#AD A conversation with a psoriasis expert – Pharmacist, Sultan Dajani

As my blogger ambassadorship for Epaderm draws to a close, I am excited to share with you a really insightful interview with an expert on skin conditions such as psoriasis. Having lived with the condition for eight years now, I am always eager to hear from specialists and to find out more about how to manage it better.

I hope that this post provides some useful advice for other sufferers too...

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1)    What do we know about psoriasis as a condition?

Psoriasis is a common condition where there is inflammation of the skin. It is a long-term condition that can also affect the head, nails and joints and in some cases it is intimately linked with cardiovascular disease (heart disease and strokes).

It typically develops as plaques of red, scaly skin. Once you develop psoriasis it tends to come and go throughout life. A flare-up can occur at any time and can particularly get worse during winter.

The frequency of flare-ups varies. There may be times when psoriasis clears for long spells. However, in some people the flare-ups occur often. Psoriasis is not due to an infection. You cannot pass it on to other people and it does not turn into cancer.

Treatment with creams or ointments can often clear or reduce plaques of moderate and mild psoriasis. Special light therapy and/or powerful medication are treatment options for severe cases where creams and ointments have not worked very well.

2)    Can our lifestyle have an impact on our condition?

The severity of psoriasis varies greatly. In some people it is moderate to mild with a few small plaques that are barely noticeable. In others, there are many patches of varying size. In most people the severity is somewhere between these two extremes.

About 1 in 50 people develop psoriasis at some stage of their lives. Psoriasis is more common in Caucasians. It can first develop at any age but it most commonly starts between the ages of 15 and 30 years.

In about 3/10 people with psoriasis, it is hereditary.

Also, one large study found that smokers (and ex-smokers for up to 20 years after giving up) have an increased risk of developing psoriasis compared with non-smokers. One theory for this is that poisons (toxins) in cigarette smoke may affect parts of the immune system involved with psoriasis.

Alcohol consumption may also be a trigger for psoriasis flare-ups.

3)    What are your tips for living with and managing psoriasis?

Many people have a few plaques of psoriasis that are not too bad or not appearing in a noticeable place. Treatment is not essential and some people may not want any treatment if they are only mildly affected.

Having a healthy diet and regular exercise have been shown to improve psoriasis, as well as reducing the risk of developing heart disease and stroke.

In most people who have psoriasis, there is no direct reason why a flare-up happens at any given time. However, in some people, psoriasis is more likely to flare up in certain situations, including:

- Stress. Stress seems to trigger a flare-up of psoriasis in some people. There is also some evidence to suggest that the treatment of stress may sometimes be of benefit.

- Smoking. Smoking may trigger psoriasis to initially develop in some people and may aggravate existing psoriasis. Stopping smoking will not only help your psoriasis but will also help to reduce the risk of heart disease and stroke.

- Obesity and overweight. Being obese or overweight makes developing psoriasis more likely and more severe. Losing weight may improve psoriasis in people who are overweight.

- Alcohol. Drinking a lot of alcohol may cause a flare-up in some people.

- Infections. Certain types of infections may cause a flare-up of psoriasis. In particular, a sore throat caused by a certain type of germ (bacterium).

- Medication. Some medicines may possibly trigger or worsen psoriasis in some cases, such medicines include: blood pressure medications, painkillers and some antibiotics. In some cases, the psoriasis may not flare up until the medication has been taken for weeks or months.

- Trauma. Injury to the skin, including excessive scratching, may trigger a plaque of psoriasis to develop. The development of psoriatic plaques/patches where the skin has been damaged is known as Köbner's reaction.

- Sunlight. Most people with psoriasis say that sunlight seems to help ease their psoriasis. Many people find that their psoriasis is less troublesome in the summer months. However, a few people find that strong sunshine seems to make their psoriasis worse. Severe sunburn (which is a skin injury) can also lead to a flare-up of psoriasis.

- Hormonal changes. Psoriasis in women tends to be worse during puberty and menopause. These are times when there are some major changes in female hormone levels. Some pregnant women with psoriasis find that their symptoms improve when they are pregnant, but it may flare-up in the months just after having a baby.

- There is no evidence indicating that any particular foods or diets are any better or worse for psoriasis, apart from some weight loss diets which can increase the chances of a flare up.

  

4)     Is it true that hot baths and showers can make psoriasis worse, and why?

Yes, hot baths and showers make damaged skin more dehydrated through evaporation and irritation.

5)    Why can some toiletries also make psoriasis worse?

Some toiletries contain ingredients that can cause allergic reactions and irritate the skin.

6)    How often should someone with psoriasis moisturise?

People with psoriasis should moisturise around eight times a day, depending on the severity of their condition.

7)    Which topical treatments and routines do you recommend?

Moisturisers (emollients) - These are essential for anyone with psoriasis, no matter what other treatments they use. They help to soften hard skin and patches, remove scales and prevent itchiness. There are many different brands of moisturising creams and ointments so find one that you like. My preferred emollient to recommend is the Epaderm range as it is free from fragrance and sodium lauryl sulphate (SLS) and is also available on prescription. Using a moisturiser may also make other treatments more effective. However, apply the emollient first and allow about 30 minutes for it to be absorbed into your skin before applying any other treatment.

There are several prescription-only medicine creams available too (inc. steroids, vitamin D, coal tar, dithranol, salicylic acid, and various combinations).

8)    How can the condition change over time?

Psoriasis affects different people in different ways. In general, plaque psoriasis is a persistent (chronic) condition with flare-ups that come and go. However, some studies have shown that, over time, plaque psoriasis may go away completely at some point in around 1 in 3 people. Some people have a number of years where they are free from psoriasis and then it may flare-up again. 

The less common scaly psoriasis usually goes away completely after a few months. But, if you have an episode of scaly psoriasis, you have a higher than usual chance of developing chronic plaque psoriasis at a later time.