Psoriasis Beyond The Basics
There are many different types of psoriasis, including chronic plaque psoriasis, types of pustular psoriasis , guttate psoriasis, scalp psoriasis, flexural psoriasis, napkin psoriasis, nail psoriasis and erythrodermic psoriasis .
For those that have psoriasis around 1 in 4 may develop an associated psoriatic arthritis , which is about 325,000 people, or around 0.5% of the UK population. PsA causes pain and swelling in the joints and tendons, accompanied by stiffness particularly in the mornings. The most commonly affected sites are the hands, feet, lower back, neck and knees, with movement in these areas becoming severely limited.
Not all people will be affected in the same way and doctors will class the condition as mild, moderate or severe.
Remember, although psoriasis is a chronic condition, it can be controlled and go into remission .
Traditional Treatment Cautions Guttate Psoriasis Early Stages
You make an appointment to see your doctor because your psoriasis is flaring. He takes a look and then whips out his prescription pad to order one of the following:
. A prescription strength topical treatment
. phototherapy
. oral and injection therapy
. over the counter drugs
Any of these treatments may work fine to relieve your symptoms and make you feel better for now. The trouble with conventional treatment methods is that they rarely work to cure the underlying cause of this skin condition and that can leave you suffering repeat attacks. Still it is important to know what helps are available, and how they may help or hurt your chance of treatment success.
Topical Ointments Guttate Psoriasis Early Stages
Topical ointments are used at the first sign of psoriasis. If caught early enough they can sometimes stave off a full-blown attack. Unfortunately, most people report becoming immune to them when used often, which makes them useless for long term use. Still, using the occasional cream or gel can help relieve some of your symptoms. Steroids
Both topical and internal steroids can be prescribed to help ease psoriasis swelling inflammation and itching. Immunomodulators
An immune suppressing drug that was originally used to help transplant patients beat organ rejection, Cyclosporine helps to inhibit T lymphocyte production so that scaly plaque is unable to grow on the surface of the skin.
Oral Retinoid Guttate Psoriasis Early Stages
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What Is Psoriasis And How Can It Affect The Hands
Psoriasis is a chronic, autoimmune skin condition that causes an overgrowth of inflamed, scaly, and sometimes itchy patches on the skin. Your body basically produces way too many new skin cells due to an immune system malfunction, which most commonly results in plaques, per the American Academy of Dermatology . While psoriasis tends to occur in places like the knees, elbows, and scalp, it can also appear on the hands. And when it does affect the hands, its traditionally more difficult to treat. This type is actually called palmoplantar psoriasis, because it only affects the hands and feet.
Psoriasis is uncomfortable, but when it appears in a highly visible place , the condition becomes a whole new issue. But you dont have to go to Elsa-level lengths to conceal your hands with gloves. There are many psoriasis treatments available to help you find relief.
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What Can I Do To Help Treat My Psoriasis
There may not be a cure yet but there is much you can do to help maintain and control your psoriasis. Psoriasis, regardless of location or type, is often irritated by contact, particularly tight clothing such as elasticated waistbands, socks, tights, and underwear. It may be useful to wear looser clothing where psoriasis is likely to be irritated either when flaring or during periods of treatment. Identifying factors that may cause your psoriasis to flare, using a diary, can be helpful.
What Is Psoriatic Arthritis Video
Psoriatic arthritis can cause pain, swelling and stiffness in and around your joints.
It usually affects people who already have the skin condition psoriasis . This causes patches of red, raised skin, with white and silvery flakes.
Sometimes people have arthritis symptoms before the psoriasis. In rare cases, people have psoriatic arthritis and never have any noticeable patches of psoriasis.
Psoriatic arthritis and psoriasis are autoimmune conditions. Our immune system protects us against illness and infection. In autoimmune conditions, the immune system becomes confused and attacks healthy parts of the body.
Both conditions can affect people of any age.
Its estimated that around one in five people with psoriasis will develop psoriatic arthritis.
People with psoriasis are as likely as anyone else to get other types of arthritis, such as osteoarthritis or rheumatoid arthritis. These conditions are not linked to psoriasis.
Psoriatic arthritis is a type of spondyloarthritis. These are a group of conditions with some similar symptoms.
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What Can I Do As A Young Person With Psoriasis
Here are some popular home remedies for scalp psoriasis:
- aloe vera cream applied three times a day to the scalp and other effected areas
- apple cider vinegar solution, washing over effected areas
- baking soda and water paste, used to reduce scalp itchiness
- capsaicin cream, used to reduce flaking, redness, and inflammation
- coconut or avocado oil, to moisturize affected areas
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Dry Cracked Skin: Irritation That Can Lead To Infection
Dry, cracked skin is a psoriasis symptom. However, dry air can also cause your skin to become dry and itchy. When the skin is dry and irritated , it’s more likely to get infected. Infection may cause your skin to become red and swollen. If you have any skin rashes that keep coming back or won’t go away, see your doctor. Most cases of psoriasis can be diagnosed with a physical examination but because psoriasis can look like many other skin conditions, a skin biopsy may have to be done to definitively diagnose it.
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Treatments Designed With Hair In Mind
In recent years, pharmaceutical companies have worked not just on making scalp psoriasis treatments more effective, but on making them easier and more pleasant to apply.
This gives health care providers and patients options that now include shampoos, lotions, creams, sprays, gels, foams/mousses, and ointments. For more severe scalp psoriasis or when it also appears elsewhere on the body, there are also daily pills, occasional injections, and periodic infusions available that are effective on the scalp. UV light therapy is also appropriate in select cases .
A brief introduction to the many options follows, so you can make the most of your doctor visits and get on track to improve the condition of your scalp and give you a sense of peace that scalp psoriasis so often disrupts.
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Treatment: Where To Start
The most common treatments for mild cases are medications that you put directly on your scalp. If you have a more severe case or have psoriasis elsewhere on your body, you may need a medication that treats your whole body. You can take these medications by mouth or injection.
If your psoriasis doesnât respond well after repeated use of one medication, your doctor may replace or combine it with another type of treatment.
One of the first steps is to soften and remove scales. This makes it easier for medications to do their job.
- Apply over-the-counter products to your scalp to help soften scales and make them easier to peel off. Look for products with the active ingredients salicylic acid, lactic acid, urea, zinc pyrithione, or selenium sulfide.
- Gently loosen the scales with a brush or fine-toothed comb.
- Shampoo your scalp to remove the scales, using a salicylic acid shampoo or soap.
- Apply thick creams to your scalp while itâs still damp to hold in the moisture.
To apply medication:
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What Are Other Types Of Psoriasis
Plaque psoriasis is the most common type. About 80% to 90% of people with psoriasis have plaque psoriasis.
Other, less common types of psoriasis include:
- Inverse psoriasis appears in skin folds. It may look like thin pink plaques without scale.
- Guttate psoriasis may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots in children and young adults.
- Pustular psoriasis has small, pus-filled bumps on top of the red patches or plaques.
- Sebopsoriasis typically appears on the face and scalp as red bumps and plaques with greasy yellow scale. This type is a cross between psoriasis and seborrheic dermatitis.
How Does Psoriasis Affect The Palms And Soles
Psoriasis may be localised to the palms and soles or part of generalisedchronic plaque psoriasis. Two common patterns are observed:
- Well-circumscribed, red, scaly, plaques similar to psoriasis elsewhere
- Patchy or generalised thickening and scaling of the entire surface of palms and/or soles without redness
Palmoplantar psoriasis
Palmoplantar pustulosis and the rare acrodermatitis continua of Hallopeau , in which yellow-brown pustules occur, are no longer classified as psoriasis. However, the conditions are associated. About 1025% of people with palmoplantar pustulosis also have chronic plaque psoriasis.
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Can Psoriasis Be Treated
Yes, there are many forms of treatment for psoriasis, which range from those you apply to the skin to tablets, and more recently injectable therapies, See Treatments for Psoriasis.
Many people who have psoriasis find that the sun and artificial ultraviolet light helps to improve their skins appearance. For some the change is dramatic. Be aware that exposure to the sun and artificial UV therapy can cause damage to the skin. See Psoriasis and the sun and Psoriasis and phototherapy
For some people, talking therapies such as cognitive behaviour therapy can also help them understand the psychological impact of psoriasis and provide a safe therapy which may help them cope with psoriasis. See our free online CBT programme
Your general practitioner or dermatologist will be best placed to advise you and keep you informed of all current and new treatments available and to recommend the best treatment programme for you personally.
Remember: Your treatment can only be as good as you allow it to be – that means if the treatment takes six weeks, you have to follow it as instructed for six weeks and no ducking out! Adherence to treatment instructions is an essential part of managing your psoriasis.
Don’t Linger In The Tub
Long, hot baths and showers can dry out your hands and make your symptoms worse. Try to take no more than one a day, and keep it short — 5 minutes in the shower and 15 in the bath. Use warm — but not hot — water and a soap for sensitive skin. Skip loofahs and washcloths since they can be hard on your hands. Once you’re done, gently pat your skin with a towel and put on cream while your hands are still damp.
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Can You Prevent Psoriasis On Hands
Its not always possible to prevent psoriasis on your hands. If you happen to know what triggers your psoriasis or makes it worse, avoiding those can help. This includes things like:
- Refraining from smoking
- Trying to keep your stress levels down
- Wearing protective equipment to avoid injury to your hands
- Refraining from exposing your skin to household or other chemicals
However, if you try these and you still get hand psoriasis, know that you arent alone. There is a genetic component to the condition and other underlying immune system responses that you cant necessarily control. Fortunately, there are lots of treatments you can try for hand psoriasis. While they do require patience and carefully following the suggested treatment plan, working closely with your dermatologist can help you figure out what works best for you.
Past Research And Achievements In This Area
In 2015, research led by our centre for genetics and genomics at the University of Manchester identified genetic variants associated with psoriatic arthritis, but not with psoriasis or rheumatoid arthritis. This helped to establish psoriatic arthritis as a condition in its own right. The findings could lead to the development of drugs specifically for psoriatic arthritis.
Later in the same year, our TICOPA trial looked at the benefits of early aggressive drug treatment for people with psoriatic arthritis followed by an increase in drug dosage if initial treatment isnt working. The trial found that patients treated this way, required fewer hospital- and community-based services than patients receiving the standard care.
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How Can I Boost My Immune System To Fight Psoriasis
Salad greens, such as spinach, Swiss chard, and kale, as well as broccoli and cabbage, are full of rich vitamins and minerals. Studies have shown that they contain special immune-boosting compounds too. Filling your plate with these nutritious foods may help protect you from unwanted viruses and more.
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What Does Psoriasis Look Like On Your Hand
Psoriasis is a chronic autoimmune skin condition that causes skin to be red, thick, scaly, and flaky. When it occurs on the palms of the hands or soles of the feet, its called palmoplantar psoriasis, and it affects about 40% of people with psoriasis.
In addition, fingernails and toenails may be affected. Psoriatic nail disease can cause symptoms in the nail bed and the area where fingernails and toenails start their growth.
Palmoplantar pustular disease occurs in about 5% of patients who have psoriasis and appears as small, pus-filled blisters on reddened, tender skin. It can also cause painful cracking and fissuring.
Symptoms of psoriasis on the hands may include:
- Patches of skin on the hands
- Look red or dark
- Silvery-white scales that itch or burn
- Small, pus-filled blisters on reddened, tender skin
- Painful cracking and fissuring
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What Is The Treatment For Palmoplantar Psoriasis
Improvement in general health can lead to an improvement in palmoplantar psoriasis.
- Weight loss, if overweight
- Investigation and management of associated health conditions
Mild psoriasis of the palms and soles may be treated with topical treatments:
- Emollients: thick, greasy barrier creams applied thinly and frequently to moisturise the dry, scaly skin and help prevent painful cracking.
- Keratolytic agents such as urea or salicylic acid to thin down the thick scaling skin. Several companies market effective heel balms containing these and other agents.
- Coal tar: to improve the scale and inflammation. Because of the mess, coal tar is often applied at night under cotton gloves or socks.
- Topical steroids: ultrapotent ointment applied initially daily for two to four weeks, if necessary under occlusion, to reduce inflammation, itch and scaling. Maintenance use should be confined to 2 days each week to avoid thinning the skin and causing psoriasis to become more extensive.
Calcipotriol ointment is not very successful for palmoplantar psoriasis. It may also cause an irritant contact dermatitis on the face if a treated area inadvertently touches it. Dithranol is too messy and irritating for routine use on hands and feet.
More severe palmoplantar psoriasis usually requires or systemic agents, most often:
Who Does It Affect
It affects men, women and children alike. It can appear at any age in varying degrees but usually between the ages of 10 and 30. The severity of the disease varies enormously, from a minute patch to large patches covering most body areas. Psoriasis can also run in familiesand it is known that the disease is multi-genetic and therefore children may not necessarily inherit psoriasis. It is estimated that if one parent has psoriasis then there is a 3 out of 20 chance that a child will develop the condition. If both parents have psoriasis this increases to about 15 out of 20 . Interestingly, if a child develops psoriasis and neither parent is affected there is a 1 out of 5 chance that a brother or sister will also get psoriasis. This is because the condition is known to skip generations, so somewhere there will be a familial link to a relative via one or both parents.
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How Is The Diagnosis Of Palmoplantar Psoriasis Made
Palmoplantar psoriasis is diagnosed by its clinical appearance, supported by finding chronic plaque psoriasis in other sites. Mycology of skin scrapings may be performed to exclude fungal infection. Skin biopsy is rarely needed.
The differential diagnosis of palmoplantar psoriasis includes:
- Other forms of acquired keratoderma.
Approach To The Patient
Evidence-based guidelines35 on the treatment of patients with chronic plaque psoriasis were published in 2004 by the Finnish Dermatological Society. Recommendations for the management of psoriasis in primary care, based on these guidelines, the evidence cited above, and considering common practice among American dermatologists, are shown in Figure 9.35
Management of Chronic Plaque Psoriasis
Figure 9
Algorithm for the management of chronic plaque psoriasis, based on recent guidelines,35 current evidence, and common practice among American dermatologists.
Management of Chronic Plaque Psoriasis
Figure 9
Algorithm for the management of chronic plaque psoriasis, based on recent guidelines,35 current evidence, and common practice among American dermatologists.
For the initial treatment of psoriasis on limited areas of skin, the most effective treatment is a combination of potent topical steroids and calcipotriene. This recommendation, however, is based on limited evidence.18,29,30 An alternative would be to start with a potent topical steroid, calcipotriene, or a topical retinoid alone. Calcipotriene and topical retinoids can be used long-term, but topical steroids must be used intermittently because of their side effects.35
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