfortable, itchy, and sometimes painful. The condition affects people of all ages and backgrounds, with symptoms ranging from mild to severe.
Common Types of Psoriasis
There are several types of psoriasis, each with distinct characteristics:
- Plaque Psoriasis: The most common form, characterised by raised, red patches covered with silvery-white scales.
- Guttate Psoriasis: Appears as small, drop-shaped lesions, often triggered by infections.
- Inverse Psoriasis: Occurs in skin folds, presenting as smooth, red patches without scales.
- Pustular Psoriasis: Characterised by white pustules surrounded by red skin.
- Erythrodermic Psoriasis: A severe form that affects large areas of the body, causing intense redness and shedding.
What are the Causes of Psoriasis?
The exact cause of psoriasis remains unknown, but research suggests a combination of genetic and environmental factors play a role. Here are some factors that contribute to the development and exacerbation of psoriasis:
- Genetics: If you have a family history of psoriasis, you’re more likely to develop the condition. Certain genes associated with the immune system have been linked to psoriasis.
- Immune System Dysfunction: In psoriasis, your immune system mistakenly attacks healthy skin cells, accelerating the skin cell production process.
- Triggers: Various environmental factors can trigger psoriasis flare-ups, including:
- Stress
- Infections (such as strep throat)
- Skin injuries
- Certain medications
- Cold, dry weather
- Excessive alcohol consumption
- Smoking
- Hormonal Changes: Some people experience psoriasis flare-ups during hormonal shifts, such as during puberty, pregnancy, or menopause.
- Obesity: Being overweight or obese can increase the risk of developing psoriasis and may make symptoms more severe.
- Vitamin D Deficiency: Some studies suggest a link between low vitamin D levels and increased psoriasis severity.
What are the Psoriasis Symptoms?
Psoriasis symptoms can vary greatly from person to person, but common signs include:
- Red, inflamed patches of skin
- Silvery-white scales on the red patches
- Dry, cracked skin that may bleed
- Itching, burning, or soreness
- Thickened, pitted, or ridged nails
- Swollen and stiff joints (in cases of psoriatic arthritis)
You should know that psoriasis can affect any part of the body, including the scalp, face, hands, feet, and genitals. The severity and location of symptoms can impact your daily life, self-esteem, and overall well-being.
Diagnosing Psoriasis
If you suspect you have psoriasis, you should consult a dermatologist like Dr Dalia for a proper diagnosis. The diagnostic process typically involves:
- Physical examination: Your dermatologist will examine your skin, nails, and scalp for characteristic signs of psoriasis.
- Medical history: You’ll be asked about your symptoms, family history, and potential triggers.
- Skin biopsy: In some cases, a small skin sample may be taken for microscopic examination to confirm the diagnosis and rule out other skin conditions.
- Blood tests: These may be performed to check for signs of infection or other underlying health issues.
Treatment Options for Psoriasis
While there is no cure for psoriasis, a wide range of treatment options are available to manage symptoms, reduce inflammation, and improve your quality of life. The choice of treatment depends on different factors, including the severity of your condition, the areas affected, your overall health, and your personal preferences.
Topical Treatments for Psoriasis
Topical treatments are usually the first treatment option for mild to moderate psoriasis. They are applied directly to the skin and can be very effective in managing localised symptoms.
Corticosteroids
These anti-inflammatory medications are the most commonly prescribed topical treatment for psoriasis. They come in various strengths, from mild to very potent, and in different formulations such as creams, ointments, gels, and foams.
- How they work: Corticosteroids reduce inflammation, itching, and slow down skin cell growth.
- Usage: They are typically applied once or twice daily for a few weeks.
- Considerations: Long-term use of high-potency steroids can lead to skin thinning and other side effects. Your dermatologist will guide you on the appropriate strength and duration of use.
Vitamin D analogues:
These are synthetic forms of vitamin D that can help slow skin cell growth and reduce inflammation.
- Examples: Calcipotriene (Dovonex) and calcitriol (Vectical)
- How they work: They help normalise skin cell production and reduce inflammation.
- Usage: Usually applied once or twice daily.
- Considerations: They can be used alone or in combination with topical corticosteroids for enhanced effectiveness.
Retinoids:
Topical retinoids are vitamin A derivatives that can help normalise skin cell production.
- Example: Tazarotene (Tazorac, Avage)
- How they work: They help slow skin cell growth and reduce inflammation.
- Usage: Applied once daily, typically in the evening.
- Considerations: They can cause skin irritation and increase sensitivity to sunlight. They’re not recommended during pregnancy due to potential risks.
Calcineurin inhibitors
These drugs reduce inflammation and plaque build-up, especially in sensitive areas like the face, genitals, and skin folds.
- Examples: Tacrolimus (Protopic) and pimecrolimus (Elidel)
- How they work: They suppress the immune response in the skin, reducing inflammation.
- Usage: Applied twice daily to affected areas.
- Considerations: They’re particularly useful for areas where steroids might be too harsh.
Coal tar:
This is one of the oldest treatments for psoriasis and can be found in various over-the-counter products.
- How it works: Coal tar can help slow skin cell growth, reduce inflammation, and relieve itching.
- Usage: Available in shampoos, creams, and ointments.
- Considerations: It can be messy to apply and may stain clothing or bedding. Some people find the odour unpleasant.
Salicylic acid:
This ingredient helps remove scales and soften the skin.
- How it works: It acts as a keratolytic agent, helping to lift and remove scales.
- Usage: Often combined with other treatments like coal tar or corticosteroids.
- Considerations: It can cause skin irritation in some people and shouldn’t be used on large areas of the body.
Light Therapy (Phototherapy)
Light therapy involves exposing the skin to controlled amounts of natural or artificial light. It can be an effective treatment for moderate to severe psoriasis, especially when combined with other therapies.
Narrowband UVB therapy:
This is the most common form of light therapy for psoriasis.
- How it works: Controlled exposure to a specific wavelength of ultraviolet B (UVB) light slows skin cell growth and reduces inflammation.
- Usage: Treatments are typically given 2-3 times a week in a clinical setting.
- Considerations: It may increase the risk of skin cancer, so regular skin checks are important.
Psoralen plus ultraviolet A (PUVA):
This treatment combines UVA light with a light-sensitising medication called psoralen.
- How it works: The psoralen makes the skin more responsive to the UVA light, enhancing its effectiveness.
- Usage: Psoralen can be taken orally or applied topically before UVA exposure.
- Considerations: PUVA can be more effective than UVB therapy but carries a higher risk of side effects, including an increased risk of skin cancer.
Excimer laser:
This targeted light therapy can treat specific areas of psoriasis without affecting surrounding healthy skin.
- How it works: It delivers a high dose of UVB light to small areas of psoriasis.
- Usage: Treatments are typically given twice a week for several weeks.
- Considerations: It’s particularly useful for treating stubborn plaques or psoriasis in difficult-to-treat areas.
Systemic Medications
For moderate to severe psoriasis that doesn’t respond adequately to topical treatments or light therapy, systemic medications that work throughout the body may be prescribed.
Methotrexate:
This drug has been used to treat psoriasis for decades.
- How it works: It suppresses the immune system and slows skin cell growth.
- Usage: Taken orally once a week.
- Considerations: Regular blood tests are needed to monitor for potential liver damage and other side effects.
Cyclosporine:
This powerful immunosuppressant can be effective for severe psoriasis.
- How it works: It suppresses the immune system, reducing inflammation and slowing skin cell turnover.
- Usage: Taken orally daily.
- Considerations: It can increase the risk of infection and certain cancers. It’s typically used for short periods due to potential side effects.
Oral retinoids:
These are vitamin A derivatives that can help reduce skin cell production.
- Example: Acitretin (Soriatane)
- How they work: They help slow skin cell growth and reduce inflammation.
- Usage: Taken orally daily.
- Considerations: They can cause significant side effects and are not suitable for women who are pregnant or planning to become pregnant.
Biologic Drugs
Biologics are a newer class of medications that target specific parts of the immune system involved in psoriasis. They can be highly effective for moderate to severe psoriasis and psoriatic arthritis.
TNF-alpha inhibitors:
These drugs block tumour necrosis factor-alpha, a protein involved in systemic inflammation.
- Examples: Adalimumab (Humira), Etanercept (Enbrel), Infliximab (Remicade)
- How they work: They reduce inflammation by blocking TNF-alpha.
- Usage: Administered by injection or intravenous infusion, frequency varies by medication.
- Considerations: They can increase the risk of infections and certain cancers.
Interleukin inhibitors:
These biologics target specific interleukins, which are proteins involved in the immune response.
- Examples: Ustekinumab (Stelara), Secukinumab (Cosentyx), Ixekizumab (Taltz)
- How they work: They block specific interleukins (IL-12, IL-23, or IL-17) involved in psoriasis.
- Usage: Administered by injection, frequency varies by medication.
- Considerations: Like other biologics, they can increase the risk of infections.
Complementary and Alternative Therapies
While not substitutes for medical treatment, some people find relief with complementary approaches:
- Acupuncture: Some patients report improvement in psoriasis symptoms with acupuncture treatments.
- Herbal remedies: Certain herbs like Oregon grape, aloe vera, and tea tree oil may have anti-inflammatory properties.
- Dietary changes: Some people find that certain dietary approaches, such as anti-inflammatory diets or gluten-free diets, help manage their symptoms.
- Stress-reduction techniques: Practices like meditation, yoga, or tai chi can help manage stress, which is a common trigger for psoriasis flares.
- Balneotherapy: Bathing in mineral-rich waters, such as the Dead Sea, has shown benefits for some people with psoriasis.
It’s important to remember that what works best can vary significantly from person to person. Your treatment plan may involve a combination of these approaches, and it may need to be adjusted over time as your condition changes or as you respond to different treatments.
Always consult with your dermatologist before starting any new treatment, including over-the-counter products or complementary therapies. Dr Dalia can help you weigh the potential benefits and risks of each option and develop a personalised treatment plan that’s right for you.
Lifestyle Changes to Manage Psoriasis
In addition to medical treatments, certain lifestyle changes can help manage your psoriasis:
- Moisturise regularly: Keep your skin well-hydrated to reduce dryness and itching.
- Avoid triggers: Identify and avoid factors that worsen your symptoms.
- Manage stress: Practice stress-reduction techniques like mindfulness or deep breathing exercises.
- Maintain a healthy weight: Losing excess weight can reduce the severity of symptoms.
- Limit alcohol consumption: Excessive drinking can interfere with treatments and worsen symptoms.
- Quit smoking: Smoking can trigger flare-ups and reduce treatment effectiveness.
- Protect your skin: Use gentle skincare products and avoid hot showers or baths.
- Get regular exercise: Physical activity can help reduce stress and maintain a healthy weight.
- Consider dietary changes: Some people find that certain foods worsen their symptoms. Keep a food diary to identify potential triggers.
Psoriasis and Comorbidities
It’s important to be aware that people with psoriasis have an increased risk of developing certain other health conditions, including:
- Psoriatic arthritis
- Cardiovascular disease
- Type 2 diabetes
- Inflammatory bowel disease
- Depression and anxiety
- Metabolic syndrome
Regular check-ups with your GP and dermatologist can help monitor for these conditions and ensure early intervention if needed.
FAQs about Causes and Treatment for Psoriasis
Can psoriasis affect children, and how does treatment differ for younger patients?
- Yes, psoriasis can affect children, even infants. It’s estimated that about one-third of people with psoriasis develop symptoms before age 20. Treatment for children often focuses on topical therapies and lifestyle modifications to minimise side effects. Systemic treatments are used more cautiously in children and only in severe cases. Additionally, paediatric psoriasis can have a significant impact on a child’s self-esteem and social development, so psychological support is often an important part of treatment.
Is there a link between psoriasis and vitamin D levels?
- Research suggests there may be a connection between vitamin D deficiency and psoriasis severity. Some studies have shown that people with psoriasis tend to have lower levels of vitamin D, and that supplementation can help improve symptoms. However, more research is needed to fully understand this relationship. It’s important to have your vitamin D levels checked and discuss potential supplementation with your healthcare provider.
Can psoriasis go into remission, and if so, for how long?
- Yes, psoriasis can go into remission, where symptoms significantly improve or disappear entirely. The duration of remission can vary greatly from person to person, lasting anywhere from a few months to several years. Remission can occur spontaneously or as a result of effective treatment. However, psoriasis is a chronic condition, and symptoms may return even after a long period of remission. Maintaining a healthy lifestyle and continuing prescribed treatments can help prolong remission periods.
How does psoriasis affect pregnancy and breastfeeding?
- Psoriasis can be unpredictable during pregnancy. Some women experience improvement in their symptoms, while others may see their condition worsen. Certain psoriasis treatments are not safe during pregnancy or breastfeeding, so it’s important to work closely with your dermatologist and obstetrician to manage your condition safely. Topical treatments are generally preferred during pregnancy, but each case is unique. There’s also a slightly increased risk of pregnancy complications in women with psoriasis, so additional monitoring may be necessary.
Is there a connection between psoriasis and eye problems?
- While not commonly discussed, psoriasis can indeed affect the eyes. Ocular manifestations occur in about 10% of people with psoriasis. These can include uveitis (inflammation of the middle layer of the eye), conjunctivitis, blepharitis (inflammation of the eyelids), and dry eye syndrome. In some cases, psoriatic lesions can develop on the eyelids. Regular eye exams are important for people with psoriasis, especially those with psoriatic arthritis, as they have a higher risk of eye complications
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