Psoriasis is a condition which affects 2% of the population. It can affect the skin, nails and scalp and responds well to treatment with creams, medication or light.
- Psoriasis is an autoimmune condition
- Symptoms are red, dry, itchy and flaky patches of skin
- Psoriasis is not contagious
- Psoriasis may be hereditary
- It can affect the scalp, skin or nails, and may occasionally involve the joints
- The majority of cases respond well to creams and phototherapy
Psoriasis is a chronic immune condition commonly appearing in adults. It occurs when the immune system develops an abnormal signal to speed up skin cell growth. This causes the affected area of skin to thicken, redden and shed what are known as skin scales.
Psoriasis on the skin may take various forms. Most commonly, psoriasis spots are dry, raised, red and scaly areas. There may be a few spots or multiple broader areas, and they can appear anywhere on the body. Most commonly, psoriasis is seen on the elbows, knees and scalp.
The guttate form of psoriasis usually occurs after a sore throat, and appear as numerous small teardrop-shaped spots.
Psoriasis may also affect the nails, hands and feet.
(Modified from the Australasian College of Dermatologist Website)
A range of treatments are available for people with psoriasis. Unfortunately, no single therapy helps everyone.Treatment recommendations vary according to the severity and location of psoriasis, its impact on quality of life and other existing medical conditions.
It may be necessary to rotate different treatments at different times or to combine treatments for faster clearance, particularly in those with more severe or widespread psoriasis.
If your psoriasis is getting you down or interfering with your life, tell your general practitioner or dermatologist about your feelings and start to look into the most effective psoriasis treatments.
Numerous topical therapies are available without prescription. Over-the-counter products contain ingredients such as tar and oils. Special medicated shampoos and moisturisers are also available. Those suffering from mild psoriasis may find sufficient relief.
Cortisone, tar, anthralin (Dithranol) and vitamin D (calcipotriol) based creams and ointments remain the mainstay of treatment for the majority of psoriasis sufferers.
Cortisone (steroid) creams
The most common product prescribed for psoriasis to reduce inflammation and irritation is cortison. The main issues include the skin becoming accustomed to this steroid over a period of time and, with prolonged use of strong cortisone creams, skin thinning can occur. The choice of steroid varies depends on the severity of the lesions and their location. You should always check with your doctor and pharmacist about how often and for how long the steroid cream prescribed for you can be used on the same area. Also, by attending your doctor’s recommended follow-up appointments, he or she can correctly assess and tailor your maintenance plan to minimise the risk of side effects.
Tar has been used to treat psoriasis for over a century and is a very effective therapy but rarely enjoyed due to the smell and staining properties of tar. They are usually applied at night to minimise daytime odour. Tar may also increase sensitivity to the sun.
Calcipotriol is a medication related to vitamin D and effective in treating psoriasis. It is very well tolerated but may cause irritation, particularly when applied on to sensitive areas of skin like the face or groin. If calcipotriol makes areas of psoriasis more red, inflamed or itchy, you should discontinue its use and visit your doctor. Overdose is possible, especially in children, increasing blood calcium levels. Blood tests should be regularly carried out when using this medication.
Anthralin is extracted from tree bark. It is processed into a thick ointment that is left on overnight, usually under dressings or more commonly applied at higher concentrations for 10-15 minutes before removal.
Anthralin is usually very effective in treating psoriasis. The main potential side effects of anthralin use are irritation of the skin, temporary skin discolouration and permanent staining of fabric.
Light treatment (phototherapy)
Psoriasis sufferers often take advantage of the natural sunlight’s beneficial effects. Sunlight is a combination of visible light and invisible rays. These invisible rays consist of ultraviolet and infrared or heat rays. The ultraviolet wavelengths of sunlight are effective in the improvement of psoriasis.
UV light treatment is effective in most people with psoriasis. Light therapy is mainly used for treating widespread psoriasis. In Australia, we Narrowband UVB, and PUVA to treat this condition. A measured dose of the appropriate wavelength of light is delivered by a number of specially designed fluorescent tubes that line the walls of a light cabinet.
Narrowband UVB (NB-UVB) can be compared to tuning a radio to a single band (around 311nm). A narrow band of light is represented by specific characteristics and effects such as warmth, colour and ability to burn the skin. Narrowband incorporates the equivalent of the most beneficial sun rays and leads to faster and more prolonged benefits compared to broadband phototherapy and natural sunlight. NB-UVB does not contain ultraviolet light’s shorter, burning and potentially dangerous wavelengths.
Since it is a powerful and potentially dangerous treatment, ultraviolet light should only be performed by specialists. Disadvantages include the need for several treatments per week over multiple weeks. Treatments with narrowband phototherapy have a proven safety record, providing treatments are kept below illumination levels of 300.
Numerous oral therapies are available that have proven very effective in cases of psoriasis but, like all medications and therapies, have the potential to cause harmful side effects. Treatments include methotrexate, acitretin and cyclosporin. The careful choice of therapy and skillful monitoring may reduce the associated risks of these therapies, which are generally very effective in controlling even severe cases of psoriasis. Methotrexate and cyclosporine work by modulating the immune system. Acitretin is a derivative of vitamin A and helps program the skin cells to grow at a normal rate with additional effects on the immune system.
Injections – New treatments
Many new biological agents have been developed or are under development for the treatment of psoriasis. These target the immune mechanisms that lead to psoriasis, helping to balance or normalise the skin’s immune system. They work by targeting abnormal immune cells or their chemical products that are involved in the development of psoriasis.
At present, only a limited number of biological agents have been shown to be effective in treating psoriasis. These all need to injected into either a vein or muscle). This new psoriasis treatment method is known as biologic therapy.
Patients who suffer from psoriasis that responds poorly to treatments such as Narrowband light, creams and medication can be considered for biologic therapy.
People who smoke have a higher risk of developing psoriasis than non-smokers. Giving up smoking after the onset of psoriasis will not, unfortunately, clear it up.
People with psoriasis often take advantage of natural sunlight’s beneficial effects. Light therapy delivered by Narrowband is, however, safer and more effective.
Any cream with high moisturising properties can be beneficial in improving psoriasis and this is the basis of a number of non-prescription ‘miracle’ treatments.
Diet has not been shown to be an important factor in controlling or treating psoriasis. However, obesity leading to large folds of skin can make psoriasis in these folds very difficult to manage. Excessive alcohol consumption may worsen cases of psoriasis.
Wearing light rather than dark coloured clothes can make shed skin flakes less obvious.
Vitamin A and vitamin D are beneficial in the treatment psoriasis, but the high doses required to make a real difference are potentially toxic. Safer, less toxic vitamin analogues have been developed (calcipotriol & acetretin) which require a prescription from your doctor. Check with your doctor before taking a specific high dose vitamin A or vitamin D supplement.
Psychological distress can have profound effects on the immune system. Such distress is reported as a trigger factor by approximately two thirds of people with psoriasis, and those suffering from the most stress have the worst results after psoriasis treatment. A psychologist may be able to teach you better ways of coping with the problem.
With appropriate treatment, psoriasis can be well controlled for the vast majority of sufferers and a normal lifestyle enjoyed. However, very few of these therapies are natural ones. Combination therapy is usually the best option.
Our dermatologists are trained medial practitioners specialised in skin disorders, skin diagnosis and all forms of skin treatments. Furthermore, they know a lot about psoriasis. Cutis Clinic psoriasis treatments range from creams, diet, prescribed medication and Narrowband phototherapy.
The presence of medical doctors at Cutis Clinic means our patients are eligible for a Medicare rebate for their psoriasis consultation. Many patients also qualify for refunds on prescribed medication.
Additionally, treatments such as Narrowband phototherapy can be bulk-billed with no additional cost to our covered patients.
As we are a specialist group of doctors, a referral from your GP is advised for all Medicare claims. Call us directly on (07) 3088 6985 to arrange an appointment or enquire about the referral process.