What is Psoriasis?
Basically in psoriasis (sore-aye-asis), the life cycle of the skin cells decreases in time, and hence skin cells are turned over more rapidly. This results in extra skin cells (more than are needed!) being present, which coalesce to form hardened plaques on the skin.
These plaques can be itchy and painful, and may vary in severity from person to person, and from time to time in the same person.
It is a non-contagious, autoimmune condition, which is lifelong, and for now there is no cure, so the best we can do, is manage flare ups when they occur. Luckily, most cases of psoriasis do not affect general health and well-being, however there are mental health and social implications associated with psoriasis, which I think are also really important to address.
How common is Psoriasis?
It occurs in as many as 2% of the world’s population – that’s a lot of people! It occurs with the highest frequency in Caucasians. Men and women are equally likely to suffer from it also, and it can occur at any age.
Two thirds of psoriasis patients have mild disease, while one third. Have moderate to severe disease.
Symptoms of Psoriasis:
Symptoms can differ in appearance and severity from person to person, but generally, psoriasis is associated with:
Well defined red patches of skin, which are raised in height from the rest of the skin, and covered with thick, silvery scales
Small, scaly spots
Dry, cracked skin
Itching, burning, or soreness
Nail deformities
Swollen and stiff joints
Someone with psoriasis may experience just some, or all, of these symptoms, depending on multiple factors, including the type of psoriasis they suffer from.
Patient complaints:
Lesions are unsightly and affect self-confidence
Feeling socially outcast – even though the lesions are not contagious
Excessive scale (the silvery dead skin)
Chronic plaque psoriasis
This is the most common form of psoriasis. It is a chronic inflammatory skin disease which is characterised by well-defined raised scaly patches usually present on the skin surrounding the joints, such as the skin on the back of elbows, the front of the knee (places where the skin is stretched), and may also appear anywhere else on the skin, including in the genital area, and the hands and feet.
The plaques/lesions can be itchy, sting, and occasionally even bleed.
It is important to note that it tends to go through phases in terms of exacerbation and remission – cycles of good and bad periods of psoriasis. In one third of people with this most common form of psoriasis, nail deformities will be experienced. It is also not unusual to also experience problems with the joints (affects between1 and 10% of patients).
The plaques can be as large as 20cm. It also tends to be very much a symmetrical disease – so usually if one elbow is affected, the other one will also be affected.
Most patients experience nail changes – which may even include loss of the nail plate.
Treatment of psoriasis
Treatments are chosen on the basis of disease severity, other relevant illnesses, patient preference (including cost and convenience), efficacy, and evaluation of individual patient response. Although medication safety plays an important role in treatment selection, this has to be balanced by the risk of under-treatment of psoriasis, leading to poor quality of life for the patient. As with treating any disease, benefits of treatment have to. outweigh the risks, in terms of quality of life, which is obviously paramount in any line of care. Generally, according to the national psoriasis foundation, the aim of treatment is to have 3% or less of the body surface area covered with plaques, or to. have a 75% improvement on the baseline level of psoriatic plaques, within 3 months.
What can you buy 'Over The Counter (OTC)' in a pharmacy, for psoriasis?
The first key point is to be diagnosed with psoriasis. If you have not been diagnosed by your GP or other physician with psoriasis, then you should not treat it as such. Once you have been diagnosed, and prescribed treatment, there are some products you can purchase in the pharmacy as maintenance therapy, without needing a prescription.
Emollients
Help to ease itch, pain, dryness - used all year round regardless of severity of plaques/pain/symptoms. They should be a staple in the daily skincare routine of someone with psoriasis. The key with emollients is not to be afraid to use plenty of them! It is not unusual for an adult to go through a 500g tub in a week - make sure to get plenty prescribed/to stock up as many don't require a prescription - find out whichever way is cheaper for you to get them. Emollient moisturisers lock in hydration and moisture which allows scale to soften and relieve/prevent the irritation that dry skin causes.
Should be used to soften the hard scale and reduce any irritation, as well as all year round to provide soothing relief, and keep dryness at bay.
Some great emollients available without prescription in pharmacies, which are effective for use in psoriasis skincare:
1. Epaderm
2. Hydromol
3. Emulsifying ointment
These can all be used not only as an emollient moisturiser, but as a soap substitute.
Shampoos/conditioners/body wash for psoriatic skin:
Various Ranges available that are sulfate-free with no fragrance or other irritants, for example, ones that I recommend based on ingredients and popularity with psoriasis patients are:
1. Elave skincare range. Check it out here
2. Child's farm. Take a look at their products here. They're super gentle products,manyof which are suitable even for a newborn baby!
3. La Roche Posay - Speak to the staff in your local pharmacy about the right products for you, as there are many different ranges available within LRP to suit your needs.
These three brands are very popular in Irish pharmacies, but please do let me know what works for you!
Vitamin D3 Analogue creams (Dovonex – calcipotriol)
Dovonex is licensed as a pharmacy only medicine, for the treatment of adults with mild to moderate plaque psoriasis which has been previously diagnosed by a doctor. It should be applied to the trunk and/or limbs as appropriate. It is only sold OTC for patients over the age of 18 as more monitoring is required for patients below this age.
Usually applied once or twice daily
Not messy or smelly but mildly irritant
Wash hands before or after applying
Can make your skin more photosensitive which means you need to be careful in the sun - cover these areas and use high UVA/UVB sun protection
Very effective and suitable for long-term use
Using too much can cause elevated calcium levels
Calcipotriol (Dovonex for example) should not be used on the face
Can also have a combination of steroid/vitamin D – they work well together – (have a synergistic effect)
Tar-based creams/shampoos/bath additives available OTC
Tar-based products help to slow the rapid growth of skin cells and restore the skin's appearance. They can also help to reduce the inflammation, itching and scaling that occurs with psoriasis. Tar products can vary dramatically from brand to brand. Generally, the higher the concentration of tar, the more potent the product.
Tar can cause irritation and may redden and dry the skin. Before using a tar-containing product, you should patch-test it on a small area of the skin first. Tar can stain clothing, bed linen and blond hair. Tar can also make skin more sensitive to sunlight (photosensitive), so make sure to rinse it off thoroughly, use sunscreen and/or avoid sun whilst using it. Tar remains active on the skin for at least 24 hours, so limit your outdoor time, as you will be at an increased risk of sunburn during this period.
Polytar
Psoriderm
Capasal – shampoo – coaltar 1%
Cocois ointment
Neutrogena T gel therapeutic shampoo
Salicylic acid
Can be used to loosen scaly plaques (keratolytic - lyses/breaks down keratin!) before using other treatments such as steroid creams – to increase the chance that the other treatments will be effective. It is present in Cocois ointment and Capasal shampoo above.
Mental health and social (psychosocial) effects of psoriasis
