Leaving a trail of flakes? Conscious of plaques on your arms or elbows – or of your scalp shedding and “snowing” on your shoulders? Those can be the experiences of the two people in every 100 in Ireland who have psoriasis, the condition that involves skin cells reproducing too quickly in some areas of the body.
A recent global survey showed that living with psoriasis has a significant impact on the lives of those with the condition.
Almost eight in 10 experienced discrimination or humiliation due to psoriasis, the Clear About Psoriasis research found. Callous comments included some people being asked if they are “contagious”.
TREATMENTs
So what are the standard treatments available at present for mild to severe psoriasis?
Dr Nicola Ralph is a consultant dermatologist based in the Mater Hospital, and she says that finding the right doctor and treatment is an important part of managing this skin disease. “Nobody should feel they have to settle,” she says.
Dermatologists generally see patients who have moderate to severe psoriasis, and treatment plans are very much tailormade. “Many health factors have to be taken into account before treatments are prescribed, so the initial consultation is very important.
“Psoriasis is difficult to manage, and the drugs now available for it are fantastic, but you have to balance it with the person who might have some kidney disease because they have high blood pressure, for example, so it’s a bit complicated,” she explains.
People who come to her are sick of using creams to manage their psoriasis, she says, and many have been doing that for a couple of decades.
“Creams will work for a while, but within three or four days of stopping, the scale will build back up again, so they’re back to square one. They are usually looking for longer-term treatment, like phototherapy or medication,” she finds.
CREAMS
Following the usage advice given is key with creams, but not easy to achieve. “Everyone has a busy life, and some of the creams we would use for psoriasis are tar-based. They smell of tar and ruin your clothes and sheets, so that’s going to reduce compliance.
“It’s a catch-22 situation: you’re trying to get someone on treatment, but if they don’t use what’s prescribed they are not going to get any better,” explains the doctor.
Moisturisers are also important to hydrate the skin and ameliorate the symptoms of the discomfort, as 70% of people with psoriasis report itch with it.
“Steroid creams are stronger and shouldn’t be applied all over the body on a long-term basis, because they can thin your skin,” Dr Ralph says.
“We would often make up compounded mixtures for the body involving tar, to reduce the scale, and urea, which softens the skin.
“Vitamin D analogue creams are another option. You put these on the plaques. There is a plain and steroid combination version of these,” she says.
“These creams work by trying to stop the cell turnover. “With psoriasis, skin on the areas where you have plaques is turning over every three to four days, rather than following the normal 28-day cycle. That’s why the thick scale appears. These treatments are aimed at slowing down that process.”
PHOTOTHERAPY
This treatment is only suitable for people who can attend the hospital two to three times a week. “It’s a big commitment, going on for six to 10 weeks, so a large portion of your life is taken up with going to the hospital each day on an outpatient basis,” she says.
“This light treatment may also only offer a temporary reprieve. “Some people get months or years, while some only get weeks – but it is a very safe form of treatment and can be used on pregnant patients or on those who have had transplants,” she says.
TABLETs
There are about five tablets in this systemic agent bracket of medication, she says. “They are all slightly different, but the majority work by suppressing your immune system slightly.
“They can have side effects, like nausea, and can affect blood pressure or kidney function, so they all require blood monitoring. One type can only be used in post-menopausal women, and another can affect fertility in men, so treatment has to be tailored to the person.”
BIOLOGICS
Treatments that are given by injection or infusion (via a drip) are known as biologics. “We have four injections on the market at the moment that you can administer at home. There is also a hospital infusion available,” explains Dr Ralph.
“Blood tests are done regularly if a person is using this kind medication, and biologics are generally used if other treatments haven’t worked. “We wouldn’t usually jump from phototherapy to injection treatment unless the patient has bad joint disease,” she says.
“That’s in order to prevent further joint damage, as it’s irreversible.”
OBESITY effect
Obesity can go hand in hand with psoriasis. “Basically, the hormones you produce and hold on to when you are overweight drive the psoriasis. No matter how much of the biologic treatment we give you, if you’re very heavy we can only clear your psoriasis so much.”
It is only in the last five years that it has been discovered that psoriasis is deeper than a skin disease, she adds. “We now know that it affects your artery lining. It’s a systemic inflammation, which puts you at increased risk of heart attack, stroke and diabetes when you’ve got moderate to severe symptoms.”
TIPS
Dr Ralph has these tips to help manage your psoriasis better:
• Lose weight to get the maximum benefit from treatments.• Exercise regularly to reduce stress. Psoriasis is driven by stress. It can flare when you are under stress even if you are on medication.• Avoid excess alcohol, as it makes psoriasis worse.• Don’t smoke. • Learn relaxation techniques like mindfulness, meditation and use along with exercise.• Keep a diary to identify triggers. • Try CBT (cognitive behavioural therapy) to help relieve anxiety around having psoriasis.CBT CAN HELP
Dr Ralph finds that a lot of patients with psoriasis have high levels of anxiety. “They are worried about the future,” she says.
“Even if the drug is working they ask: ‘What if it stops working?’; ‘What if my doctor decides to stop my drug?’; ‘What if I go back to looking the way I did five years ago?’; ‘What if the Government stops paying for it?’
“Anxiety levels can be out of proportion compared to age-matched population. Often cognitive behavioural therapy (CBT) can help to try and change their way of thinking, thereby reducing anxiety,” recommends Dr Ralph.
>> Style tips for sufferers
As anyone who has the condition knows, psoriasis can be worse at some times than at others. Stress can aggravate it and it may or it may not even itch. But it is nothing to be ashamed of, and useful tips can go a long way to helping.
Helen Hanrahan of www.TheFlakyFashionista.com, who has psoriasis herself, has these tips that may help on the clothes and presentation front:
AVOID THE DARK SIDE
White, taupe, camel, pale grey and cream are perfect colours to wear on your top half if you suffer from scalp psoriasis. Falling flakes are instantly invisible. Remember: black is not your friend on the top half.
CLASSIC CAMEL
Camel colour never dates, flatters almost everyone and conceals psoriasis flakes. Invest in a camel blazer, coat or jacket for a wardrobe staple that always works.
IT’S IN THE DETAILS
Draw the eye away from your skin with clever accessorising. A leopard clutch; a brightly coloured tote; a blanket scarf; a jaunty fedora, a cocktail ring or a bling-tastic necklace should be the first thing that people notice.
CELEB STYLE
A white tuxedo jacket is a timeless classic. Channel your inner Olivia Palermo and add a silk vest top, some black skinnies, a clutch and some killer heels. Then go forth and be glamorous.
PARTY TIME
A maxi dress and cropped leather jacket. A long-sleeved jumpsuit with killer heels. A sequin jacket with jeans and peep-toe boots because it is always possible to be flaky and fabulous!
PATTERN NOT PLAIN
Plain chiffon will not camouflage the plaques on your skin, no matter how dark the colour. It will only conceal it if it is patterned.
EQUESTRIAN STYLE
For a truly stylish look, you can’t beat a flat riding boot, jeggings and blazer. Jegging material tends to be softer to wear than denim, while flat boots are a blessing should feet be a problem area.
SPARKLE THIS PARTY SEASON
For the party season, invest in some sequins tops or dresses. Flakes simply slide off them.
HANDS UP
Buy some fabulous brightly coloured gloves to keep your hands warm during the colder months, as the cold can have an adverse effect on psoriasis, so make sure you stay well covered.
Leaving a trail of flakes? Conscious of plaques on your arms or elbows – or of your scalp shedding and “snowing” on your shoulders? Those can be the experiences of the two people in every 100 in Ireland who have psoriasis, the condition that involves skin cells reproducing too quickly in some areas of the body.
A recent global survey showed that living with psoriasis has a significant impact on the lives of those with the condition.
Almost eight in 10 experienced discrimination or humiliation due to psoriasis, the Clear About Psoriasis research found. Callous comments included some people being asked if they are “contagious”.
TREATMENTs
So what are the standard treatments available at present for mild to severe psoriasis?
Dr Nicola Ralph is a consultant dermatologist based in the Mater Hospital, and she says that finding the right doctor and treatment is an important part of managing this skin disease. “Nobody should feel they have to settle,” she says.
Dermatologists generally see patients who have moderate to severe psoriasis, and treatment plans are very much tailormade. “Many health factors have to be taken into account before treatments are prescribed, so the initial consultation is very important.
“Psoriasis is difficult to manage, and the drugs now available for it are fantastic, but you have to balance it with the person who might have some kidney disease because they have high blood pressure, for example, so it’s a bit complicated,” she explains.
People who come to her are sick of using creams to manage their psoriasis, she says, and many have been doing that for a couple of decades.
“Creams will work for a while, but within three or four days of stopping, the scale will build back up again, so they’re back to square one. They are usually looking for longer-term treatment, like phototherapy or medication,” she finds.
CREAMS
Following the usage advice given is key with creams, but not easy to achieve. “Everyone has a busy life, and some of the creams we would use for psoriasis are tar-based. They smell of tar and ruin your clothes and sheets, so that’s going to reduce compliance.
“It’s a catch-22 situation: you’re trying to get someone on treatment, but if they don’t use what’s prescribed they are not going to get any better,” explains the doctor.
Moisturisers are also important to hydrate the skin and ameliorate the symptoms of the discomfort, as 70% of people with psoriasis report itch with it.
“Steroid creams are stronger and shouldn’t be applied all over the body on a long-term basis, because they can thin your skin,” Dr Ralph says.
“We would often make up compounded mixtures for the body involving tar, to reduce the scale, and urea, which softens the skin.
“Vitamin D analogue creams are another option. You put these on the plaques. There is a plain and steroid combination version of these,” she says.
“These creams work by trying to stop the cell turnover. “With psoriasis, skin on the areas where you have plaques is turning over every three to four days, rather than following the normal 28-day cycle. That’s why the thick scale appears. These treatments are aimed at slowing down that process.”
PHOTOTHERAPY
This treatment is only suitable for people who can attend the hospital two to three times a week. “It’s a big commitment, going on for six to 10 weeks, so a large portion of your life is taken up with going to the hospital each day on an outpatient basis,” she says.
“This light treatment may also only offer a temporary reprieve. “Some people get months or years, while some only get weeks – but it is a very safe form of treatment and can be used on pregnant patients or on those who have had transplants,” she says.
TABLETs
There are about five tablets in this systemic agent bracket of medication, she says. “They are all slightly different, but the majority work by suppressing your immune system slightly.
“They can have side effects, like nausea, and can affect blood pressure or kidney function, so they all require blood monitoring. One type can only be used in post-menopausal women, and another can affect fertility in men, so treatment has to be tailored to the person.”
BIOLOGICS
Treatments that are given by injection or infusion (via a drip) are known as biologics. “We have four injections on the market at the moment that you can administer at home. There is also a hospital infusion available,” explains Dr Ralph.
“Blood tests are done regularly if a person is using this kind medication, and biologics are generally used if other treatments haven’t worked. “We wouldn’t usually jump from phototherapy to injection treatment unless the patient has bad joint disease,” she says.
“That’s in order to prevent further joint damage, as it’s irreversible.”
OBESITY effect
Obesity can go hand in hand with psoriasis. “Basically, the hormones you produce and hold on to when you are overweight drive the psoriasis. No matter how much of the biologic treatment we give you, if you’re very heavy we can only clear your psoriasis so much.”
It is only in the last five years that it has been discovered that psoriasis is deeper than a skin disease, she adds. “We now know that it affects your artery lining. It’s a systemic inflammation, which puts you at increased risk of heart attack, stroke and diabetes when you’ve got moderate to severe symptoms.”
TIPS
Dr Ralph has these tips to help manage your psoriasis better:
• Lose weight to get the maximum benefit from treatments.• Exercise regularly to reduce stress. Psoriasis is driven by stress. It can flare when you are under stress even if you are on medication.• Avoid excess alcohol, as it makes psoriasis worse.• Don’t smoke. • Learn relaxation techniques like mindfulness, meditation and use along with exercise.• Keep a diary to identify triggers. • Try CBT (cognitive behavioural therapy) to help relieve anxiety around having psoriasis.CBT CAN HELP
Dr Ralph finds that a lot of patients with psoriasis have high levels of anxiety. “They are worried about the future,” she says.
“Even if the drug is working they ask: ‘What if it stops working?’; ‘What if my doctor decides to stop my drug?’; ‘What if I go back to looking the way I did five years ago?’; ‘What if the Government stops paying for it?’
“Anxiety levels can be out of proportion compared to age-matched population. Often cognitive behavioural therapy (CBT) can help to try and change their way of thinking, thereby reducing anxiety,” recommends Dr Ralph.
>> Style tips for sufferers
As anyone who has the condition knows, psoriasis can be worse at some times than at others. Stress can aggravate it and it may or it may not even itch. But it is nothing to be ashamed of, and useful tips can go a long way to helping.
Helen Hanrahan of www.TheFlakyFashionista.com, who has psoriasis herself, has these tips that may help on the clothes and presentation front:
AVOID THE DARK SIDE
White, taupe, camel, pale grey and cream are perfect colours to wear on your top half if you suffer from scalp psoriasis. Falling flakes are instantly invisible. Remember: black is not your friend on the top half.
CLASSIC CAMEL
Camel colour never dates, flatters almost everyone and conceals psoriasis flakes. Invest in a camel blazer, coat or jacket for a wardrobe staple that always works.
IT’S IN THE DETAILS
Draw the eye away from your skin with clever accessorising. A leopard clutch; a brightly coloured tote; a blanket scarf; a jaunty fedora, a cocktail ring or a bling-tastic necklace should be the first thing that people notice.
CELEB STYLE
A white tuxedo jacket is a timeless classic. Channel your inner Olivia Palermo and add a silk vest top, some black skinnies, a clutch and some killer heels. Then go forth and be glamorous.
PARTY TIME
A maxi dress and cropped leather jacket. A long-sleeved jumpsuit with killer heels. A sequin jacket with jeans and peep-toe boots because it is always possible to be flaky and fabulous!
PATTERN NOT PLAIN
Plain chiffon will not camouflage the plaques on your skin, no matter how dark the colour. It will only conceal it if it is patterned.
EQUESTRIAN STYLE
For a truly stylish look, you can’t beat a flat riding boot, jeggings and blazer. Jegging material tends to be softer to wear than denim, while flat boots are a blessing should feet be a problem area.
SPARKLE THIS PARTY SEASON
For the party season, invest in some sequins tops or dresses. Flakes simply slide off them.
HANDS UP
Buy some fabulous brightly coloured gloves to keep your hands warm during the colder months, as the cold can have an adverse effect on psoriasis, so make sure you stay well covered.
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