Learn about psoriasis
What is Psoriasis? |Triggers & Exacerbating Factors
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What is Psoriasis?
Just over two per cent of the world's population - men, women, children, and even newborn babies - endure the symptoms of psoriasis.
That's over 125 million people worldwide who have to tolerate pain from cracking and bleeding skin, as well as embarrassment from continually shedding scales of skin.
In Australia, around 450,000 people suffer from some form of psoriasis, including 120,000 in Victoria.
Psoriasis affects males and females equally. Despite this huge number, most people find psoriasis a trivial matter - a minor skin condition that requires little understanding or sympathy. Worse, some people treat psoriasis as a contagious skin condition, self-imposed on those who fail to clean themselves.
Psoriasis is a common, chronic skin condition, driven by an overactive immune system. It is not caused by dirty skin and is definitely not contagious.
The condition onset usually occurs in people in their early twenties, however there is also a smaller peak onset between 55-60 years of age.
Most commonly, psoriasis causes skin cells to grow too quickly, resulting in thick, scaly and inflamed areas of skin. However, there are many other types of psoriasis, including psoriatic arthritis.
Psoriasis and psoriatic arthritis can cause painful physical, functional and psychological disability. Emotional impacts of psoriasis can include: anxiety, embarrassment, depression and feelings of unattractiveness.
Although it is a relatively common condition, the exact cause of psoriasis has not yet been determined. However, we do know that it's related to the body's immune system and has a genetic predisposition (one third of patients with psoriasis report relatives with the disease).
There is no current cure for psoriasis. This is why far more attention is needed to increase the public's awareness and understanding of psoriasis, so that psoriasis research can attain more funding.
What triggers and exacerbates my psoriasis?
Psoriasis triggers are not universal. What may cause one person's psoriasis to become active, may not affect another. Established psoriasis triggers include:
Stress can cause psoriasis to flare-up for the first time or can aggravate existing psoriasis. Relaxation and stress reduction may help prevent stress from impacting psoriasis.
Injury to skin (scratches, bites and sunburn)
Psoriasis can appear in areas of the skin that have been injured or traumatised. Vaccinations, sunburns, and scratches can all trigger psoriasis. This initial psoriasis can be treated if it is caught early enough.
Sun and psoriasis is a tricky relationship. While a small amount of sun can sometimes relieve the symptoms of psoriasis, too much sun and sunburn almost certainly results in a flare-up.
Cold, dry weather
This type of weather is generally the worst-case scenario for psoriasis patients. In winter, there is often much less moisture in the air, which results in skin becoming drier. Indoor heating usually makes matters worse. If you suffer from psoriasis, try to minimise time spent in the elements during the coldest days and invest in a humidifier for your home.
Certain medications are associated with triggering psoriasis, including:
- Lithium: Used to treat manic depression and other psychiatric disorders. Lithium aggravates psoriasis is about half of those with psoriasis who take it.
- Antimalarials: Plaquenil, Quinacrine, chloroquine and hydrochloroquine may cause a flare-up of psoriasis, usually two to three weeks after the drug is taken.
- Inderal: This high blood pressure medication worsens psoriasis in about 25 to 30 per cent of patients with psoriasis who take it. It is not known if all high blood pressure (beta blocker) medications worsen psoriasis, but they may have that potential.
- Quinidine: This heart medication has been reported to worsen some cases or psoriasis.
- Indomethacin: This is a nonsteroidal anti-inflammatory drug used to treat arthritis. It has worsened some cases of psoriasis. Other anti-inflammatories usually can be substituted. Indomethacin's negative effects are usually minimal when it is taken properly. Its side effects are usually outweighed by its benefits in psoriatic arthritis.
Anything that can affect the immune system can affect psoriasis. In particular, streptococcus infection (strep throat) is associated with guttate psoriasis (widespread small, red drop-like patches covering large parts of the body). Strep throat often triggers the first onset of guttate psoriasis in children. You may also experience a flare-up of psoriasis following an earache, bronchitis, tonsillitis or a respiratory infection.
It is not unusual for someone to have an active psoriasis flare-up with no strep throat symptoms. Talk with your doctor about getting a strep throat test if your psoriasis flares.
The hormonal changes within the body of growing children can trigger the immune system and make psoriasis worse.
Although scientifically unproven, some people with psoriasis suspect that allergies, diet and weather trigger their psoriasis.
How can I treat my psoriasis?
Although there is no cure for psoriasis, there are many treatment options available to reduce the physical appearance and discomfort of psoriasis.
It is important to understand as many aspects of your psoriasis as is possible. "Own" your condition, so you feel in charge of the decisions you will have to make.
Psoriasis often seems to start after some sort of trigger factor. This may be due to:
- Emotional stress
- Skin injury (e.g. cuts, scratches, sunburn)
- Infections (e.g. Tonsillitis)
- Hormones (psoriasis can first occur at puberty)
- Certain medications (this is rare)
These factors should be avoided whenever possible by people with psoriasis. There are probably others that we haven't discovered yet.
Psoriasis is not due to any particular food, so special diets are not helpful. Although moderate alcohol intake doesn't appear to affect psoriasis, excessive consumption of alcohol may make your psoriasis worse. Alcohol may also interfere with certain treatments you are taking, so check with your dermatologist or GP.
Sunshine may help to clear psoriasis as it contains ultraviolet (UV) radiation. During sunny holidays many people notice a dramatic improvement in their psoriasis. However, it is important to take care, as psoriasis may develop in areas of sunburn, and fair skin exposed to UV radiation becomes prematurely aged and may develop skin cancer. Sunscreen is required on unaffected skin and time in the sun should be limited.
Soaking in warm water with a bath oil, salt crystals or tar solution can soften the psoriasis and lift the scale. Bland soaps or soap substitutes are useful but detergents and antiseptics are not necessary and may irritate your skin. Excessively hot water should be avoided and the skin is best patted dry rather than rubbed. Since medication is absorbed better through damp skin, putting it on after a shower or a bath is helpful.
Psoriasis should be kept soft with bland moisturising creams/lotions/ointments to prevent the skin cracking and becoming itchy and sore. Mositurisers help prevents water loss from the skin. Apply moisturisers immediately after a bath or shower as this may help to 'lock in' moisture.
Some small areas may improve with occlusive dressings (e.g. waterproof adhesive dressings) that retain moisture, heat or medication.
Medicated shampoos containing coal tar can be purchased from your pharmacist. Rub the shampoo into your scalp well and leave in for 5-10 minutes, rinse and then reapply.
More severe cases of scalp psoriasis may require "leave on" applications. Redness and itch may be reduced by using alcohol-based lotion or gel forms of corticosteroid or vitamin D treatments.
If your psoriasis continues to flare-up or persist despite following the above tips, you should seek the advice or a dermatologist.
The treatment option prescribed by your dermatologist will be dependent on the type and extent of your psoriasis. Some common examples of treatments available are listed below.
1. Topical Treatments
- Reduce build-up of skin scale and itch
- May allow other prescribed topical treatments to work more effectively
- Available over the counter in either cream or ointment preparations
Topical steroid treatments:
- Creams, ointments, gels, scalp lotions and shampoos containing steroid ingredients
- Available in a variety of strengths - mild, moderate, potent and very potent
- Work by slowing down the skin cell turnover rate, which may reduce thickness and scale
- Reduce inflammation and itch
- Anti-inflammatory soaps, bath oils, shampoos and creams
- Reduce inflammation
- May reduce itch and scale
Vitamin D Analogues:
- Creams, ointments and scalp gels containing a vitamin D derivative alone or in combination with a steroid
- Works by slowing down skin cell turnover rate, which may reduce thickness and scale
2. Ultraviolet Therapy
- Mimics the effects of sunlight, which is generally found to be beneficial for psoriasis
- Reduces inflammation
- Narrow band UVB - usually requires three visits per week to a dermatologist or hospital phototherapy treatment centre
- Psoralen and UVA (PUVA) combines Psoralen (a photosensitising agent) in either capsule or bath form with UVA
3. Systemic Treatments
- Capsule containing a vitamin A derivative
- Works by slowing down skin cells turnover rate, which may reduce thickness and scale
- May be used in combination with phototherapy
- Capsule containing an immune suppressant medication
- Works by reducing inflammation in the skin
- May be used for short term management of moderate to severe psoriasis
- Tablet or injection taken weekly that contains an immune suppressant medication
- Works by slowing down skin cells turnover rate and reducing inflammation in the skin
- Is one of the most commonly used oral treatments for psoriasis
- Approved for the treatment of moderate to severe plaque psoriasis that has not responded to topical treatments, light therapy or systemic treatments
- Biologics are given by injection under the skin or into a vein
- Work by blocking specific pathways within the immune system that are responsible for skin inflammation and excessive skin cell turnover
- Medicare Australia has strict criteria that must be met before a dermatologist can prescribe a PBS-funded biological treatment
Psoriasis Myths and Misconceptions
There are many myths surrounding psoriasis, the main being that it is a contagious condition. These myths and misconceptions do not help anyone who suffers from psoriasis. Instead, they can increase the burden of what is often already an emotionally distressing and physically painful condition.
Myth: Psoriasis is contagious
Psoriasis is an autoimmune disease that affects the skin - often producing patches called plaques that can crack and bleed. Many people see lesions on the skin and assume they're something that they can catch. Psoriasis is not a skin infection and is not contagious. You cannot catch it from touching another person.
Myth: Psoriasis is caused by poor hygiene
Although it appears on the skin, psoriasis is a disease of the immune system and is not caused or exacerbated by poor personal hygiene. People with psoriasis have a genetic tendency to develop the condition and no amount of cleaning of the skin can prevent psoriasis from precipitating or exacerbating. Stress, infection, skin injury, hormonal changes, excessive alcohol consumption, and exposure to certain medications can trigger a flare-up of psoriasis.
Myth: Psoriasis is only a cosmetic condition
Psoriasis is a serious, chronic, lifelong autoimmune disease. Its symptoms, which usually emerge on the skin as flaky scales, are not only embarrassing but can also cause physical pain and intense itching. In addition, 10 to 30 per cent of psoriasis patients may develop psoriatic arthritis. Like other forms of inflammatory arthritis - such as rheumatoid arthritis - psoriatic arthritis causes joint pain, swelling, and stiffness.
Myth: Psoriasis is simple to diagnose
As skin rashes are common, doctors have to rule out other causes, such as allergic reactions to food or medication, viruses, or eczema, before they can make a diagnosis of psoriasis. A psoriasis diagnosis requires careful visual inspection and sometimes even a skin biopsy. If you are concerned you may have psoriasis you should visit your GP or ask for a referral to a dermatologist.
Myth: Psoriasis cannot be treated
While there is no cure for psoriasis, there are many ways to relieve its symptoms. Psoriasis treatments may include topical creams or ointments, pills or injections, and UV or light therapy administered by a dermatologist. Visiting a dermatologist is the best way to find out which treatment options are available and the most appropriate for your skin.
Myths and misconceptions about psoriasis can have serious consequences. The myth that psoriasis is a contagious skin conditions can lead to discrimination, which can leave the sufferer feeling embarrassed, anxious, unattractive and depressed.
The myth that psoriasis is not a serious condition is just as dangerous, as it can dissuade people from seeking treatment. Failure to treat psoriasis can lead to needless suffering from the disease itself and to an increased risk for other health conditions.
Types of Psoriasis
Knowing which kind of psoriasis you have helps you and your doctor make a treatment plan. Most people only have one type of psoriasis at a time. Sometimes, after your symptoms go away, a new form of psoriasis will crop up in response to a trigger.
There are eight main types of psoriasis - here's how you can identify them:
1. Chronic Plaque Psoriasis
- The most common type of psoriasis
- Occurs in about 85% of all cases
- You may hear your doctor or dermatologist call it "psoriasis vulgaris"
- Plaque psoriasis causes raised, inflamed, red or salmon pink skin, covered with silvery, white scales
- These patches may itch and burn
- Common areas of involvement are the elbows, knees and torso but may be widespread
2. Guttate Psoriasis
- Often starts in children or young adults
- Occurs in less than 2 per cent of psoriasis cases
- Widespread small, red drop-like patches, covering large parts of the body
- Often affecting the trunk, arms and thighs
- Rash may appear very quickly
- Rash typically appears after a streptococcal infection of the throat
- May go away within a few weeks, even without treatment. Some cases, though, as more stubborn and require treatment
3. Pustular Psoriasis
- Small elevations of the skin resembling a pimple of blister that contain sterile pus
- Skin surrounding pustules is often red and tender
- May be widespread or localised to hands or feet
- May be caused by withdrawal from oral or injected corticosteroid treatments, use of high potency psoriasis treatments, infection, or pregnancy
- This kind of psoriasis is uncommon and mostly appears in adults
4. Flexural Psoriasis
- Smooth, shiny plaques of psoriasis that occur in body folds. E.g. armpits, groins, under the breasts, navel, crease of buttocks
5. Palmoplantar Psoriasis
- Psoriasis affecting the palms of the hands and soles of the feet
- May result in painful cracks (fissures) in the skin
6. Scalp Psoriasis
- Red, thickened and scaly areas of skin covering parts of the scalp
- May be small, isolated patches or widespread
7. Nail Psoriasis
- May affect up to 55 per cent of patients with psoriasis
- Commonly seen in psoriasis patients who also have psoriatic arthritis
- Nails may loosen from the nail bed, crumble, be pitted, thickened and/or discoloured
8. Erythrodermic Psoriasis
- Uncommon form of psoriasis
- Widespread redness of the skin - typically involving all skin surface areas
- Usually related to psoriasis that has become unstable
Is it contagious?
Absolutely not. Psoriasis cannot be caught from another person, nor can it be spread to other parts of the body. However, if you have psoriasis, a new patch may appear at a site of trauma.
How long will it last?
There is no way of knowing in any particular case whether your psoriasis will persist for a long time or whether it will go away on its own. Often it does clear up but it is impossible to predict how long it will take or how long the remission will last.
Is there a cure?
Although we know much about the skin changes that occur and have identified many triggers, permanent cures are not yet possible. In many cases, psoriasis is controlled or improved by treating the visible effects (and underlying inflammation) rather than the basic cause.
Does it affect life and work?
Most people with psoriasis find it a burden and a nuisance, but generally they are not stopped from enjoying life and doing their usual work if their psoriasis is mild to moderate. If a person has severe psoriasis, it can have a very negative effect on their work.
What can I do to help myself cope with psoriasis?
Talking about psoriasis can help. It helps to talk to others who have psoriasis because they can relate to specific issues that you may run into on a day-to-day basis, such as wearing swimsuits or shorts in public.
It's important to find someone, whether they have psoriasis or not, who will listen and let you express the strong feelings that accompany psoriasis. Your feelings are real. Don't dismiss or trivialise them. The power of the emotions that come from having psoriasis should be not underestimated. Find a dermatologist you can talk to about your feelings and condition. He or she may suggest how to deal with the emotional aspects of psoriasis. You could also talk to your GP or a psoriasis patient support group. All can help by providing support and information.
Once I come to terms with my psoriasis, what next?
One of the hardest things about living with psoriasis is that you go through cycles of strong emotions, usually when the psoriasis goes into remission or reappears.
The disease is unpredictable, and the emotions it triggers may occur repeatedly. It is important to respect your feelings as they occur and to learn to cope with them, so they do not hold your life hostage.
Will I have to deal with others' reactions to my skin all the time?
Not necessarily. Psoriasis is a reality that you have to live with, but it doesn't have to control you. You can avoid dealing directly with others about your psoriasis when you don't have the emotional energy to answer questions. Wearing long sleeves, for example, can making coping in public a lot easier on "low-energy" days.
People are curious when they see something different. You have many choices about how to react to their curiosity. You may choose to ignore their attention, or you can explain that psoriasis is a skin condition that is not contagious.
What about my future?
Your skin doesn't have to be the determining factor in life's important decisions, like your choice of work, whether to attend university or school, and the type of person you want to be. People who have psoriasis have normal lives.
What are some practical things I can do?
- Ask for support or no one will know that you need it. Make use of the services available to you such as your GP, dermatologist, clinic nurse, and psoriasis support group. You may also find it helpful to talk to a counsellor or psychologist.
- The more people who know about and understand your psoriasis, the better and easier it will be to manage. Be willing to discuss your psoriasis with others, to the extent that you feel comfortable.
- Real friends will want to know about your health and will want to help. They won't be put off by psoriasis.
- There is nothing to be ashamed of or embarrassed about. You didn't do anything wrong. Skin disease has no meaning other than what it is, even if other people attribute odd things to it.
- Accept that it is sometimes natural to feel anxious, angry and depressed.
If you are concerned about your psoriasis, you should seek advice from your GP or a dermatologist.
A/Prof Chris Baker interviewed on 3AW's 'Talking Health'
Skin & Cancer Foundation Inc consultant, and former President, Associate Professor Chris Baker, recently spoke on 3AW's popular program, Talking Health, about psoriasis and psoriatic arthritis.
A/Prof Baker was joined by rheumatologist, Dr Mandy Nikpour, and 'Talking Health' host, Dr Sally Cockburn, to answer psoriasis and psoriatic arthritis patient calls and questions about their conditions.
A/Prof Baker described psoriasis as a "troublesome, chronic skin condition - red scaly pacthes - sometimes just as dandruff, sometimes as a small patch just on the part of the body not causing great trouble; but we've understood now that psoriasis is an autoimmune disorder, and that it has other systems, it affects other systems of the body, like the joints."
The significance of psoriasis patient support groups was also discussed throughout the program, with A/Prof Baker stressing the important role these groups play.
"I think sharing information and having access to information is very important," A/Prof Baker said. "I think patient support groups fulfil such a great role... they're sharing information and advising people who have the condition but, very importantly, they [also] help the medical profession advocate on behalf of patients, which helps us to take the story to government, to get drugs reimbursed, to make sure research is being [conducted] into these conditions."
Listen to the full conversation from Sunday 13th September on 3AW's 'Talking Health' here: Psoriasis 'Talking Health' Podcast on 3AW