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What is psoriasis?
Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales which are referred to as plaques. Your body produces new cells in your deepest skin level. These skin cells gradually move up through the layers of your skin until they reach the outermost level, then they die and flake off. The whole process normally takes around 21-28 days. With psoriasis, this process is sped up and only takes 2-6 days. As a result, cells that are not fully mature build up rapidly on the surface of the skin causing plaques. It can occur on any part of the body, but is most common on the elbows, knees, lower back and scalp.
Psoriasis is a common skin condition affecting 2-3% of the population of the United Kingdom and Ireland.

The exact cause of psoriasis is unknown, however, family history plays a part as there is a genetic tendency to suffer from psoriasis. One in three people with psoriasis have a close relative with the condition too. Many people with psoriasis find that their symptoms start or become worse because of a certain event, known as a trigger. A trigger is required for psoriasis to develop and this could be a throat infection, injury to the skin, certain drugs and physical or emotional stress.

There are several types of psoriasis. Plaque psoriasis is the most common form, accounting for 80% of cases. Its symptoms are dry, red skin lesion, known as plaques, that are covered in silver scales. These plaques can be itchy,sore or both. Guttate psoriasis patches are small (often less than 1cm in diameter) and scaly, can be numerous, covering many areas of the body. It is seen most often in children and teenagers and can be triggered by a throat infection. Scalp psoriasis can occur on parts of your scalp or on the whole scalp. It causes red patches of skin covered in thick silvery-white scales. Some people find scalp psoriasis extremely itchy. Pustular psoriasis is a rarer type of psoriasis that causes pus-filled blisters (pustules) to appear on your skin. Different types of pustular psoriasis affect different parts of the body.

Plaque psoriasis of scalp and knees

Diagnosis and treatment
It is recommended that you consult your doctor if you suspect that you may have psoriasis to get an accurate diagnosis. Your doctor, nurse or pharmacist can then discuss with you what type and formulation of treatment will best suit you and fit with your personal preferences and lifestyle.

Depending on the type and severity of your psoriasis, there are various treatment options. They include:

1. Topical therapies - Treatments that are applied directly to the skin are known as topical therapies. They include creams, gels, foams, ointments, pastes, lotions and shampoos. If your psoriasis is mild to moderate, topical therapies may be the mainstay of your treatment. Topical treatments may include the following: Emollients; Topical steroids; Tar preparations. Dithranol; Vitamin A or D analogues or a combination product.

2. Phototherapy - This term refers to treatment with various forms of ultraviolet light, sometimes assisted by taking particular tablets. Phototherapy is helpful if your psoriasis is extensive and tends to be used when topicals fail. Combining phototherapy with other treatments often increases its effectiveness. Some doctors use UVB phototherapy in combination with coal tar, as the coal tar makes the skin more receptive to light. Combining UVB phototherapy with dithranol cream may also be effective (this is known as Ingram treatment).

3. Systemic (oral) treatments – These drugs are taken by mouth in liquid or pill form or given by injection. They are usually used for individuals with moderate to severe psoriasis. Systemic medications are also used in those who are not responsive or are unable to take topical medications or UV light therapy.

Main systemic medications include acitretin (related to vitamin A), ciclosporin (suppresses the immune system), methotrexate (slows down the rate at which the skin cells are dividing in psoriasis). Biologicial injections are available to treat severe psoriasis that has not responded to any of the aforementioned treatments (adalimumab, etanercept, ustekinumab and infliximab).

When to consult your pharmacist
Many topical treatments are available without a prescription but you need to discuss your options with your pharmacist/doctor to ensure that together you choose what is best for you. If you have been prescribed any other treatment, always let your pharmacist/doctor know, especially when buying other medicines or health food supplements as they may interact with each other.

When to consult your doctor
Consult your doctor if you are worried about psoriasis, or if you have tried and not managed to treat the condition successfully yourself. Psoriasis is a long-term condition that can keep coming back. Using your treatments regularly, as instructed, is the best way to control symptoms. If you are using your skin products correctly, but are not happy with the results, talk to your doctor. Make sure you tell your doctor about all the treatments you have bought or tried for your psoriasis and any other treatments you may be taking or using.

People with psoriasis should ideally see their doctor at least once a year. This is because psoriasis may increase your risk of other health problems such as heart disease, psoriatic arthritis and depression. As well as screening your general health, a regular review can ensure your psoriasis treatment is up-to-date. If you have not seen your doctor in the last year, make an appointment to discuss your treatment and general health.

2010/10673 April 2011

LEO Pharma has had editorial input, reviewed and wholly sponsored the production of this article.