Psoriasis

Psoriasis is a term derived from the Greek word psōra which means itch and is a common, long lastinginflammatory skin condition which affects 1-3% of the UK population and about 80 million people worldwide.  Psoriasis is not contagious – you cannot catch it by touching someone who has it. Many factors play a role in psoriasis and these include your genes, your immune system and environmental triggers resulting in inflammation and the formation on the skin surface of red, raised plaques, with silvery-white scales and sharp edges that vary in shape and size. Psoriasis can be itchy and the plaques can be dry and cracked making the skin feel sore.

The plaques can appear anywhere on the body but most commonly affect the scalp, the outer surfaces of the knees and elbows and the lower back. A person who is affected by the condition will go through periods where it worsens (known as flare-ups) and, although it is not curable, will have times when it gets better (known as remissions).

There are many different types of psoriasis and the most common ones are described in Table 1, along with their characteristics.

TypeWho Does it AffectCharacteristicsCommon Areas Affected
Psoriasis Vulgaris
or Chronic Plaque Psoriasis
80% of people with psoriasis have this type
  • Red, raised, inflamed skin with
    silvery-white scales and sharp edges (plaques), which may be itchy

  • Plaques are usually symmetrical i.e. they appear on both knees or elbows and vary in size from 1cm to several cm
Knees or shins

Elbows

Lower back

Scalp
Guttate PsoriasisAffects about 18% of psoriasis sufferers and is most often seen in children and young adults usually after a throat infection such as tonsillitis
  • Many small (less than 1cm diameter),
    pink-red, droplet-like patches which may clear within a couple of weeks, even without treatment

  • Sometimes it disappears and is never seen again however, in other instances, the person can go on to develop chronic plaque psoriasis
Thighs

Trunk

Upper arms

Scalp
Inverse Psoriasis or Flexural PsoriasisTends to be seen more in older people and women
  • Regions of skin that are bright red, smooth, shiny and have no scales

  • It is made worse by sweating and rubbing

  • Occurs in the skin creases (called flexures)
Armpits

Under the breasts

Groin

Between buttocks

Genitals
Pustular PsoriasisAn uncommon form which mainly appears in adults especially women
  • Yellow or brown pus-filled bumps which are surrounded by red skin that is tender
There are two types:

Palmo-plantar pustular psoriasis affects the palms of the hands and soles of the feet

Generalised pustular psoriasis which can affect any part of the skin and is widespread. This is a very serious condition which needs urgent treatment by a specialist
Erythrodermic PsoriasisRare but serious (potentially life-threatening)
  • Inflamed, widespread redness with merged plaques (so aren’t noticeable)

  • Painful, skin feels warm and the person may have a fever

  • Affects the skins ability to control temperature and protect against infections
Most of the person’s body
Nail PsoriasisAffects up to 50% of those with psoriasis
    The nails may:

  • Separate from the nail bed

  • Have irregular pitting on their surface

  • Thicken

  • Discolour
Finger nails (more common)

Toe nails
Psoriatic ArthritisOccurs in about 10% - 20% of psoriasis sufferers
  • Inflammation, pain and joint swelling but other areas can also be affected
Neck

Toes

Knees

Lower back

Fingers

Table 1: Different types of Psoriasis and their Characteristics

Chronic plaque psoriasis is the most common form of psoriasis and affects about 80% of sufferers. Psoriasis affects men, women and children of all races, however, it is seen more often in Caucasians compared to Non-Caucasians. It can occur at any age but more commonly starts between the ages of 15-20 years and 55-60 years and affects
10-15% of children under the age of 10.

About one third of those who suffer from psoriasis have a family history involving several genes so whether a person develops psoriasis or not is complex.

globe_bullet   People who develop psoriasis at an early age tend to have more of a family history of it.

globe_bullet   If one parent has psoriasis there is about a 25% chance that their child will develop it however this goes up to 60% if both parents have it.

globe_bullet   If neither parent has psoriasis but their child develops it then there’s a 20% chance that a sibling will get it – this is because psoriasis can skip a generation.

The exact cause of psoriasis is unknown, however it involves your genes, the immune system and environmental triggers.

Our skin is made up of three layers:

globe_bullet   Epidermis

globe_bullet   Dermis

globe_bullet   Hypodermis

The Epidermis is the outer skin layer and is made up of five further layers, with the layer furthest from its surface being the stratum basale. It is in this bottom layer that the main skin cells of the epidermis are made. These then move up through the other epidermal layers, continually undergoing changes, and once they reach the top they replace those that have died and are being shed from the stratum corneum. This whole process usually takes on average between 21 to 28 days.

In those suffering from psoriasis the rate of this process is much faster (3 – 4 days) which experts believe is due to the immune system accidentally attacking healthy cells. This results in dead and alive cells building up on the skin surface which form clumps or patches of thickened, red, scaly plaques. As well as this there are also changes in the blood vessels (these increase in numbers and widen) and an increase in the number of cells that are involved in inflammation is seen, these changes are responsible for the skin under the plaques being red.

Some people will not know what causes their flare-ups (makes their psoriasis worse) whilst others know that certain factors (known as triggers) can cause their psoriasis to flare-up. Not only do these triggers vary from person to person but so does an individual’s response to them, however, if you can identify what your particular triggers are then you may be able to avoid them and so reduce your flare-ups.

Common triggers include:

globe_bullet   Anxiety & Stress – including situations like a divorce or a bereavement. Managing the stress may help

globe_bullet   Skin injury – due to scratching, cuts, rubbing and sunburn (known as Koebner Phenomenon)

globe_bullet   Excess Alcohol – reducing the amount of alcohol that you drink is advisable

globe_bullet   Smoking – quitting may help

globe_bullet   Sunlight – although most people find that sunlight helps with psoriasis in 10% of sufferers it can make it worse

globe_bullet   Infections – especially a sore throat (tonsillitis), seen mainly in children and young adults

globe_bullet   Medication – Beta-blockers, ACE inhibitors, lithium, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), certain antibiotics and Anti-Malarials with chloroquine in

globe_bullet   Hormonal changes – during puberty and menopause, although some people find that during pregnancy their symptoms get better

Symptoms of psoriasis vary depending on the severity of the condition and the type of psoriasis. In mild cases there are small areas of rash and as the severity of the psoriasis worsens symptoms include inflamed skin with raised, red, scaly, itchy plaques, which can dry and crack making the skin feel sore.

50% of people suffering from psoriasis also experience changes to their nails, these can include the nails separating from the nail bed, irregular pitting on their surface, splitting easily, thickening and changing colour (translucent yellow-red discolouration).

Treatments will vary depending on severity, site and type of psoriasis, however, emollients such as the AproDerm® range help manage the severity of psoriasis and form the basis of all treatments.

Some sufferers have swollen, painful and stiff joints – this is called psoriatic arthritis.

Although there is currently no cure for psoriasis, treatments can help to improve symptoms and the appearance of patches. The first step in managing your condition would be to avoid any known triggers, unfortunately, this may not be as easy as it sounds as certain triggers are unavoidable such as puberty and menopause whilst some sufferers don’t know what triggers their psoriasis.

The severity of Psoriasis can generally be classed as:

globe_bullet   Mild – affects 80% of sufferers, is easily controlled, with few patches and involves less than 3% of a person’s body surface area.

globe_bullet   Moderate – affects 15% of sufferers, can normally be self-managed under the supervision of a healthcare professional with between 3% – 10% of skin area being affected.

globe_bullet   Severe – affects 5% of sufferers, may not be responsive to treatment or be self-managed and affects over 10% of body surface area.

Treatments will vary depending on the site, type and severity of the psoriasis and will be stepped down and up as your condition gets better or worse, however, as emollients such as the AproDerm® range help manage the severity of the psoriasis they form the basis for all treatments. They should always be used even when your psoriasis has improved as this reduces the risk of flare-ups.

Emollients are moisturising treatments which are used to break the itch-scratch cycle and to maintain the smoothness of the skin. They work by:

globe_bullet   Helping skin retain water

globe_bullet   Moisturising the skin

globe_bullet   Soothing the skin

globe_bullet   Easing itching

globe_bullet   Reducing scaling

globe_bullet   Softening cracks

globe_bullet   Protecting the skin

Although emollients are a leading symptomatic treatment for psoriasis, where a person’s skin has become reddened, dry, itchy and cracked, many of them can contain SLS, parabens, halogens, fragrances or colours. These substances can irritate and sensitise the skin, however, unlike these the AproDerm® range is:

usp-text-c

They work by:

globe_bullet   Forming a protective layer over the skin surface, trapping in water which then goes into the skin cells, rehydrating them and making them swell again. AproDerm® also penetrates through the upper layers of the stratum corneum filling the gaps between the skin cells thus restoring the skin barrier so that irritantspathogens and allergens are kept out whilst keeping in water and other substances. Rehydration of the skin helps relieve the itching, irritation, discomfort and dryness associated with psoriasis and softens psoriatic patches, which makes them less likely to crack and cause the skin to become sore.

globe_bullet    Removing the scales, which helps with the application of other topical psoriasis treatments. AproDerm® should be applied 30 minutes before these treatments and in very mild cases you may only need AproDerm®  to keep your psoriasis under control.

globe_bullet   In addition to the above AproDerm® Colloidal Oat Cream, which is specially developed with active colloidal oatmeal, has been clinically proven to improve dryness, scaling, roughness, as well as protecting and restoring the epidermal barrier damaged by psoriasis with its direct anti-inflammatory and anti-oxidant activities. AproDerm® Colloidal Oat Cream also soothes and relieves the itch and irritation that you get with dry skin conditions like psoriasis (in fact oatmeal has been used for centuries for this purpose), and has humectant, buffering and cleansing effects.

The AproDerm® Range is suitable from birth and in order to achieve maximum benefit from it you should apply AproDerm® regularlyliberally and at least three times a day in gentle, downward strokes following the direction of hair growth. Once your psoriasis has improved continue applying AproDerm® in order to reduce the risk of flare-ups.

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