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Psoriasis is a common skin problem affecting about 2% of the population. It occurs equally in men and women, at any age, and tends to come and go unpredictably. It is not infectious, and does not scar the skin.
The skin is a complex organ made up of several different layers. The outer layer of skin (the epidermis) contains cells which are formed at the bottom and then move up towards the surface, gradually changing as they go, finally dying before they are shed from the surface. This process normally takes between 3 and 4 weeks. In psoriasis, the rate of turnover is dramatically increased within the affected skin, so that cells are formed and shed in as little as 3 or 4 days. There is also inflammation and blood vessel proliferation on the affected skin; the reasons for these are still not fully understood.
Some people are more likely to develop psoriasis than others, particularly if there is someone else in their family who has psoriasis: in other words, it is a genetic or hereditary disease (see below). However, the trigger for psoriasis to appear is often an outside event, such as a throat infection, stress or an injury to the skin.
In practice, for most patients who develop psoriasis, or for whom it clears and then comes back, no obvious cause can be detected. Usually, sunlight improves psoriasis, though occasionally it makes it worse (especially if the skin gets burned). A high alcohol intake and smoking can worsen psoriasis too, as can medicines used for other conditions – such as lithium, some tablets used to treat malaria, and other drugs such as beta blockers (medicines commonly used to treat angina and high blood pressure). There is no apparent relationship between diet and psoriasis.
This will depend on the type of psoriasis that you have, and on its severity.
1. Topical therapies:
Treatments that are applied directly to the skin are known as topical therapies. They include creams, ointments, pastes and lotions. If your psoriasis is mild, topical therapies will be the mainstay of your treatment. Topical treatments include the following:
2. Phototherapy :
This term refers to treatment with various forms of ultraviolet light, sometimes assisted by taking particular tablets. It is helpful if the psoriasis is extensive, or fails to clear with topical treatment, or comes back quickly after seeming to clear. Topical therapy will usually continue during the phototherapy.
Two types of ultraviolet (UV) light may be given, using special machines: UVA and UVB. These are different parts of normal sunlight. Treatment with UVA is helped by taking a medication known as a psoralen – a combination known as PUVA therapy. Treatment with UVB does not need tablets.
Both UVB and PUVA treatments have to be given with great care, and you will have to come up to the skin department 2 or 3 times a week for a number of weeks. Full details are given in other leaflets issued by the British Association of Dermatologists ( Treatments for moderate and severe psoriasis and Phototherapy ).
3. Internal treatments :
In cases, where the disease is very extensive or severe, patients may need oral treatment; however all of the different tablets have potential risks. In addition, you will usually have to continue with some topical therapy even though you are taking the tablets.
Your dermatologist will discuss the risks with you if you start on this kind of treatment. All of the tablets will require blood tests, and many interfere with other medicines. Female patients should not become pregnant whilst on any tablets for psoriasis, and with some of them it is important that male patients should not father a child.
The oral treatments include acitretin (related to vitamin A), ciclosporin (suppresses the immune system),methotrexate(slows down the rate at which the skin cells are dividing in psoriasis), and hydroxycarbamide (formerly known as hydroxyurea – also slows down the rate at which the skin cells are dividing).
There are also several injectable forms of treatment available for severe forms of psoriasis. The biologic medications, that target more specific components of the defence system, include adalimumab, ustekinumab, etanercept and infliximab.
Acne is a very common skin condition characterised by comedones (blackheads and whiteheads).