Dr Ian Webster

Managing Psoriasis

Psoriasis is a chronic, immune-mediated inflammatory disease that affects approximately 3% of the world’s population. It affects males and females equally. Millions of US dollars is being spent on research into psoriasis but unfortunately there is still no cure as such but with the correct treatment it is controllable.

The causes are multi-factorial and there is often a positive family history of psoriasis.

It usually presents with well-defined, red, scaly plaques, often involving the scalp, the elbows and the knees. Some people will have a few red, scaly plaques on the scalp and body for years that do not really bother them but in other cases the psoriasis may involve the whole body and this is called Erythrodermic psoriasis.

Another type of psoriasis is called Inverse or Flexural psoriasis where instead of involving the extensor surfaces, the psoriasis involves the folds of the skin which may be under the breasts, under the armpits or in the groin.

Another quite common sub-type of psoriasis is what is called Sebopsoriasis (it clinically has features of both seborrhoeic dermatitis and psoriasis) and this is often found on the scalp, face and in the folds of the skin and presents with multiple red, greasy, scaly papules and plaques.

Psoriasis does not only affect the skin but it can affect the joints (Psoriatic arthritis) and there is an association between obesity, Type 2 diabetes, smoking, hypertension, raised cholesterol and insulin resistance.

Treatment tips that can help with Psoriasis

Prescription

Topical:

Vitamin D analogues (calcipotriol) on their own or combined with topical corticosteroid creams or ointments
Topical calcineurin inhibitors e.g. tacrolimus ointment or pimecrolimus cream are especially useful for facial psoriasis as they do not contain any corticosteroids
Light Treatment (Phototherapy)
PUVA or narrow-band UVB treatment is usually performed in a Dermatologist’s office

Systemic Treatments:

Methotrexate
Oral Retinoids
Biologics – these work well but are expensive

Non-Prescription

General:

Maintain an optimal weight
Stop smoking
Keep alcohol intake to a minimum

Skincare ingredients that can help with Psoriasis

Ceramides
Urea
Salicylic Acid
Alpha Hydroxy Acid (AHA)
Maltobionic Acid – Polyhydroxy Acid (PHA)
Shale Oils
Liquor Picis Carbonis (LPC)

Skincare products that can help with Psoriasis

As the epidermal barrier function is often disturbed in psoriasis, use the mildest of soaps and/or liquid cleansers for the face and body (with a pH as close to 5.5 as possible).

For the thick plaque psoriasis on the extensor surfaces i.e. the elbows and knees, use a richer moisturiser containing urea and salicylic acid.

For thinner skin areas like the folds under the arms and in the groin, use a moisturiser that contains ceramides.