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Psoriasis

What can cure psoriasis?
Psoriasis can’t actually be cured as it’s is a chronic inflammatory skin condition triggered by the immune system. It’s a permanent skin condition but it is not infectious.
However psoriasis can be managed and controlled through medications, creams and lifestyle factors.
Psoriasis effects approximately 2% of the population and is usually inherited from a parent or grandparent, although not always. It can also be triggered by physical or mental trauma such as infection, disease, injury, pregnancy, medications or weight gain or loss or grief, anxiety or stress.
80% of those affected by psoriasis have mild-to-moderate symptoms of the condition that can be treated and controlled with ointments applied to the skin.
The remaining 20% of those with severe psoriasis usually require other therapies and medications to control flare ups.

What happens to skin affected by psoriasis?
The skin of a psoriasis sufferer in working in overdrive. The skin cell replacement process speeds up in patches of skin effected by psoriasis, taking just a few days to replace skin cells that usually take 21-28 days.
The extra skin cells produced by the speeded up turnover of skin cells accumulate on the skin’s surface causing silvery red plaques on light coloured skin and darker silvery patches on darker skins. These patches are often itchy and very dry and can appear anywhere on the body.
The condition may stay in one area of the body or spread to several areas. It can also spread into the bones, causing a condition called psoriatic arthritis. It can also spread into the eyes and nails.

What is the first step to take after psoriasis develops?
An immediate diagnosis is critical for early intervention and treatment before the condition has the chance to spread or intensify.
It’s important to see a dermatologist and not just your local doctor to get an accurate diagnosis. The wrong diagnosis can lead to more severe problems down the line as treatments for psoriasis are very specific.

Treatments
Moisturisers
Psoriasis is a dry skin condition so the regular use of creams that help intensely moisturise skin can hugely help minimise the discomfort of the condition as well as reduce some secondary symptoms.
Skin that is less dry is also more receptive to topical treatments applied to treat the psoriasis.
In addition keeping the skin of effected areas well moisturised reduces the risk of cracking or splitting. Any form of cracking, flaking  or ‘opening up’ of the skin puts the skin at much greater risk of infection from bacteria and pollutants which can inflame skin and make the problem worse.
Highly moisturising creams with as few chemical ingredients in as possible and formulated for very sensitive skin are the best.

Vitamin D skin products
There is good evidence to suggest that applying vitamin D treatments to the skin can counter act the accelerated rate of growth of psoriatic skin cells by speeding up the growth of ‘normal’ skin cells to help strengthen healthy skin.
The three main vitamin D treatments used for psoriasis are Calcitriol, Calcipotriol and Tacalcitol. The good thing about vitamin D treatments is that they are not steroids and so can be used regularly without fear of side effects.

Vitamin A treatments
Tazarotene is a vitamin A treatment for psoriasis which may be used for up to 12 weeks and must only be applied to affected areas of skin and never on the face. This treatment can make skin extra sensitive so skin should be kept out of the sun during treatment.
A prescribed systematic vitamin A treatment for more sever forms of psoriasis is Acitretin, which classed as a retinoid. It helps slow down the rapid growth of skin cells, and calms inflammation. It is taken in tablet form and often used in combination with other treatments and UV therapy.
Side effects are that it can cause birth defects and so women taking it should use safe contraception during treatment and up to two years after treatment has stopped.

Coal Tar products
Products containing coal tar have been shown to be beneficial to helping minimise psoriasis symptoms. They are mostly used in scalp and bath products.
Some products can be bought in the pharmacy while others are on prescription. The main drawback to coal tar treatments are their messiness to use and their unpleasant smell.

Topical steroids
Topical steroids are available only on prescription and are applied directly to the affected skin. They can help bring down inflammation and slow down skin cell production in psoriasis effected skin.
However they are not recommended for long-term or regularly repeated use and so can only be used during flare ups. The skin can also build up a tolerance to steroids and so they may become less effective over time if over-used.

Dithranol
Dithranol is a Hydroxyanthrone, is an anthracene derivative, and is a prescribed cream to be applied to skin significantly affected by psoriasis. It can be harmful to healthy skin so needs to be applied with care and cannot be used on the face or genital area.

Sunbeds, sunlamps and natural sunshine
Ultraviolet light reduces inflammation in the skin and therefore can be effective for psoriasis. But only UVB light is beneficial to psoriasis
The sun is a natural source of UVB light but exposure must be controlled and in small regular doses as the sun also contains other ineffective rays which can damage healthy skin.
Using a sun bed or UV lamp is not advisable as the light from a sunbed or lamp is broad spectrum (mostly UVA) and so is largely ineffective for psoriasis and can do harm to healthy skin.

UVB treatment
Narrowband UVB is used to treat persistent psoriasis that is severe and has not responded to topical treatments.
UVB therapy is administered at a hospital or dermatology clinic where the dosage of light therapy is tightly controlled and monitored. Several sessions over a protracted period are required for any positive effects.

PUVA treatment
PUVA is a combination of UVA light and a plant chemical called psoralen and is administered at a hospital or clinic. UVA is not beneficial in treating psoriasis on its own; instead it must be combined with psoralen to makes the skin more sensitive to the UVA light. Some people experience nausea when taking psoralen orally.
PUVA can be more successful on thicker plaques of psoriasis than UVB, as the UVA is absorbed deeper in the skin. Treatment is given over a 6-8 week period.

Immune suppressant systematic treatments for Psoriasis
Immune suppressant treatments can help slow down the turn-over of skin cells and reduce inflammation and are usually in tablet form or can be injected.
They are for more severe forms of psoriasis where most other forms of treatments have become ineffective. Some Immune suppressant treatments can also be used to treat psoriatic arthritis, such as methotrexate.
Liver damage is a risk of regular usage of Immune suppressant medications and needs to be monitored carefully and side effects are common and can include nausea and sickness, diarrhoea, mouth ulcers, skin rashes and hair loss. With a lowered immunity, you are also more at risk of colds and flu while on Immune suppressant medications.


Enzyme blockers
Enzyme blockers are a relatively new treatment for psoriasis and work by blocking enzymes that trigger the inflammatory response in skin cells. Currently the only enzyme blocking treatment available on the NHS is Otezla, which is a tablet that needs to be taken daily. It’s only available in Scotland but may soon be more widely available across the UK.

Herbal Remedies for Psoriasis
The most helpful and widely studied herbal remedies for the treatment for psoriasis are those which contain plant steroids, which can act in a similar way to chemical steroids but with fewer negative side effects.
Oregon Grape Root (Mahonia aquifolium) is a plant extract which has been widely studied for its positive effect on psoriasis.
Oregon grape root is a native plant of North America and has been extensively examined as a treatment for psoriasis in several published studies. These studies have found that compounds isolated from extracts of OGR have shown some level of inhibitory activity against Lipoxygenase (an enzyme involved in psoriatic skin cell production).

Lifestyle factors that can effect psoriasis
Smoking
Numerous studies have confirmed a link between smoking to an increased risk and more persistent and severe forms of psoriasis.

Obesity
Studies confirm that obesity raises the risk of psoriasis ad also exacerbates symptoms.

Stress
High levels of stress are linked to a greater risk of psoriasis.

What’s in the future for the treatment of psoriasis?

Biologic treatments for psoriasis
Biological medications are those made from living or animal proteins that mimic human molecules and target specific areas of the body. A number of different biologics have already been approved for use in the UK but are still in the process of being investigated and trialled for their long term effects.
For more information on how to trial a biologics treatment contact the British Association of Dermatologists Biologics Intervention Register (BADBIR).

Tacrolimus
Tacrolimus is a new immune suppressant medication currently being trialled for the treatment of psoriasis as a safer and more effective replacement for cyclosporine.

Oral PDE4 inhibitors
Phosphodiesterase 4 (PDE4) Inhibitors supress the immune system in a more targeted way than more general systematic immune suppressants and are currently being investigated for the treatment of psoriasis.
One PDE4 inhibitor currently under investigation for psoriasis is Apremilast, which is in Phase 3 efficacy studies on over 800 people.

Topical PDE4 Inhibitors
Due to the side effects of orally administered immune suppressants, even more targeted ones, a topical form (ointment) that contains a PDE4 inhibitor is currently in development for the treatment of psoriasis. The ointment, developed by pharmaceutical company Anacor, has completed Phase 2 trials on 145 people and is about to start Phase 3 trials.

Helpful links

www.psoriasis-association.org.uk
www.papaa.org
www.talkpsoriasis.org
www.badbir.org