Psoriasis

• Chronic Nature: Psoriasis is a long-term condition that can flare up periodically.
• Immune-mediated: It is believed to be caused by over-activity of particular parts of the immune system.
• Inflammatory: Psoriasis causes areas of the skin to become inflamed and scaly due to an overproduction of skin cells.
• Varied Severity: The severity of psoriasis can range from mild, with a few small patches, to severe, where large areas of the body are affected.
• Chronic Plaque Psoriasis: The most common form of psoriasis is chronic plaque psoriasis, characterized by well-demarcated plaques covered with thick silvery scales. These raised skin patches often appear on areas such as the elbows, knees and scalp. The presentation can vary among different ethnic groups. Psoriasis can have a significant impact on mental health and is associated with a risk of other health conditions.

There are many treatments available for psoriasis, aimed at reducing symptoms and preventing flare-ups. Topical treatment options, such as corticosteroids, vitamin D analogues, and coal tar, are commonly used for managing mild disease. Additionally, ultraviolet light therapy, sometimes combined with medications like psoralen, can help to reduce inflammation in the skin and slow down skin cell turnover. Here is an overview of common psoriasis treatments:

Topical Treatments

• Corticosteroids: Reduce inflammation and relieve itching. Keeping the skin well moisturised is crucial, especially during colder weather, as it helps alleviate symptoms and prevent flare-ups.
• Vitamin D Analogues: Slow down the growth of skin cells.
• Coal Tar products: Reduces scaling, itching, and inflammation.

Oral Medications

• Methotrexate: Modulates the immune system to reduce inflammation and improve psoriasis symptoms. Regular monitoring of liver function and blood counts is essential, as methotrexate can potentially affect the liver and bone marrow.
• Ciclosporin: An immunosuppressant that reduces immune activity and inflammation, used for severe or rapidly worsening psoriasis. Kidney function and blood pressure need regular monitoring.
• Acitretin: An oral retinoid that normalizes skin cell production, helping to control thick, scaly plaques. Liver function and cholesterol levels should be monitored. It is teratogenic and is not suitable as a psoriasis treatment for people who could become pregnant.

Biologics

• TNF-alpha inhibitors: These medicines target specific parts of the immune system to reduce inflammation and improve psoriasis symptoms. As with other biologics, they are usually considered when psoriasis is moderate to severe.
• IL-17 inhibitors: These drugs block a protein called IL-17, which plays a key role in the inflammation that causes psoriasis.
• IL-23 inhibitors: These treatments target IL-23, another protein that drives inflammation, helping to control symptoms and prevent flare-ups.

Phototherapy

• UVB Phototherapy: Narrow band UVB phototherapy uses a narrow band of ultraviolet B light to help reduce inflammation in the skin and slow down the rapid growth of skin cells. It can be effective for psoriasis on the trunk and limbs.
• PUVA: Combines a drug called psoralen with UVA light therapy to treat severe psoriasis.

Lifestyle and Home Remedies

• Moisturisers: Keeping the skin well moisturized helps reduce itching and irritation, which can improve comfort for people with psoriasis.
  Diet: Maintaining a healthy diet and avoiding triggers like alcohol and smoking can help manage symptoms.