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| >> Leaflets You can also download this leaflet by clicking here What is Psoriasis?Psoriasis is a common skin disorder affecting about 2% of the population. It occurs equally in men and women, at any age. The condition is not infectious, and is often not itchy. Psoriasis does not scar the skin. What does psoriasis look like?Patches of psoriasis are red and are covered by silvery white scales. These patches usually occur on the knees, elbows, trunk or scalp, though any areas of the skin can be involved. Your skin and psoriasisThe skin is a complex organ made up of several layers of different types of cells. Those in the outer layer - the epidermis - gradually change, as they move towards the surface where they are continually shed. This process normally takes between 3 and 4 weeks. In psoriasis, this rate of turnover is dramatically increased within the affected skin, so that the process may take as little as 3 to 4 days. What causes psoriasis?Although the exact cause of psoriasis is not known, some people are clearly more likely to develop it than others. Many patients know of someone else in the family who has psoriasis; in other words, it is a genetic or hereditary disease. However, several factors may start an episode of psoriasis, such as a throat infection, (especially in children), stress or injury to the skin. Nevertheless, in most patients who develop psoriasis, or who have a recurrence of it, no obvious cause can be detected. Usually, sunlight improves the condition, though occasionally, it may make it worse. A high alcohol intake may worsen psoriasis. There is no apparent relationship between diet and psoriasis. How can psoriasis be treated?Treatment is usually effective. The skin becomes less scaly and may then look completely normal. However, even if your psoriasis disappears after treatment, there is a tendency for it to return. But this may not happen for many years, (or within a few weeks). Patches of psoriasis on limbs and trunkThe treatment of psoriasis on the limbs and trunk will usually be creams and ointments your doctor prescribes. Treatments applied directly to the skin are known as topical therapy. Topical Therapy may include the following:Emollients and salicylic acid Simple emollients such as aqueous cream, or 50% white soft paraffin in liquid paraffin can reduce scaling - these can be used as frequently as needed. Preparations containing salicylic acid can be used on heavily scaled plaques - irritation may occur. Topical Steroids These preparations are sometimes helpful, but only in certain situations. The weaker steroids often don't work very well for thick patches of psoriasis, but may work better on the face or in the skin folds. The stronger steroids have side effects, one of which may be to make your skin thinner. This is why their use needs to be closely monitored by your doctor. There is also a tendency for psoriasis to return quickly when treatment stops. Tar preparations You may be prescribed a cosmetically acceptable, medicated tar bath which will help to remove the loose scales from the patches. Other tar preparations are cream or ointment formulations. These help most patients but many patients find them messy and they can stain clothing. Dithranol Dithranol is good for uncomplicated psoriasis and can be prescribed for use at home if you have minor or moderate psoriasis, particularly if the water washable creams are prescribed. It is almost always used as short contact therapy. Short contact therapy Apply dithranol cream sparingly only to those areas of skin affected by psoriasis, and rub in gently until it is absorbed, afterwards washing your hands. Dithranol stains clothes and you should therefore wear old clothes for the next 30-60 minutes, though you can still carry on with you everyday activities. After 30-60 minutes, remove the cream by bathing or showering (using soap or shower gel). The bath or shower should be cleaned immediately with a proprietary cleanser to avoid permanent staining. Treatment is usually carried out once daily. As the psoriasis is clearing, you will notice the treated areas will gradually stain brown. Occasionally, dithranol irritates the skin causing inflammation and soreness in and around the treated areas. Psoriasis in the bends of the elbows or knees should not be treated with dithranol without a doctor's advice, as irritation is likely. Similarly, the face should not be treated with dithranol without a doctor's advice, as contact with the eyes must be avoided and skin staining may prove unsightly. The strength of the dithranol is gradually increased every 3-5 days. If treated areas become inflamed, treatment should stop until this settles, but may then be resumed at a lower concentration. Once you can no longer feel the patches of psoriasis, treatment can stop. Many patients can clear their psoriasis in 6 weeks. The staining goes away over the next couple of weeks. Any new patches can be treated with the dithranol in the same way. Please note that all concentrations of any dithranol brand can be dispensed for the cost of a single prescription charge. In patient therapy Some patients do not respond to short contact therapy or their psoriasis may be too extensive to do this treatment at home. In such circumstances, you may be treated in a dermatology out-patient unit or sometimes by admission to a dermatology ward for 3-4 weeks. As an out-patient, you will come each day for 1 to 2 hours, during which you may be given a tar bath, ultraviolet light and applications of dithranol in a stiffer paste than is used for short contact treatment. The dithranol will be left on for 24 hours under a tube-gauze dressing suit, which should reduce dithranol staining of clothing and linen. Vitamin D analogues Calcipotriol and Tacalcitol preparations Irritation may occur, especially on the face, bottom and genitals. Treatment should only be applied to those areas on the specific instructions of the doctor. Vitamin A analogues Tazarotene is a new vitamin A gel that is applied once daily to patches of psoriasis. Irritation may occur if applied to the face or skin folds. Special Sites Skin folds and face Scalp Nails There are other methods of treatment for patients whose psoriasis is considered:a) moderate or severe b) not helped by the simpler topical treatments c) frequently recurring Unlike the topical treatments described earlier, these involve taking medication internally or attending a local dermatology centre for ultraviolet light treatment. The decision to move to this form of treatment will be made by a senior dermatologist experienced in the management of psoriasis. All the details will be discussed with you personally and the treatment will be given under strict hospital supervision. It is important to note these treatments cannot be used during pregnancy. Please see the separate leaflet entitled Moderate and Severe Psoriasis. Further information on Psoriasis is available from:The Psoriasis Association Psoriatic Arthropathy Alliance 'Switch on to Skin Problems' an interactive CD-ROM written by Dr Warin and produced by LEO Pharmaceuticals may be available at your local dermatology centre. Publication Sponsored by LEO Pharmaceuticals.
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