What impact does psoriasis have on the skin?

Psoriasis is a complex condition that affects both the skin and the immune system. Fortunately, there are several treatment options available to manage psoriasis, from topical solutions to advanced biologics.

Dr Ravi Ramessur, Consultant Clinical-Academic Dermatologist, provides an insight into psoriasis, its impact on health, the treatments available to manage it, and the role of biologics.

What is psoriasis, and how does it affect the skin?

Psoriasis is a chronic condition that occurs when the immune system mistakenly attacks healthy skin cells, leading to inflammation and the excessive production of new skin cells.

Normally, skin cells grow and shed in a cycle that lasts about a month, but in people with psoriasis this process is accelerated, and skin cells are produced and shed within a few days. The rapid turnover causes the accumulation of skin cells, forming thick, raised, red patches covered with silvery-white scales.

These patches, known as plaques, can appear anywhere on the body, but they are most commonly found on the scalp, elbows, knees, and lower back. The affected areas can vary in size and may be itchy, sore, or even cracked. Some people experience only a few small patches, while others may have widespread plaques covering large areas of the body.

Psoriasis also tends to appear in flare-ups, where symptoms worsen for a period before improving or going into remission. During flare-ups, the plaques can be itchy, painful, and even crack or bleed, further complicating the condition.

Is psoriasis related to other health conditions?

Yes, psoriasis isn’t only a skin condition; it’s also associated with several other health conditions. One of the most common associations is with psoriatic arthritic, a form of arthritis that causes inflammation, pain, and swelling in the joints. It affects up to 30% of people with psoriasis and can lead to permanent joint damage if left untreated.

Another potential complication is an increased risk of cardiovascular disease, hypertension, and stroke. The chronic inflammation associated with psoriasis is thought to contribute to the development of atherosclerosis, raising the risk of cardiovascular issues.

In addition, people with psoriasis are more likely to experience mental health conditions, including depression and anxiety. The visible nature of psoriasis, along with the discomfort it causes, can lead to significant emotional distress. The impact on self-esteem and body image is particularly significant in severe cases.

Lastly, research also suggests a potential connection between psoriasis and metabolic syndrome, which includes obesity, type 2 diabetes, and high cholesterol. The link between these conditions is likely due to the systemic inflammation that occurs in both psoriasis and metabolic syndrome.

What treatments are available for psoriasis?

There is currently no cure for psoriasis, but there are several treatment options that can help control symptoms and reduce flare-ups.

Topical treatments

Topical treatments are the first line of treatment for mild to moderate psoriasis. Corticosteroid creams reduce inflammation and soothe irritated skin; vitamin D analogues slow down skin cell turnover and reduce inflammation; and topical retinoids manage skin cell growth and reduce scaling.

Phototherapy

Phototherapy (also known as light therapy) is an option for moderate to severe psoriasis. This treatment involves exposing the skin to controlled amounts of ultraviolet (UV) light to slow down the rapid growth of skin cells.

Systemic treatments

Systemic treatments may be necessary for severe psoriasis that don’t respond to topical treatments or phototherapy. These include oral medications like methotrexate that work throughout the body to reduce inflammation and slow down the production of skin cells. 

What are biologics, and when are they used in psoriasis treatment?

Biologics are a class of drugs made from living cells that target specific proteins involved in the immune response of psoriasis, such as tumour necrosis factor (TNF), interleukins, or T cells. By blocking these inflammatory pathways, biologics can then help reduce inflammation and slow down the overproduction of skin cells.

Common biologics used to treat psoriasis include drugs like etanercept, adalimumab, ustekinumab, and secukinumab. These medications are typically given by injection or intravenous infusion and are reserved for people with the most severe cases of psoriasis.

Biologics have shown to be highly effective in treating psoriasis, with many people experiencing significant improvement or even complete clearance of their skin plaques. However, they come with risks and potential side effects, such as an increased susceptibility to infections. For this reason, the use of biologics requires close monitoring by healthcare professionals.

To book an appointment with Dr Ravi Ramessur, head on over to his Top Doctors profile today.