Psoriasis

Psoriasis is a chronic, systemic, inflammatory skin disorder in which there is an increase in the rate at which skin cells are produced and shed from the skin.

Normally, skin cells reproduce and mature as they move from the deeper layers of the epidermis (the outermost layer of the skin) to the surface. This process is called proliferation and usually takes approximately 28 days. In psoriasis, this process is accelerated, only taking about 4 days. The new skin cells reproduce too quickly and move toward the skin surface in an immature form, causing a build-up of silvery scale (dead skin cells). There is also an increased blood flow to the skin and a thickening of the epidermis, leading to the development of red, raised plaques (a plaque is a raised, red, scaling, well-defined area more than 1cm in size).

Psoriasis can affect any part of the skin surface, but most commonly involves the elbows, knees, scalp, and the sacrum (lower back).

Psoriasis is a condition which tends to run in families. Several different genes have been identified but the exact way in which the disorder moves from generation to generation has not yet been established. What is known is that both the immune system and genetics are important in its development. So although the potential to develop psoriasis is genetically inherited, it is by no means certain that it will ever occur.

Environmental factors can also play a role in developing the condition. In some cases, emotional stress (like moving house, a divorce or bereavement), infection (such as a strep throat), injury to the skin or certain medications can trigger the first episode of psoriasis, while certain lifestyle factors (such as heavy drinking and smoking) may worsen it.

Psoriasis is not contagious, infectious or the result of poor hygiene.

Psoriasis: the facts

Psoriasis may seem only skin deep, but it begins inside the body within the immune system. The red, scaly, flaky, and itchy patches occur when the skin cells grow too quickly as a result of inflammation caused by the body’s immune system.

Triggers for this abnormal immune reaction can include physical injuries or infections (in particular, a streptococcal throat infection), certain medicines, and emotional stress.  Psoriasis varies in severity from person to person and can vary in severity in the same person at different times.

Occasionally psoriasis can disappear without treatment but more usually, it is a chronic disease that requires treatment.  Patches (also called plaques or lesions) can occur on various parts of the body, including the scalp, elbows, and or knees.

Some things you should know about psoriasis

  • It is a chronic, systemic, inflammatory skin disease.
  • It is related to the immune system – an autoimmune disease.
  • It may run in families (there are several different genes involved in psoriasis).
  • It is not curable, but treatments are available.
  • It is not contagious.
  • It is sometimes associated with psoriatic arthritis.
  • It is associated with a slightly higher risk of diabetes, high blood pressure, high cholesterol and obesity.
  • It is associated with a slightly higher risk of cardiovascular disease (angina, heart attack and stroke).
  • There is a strong association between psoriasis and depression.

Potential triggers

Infections

In those with a family history of psoriasis, a streptococcal throat infection sometimes triggers the first symptoms of psoriasis. Guttate psoriasis often develops in this way. Typically, patients will report a history of a sore throat approximately 2 weeks before the widespread appearance of small, red teardrop shaped patches.

Emotional stress

In those with a genetic predisposition to develop psoriasis, emotionally stressful events, such as an important exam or the death of a loved one, can trigger the first episode of psoriasis or worsen an existing flare-up.

Medications

Certain medications, such as lithium, beta blockers, and anti-malarials, have been reported to aggravate psoriasis symptoms. To prevent this from happening, ensure that your doctors knows that you have psoriasis (even if you haven’t had any symptoms in years). Stopping some medicines abruptly can also lead to flare-ups, so be sure to talk to your doctor about the best way to taper off a medication and when it’s appropriate to do so.

Skin Injury (Koebner phenomenon)

In about one third of patients, physical trauma to the skin, such as a cut, scrape, insect bite, or burn, can cause psoriasis to develop at the site of the injury. This occurrence was first described by a doctor named Koebner in 1872, and was subsequently called the Koebner phenomenon.

How is psoriasis treated?

The treatment of psoriasis depends on its severity and location, and can be divided into four main categories: topical treatments (creams or ointments applied directly to the skin), ultraviolet light therapy (also called phototherapy, delivered in hospital dermatology departments), systemic medications (medicines that work inside your body) or biologic treatments (medicines based on compounds made by living cells). The use of emollients and soap substitutes also form an integral part of treatment.

Talk with your doctor to find a treatment regimen that is most appropriate for you.

For psoriasis, the good news is that there is a range of treatment options available, as well as on-going research examining potential new treatments. Be sure to talk to your doctor about your symptoms and progress. Only your doctor, working together with you, can choose the right treatment for your condition.

Climate

Sudden exposure to cold weather can sometimes trigger a flare-up. In general, psoriasis tends to improve in warmer climates and worsen in colder ones.

Lifestyle factors

Stress, alcohol, cigarette smoking, and obesity have all been associated with flare-ups, so it can be useful to look at changing lifestyle behaviours, and seek out healthy ways to manage stress levels. Your psoriasis may improve by limiting your alcohol intake, giving up smoking and maintaining a healthy weight. Exercise is good to relieve stress and to reduce weight.

Living with psoriasis

Identifying what triggers or aggravates your symptoms can help you find a more effective treatment plan. For example, in about one third of people with psoriasis, physical trauma to the skin, such as a cut, scrape, insect bite, or burn, can cause psoriasis to develop at the site of the injury. This occurrence was first described by a doctor named Koebner in 1872, and was subsequently called the Koebner phenomenon.

General Skin Care Tips

You may wish to consider the following psoriasis skin care tips below:

  • Be gentle – don’t scrub your skin or take a bath or shower in hot water — use warm water only. Pat your skin dry after cleansing rather than rubbing and irritating it.
  • Keep your skin well moisturised – dry skin itches, and you may be tempted to scratch. If you apply a moisturiser immediately after your shower or bath, it will help lock in moisture. Emollients and soap substitutes form an important part of treatment.
  • Keep nails trimmed – you’re less likely to scratch yourself.
  • If facial psoriasis is a problem, consider skipping a day between shaves. Be sure to change your razor blade frequently or opt for an electric razor.
  • Wear cotton next to your skin – cotton is much less likely to irritate your skin compared with other fabrics, such as wool. If your skin is irritated, you’re more likely to scratch.
  • Sun protection – while psoriasis can benefit from sunlight, sunburn can cause psoriasis flares.

Lifestyle Factors

Certain lifestyle factors, such as stress, alcohol, cigarette smoking, and obesity have all been associated with flare-ups, so it can be useful to look at changing lifestyle behaviours, and seek out healthy ways to manage stress levels.

  • Consider keeping a diary to pinpoint situations, places or events that trigger your stress – understanding your triggers can empower you and help make stress more manageable.
  • Be sure to exercise regularly, but also to get adequate rest. Exercise and rest help maintain your health and reduce stress. They also reduce the risk of heart disease (which is higher in those with psoriasis).
  • Avoid excessive alcohol. As well as making psoriasis worse, it can contribute to low mood, anxiety, obesity and heart disease.
    Do not smoke. Smoking makes psoriasis worse and increases your risk of heart disease.
  • Eat a healthy diet. Obesity makes psoriasis worse and increases the risk of heart disease, high blood pressure and cholesterol. Recommended waist measurements are less than 32 inches (80cm) for women and less than 37 inches (94cm) for men. A lifelong healthy diet is important for everyone.

Advice sourced from Irish Skin Foundation. Learn more at www.irishskin.ie