health articles Psoriasis
Psoriasis is a skin condition in which the skin is thickened with itchy, red, scaly plaques. It is caused by chronic inflammation and most commonly affects the trunk and the knees, elbows and scalp.
Psoriasis can be scratchy, flaky and unsightly. If your psoriasis is interrupting your sleep or affecting your quality of life, the experienced doctors at Virtually Healthcare can provide expert advice, support and treatment to ease itching, reduce the area of skin affected, and prevent your psoriasis flaring-up 1.
Psoriasis Care at Virtually Healthcare
Virtually Healthcare has a dermatology team made up of GPs with a particular interest in skin conditions and a consultant dermatologist. In our virtual Dermatology Clinic, you can speak with our GP, upload photographs of your skin and have a video examination. If medication is recommended, your doctor will send your NHS prescription to a pharmacy of your choice.
If your psoriasis needs expert review, the GP can refer to our in-house consultant dermatologist or refer to a hospital team for further treatment.
The Virtually Healthcare difference
Virtually Healthcare is an innovative GP practice, providing expert care in the comfort, safety and privacy of your home. The Virtually Healthcare service is designed to fit with modern lives. Consultations are easy to access, discreet and convenient, with virtual appointments available seven days a week.
The highly-skilled team includes more than 40 clinicians working together to investigate and treat disease and help you optimise your health and wellbeing. As well as experienced GPs, the team includes sexual health specialists, physiotherapists and practice nurses to offer a comprehensive primary care service.
During the pandemic, many patients are finding it more difficult to access healthcare. Virtually Healthcare provides rapid access video or telephone appointments, with consultations available the same day if you contact us before 3 pm. Our clinicians can provide professional assessment and advice, arrange investigations, prescribe treatment or arrange for a face-to-face review.
Can psoriasis be diagnosed remotely?
Skin specialists can usually diagnose psoriasis from a photo or a video consultation. If your skin is causing you problems and you are worried that you may have psoriasis, Virtually Healthcare can help. Please take photos of your skin and make an appointment at our Dermatology Clinic for expert skin analysis and advice.
What is psoriasis?
Psoriasis affects around one in 50 people. It is an inflammatory skin condition that causes red scaly plaques to develop across the body, but mainly on the scalp, the trunk, the outside of the elbows and the fronts of the knees.
How do I know if I’ve got psoriasis?
Psoriasis causes a typical rash. Look out for:
- Symmetrically placed red, scaly plaques.
- The plaques have well-defined edges.
- The surface scales are usually silvery-white, but the surface might be shiny and moist in the skin folds.
- The scalp, trunk, elbow and knees are more commonly affected.
- The skin may be thickened.
- There may be scratch marks and cracks if the skin is thickened and itchy.
- As the plaques heal, they may leave areas of skin discolouration, which take months to fade. However, psoriasis doesn’t leave scars.
- Scalp psoriasis can cause severe dandruff that is difficult to clear.
- If psoriasis affects the nails, it can cause pitting, ridging and lifting of the nail plate. 2
Causes and Treatment What causes psoriasis?
Psoriasis is believed to develop as a result of many factors. It can run in families, with one in three patients having family members also affected by the condition. Psoriasis can develop at any age. However, the onset is most commonly in people between 15 and 25 years or in their fifties.
Psoriasis tends to come and go in cycles, sometimes flaring up for weeks or months, then settling down for a time. Stress, excess alcohol, steroid withdrawal and infections can trigger flare-ups in some people. Sometimes a type of psoriasis (guttate psoriasis) can develop over the trunk following a streptococcal throat infection.
When to see a doctor
Make an appointment with one of the doctors at Virtually Healthcare if you are struggling to control your psoriasis if it stops you from sleeping or reducing your quality of life.
If the skin is weeping, you’ve noticed increased redness and inflammation, or if there’s crusting or pus, you should have a prompt medical review. There may be a skin infection that needs antibiotic or antiviral treatment.
Psoriasis treatment
The doctors at Virtually Healthcare can provide the latest evidence-based advice, treatment for people living with psoriasis.
Phototherapy
A type of light therapy in which your skin is exposed to ultraviolet light. It is sometimes used in combination with dithranol or coal tar.
How to cure psoriasis
There is no cure for psoriasis. It usually persists for life. However, there are effective treatments. The doctors at Virtually Healthcare will support you in controlling your psoriasis, identifying any triggers, and reducing the risk of flare-ups.
Topical creams, ointments and shampoos
These are usually the first treatments introduced and can control psoriasis in many people. The doctors at Virtually Healthcare prescribe topical treatments according to the NICE guidelines and refer you to a hospital dermatology team for phototherapy or systemic medication. Topical treatments include:
- Emollients: Emollients are moisturisers that form a protective layer over the skin surface, trapping in water and moisturising the skin cells. They can decrease itching and scaling.
- Steroid creams and ointments: If the skin is very inflamed or thickened, your doctor may prescribe steroids to get the inflammation under control. These can be potent products with significant side-effects, so you should only apply them under medical supervision. Too much use can thin the skin and make the psoriasis rebound when you discontinue treatment.
- Vitamin D analogues: Creams such as calcipotriol and calcitriol slow down skin cell production and reduce inflammation. They can be effective in mild and moderate psoriasis, reducing the need for steroid use.
- Vitamin A analogue: Tazarotene is a gel that can reduce scaling. However, it can cause irritation if used on large areas. You should avoid using it during pregnancy or while breastfeeding.
- Calcineurin inhibitors: These creams reduce immune activity and decrease inflammation. They are particularly useful in the treatment of the scalp and sensitive areas like the armpits, groin and genitals.
- Coal tar: Coal tar has been a traditional remedy for psoriasis, and it still has a role. It’s a thick oil that eases inflammation, reduces scaling and decreases itching. It is, however, a little messy and difficult to use because it stains clothing. Many patients find coal tar shampoo helpful for scalp psoriasis.
- Dithranol: Another longstanding treatment for psoriasis that is still in use. It reduces skin cell production. It can be rather messy and difficult to use because it stains skin, clothing and bedding. As a result, it is usually applied in hospital and washed off after a set time (generally less than an hour). 3
Medications
Oral and injected medications are used for many people with uncontrolled or severe psoriasis. A hospital team will usually prescribe them, but we will list them for your information. You can find out more from the British Association of Dermatology.
- Non-biologic oral medications: Methotrexate, Ciclosporin, Acitretin and newer anti-inflammatory drugs like apremilast and dimethyl fumarate.
- Biologic medications: These are given by injection or infusion and reduce inflammation by decreasing the action of overactive immune cells. They include etanercept, adalimumab, infliximab and ustekinumab.
Can a dermatologist or a GP prescribe medication remotely?
Both the GPs and the consultant dermatologists at Virtually Healthcare can prescribe medication remotely. They will send your NHS prescription to a pharmacy of your choice so that you can collect it at your convenience.
Hot topics Hot topics in psoriasis
One of Virtually Healthcare’s GPs, with a particular interest in dermatology and skin health, reports on the questions and concerns that they are currently seeing in their consultations so that you can learn more about your condition and how to manage it.
Diet and psoriasis
More of our patients are interested in self-help and controlling chronic conditions with diet and lifestyle. Diet won’t cure psoriasis, and we wouldn’t recommend stopping treatment immediately, but using nutrition and treatments together may help protect against flare-ups.
One study found that people who followed a Mediterranean diet rich in fresh produce, lean protein and healthy fats suffered fewer flare-ups 6 . More research is needed, but the Mediterranean diet contains many foods that appear to have anti-inflammatory properties. It’s also thought to be protective against cardiovascular disease and dementia, so definitely worth considering.
Stress and psoriasis
During the current pandemic, our doctors are seeing more people affected by stress and anxiety. Stress can trigger a psoriasis flare. Although stress can also be a result of the symptoms of psoriasis, the National Psoriasis Foundation say that psoriasis is independently associated with stress-related disorders. 4
In a review of the scientific research, between 31 and 88% of people with psoriasis said that stress triggered a flare-up. Those who had a stressful life event in the previous year had a higher incidence of the skin condition8.
The negative impact of stress on the skin makes it vital to consider stress-management as a critical part of your psoriasis treatment. Studies have shown that relaxation techniques, hypnosis, biofeedback, and cognitive behavioural therapy can all be effective for patients living with psoriasis 5 . Our doctors use a holistic approach to patient care and can provide individual advice and support.
Find out more:
British Association of Dermatology.
https://www.nhs.uk/conditions/psoriasis/treatment/
NICE guidelines
Types of consultations we offer
We offer written, telephone and video consultations with a range of male and female clinicians from GPs, nurse practitioners, and primary care specialists such as physiotherapy.
Telephone
Video
Written