Raising Awareness: Psoriasis Awareness Month at the Institute of Dermatologists

Welcome to Psoriasis Awareness Month, a time dedicated to shining a spotlight on this often misunderstood and under-recognised skin condition. Here at the Institute of Dermatologists, Ireland, we are committed to educating the public, supporting those affected, and promoting research to find better treatments and ultimately a cure for psoriasis. 

What is Psoriasis?

Psoriasis is a common, chronic inflammatory skin disease that presents as a rash with itchy, pink/red scaly patches covered in a silvery white scale, most commonly seen on the knees, elbows, and scalp.

There is no cure for Psoriasis, however it can be managed with a combination of treatments depending on its severity. They include topicals (creams, ointments), phototherapy, systemic/oral medications and biologic (injectable) therapies. It can be itchy, painful, and interfere with sleep and ultimately one’s quality of life. Common triggers in people with a genetic predisposition to psoriasis include stress, illness/infections, trauma to the skin (Koebner phenomenon), and certain medications.

Thankfully there are many treatments available to help you manage your symptoms. You can also include lifestyle changes such as alcohol reduction, smoking cessation and coping strategies such as mindfulness and exercise to help you manage your psoriasis.

Common signs and symptoms of psoriasis include:

• A patchy, scaly rash that varies widely in how it looks from person to person, ranging from scaly pink/red plaques covered in a silvery scale to tear-drop like spots all over the body
• Thick scaling of the back of the scalp/nape of the neck and behind the ears
• Small scaling spots/guttate psoriasis (commonly seen in children/teenagers often post infection)
• Dry, cracked skin that may bleed/split on the soles of the feet and palms of the hands
• Itching, burning or soreness
• A skin rash that may flare following an infection and slowly improve over weeks to months
• Lifting of the nails (onycholysis), yellowish discolouration of the nails, pitting of the nails (small indentations)
• Joint pain and swelling, stiffness of the small joints of the hands/feet

There are several types of psoriasis, each of which varies in its signs and symptoms:

Plaque Psoriasis: Plaque psoriasis is the most common presentation of psoriasis and presents as itchy, raised red/pink patches of skin (plaques) covered with silvery white scales. This may belocalized to certain body sites such as the elbows, knees, lower back and scalp orcan be much more extensive involving the entire body.The patches vary in colour, depending on one’s own skin colour. The affected skin doesn't scar as it heals, but it may leave temporary changes in colour (post inflammatory hyperpigmentation), which may appear darker in those with a darker skin type such as brown or black skin.

Nail psoriasis: Psoriasis can affect fingernails and toenails, causing pitting (indentations), abnormal nail growth and discolouration. Psoriatic nails might loosen/lift and separate from the nail bed (onycholysis). Severe disease may cause the nail to crumble and become tender to touch which may affect dexterity.

Guttate Psoriasis: Guttate psoriasis primarily affects young adults and children. It's usually triggered by an infection such as strep throat. It's marked by small, tear drop-shaped, pink and scaly spots on the trunk, arms and legs. 

Inverse psoriasis/Flexural psoriasis: Inverse psoriasis mainly affects the skin folds of the groin, perineum, axillary (underarm region) and breasts. It causes smooth shiny patches of inflamed skin that worsen with friction and sweating. This looks different to the classical plaque psoriasis as there is no scale due to it affecting a moist site. This type of psoriasis may also become secondarily infected by bacteria/fungi. 

Pustular Psoriasis: Pustular psoriasis, a rare type, causes clearly defined pus-filled vesicles (pustules). It can occur in widespread patches or another subtype (palmoplantar pustulosis)  -  small areas of the palms or soles. This can present suddenly and often a person affected by severe generalized pustular psoriasis will require hospitalization to manage their disease.

Erythrodermic psoriasis: (Least common type of psoriasis) Erythrodermic psoriasis can cover the entire body (completely red skin) with a peeling rash that can itch or burn and become intensely painful. This is a very severe form of acute psoriasis and those affected may feel hot/cold/shivery with an inability to regulate their temperature and often initially require hospitalization to bring their disease under control.

What Causes Psoriasis?

While the exact cause of Psoriasis is not fully known/understood, we do know that the immune system and genetics play key roles. The genetics of Psoriasis are complex and it is still possible to develop Psoriasis even if one has no family history of the disease. The body’s immune system becomes overactive and triggers inflammation within the skin, the joints and other organs.  There is increased skin cell turnover where skin cells build up at certain sites resulting in the formation of the plaques. The condition is not contagious.

Psoriasis Triggers

Many people who are predisposed to psoriasis may be free of symptoms for years until the disease is triggered by some environmental factor. Common psoriasis triggers include:

• Stress
• Infections, such as strep throat
• Weather, especially cold weather during winter months, (Psoriasis tends to improve during the summer months with regular sun exposure)
• Injury to the skin, such as a cut or scrape, or a severe sunburn (Koebner phenomenon)
• Heavy alcohol consumption
• Certain medications — including lithium, high blood pressure drugs and antimalarial drugs

Treatment for Psoriasis

A wide range of treatments are available for psoriasis, but identifying the most effective one can be challenging. It is crucial to talk to your doctor if you feel a treatment is not working or if you experience uncomfortable side effects. Treatments generally fall into three categories:

1. Topical Treatments: These include creams and ointments applied directly to the skin to reduce inflammation and slow the growth of skin cells. Common topical treatments are corticosteroids,  vitamin D analogues, calcineurin inhibitors and coal tar.

2. Phototherapy: This involves exposing the skin to certain types of ultraviolet light under medical supervision. Phototherapy can help to slow the growth of affected skin cells.

3. Systemic Treatments: These are oral or injected medications that work throughout the entire body, including joints and nails. Systemic treatments can be particularly effective for severe psoriasis. Examples include biologics and methotrexate.

Different types of treatment are often used in combination to achieve the best results. Your treatment plan for psoriasis may need to be reviewed regularly, and a care plan – an agreement between you and your healthcare professional – can help you manage your day-to-day health.

 

 

4 Tips for Managing Psoriasis at home:

1. Emollients: Moisturise the skin daily and shower with a soap-free emollient to help alleviate the dryness and itch associated with psoriasis. Regular use of emollients will also improve the appearance of the silvery-white scales. Emollients work by forming a protective barrier over the skin, preventing moisture loss and keeping the skin hydrated. This can be especially beneficial after bathing when the skin tends to lose moisture rapidly. Opt for fragrance-free and hypoallergenic emollients to minimise irritation.

2. Avoid Scratching/Picking: Refrain from scratching or picking at the affected areas, particularly on the scalp, as this may lead to the spread of psoriasis at these sites (a phenomenon known as Koebner's phenomenon). Scratching can also cause skin breaks, leading to infections and further complications. Instead, try to soothe the itch with a cool compress or gentle tapping. Keeping your nails short and wearing gloves at night can help reduce the risk of damaging your skin while you sleep.

3. Topical Therapies: Apply topical treatments to the affected areas. These may include a combination of steroid-based creams or ointments, tar therapies, salicylic acid, and Vitamin D analogues for the body, and liquid scalp applications for the scalp. These treatments help reduce inflammation and slow down the rapid growth of skin cells, making it easier to manage symptoms. Steroid creams can reduce redness and swelling, while tar therapies can help slow skin cell growth and improve scaling. Salicylic acid aids in removing scales and softening the skin, and Vitamin D analogues help to normalise skin cell production.

4. Gentle UV Exposure: Exposure to sunlight can improve mild to moderate psoriasis. Gentle UV exposure during the summer months can be beneficial, but it's crucial to avoid burning the skin, as this can exacerbate the condition. Aim for short, regular periods of sun exposure, and always use a sunscreen on unaffected areas to protect them from UV damage. If natural sunlight is not an option, consider phototherapy under medical supervision, which uses controlled UV light to treat psoriasis.

By incorporating these tips into your daily routine, you can effectively manage the symptoms of psoriasis and improve your quality of life.

HPOS STUDY

As part of Psoriasis Awareness Month, we want to remind you about the exciting HPOS study. This groundbreaking research is aimed at identifying psoriasis patients at risk of developing psoriatic arthritis, with the goal of preventing arthritis before it occurs.

Find out about the study here.

Who Can Participate? Any adult with psoriasis! They want to hear from you if you have psoriasis, as up to one-third of psoriasis patients may develop related arthritis. Your participation could help them make a significant impact in preventing this condition.

How to Participate? The study is entirely online—no hospital visits required! Simply complete a few questionnaires on our website. You can choose which parts of the study to participate in and how you'd like them to contact you. Your involvement can be as flexible as you need it to be.

Why is This Important? By participating, you contribute to a major European research initiative aiming to revolutionise the care and treatment of psoriasis and psoriatic arthritis. Your involvement helps them work towards a future where we can prevent arthritis in psoriasis patients before it even begins.

Remember, Your Participation Matters! If you haven't already, please consider joining the HPOS study. Your contribution is invaluable to advancing dermatological research and improving patient outcomes across Europe.

During Psoriasis Awareness Month, your participation is more crucial than ever! Let's spread awareness and work together to make a difference.

 

At the Institute of Dermatologists, all of our Consultant Dermatologists are experts in the treatment of psoriasis. Please get in touch if you would like to book a consultation to explore your treatment options.