The NHS estimates that psoriasis affects roughly one in 50 people in the UK, yet it’s still a condition which many people don’t know much about.
This is why campaigns like World Psoriasis Day (taking place next week on the 29th) and Psoriasis Awareness Week (running from the 1st to the 8th of November) are so important.
As well as providing those who live with the condition with a reminder that they aren’t alone and that support networks are available, they also help people who aren’t directly affected by psoriasis to achieve a better understanding of it and the impact that it can have.
Here at Treated.com we like to do our bit. Those who have recently been diagnosed with psoriasis, as well as those who have a close friend or relative who has had a diagnosis, may be keen to find out more about the condition.
With this in mind, we got in touch with two specialists this week to discuss psoriasis in more detail: Professor Chris Griffiths, University of Manchester & British Skin Foundation Spokesperson; and Carla Renton, Information and Communications Manager at The Psoriasis Association.
Age of onset
What sets psoriasis apart from many other skin conditions is that it is chronic in nature.
For instance, while it is possible for childhood cases of atopic eczema can continue into adulthood, around two thirds of those with the condition will show significant signs of improvement by the age of 16.
Psoriasis, however, generally has a later age of onset, and a recurrence rate which is difficult to forecast, as Professor Griffiths explains:
‘Psoriasis tends to come and go unpredictably and can appear at any age. Most cases (75%) occur before the age of 35, with an average age of onset of around 20. There is a second peak of onset around the ages of 55 to 60.’
The condition is, however, being recognised more in teenagers, as Carla Renton illustrates:
‘Traditionally, psoriasis was thought of as an adult or older-person’s condition, but we know now that around a third of people with psoriasis first developed it before they were 16. It can and does occur in children.’
For those who have never encountered skin symptoms before or are only doing so for the first time, it can be hard to know what constitutes a minor irritation, and what could possibly signify psoriasis and thereby warrant a trip to the doctor.
However, psoriasis does present symptoms which are distinguishable from other conditions like eczema, as Professor Griffiths notes:
‘Psoriasis appears as pink or red coloured areas on the skin with silvery-white scales. These are known as plaques. Plaques of psoriasis usually appear on the knees, elbows, trunk and scalp but are not exclusive to these areas. Some people with psoriasis are also affected in the nails or joints as well as the skin.’
Another difference between psoriasis and eczema is that the latter can often be linked to asthma and other allergies. However, Professor Griffiths points out that: ‘Psoriasis isn't due to an allergy and isn't associated with asthma or rhinitis.’
As unpredictable as psoriasis is, there are certain things which experts and people living with the condition have identified as being initiators of a flare up of symptoms.
‘Flare ups can happen from a combination of genetic susceptibility and environmental triggers,’ explains Professor Griffiths, ‘such as streptococcal tonsillitis or pharyngitis, stress, alcohol and some medicines.’
While there is no uniform consistency to what particular elements (or combination of elements) triggers a flare-up, certain trends have been identified.
‘Psoriasis is a condition which is unique to each individual,’ Carla tells us, ‘something that triggers or worsens one person’s psoriasis may not have the same effect on another’s.’
‘However, there are a few triggers that seem to be quite common. For example, there is an established link between the brain and the skin, and a large percentage of people do think that their psoriasis is worsened by periods of stress.’
As Carla goes on to explain, however, stress isn’t something everyone can easily eliminate contact with:
‘Unfortunately, the suggestion that people avoid stress is often not feasible for many with busy working and personal lives, and many people are subject to circumstances they cannot control. However, it is vital that people do ask their GP or dermatologist for advice and support if they feel they are struggling to cope.’
Beyond the prevention of stress and limiting alcohol intake, are there any other measures someone can take to lower their risk of a flare?
‘Koebner Phenomenon, which is when psoriasis occurs in areas where skin is injured, is also quite common.’ Carla tells us. ‘This may be easier to avoid by ensuring that clothes and jewellery don’t rub, and being ready to quickly treat any psoriasis which might appear around an injury.'
Frequency of flares
Perhaps one of the first things someone who has recently been diagnosed with psoriasis will want to know is how often they can expect to see symptoms; or, for instance, how many flare-ups they may get on average a year.
‘Unfortunately, in our experience there is no real ‘average’ and this depends entirely on the individual concerned.’ Carla explains. ‘In the case of Guttate psoriasis, most cases are self-limiting and will disappear of their own accord in a number of weeks or months. Some people will then go on to develop another kind of psoriasis, but some never will.’
‘In most people, psoriasis does wax and wane and there will be some times when it flares and some times when it’s better. Part of the frustration of psoriasis is the very fact that it is so unpredictable.’
Is it possible for some to present symptoms on a continual basis. But there are options available which can help in such cases, as Carla illustrates:
‘Yes, unfortunately some people do have symptoms perpetually, but we thankfully have a large armoury of treatments that can help to manage the condition. It is often a process of trial and error, but many people do eventually find a treatment (or combination of treatments) which benefits them. It can, however, take some time.’
As with other conditions, there are different levels of treatment depending on the severity of symptoms:
‘In the UK, there is a ‘treatment hierarchy’ which people with psoriasis usually have to work through.’ Carla tells us. ‘Most people with psoriasis will start with various topical treatments, and for many people these are enough to clear flares and help them keep their psoriasis under control.’
‘For people whose psoriasis is more moderate or severe, or if their psoriasis doesn’t respond well or stops responding to topical treatment, there are various other levels of treatment which can be prescribed by a dermatologist.'
This might include phototherapy, where UV rays are used to try and slow the generation of skin cells; or systemic treatments, which are mainly given as tablets or injections.
But there are other products, some available over-the-counter, which Carla suggests may be helpful, particularly when applied alongside prescribed treatments:
‘One of the keys to treating psoriasis is moisturising; it can help to relieve dryness, itching and cracking, and can help to soften and lift scale. This softening and removing of scale will often help ‘active’ topical treatments (such as steroid or vitamin D-based creams, gels etc) to be better absorbed.’
‘It is therefore very important to moisturise a number of times a day, particularly around half an hour before applying the ‘active’ topical treatment. Many moisturisers and emollients are listed in the British National Formulary and are therefore able to be prescribed. Make sure you ask your GP or dermatologist if they don’t mention it.’
Even though psoriasis cannot be ‘cured’, Carla assures those who have been recently diagnosed that it is a condition which millions of people live with and successfully manage:
‘Unfortunately, often when people hear there is no cure, they believe this means that nothing can be done. Thankfully this is not the case.'
'Finding a treatment or combination of treatments which works for you can be a difficult process of trial and error, but we advise people to familiarise themselves with what is available, and to persist in meeting and discussing their condition with their doctor.’
Living with psoriasis obviously comes with its challenges, but those affected by it can perhaps take some comfort in the fact that innovations in treatments are being made.
‘In the last decade the use of biologic medications for severe psoriasis (they are not suitable for mild to moderate psoriasis) has become commonplace.’ Carla explains.
‘These were revolutionary as not only are they effective for many people, they target specific parts of the inflammatory pathway, meaning they tend to have fewer possible adverse effects than medications which work by simply suppressing the entire immune system.'
These new medications, Carla points out, are also providing an insight on the condition itself, as well as widening the treatment field:
‘More and more of these drugs are being developed and licenced, which not only give us more treatment options, they also help us to understand the nature and behaviour of psoriasis and what is going on within the body to cause this condition. In addition to these developments, the recently-funded PSORT research also promises to be fascinating.’