Psoriasis
WHAT IS PSORIASIS?
Psoriasis (pronounced suh. rai. uh. sis) is a long-term skin condition that causes red, scaly patches on the skin. The cause of psoriasis isn’t fully understood, though it’s thought to be related to an overactive immune system, meaning it occurs when the immune system mistakenly attacks healthy skin cells causing an overproduction of new skin cells.
This rapid cell turnover leads to the symptoms of psoriasis. While it mainly affects the skin, it can affect the nails and joints in some cases, with the impact varying from one person to another.
LET’S LEARN ABOUT PSORIASIS
Psoriasis causes flaky patches and scales on the skin. It affects people differently, with most having small patches, and may cause itching or soreness. Around two out of 100 people in the UK have psoriasis, which can start at any age. Adults between the ages of 20 and 30 are most likely to suffer from this disease. Both men and women are affected by psoriasis.
Psoriasis is a long-term (chronic) condition. Symptoms might be mild at times and severe at others. Boots is here to support you in managing your psoriasis effectively.
Psoriasis is a condition where the immune system mistakenly attacks the healthy skin cells, which means they regenerate and are produced at a quicker rate than they would normally be. The immune system is designed to defend the body against disease and infection, but with psoriasis, it attacks the body’s own cells. Normally, skin cells take three to four weeks to be replaced and made, but with psoriasis, this time is reduced to three to seven days. This build-up of skin cells creates the patches that are associated with psoriasis.
Although the exact cause of this problem with the immune system isn’t known, a family history (genetics) and the environment have been thought to play a part. Many people’s symptoms can get worse or begin because of triggers (certain events). Triggers can include infections, medicines, or an injury.
Psoriasis isn’t contagious, so it can’t be spread.
Psoriasis typically shows itself as raised, red, dry patches of skin with silvery scales. On brown, black, and white skin, the patches can look pink or red, and the scales can look white or silvery. On brown and black skin, the patches can also look purple or dark brown, and the scales might look grey.
These patches, known as plaques, can be:
• itchy
• uncomfortable
• sometimes painful
• sore
The most common areas affected include:
• scalp
• elbows
• knees
• lower back
Psoriasis can occur anywhere on the body and there are different types of psoriasis. These will be covered in more detail later in the page. Many people have only one type at a time, although you can have two different types together. One type may change into another or become more severe.
Most cases of psoriasis go through cycles, causing problems for a few weeks or months before easing or stopping. If you think you have psoriasis, speak to your GP for advice.
Certain things can trigger psoriasis or make it worse. Knowing and recognising your triggers can help you manage your condition effectively. These triggers depend on the person and can include:
• stress
• infection – for example, throat infections can be a trigger for a form of psoriasis called guttate psoriasis
• certain medications – for example, medicines that contain lithium, some antimalarial medicines, anti-inflammatory medicines including ibuprofen, ACE inhibitors which are used to treat high blood pressure and beta blockers which are used to treat angina and heart failure
• cold weather
• certain foods
• a skin injury like a cut or insect bite
• smoking
• hormonal changes for example, in puberty or the menopause
• autoimmune disorders like HIV
When you understand your triggers, you can try to manage and minimise your flare-ups.
There are several types of psoriasis. Many people have one type at a time, but you can have two different types together. The common types of psoriasis are:
• plaque psoriasis
• scalp psoriasis
• nail psoriasis
• guttate psoriasis
• Inverse (flexural) psoriasis
There are less common types of psoriasis. There is more information about the types of psoriasis further down in the page.
Plaque psoriasis is the most common form of psoriasis. Its symptoms are dry skin patches, known as plaques, covered in scales. Plaque psoriasis typically appears on the elbows, knees, scalp and lower back. They can range in size and may itch or be painful. It’s a long-term condition and it can happen in episodes, with flare-ups triggered by different factors.
While the exact cause of plaque psoriasis is unclear, certain triggers can make it worse including stress, infections and smoking.
Although there’s no cure for plaque psoriasis, there are different options to manage symptoms including:
• Topical creams (creams you apply to your skin) including emollients that you can apply daily like the Boots Derma Care daily moisturising cream. Please always read the product information before use.
• Light therapy (phototherapy)
• Systemic treatments
If you have been diagnosed with plaque psoriasis by a medical professional, Boots Online Doctor Psoriasis Treatment2 can help support you with topical treatment, following an online consultation.
Living with plaque psoriasis can be challenging, affecting physical and emotional well-being. Remember, you’re not alone in your journey with plaque psoriasis. With management and support that’s suitable for you, you can lead a fulfilling life while effectively managing your skin.
Guttate psoriasis is a distinctive form of psoriasis that often appears as small (less than one cm) teardrop-shaped spots and is red.
It sometimes happens after an infection such as a streptococcal throat infection (strep throat). It’s more common in children and young adults and often appears suddenly as numerous small spots on the skin.
Guttate psoriasis can clear up after several weeks or months. Some people may have flare-ups from time to time, or find that it changes into another type of psoriasis.
The spots in guttate psoriasis usually appear on the arms, legs, face and scalp. It can also be triggered by various infections, stress, skin injuries or certain medicines. Identifying triggers and avoiding them can help to manage flare-ups.
Managing guttate psoriasis can involve a range of treatment options. These can include:
• Topical creams
• Phototherapy
• Oral medications (taken by mouth)
Looking after your skin can help to manage guttate psoriasis. Regular moisturising can help soothe and alleviate dryness and itching. Avoiding irritants and protecting the skin from injuries can prevent it from getting worse.
Proactive management can lead to improved skin health and quality of life.
Inverse psoriasis, also known as flexural psoriasis, is a form of psoriasis that affects skin folds and areas where skin rubs against skin like:
• armpits
• groin
• under the breasts
• around the genitals
• buttocks
These affected areas may be bright red, and smooth, they might not have the thick scales commonly seen with other psoriasis types. On darker skin, it can appear purple, brown or darker than the surrounding skin. It tends to develop in warm and moist areas, which can cause discomfort and itching. The affected skin might also become sensitive and prone to infection.
Triggers for inverse psoriasis can include friction and infections. Avoiding potential triggers and maintaining good hygiene can help in managing any flare-ups.
Managing inverse psoriasis can include:
• avoiding tight clothing that can make any friction worse
• topical creams
Psoriatic arthritis is a type of arthritis that can affect some people with psoriasis, impacting the joints and skin. It can affect any joint in the body but often affects:
• hands
• feet
• knees
• neck
• ankles
• elbows
Psoriatic arthritis can manifest in various ways, causing joint pain in the affected joints, stiffness and swelling. It can also manifest as pitted nails, fatigue and tenderness of the affected joints.
There’s no single test for psoriatic arthritis. It’s normally diagnosed using a combination of methods, including physical examinations, blood tests, X-rays and MRI.
If the GP thinks you have psoriatic arthritis, they may refer you to a rheumatologist (a specialist who deals with joint conditions).
Nail psoriasis affects the nails, causing changes in their appearance and structure. It’s often linked to psoriasis affecting the skin and joints, and it can lead to discomfort if it’s left untreated. Nail psoriasis affects around half the people with psoriasis.
Recognising nail psoriasis needs careful observation. If your nails are affected, you might see pitting, ridges, discolouration and separation from the nail bed. In some cases, nails may become brittle.
There are management techniques which can help with nail psoriasis including adopting nail care practices. These include:
• keeping nails trimmed with nail clippers like the Boots nail clippers
• avoiding trauma to your nails
• moisturising your nails
• using gloves when dealing with harsh chemicals or household chores
Scalp psoriasis is a type of plaque psoriasis that specifically affects the scalp. It can affect the whole scalp or just part of the scalp. It leads to red patches which are covered with silvery-white scales on the scalp. It can cause:
• itchiness
• flaking
• discomfort
It may not only affect the scalp; in some situations, it can affect the areas behind the ears, the forehead and the back of the neck. Some people find scalp psoriasis extremely itchy, while other people have no discomfort. In extreme cases, it can cause hair loss, but this is temporary.
The exact cause of scalp psoriasis isn’t fully understood, but triggers can make it worse.
Effective management is essential. Treatments include:
• medicated shampoos
• topical treatments
• phototherapy
Psoriasis can show itself in different forms including as less common types. These include:
Pustular psoriasis- this is characterised by the appearance of pus-filled blisters (pustules) on red, tender and inflamed skin. These pustules can form in just one area or can spread across the body.
Generalised pustular psoriasis (Von Zumbusch psoriasis)- this is a rare and severe type that presents with pustules that cover the body. It usually needs emergency treatment. The pus is made up of white blood cells and isn’t a form of infection. The pustules sometimes reappear every few days or weeks and at the start, it can cause fever, chills, weight loss and fatigue.
Palmoplantar pustulosis- this affects the palms of your hands and the soles of your feet. It also leads to pustules which develop into red, scaly spots that then peel off.
Erythrodermic psoriasis- this is a severe and rare type of psoriasis that can cover extensive areas of the body with red, inflamed skin. This skin might shed rapidly in sheets, which can lead to infection, dehydration, heart failure, hypothermia and malnutrition. If you have symptoms of erythrodermic psoriasis, call NHS 111 or speak to your GP urgently, as emergency treatment might be needed.
Treating psoriasis usually helps to manage the condition. Treatments are determined by the type of psoriasis you have and how severe it is. Most people can be treated by their GP, but if the symptoms are very severe, or not responding to treatment, you may be referred to a skin specialist (a dermatologist). You may also choose to access a Circle Health Group private dermatologist for face-to-face assessment and, if appropriate, treatment1.
When managing psoriasis, you can speak to your GP to help you determine which treatment is the most suitable for you. They may suggest a topical treatment. For mild to moderate psoriasis, topical treatments can help offer relief to soothe your skin and help with symptoms you may be experiencing. Treatments include:
• Emollients such as the E45 psoriasis cream can help reduce scaling and itching. Regular application helps to soothe irritation. Emollients can be bought from pharmacies or can be prescribed. A Boots pharmacist can help advise you on a topical treatment
• Topical corticosteroids are available in various strengths and they work to reduce inflammation and itching. They are particularly effective for mild to moderate psoriasis patches
• A man-made form of vitamin D (called a vitamin D analogue) can help slow down skin cell growth and reduce inflammation
• Coal tar is a thick heavy oil. It’s probably the oldest treatment for psoriasis. It can help ease itching, reduce inflammation and reduce scales
• Calcineurin inhibitors are available as creams or ointments and are sometimes used to treat psoriasis in sensitive areas like the face and skin folds. They help to reduce inflammation
• Dithranol has been shown to be effective in suppressing the production of skin cells, however, it can burn if it’s too concentrated. It’s usually applied to your skin by someone wearing gloves, left for 10 to 60 minutes and then washed off. Dithranol is typically used as a short-term treatment, under hospital supervision, but your GP might be able to prescribe a preparation to use at home
It’s important to remember that all situations are individual so what works for someone else might not work for you. For optimal results, it’s important to follow the instructions on the product information leaflet or packaging and follow any advice from your healthcare professional.
Topical treatments can be complemented with lifestyle choices (we’ll be covering these later in the article), so avoiding triggers and adopting stress-reducing practices can also help.
Phototherapy, also known as light therapy, involves exposing your skin to controlled amounts of natural or artificial light (ultraviolet or UV light). This therapeutic light penetrates your skin, slowing down cell turnover and reducing inflammation. There are different types of UV light therapy which include:
• Ultraviolet B (UVB) phototherapy targets affected areas with specific wavelengths. It slows down the production of skin cells and is an effective treatment for some psoriasis that hasn’t responded to topical treatments. Each session only takes a few minutes, but you may need to go to the hospital two or three times a week for six to eight weeks
• Psoralen plus ultraviolet A (PUVA) combines a medication called psoralen with UVA light exposure. Psoralen makes your skin more receptive to UVA’s healing effects. It’s often suitable for more extensive or resistant psoriasis patches. UVA penetrates your skin more deeply than UVB light. It can have side effects like nausea, headaches, burning and itchiness
Combining phototherapy with topical treatments can be used if:
• Your psoriasis isn’t responding to phototherapy alone
• You can’t or don’t want to take systemic medicines for your psoriasis
During phototherapy sessions, your skin will be exposed to the light for a specific duration, however, long-term use of PUVA isn’t encouraged, as it can increase your risk of developing skin cancer.
Phototherapy is usually done under the care of a healthcare professional (mostly dermatologists) in hospitals and some specialist centres.
If your psoriasis is severe, or other treatments haven’t worked, you might be prescribed systemic treatments by a specialist. Systemic treatments are oral and injected medications that work from the inside out throughout the entire body. They are prescribed by specialists. These medications can be very effective in helping to treat psoriasis, but they all have potentially serious side effects.
If you’re planning to have a baby, become pregnant, or are thinking of breastfeeding, you should speak to your doctor before taking any new medicine to check if it’s suitable. There are two main types of systemic treatment. They’re called:
• Non-biological (usually given as tablets or capsules)
• Biological (usually given as injections)
Non-biological medications include:
• Methotrexate, which can help control psoriasis by slowing down the production of skin cells and suppressing inflammation. It’s usually taken once a week. It can be very harmful to a developing baby, so it’s important to use contraception and delay trying for a baby until at least six months after your last dose.
• Ciclosporin suppresses your immune system and is usually taken daily. It can increase the chances of kidney disease and high blood pressure which will need monitoring.
• Acitretin is an oral retinoid that reduces skin cell production. It’s derived from vitamin A and can be very harmful to a developing baby. It’s therefore important that those assigned females at birth, use contraception and wait for at least three years after taking Acitretin to begin trying for a baby. However, if you were assigned male at birth and want to have a baby, it’s safe to do so.
Biological treatments reduce inflammation by targeting overactive cells in the immune system. They include:
• Etanercept which is injected twice a week. You’ll be shown how to inject this yourself safely at home but if there’s no improvement after 12 weeks, the treatment will be stopped.
• Adalimumbad is injected once every two weeks, and you’ll be shown how to do this yourself safely at home. If there’s no improvement after 16 weeks, the treatment will be stopped.
• Infliximab is given as a drip in the hospital. If there’s no improvement after 10 weeks, the treatment will be stopped.
There is an increasing number of biological treatments that are given as injections. Speak to your healthcare professional to understand what treatment might be appropriate for you.
These are recommended for people who have severe psoriasis that has not improved with other treatments or when other treatments are not suitable.
There are several lifestyle changes you can make to help improve your general health and well-being, which may also help improve your psoriasis. These include:
• Staying fit by exercising and engaging in activities that can help release endorphins can help improve your overall mood and well-being
• Eating a healthy and nutritious diet can help support your skin’s health
• Stopping smoking, as smoking can be a trigger for flare-ups
• Cutting down on alcohol and staying within recommended limits
• Losing weight if you’re overweight or obese
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LEARN MORE ABOUT PSORIASIS
FREQUENTLY ASKED QUESTIONS
Psoriasis is not contagious. This means you cannot get psoriasis from contact (for example touching skin patches) with someone who has it.
Sunbeds can cause skin damage and increase the risk of skin cancer. As a result, the use of tanning beds is actively discouraged by healthcare professionals. Phototherapy (administered by a healthcare professional) is the medically appropriate way of using light therapy to treat psoriasis.
Psoriatic arthritis is a type of arthritis that develops in some people with the skin condition psoriasis. It typically causes affected joints to become inflamed (swollen), stiff and painful. Between 20-40% of people with psoriasis will develop psoriatic arthritis.
Psoriasis and eczema are two separate skin conditions. The cause of psoriasis isn’t fully understood, it is thought to be related to an overactive immune system, whereas eczema is thought to be caused by a combination of genetic and environmental factors. You can learn more about the differences between eczema and psoriasis with us.
There's no cure for psoriasis, but a range of treatments can improve symptoms and the appearance of skin patches. Your doctor will ask you about how much the condition is affecting your everyday life and help to come up with the best treatment for you.
1 Subject to availability. Eligibility criteria may apply. Charges may apply.
2 Access to prescription-only treatment is subject to an online consultation with a clinician to assess suitability. Subject to availability. Charges apply.
3 Subject to availability. Eligibility criteria apply.
12 Please note free home postal delivery is only available to patients registered with a GP in England. However, the option to collect in-store is available for all customers registered with a participating GP anywhere in the UK.
