Living with psoriasis

By Modupe Olubunmi Soji-Adeyemo

Psoriasis is a long-term, non-infectious inflammatory skin condition that affects men and women equally at an average of 1 in 50 people. The condition does not scar, but it can change skin colour over time. Psoriasis can be scaly, red, flaky and very itchy and affect any part of the body including the scalp, nails and joints. If you experience joint pain with psoriasis, please inform a doctor.

Psoriasis ranges from Mild to moderate to severe. Moderate to severe psoriasis can increase the risk of anxiety and depression and is also associated with other medical conditions such as; diabetes, obesity, heart disease, high cholesterol, stroke and few others. Please see a doctor if you are concerned about any scaly skin rashes/lesions on your skin.

Psoriasis can be physically diagnosed, although a biopsy may be needed (a process whereby a small sample of your affected skin area is taken under local anaesthetics to confirm diagnosis in the lab). Psoriasis can be inherited (although ‘how’ is not fully understood) and can also be linked to stress, excessive alcohol, smoking, sunlight and medications and infection.

Although there is no cure for psoriasis, there are several effective treatments that can help control the activities of psoriasis and help sufferers to live a good quality of life. The treatments include topical treatments (emollient, corticosteroid and phototherapy), systemics and biologics therapies.

Role of topical treatments

Topical treatments are anything applied directly to your skin to treat your psoriasis. These range from lotions, creams, ointments, gels and shampoos. More severe psoriasis might require more intensive treatments such as phototherapy and systemics (through mouth) therapy. The roles of topical psoriasis treatment are to remove excess scaly skin and calm the underlying inflammation. This will improve the appearance and help the skin feel more comfortable and less itchy.

Emollients are the first line of treatments in psoriasis, helping to moisturise the affected areas and provide relief from itching and scaling. Emollients can be leave-on, vary from lotions to creams and can be used as a soap substitute. They help in absorbing other topical treatments and can be applied as many times as needed to settle dryness. It’s advisable to apply emollients at least 30 – 60 minutes before other topical treatments (i.e. topical corticosteroids) in a downward stroke manner, following the pattern of hair growth. This will prevent folliculitis (inflammation of the hair follicle) and the dilution of the effects of the treatment by spreading it to other areas of the skin that don’t require it. Emollients that are paraffin-based can be highly flammable. Please read the information on the pack carefully.

Topical corticosteroids are frequently used to manage the inflammatory process of moderate psoriasis on the body and scalp. Strong (potent) and super strong (extra potent) steroids can be used short term or intermittently and are available as creams and ointment for the body and lotions, gels, foams and prescription shampoos for the scalp. These are more suitable than ointments and creams for hairy areas as they are less sticky.

How to apply your topical treatments

Psoriasis is a long-term, non-infectious inflammatory skin condition.

There is no standard rule to effective application of topical treatments. It’s advised to wash daily with the soap substitute and pat the skin gently to dry. Do not rub the towel on your skin as this may cause the skin to become too dry. Using a spoon/spatula, scoop the emollients and apply all over your body in downward stroke. Do not dip your hands in the tub and this may lead to contamination. Leave the emollients to soak into the skin for at least 30 minutes for creams and 60 minutes for ointments and remember that paraffin-based ointments are highly flammable. Following the fingertips unit in the box of corticosteroid prescribed and apply the steroid all over the affected areas as instructed. Follow the same instructions for the scalp treatments. You can apply your prescribed emollients as many times as required but at least 30 – 60 minutes before or after the application of prescribed corticosteroids.

Phototherapy

Phototherapy is a form of treatment where fluorescent light bulbs are used to treat skin conditions. Natural sunlight has been known to be beneficial in the treatment of certain skin disorders for years and the ultraviolet part of the radiation produced by the sun (mainly UVA and UVB) is used in phototherapy as a consequence. There are three main types of phototherapy that can be used to treat psoriasis: Broadband UVB (BBUVB); Narrowband UVB (NBUVB) and PUVA (Psoralen + UVA). The type most suitable for you depends on your skin type.

Your phototherapy nurse will discuss the process with you before you commence the treatment. You will need to avoid the use of your creams, ointments and lotions on treatment days unless directed otherwise by the phototherapy staff. You may continue to use moisturisers.

Things to remember

It’s important to discuss your psoriasis and how it affects your life with your GP or dermatologist and identify treatment goals. Manage your risk factors for heart disease and stroke with your GP and adopt a healthy lifestyle by eating a balanced diet, exercising regularly and trying to lose weight if you are overweight. If you smoke, stop smoking and reduce your intake of alcohol if you drink excessively. Reduce stress where possible and take medications as recommended by your GP or dermatologist. If you have pain in your joints discuss with your GP or dermatologist.

If you require further information about psoriasis, please visit the British Association of Dermatologists (BAD) website: www.bad.org.uk.

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