Psoriasis
Long-term management of psoriasis to control inflammation, scaling and flare-ups
What is psoriasis?
Psoriasis is a long-term condition in which the immune system drives the skin to renew itself far too fast. Skin cells that should take about a month to reach the surface arrive in a few days, so they pile up before they can shed.
The tendency is inherited, and something usually sets it off: a throat infection, a period of stress, a skin injury, smoking, alcohol, or starting or stopping certain medicines. It runs in flares and quieter spells, and it is neither contagious nor caused by anything you did.
Psoriasis is more than skin. Up to a third of people develop inflammation in the joints, and the condition carries a raised risk of high blood pressure, diabetes and heart disease, so your doctor treats the skin and keeps an eye on the rest.
What you might notice
- Thick scaly patches on the elbows or knees
- Pitted or lifting nails with a scaly rash
- Itchy dry patches of skin
How it is diagnosed
Your dermatologist diagnoses psoriasis by examining the skin, and the places they look are as informative as the patches themselves: the scalp along the hairline, behind the ears, the elbows and knees, the lower back, the navel, the skin folds, and the nails, where pitting and separation are strong clues.
They will ask when it began, what sets it off, whether anyone in the family has it, and what you take, since some tablets provoke it. They will also ask specifically about stiffness in the morning, swollen fingers or toes, and heel pain, because joint involvement can start before the skin is severe and changes the plan.
Where the appearance is unclear, a small piece of skin is taken under local anaesthetic and examined under a microscope. Your doctor will usually check your weight, blood pressure and blood sugar at the same visit.
Recovery
Psoriasis is controlled instead of cured, so the timeline is about getting it quiet and keeping it there. Creams applied properly need four to eight weeks of daily use before their effect can be judged, and most people apply far less than prescribed and conclude too early that it failed.
Treatments given as a course of clinic visits run over several weeks, and the schedule matters more than any single session. Tablets and injected treatments are reviewed at around three months with blood tests, and some need monitoring for as long as you stay on them.
There is no time off work. A flare settles over weeks instead of days, and the skin usually leaves a flat brown or pale patch behind that fades over months. Your dermatologist will agree a maintenance plan with you, since stopping everything the moment the skin clears is what brings most flares back.
If it is left untreated
A small patch that does not bother you can reasonably be left, and psoriasis sometimes settles for long stretches on its own.
Left alone, patches tend to spread and thicken, and the itch and the scaling disturb sleep and work more than people expect. Widespread skin inflammation is also uncomfortable in the hot months and cracks painfully on the hands and feet.
The consequence that cannot be undone is in the joints. Inflammatory arthritis linked to psoriasis damages joints permanently if it runs untreated for months, and the damage does not reverse once it is there, so new joint pain, swelling or morning stiffness needs telling your doctor promptly instead of waiting for the next skin review. Two situations need urgent care: skin that becomes red and inflamed over almost the whole body with shivering and fever, and a sudden eruption of small pus-filled spots over large areas.
Questions about psoriasis
Can psoriasis be cured?
No treatment available today removes the underlying tendency, and any clinic promising a permanent cure is worth leaving. What treatment does is clear the skin and keep it clear, and modern options do that well for most people, including those with severe disease. Many people reach long stretches with little or nothing visible. The condition still runs in flares, so the plan usually includes something you continue during the quiet periods. Ask your dermatologist what your maintenance looks like, since stopping everything once the skin clears is the commonest way a flare returns.
Is it contagious, and can I pass it to my children?
Psoriasis cannot be caught or passed on by touch, sharing a bed, swimming, or any other contact, and nobody around you is at risk. It does run in families: the tendency is inherited, so a child with one affected parent has a higher chance than the general population, though most children of people with psoriasis never develop it. Having it does not mean your children will. Nothing about your hygiene caused it, and that misunderstanding causes more distress than the skin itself for many people.
What makes it flare up?
The common triggers are throat infections, stress, injury to the skin including scratches, tattoos and sunburn, smoking, heavy alcohol use, cold dry weather, and starting or stopping certain medicines, including steroid tablets. Weight gain tends to make psoriasis harder to control. Triggers differ between people, so keeping a rough note of what preceded each flare for a few months is more useful than any general list. Tell any doctor treating you for another problem that you have psoriasis before a new medicine is started.
Other dermatology & cosmetology treatments
Treatment of acne and acne-related marks based on skin type, severity and recurrence
Day CareEvaluation and treatment of uneven skin tone, dark spots and other pigmentation concerns
Day CareTalk to a care coordinator about psoriasis
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one