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Psoriasis

Information about the skin condition psoriasis, as well as guidance about what support is available from Changing Faces and other organisations.

What is psoriasis?

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 lighter skin and dark on darker 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 lighter-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.

Something incredible happened, something that I just didn’t expect at all. As my psoriasis patches started to spread across my face, my confidence grew. I became comfortable in my own skin, happy with how I looked, and didn’t feel people’s stares as harshly anymore.

Jude, Changing Faces campaigner who has psoriasis

Types of 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

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:

  • Back
  • Limbs
  • Torso

Guttate psoriasis can appear differently on different skin tones:

  • Darker skin: Darker than the surrounding area.
  • Lighter 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

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.
  • Systemics.
  • Biologics.

Have a look at this page on nail care from the Psoriasis Association for tips which can help.

Plaque psoriasis

Plaque psoriasis causes the build-up of skin cells (plaques) in patches on the skin, which can be red, itchy, sore and scaly. You can easily tell plaques apart from the surrounding skin and clearly feel them if you run a finger over them.

Plaque psoriasis can occur anywhere on the body but tends to affect:

  • Palms
  • Soles of the feet
  • Places where skin touches skin (e.g. underarms)

Plaque psoriasis causes

The specific causes of plaque psoriasis aren’t known although like other forms of psoriasis it is considered to be an autoimmune disease, which means it is caused by the immune system attacking the body.

Plaque psoriasis treatment

Treatments for plaque psoriasis include:

  • Topical treatments such as emollients (moisturisers) applied directly to the affected area.
  • UV light phototherapy.
  • Systemics.
  • Biologics.

Plaque psoriasis on the scalp

Plaque psoriasis often occurs on the scalp. This can lead up to a build-up of scaly skin and dandruff-like flakes. It may be visible along the hairline, on the forehead and neck and behind the ears. It can cause the scalp to feel itchy and tight and may temporarily cause hair to thin.

It is often treated by shampoos, as well as topical treatments applied directly to the affected areas, such as coal tar, dithranol, emollients (moisturisers), oils, salicylic acid, steroids and vitamin D.

Pustular psoriasis

There are two types of pustular psoriasis: palmoplantar pustulosis psoriasis and generalised pustular psoriasis.

Palmoplantar pustulosis psoriasis (PPP)

PPP causes very red or dark skin on the palms of the hands and/or soles of the feet. The affected area is covered by small fluid-filled pustules which may be yellow or cream-coloured and can turn brown or crusty after bursting.

It is most common in women and people who smoke and tends to be associated with diabetes, arthritis, thyroid disorders and coeliac disease.

It is treated with steroid creams, coal tar, moisturiser, UV light phototherapy, systemics and biologics.

Generalised pustular psoriasis (GPP)

GPP is similar to PPP, but instead of affecting the hands and feet specifically, it affects the other parts of the body. Like PPP, it causes small fluid-filled pustules on very red or dark skin, which often merge to cause large areas of pus. These patches dry and peel before new pustules appear. Skin feels hot, sore, tender and itchy.

GPP can be triggered by medication, infections and pregnancy as well as coming off steroids.

GPP requires immediate medical attention and is treated in hospital by providing fluids and stabilising temperature. Oral retinoids (which provide vitamin A) may be given, followed by systemics and biologics.

Psoriatic arthritis

Some people with psoriasis develop arthritis, which is known as psoriatic arthritis. This causes joints to become swollen, stiff and painful. It can get worse if left untreated but its effects can be stopped or slowed down if you are treated early.

Psoriatic arthritis affects around one in the three people with psoriasis, and it tends to develop around five to 10 years after the first onset of psoriasis.

Psoriatic arthritis treatments

Treatments focus on reducing inflammation:

  • Corticosteroids
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Disease-modifying anti-rheumatic drugs (DMARDs)
  • Biologics

What causes psoriasis?

We have listed the specific causes of each type of psoriasis above. The underlying cause of psoriasis is poorly understood. However, it is considered to be an auto-immune disease, which means that it is caused by the immune system attacking the body with antibodies. It is sometimes known as an “immune-mediated” condition, a more specific term meaning that the particular antibody which attacks the body and causes the disease is not yet known.

It’s not clear what triggers psoriasis to occur but it is thought that the following things may be triggers:

  • Hormonal change
  • Infections
  • Injury
  • Medications
  • Stress

Is psoriasis genetic?

Psoriasis often seems to run in families but not always.

How is psoriasis diagnosed?

Psoriasis is usually diagnosed based on the appearance of your skin. If your GP isn’t sure, they may refer you to a dermatologist. Sometimes, a biopsy (a small sample of body tissue) is sent to the lab for testing.

If the doctor thinks you might have psoriatic arthritis, they may refer you to a rheumatologist (a specialists in arthritis).

Psoriasis and my appearance

Psoriasis causes changes to the appearance. The extent of this change varies from person to person and may depend on where on your body the psoriasis occurs. Sometimes changes can be very noticeable, other times they are not.

Regardless of how significant the change is, you may feel more self-conscious about your appearance if you have psoriasis. You may experience a change in your sense of body image (the way you view your body). You may be aware of others making comments and asking questions about your appearance.

If you are finding these feelings hard to deal with, there is plenty of help and support available.

My advice isn’t easy to follow but I truly believe self-acceptance is the key. If you can learn to love and accept yourself just as you are, then what everyone else thinks becomes so much less important. You realise the only opinions that matter are those of the people that love you and are kind to you.

Aimee, who has psoriasis

What psoriasis support can we offer?

At Changing Faces, we have a range of services and support options to help you if you’re struggling with the psychological impacts of living with psoriasis.

In our counselling and wellbeing support sessions, a trained practitioner will be there to provide a listening ear and provide guidance to help you manage the challenges of living with a visible difference.

We also have a range of self-help guides covering practical and psychological challenges such as self-esteem and mental health, working with a visible difference and dating and relationships. We have resources for young people and a section for parents and carers.

There are other ways we can help you here at Changing Faces if you’re struggling with the impacts of living with psoriasis:

  • Online Community: This online discussion forum is moderated by Changing Faces staff and is a space for you to talk to other people affected by visible differences.
  • Peer Group Chat Service: A place for up to eight participants with visible differences to have a discussion on Zoom or via an internet chatroom. Facilitated by Changing Faces staff.
  • Workshops for children and young people and their parents: A facilitated online space to meet others and learn ways to manage the impacts of life with a visible difference. For parents and carers as well as young people.
  • Real stories: Read stories from other people living with skin conditions such as psoriasis.

Please get in touch with our Support and Information Line to learn more about using our services. As well as connecting you with our services, our friendly team can offer support calls which provide a space for you to talk about the impacts of living with psoriasis.

Other organisations

Psoriasis Association logo

Psoriasis Association

The Psoriasis Association supports people with psoriasis and psoriatic arthritis, providing advice and information via its helpline, raising awareness, working with parliamentary bodies and healthcare organisations, and supporting research into causes and treatment through its grant programme.

Outlook logo

Outlook

A national, highly specialist psychological service based at North Bristol NHS Trust, supporting adults (16+) with appearance-related distress. They can provide face-to-face and remote support via NHS Attend AnyWhere. Please speak to your GP or healthcare professional to discuss a referral.

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NHS

Please have a look at the NHS conditions page for official guidance on the main types of psoriasis, information on when to see a GP, and advice about treatments available on the NHS. You will also find information about the current impact of coronavirus (COVID-19) on NHS services.