Psoriasis is an immune condition which causes patches to develop on the skin. It sometimes causes joint problems due to a complication known as psoriatic arthritis. In psoriasis, skin replacement happens more quickly, taking place over a few days instead of three to four weeks. Skin cells accumulate, forming raised patches known as “plaques”. These can be flaky and/or scaly, appearing very red on white skin and dark on black or brown skin. Psoriasis is not contagious.
There are different types of psoriasis, affecting different parts of the body. Some form of psoriasis affects 2-3% of the population and it is equally common in men and women. It can occur at any age, although most cases begin in those aged under 35 and those aged 50 to 60. Psoriasis is more common in white-skinned people, although it can affect people of any skin tone.
If you have psoriasis, you may feel self-conscious about your appearance. Here at Changing Faces, we offer psychological and social support to people struggling with the impact of a visible difference. On this page, we look at what psoriasis is, types of psoriasis and common psoriasis treatments. We also explore how we and other organisations can support you if you are affected by psoriasis.
In this section we look at the signs and symptoms of different types of psoriasis as well as causes and possible psoriasis treatments. For some people, psoriasis may be nothing more than an inconvenience. Itching is usually mild, although it can be more severe for some people and in particular types of psoriasis. It may cause psychological stress due to the impact on your life and the effects of changes to your physical appearance.
Note on treatments: In the treatments sections for each type of psoriasis listed below, we mention systemics and biologics:
- Systemics: Drug therapies which work throughout the body, given as an injection, infusion or oral medication (taken by mouth). Tend to be used for moderate to severe cases.
- Biologics: Human-made proteins which are designed to target the parts of the immune system which trigger inflammation, given as an injection or infusion. They come from a living source (human or animal). Tend to be used in severe cases.
Guttate psoriasis causes rain-drop-shaped rashes of small spots about a centimetre in diameter (“guttate” comes from the Latin word guttae meaning “drop”). Patches may sometimes be scaly and can be very itchy or sore. It tends to occur in younger people and usually clears after several weeks or months.
It tends to affect the:
Guttate psoriasis can appear differently on different skin tones:
- Black or brown skin: Darker than the surrounding area.
- White skin: Bright pink or red.
Guttate psoriasis causes
Causes include a streptococcal throat infection and other viral or bacterial infections. Guttate psoriasis is particularly likely to develop after tonsillitis, which often occurs alongside a streptococcal infection.
Guttate psoriasis treatment
Treatments for guttate psoriasis include:
- Topical treatments applied directly to the affected area including steroid creams, vitamin D and coal tar as well as emollients (moisturisers) to stop the skin drying out.
- UV light phototherapy given two to three times per week for six to eight weeks.
- Tonsillectomy (removal of the tonsils) – tonsillitis is common with a streptococcal infection (strep), and guttate psoriasis is particularly likely to occur after strep with tonsillitis. There is some evidence to suggest that removing the tonsils can reduce the chances of a guttate psoriasis flare-up after strep. However, the evidence that this is an effective treatment is mixed.
Nail psoriasis causes changes to the affected nails. Nails may become discoloured and/or covered in small dents. Nails may also split or crumble, thicken or loose. Nail psoriasis can be painful and make it difficult to use the hands and feet. It affects around half of people with psoriasis and up to 80% with psoriatic arthritis. It can occur on the fingernails, toenails or both.
Nail psoriasis causes
It isn’t clear what causes nail psoriasis. However, nail psoriasis almost always occurs in people who have psoriasis in another part of their body. Only 5% of nail psoriasis cases occur in people who do not have another form of psoriasis or psoriatic arthritis.
Nail psoriasis treatment
Treatments for nail psoriasis include:
- Steroids for short term use.
- Vitamin D, which can be applied directly.
- UV light phototherapy.
Have a look at this page on nail care from the Psoriasis Association for tips which can help.