Psoriasis | Causes, treatments and cures, according to experts

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When you think of psoriasis you probably envision inflamed and rough skin that pops up every now and then. While that's true, the symptoms of psoriasis are far more complex than just dry skin.

Whether you're dealing with it for the first time, or you are days into yet another flare-up, you'll know just how irritating psoriasis can be. The non-contagious, inflammatory and often chronic condition is characterised by swollen plaques that sit on the skin, which can also become very itchy.

As troublesome as psoriasis sounds, it's a common condition that affects around two in every 100 people in the UK. We won't sugarcoat things; dealing with psoriasis can be very challenging and some may experience plaques on their scalp and joints, too.

Unfortunately, like acne or rosacea, there's no definitive cure to psoriasis – nor do experts fully understand what causes the condition – but there are ways to manage the dryness and itchiness. Here, the experts share all.

Meet the Experts:
Dr Anjali Mahto, medical and cosmetic consultant dermatologist at Self London
Dr Alia Ahmed, consultant dermatologist
Dr Mary Sommerlad, consultant dermatologist
Dr Ellie Rashid, consultant dermatologist and KLIRA medical director

What is psoriasis?

'Psoriasis is a chronic autoimmune skin condition that is characterised by the overgrowth of skin cells,' explains Dr Mahto. 'It occurs when the immune system attacks healthy skin cells, causing inflammation and triggering the rapid overproduction of skin cells,' she adds. Psoriasis can affect any part of the body, but Dr Sommerlad says it has a predilection for the scalp hairline, elbows, knees and the umbilicus (the navel).

'It can start at any age, including childhood, with onset peaks at 15-25 years and 50-60 years,' explains Dr Rashid. 'It tends to persist lifelong, fluctuating in severity, and while it can affect anyone of any ethnicity, it's particularly common in people of European ancestry.'

What does psoriasis look like and what are the symptoms?

Psoriasis is a relatively easy skin condition to spot on fair skin, but it can be more difficult to identify on darker skin tones if you don't know the symptoms. It looks like a scaled, raised, well-defined area that's darker or redder than the original skin colour. These patches can vary in shape and size, with some erupting as large plaques or others emerging as small spots in an isolated area of the body.

'In skin of colour, the plaques are typically thicker with a more pronounced silver scale, and can appear dark or violet in colour,' says Dr Rashid. Confirming this, Dr Sommerlad says: 'The psoriasis appears darker than the salmon pink colour you often see in textbooks, and this is because melanin masks the redness. Both Dr Sommerlad and Dr Rashid acknowledge that, due to the lack of redness, psoriasis can be misdiagnosed on darker skin tones, often being labelled as a fungal infection or eczema.

As for non-visible symptoms, they tend to vary from person to person. But Dr Mahto cites itching, burning and general discomfort as the most common, often showing up on the elbows, knees, scalp and lower back.

What causes psoriasis?

'The causes of psoriasis are multifaceted,' says Dr Ahmed, pinpointing autoimmune, genetic and environmental components as the main contributors.

While the exact triggers will vary case by case, Dr Mahto suggests that genetics play a significant role as psoriasis tends to run in families. Dr Ahmed adds that environmental factors, such as stressful life events, physical trauma (from things like scratching), alcohol, and certain drugs, such as beta-blockers and steroids, can trigger psoriasis.

And as challenging as it may be not to, itching and picking your scaly skin can significantly worsen your psoriasis symptoms. So, no matter how irritable your spots feel, try to keep your wandering hands from rubbing.

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What are the types of psoriasis?

Psoriasis is the umbrella term we often use, but there are a few different types of the condition. While all are characterised by the same pink plaques on fair skin tones and purple/silver patches on deep tones, the types differ in size, pattern and location.

Plaque psoriasis: 'This is the most common type, characterised by raised patches covered with silvery scales that typically appear on the elbows, knees, scalp and lower back. Plaques are characterised as red or pink on light skin or can appear as dark brown, purple or grey patches on dark skin.

Guttate psoriasis: 'This is often triggered by bacterial infections and presents itself as small, red/brown, dot-like lesions all over the truck, limbs and scalp,' says Dr Mahto. Dr Ahmed adds that it's commonly seen in small children and young adults, often following a throat infection.

Inverse psoriasis: 'Also called flexural psoriasis, this type is found in skin folds like the armpits, groin, and under the breasts. It appears as smooth, red patches that worsen with friction and sweating,' says Dr Mahto.

Pustular psoriasis: 'Characterised by pus-filled blisters surrounded by red, inflamed skin. It can be localised to certain areas or spread across the body,' says Dr Mahto.

Scalp psoriasis: 'This is described as thick, itchy and scaly plaques on the scalp. The patches can sometimes cover the whole scalp, or they can manifest as smaller plaques that are scattered around the scalp,' says Dr Ahmed.

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Is psoriasis contagious?

One of the biggest misconceptions about psoriasis is that it's contagious. 'Psoriasis cannot be spread through physical contact, nor can it be transmitted through airborne particles or bodily fluids,' confirms Dr Mahto.

Because of this misconception, it's no wonder those with psoriasis often feel self-conscious about their skin – and research shows that psoriasis can take a toll on mental health, too. A GP can help to confirm a diagnosis, but they'll also understand the psychological aspect and can suggest support groups or other methods to ease anxiety.

How do you treat psoriasis?

Dr Google won't help you here; if you want to properly treat psoriasis, Dr Mahto advises seeing a dermatologist first to assess your symptoms, get a proper diagnosis and find an appropriate treatment plan.

'Although there is no cure for psoriasis, it can be managed with lifestyle and medical interventions,' says Dr Sommerlad. 'Treatments will depend on the severity, type and individual, but options often include topical treatments (like steroids and vitamin D supplements), oral medications as well as phototherapy like UVB,' says Dr Mahto.

Light therapy can be administered for at-home use or via a professional, so don't be tempted to turn to tanning beds to help heal psoriasis. Prolonged use of sunbeds can increase the risk of skin cancer and premature ageing, while clinical phototherapy is a safer and more controlled approach that's administered by a professional.

'Biologic therapies can be used for severe cases, on skin that doesn't respond to conventional treatments. These are usually given as an injection which targets immune pathways to calm the inflammatory response,' explains Dr Rashid.

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Lifestyle is another important factor to consider, as things like stress and diet can trigger flare-ups. 'I recommend following a Mediterranean diet and taking probiotics to keep the gut healthy,' says Dr Ahmed. Stick to foods that are rich in anti-inflammatories, like leafy greens, fish and fruit. Consider taking probiotics or vitamin D supplements for gut health and avoid inflammatory foods and activities like drinking and smoking, which exacerbate the condition.

One more thing Dr Ahmed advises tackling: itching. 'Psoriasis can be very itchy, and this is often overlooked. However, there are treatments available, like antihistamines or habit-reversal therapy to break the itch-scratch cycle, which can really help,' she says.

What about over-the-counter treatments?

It's advised to book in with your GP to discuss a treatment plan first, and then find skincare products that can help manage symptoms in your day-to-day life, particularly milder symptoms.

'Avoid harsh skincare. This can lead to scratching and psoriasis likes to develop in areas where the skin has been traumatised,' explains Dr Sommerlad. This is known as the Koebner Phenomenon and links back to Dr Ahmed's point: reduce itching to reduce your symptoms.

'I recommend moisturisers with ceramides or urea to hydrate and soothe dry skin. Additionally, look for products that contain colloidal oatmeal or aloe vera as these will provide additional relief,' says Dr Mahto. They may not have the same shelf appeal as other formulas around, but these caring creams and treatments are packed with nourishing ingredients and are blended into skin-softening textures to keep your skin happy.

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