Psoriasis: causes, triggers and treatments

What is psoriasis?

Psoriasis is a skin condition that comes in a number of different forms. All affect the outer layers of the skin in a noticeable way, which can be embarrassing for people with this condition.

Psoriasis can make your skin itch, and can even make your skin split. How badly you have psoriasis varies from person to person. If you have mild psoriasis you may have very few plaques, but if you have severe psoriasis you will develop far more.

Psoriasis happens when your skin produces skin cells more quickly than it should do normally. Skin cells are made in the lower (basal) layer of your skin (epidermis). As the top layer (epidermis) of your skin is shed, the lower layers move up to the surface and are shed in turn. It usually takes three to four weeks for this cycle to happen.

Psoriasis affects around 1 in 50 people. According to the British Skin Foundation Psoriasis doesn’t leave scars, but can temporarily make the affected skin lighter or darker.

When you have psoriasis, this process happens much faster – cells can be created and shed within three to four days. This creates a pile-up of skin – the plaques typical of psoriasis – on the outer layer of your skin. It also causes the dandruff that comes with scalp psoriasis.

This condition can appear and then disappear at different times – you may not have it for fairly long periods. However, flare-ups, when it becomes worse, can happen suddenly.

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The different kinds of psoriasis

Chronic plaque psoriasis

The most common type of psoriasis is chronic plaque psoriasis. The patches caused by this condition are known as plaques. They can be pink or red, and are coated with silvery-coloured scales that feel rough to touch. These can happen in an area of skin that has been hurt in some way – by scratching, for instance. When this happens it is known as the Köbner phenomenon.

This type of psoriasis often affects the knees, elbows, torso and scalp, although it can appear anywhere on the body.

Scalp psoriasis

Scalp psoriasis affects about 50% of those with chronic plaque psoriasis. Some people just have scalp psoriasis. The symptoms are similar to chronic plaque psoriasis, although this condition can appear similar to severe dandruff. In the worse cases it may cover the scalp, and can cause hair loss.

Flexural psoriasis

Flexural psoriasis is another form of chronic plaque psoriasis. It makes the skin red and sore, but doesn’t cause the rough scales that come with the chronic form. This condition affects areas of the body where there are folds in the skin, including underneath the breasts and in the groin and armpits.

Pustular psoriasis

Pustular psoriasis is rare, and the most common form of pustular psoriasis (palmoplantar psoriasis) appears on your palms and the soles of your feet. Small spots, filled with fluid (pustules), appear on skin that is red, and slightly sore.

Another, more serious form of pustular psoriasis can appear on skin anywhere on your body. This is more severe, and you will need immediate treatment from a dermatologist.

Nail psoriasis

Nail psoriasis can affect up to 50% of people with psoriasis. The symptoms include small indentations on the outer surface of your nails, and the nail separating from the nail bed underneath, and becoming thicker. You may also have discoloured patches under your nails.

Guttate psoriasis

Symptoms are small round or oval plaques which can appear on different parts of your body. This type of psoriasis can last from a couple of weeks to a few months, and may never reappear. Guttate psoriasis is caused by a bacteria called Streptococcus.

Erythrodermic psoriasis

Erythema means redness, and this type of psoriasis can cause large areas of your skin’s surface to become red and sore. You may also have a fever. This is a rare type of psoriasis, which can cause serious health problems. If you have this type of psoriasis you need urgent medical treatment, in hospital.

Psoriatic arthritis

If you develop painful, stiff joints you may have psoriatic arthritis. This is a form of arthritis associated with psoriasis. This usually affect the joints at the ends of your fingers and toes.

Can you inherit psoriasis?

Yes, psoriasis can be inherited. If you develop psoriasis when you’re young, it’s more likely that you’ve inherited it, than if you develop psoriasis when you’re older. In families where one parent has psoriasis, a child has about a one in four chance of developing it.

According to the British Skin Foundation (BSF), in cases that aren’t inherited, psoriasis can be caused or, if you already have the condition, triggered by stress, obesity, a throat infection (usually in children) or your skin being damaged by a cut, insect bite or sunburn).

Read more about what stress does to your health

How smoking and drinking affect psoriasis

Studies have found that smoking and heavy drinking can increase your risk of developing psoriasis, and reduce your chances of having a remission. Other factors can increase your risk of developing this condition, or worsen psoriasis if you already have it. These can include smoking, alcohol, taking beta-blockers, obesity and smoking.

Read our guide to giving up smoking

How hormones affect psoriasis

Triggers – things that can make your psoriasis worse – include hormonal changes especially in women when going through the menopause, for instance. Sunlight usually makes psoriasis better, but in some people can make it worse, if the sun is particularly strong.

Other possible triggers include damage to you skin – an insect bite a scrape that damages your skin, and sunburn.

Find out more about menopause symptoms and how to ease hot flushes

Medicines that can trigger psoriasis

Sunburn can trigger a flare up, as can certain medications. These include ACE inhibitors, that are prescribed for high blood pressure, beta blockers, used for anxiety, some heart conditions and thyroid problems, and even ibuprofen. Cuts, scrapes and drinking too much alcohol can also have an effect. All of these can act as triggers, so talk to your GP before taking any new over-the-counter medicine or natural remedies.

Read more about what you need to know about painkillers

Is there a cure for psoriasis?

here isn’t a cure for psoriasis, but once you find the right treatment for you, it should improve the condition of your skin and make you feel more comfortable. Most people with psoriasis use topical treatments, such as lotions that you smooth onto your skin.

Your psoriasis may clear up after a course of treatment, but it can come back (relapse). The time between relapse can vary from a few weeks to some years.

Treatment can vary depending on its severity and type, and even where it is on your body.

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Topical treatments for psoriasis

Emollients

Emollients are a very common form of treatment. These are moisturisers – they soothe the skin, help with dryness and itching and also reduce the amount of scaling.

Emollients also make the cracked area of your skin softer, and less uncomfortable and help other topical (applied to your skin) treatments to be absorbed.

Emollients for baths and showers

When you are having a bath or washing you need to use emollients instead of soap. According to the British Association of Dermatologists you should use emollients often and use them generously. If you have very mild psoriasis, it may improve using only emollients.

Emollients with salicylic acid

Your doctor may suggest using emollients containing salicylic acid. This can help reduce severe scaling. However, it doesn’t suit everyone as it can irritate the skin around the scales.

Treating psoriasis with vitamin D creams

Creams or ointments containing vitamin d, such as calcipotriol and tacalcitol can also be beneficial. They slow down the production of excess skin cells, and are anti-inflammatories.

Topical steroids

Other treatments that you put straight onto your skin include topical steroids. You may be able to use the weaker ones on your face or in the folds of your skin for short periods.

Your doctor may suggest stronger steroids for areas where the plaques are thicker, or on thicker skin, such as the palms of your hands and soles of your feet. These steroids can cause side effects, including thinning your skin, so your doctor should keep a close eye on you, and only prescribe them for short periods.

Other psoriasis treatments

Phototherapy

Phototherapy uses light to treat psoriasis. UVB phototherapy uses light that slows down the rate at which you produce skin cells. This treatment is delivered in hospital, and you may need to have it two or three times a week for up to two months.

PUVB tends to be used when you have severe psoriasis and other treatments haven’t worked. It involves taking a tablet containing psoralen (or applying this to your skin). This substance increases your skin’s sensitivity to light. You then have Ultraviolet A light shone at your skin, (this goes deeper into your skin than ultraviolet B light).

Systemic treatments

If you do have severe psoriasis, your doctor or specialist may suggest treating you with tablets, such as acitretin, ciclosporin, or methotrexate, which are known to help control severe cases of this condition. There is a risk of side effects with these tablets, which your specialist will discuss with you.

Biologics

There are some relatively new treatments, given by injection, or through a drip, known as biologics injections. These are only available for people who have very severe psoriasis, who can’t take, or haven’t had any success with other treatments.

Useful resources:

British Skin Foundation
NHS - psoriasis
NHS - psoriatic arthritis
Psoriasis Association UK
Psoriasis and Psoriatic Arthritis Alliance
British Association of Dermatologists

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