Psoriasis treatment in London
Psoriasis is a common condition of the skin that affects 2 in 100 people in the UK. Both women and men are equally affected. Psoriasis is a chronic medical skin condition and tends to wax and wane in its severity. The condition cannot be transmitted from person to person and therefore is not infectious. Psoriasis does not result in an increased risk of skin scarring but there be short lived changes in the colour of the skin. Thanks to medical advances in psoriasis treatment and despite being a chronic medical condition, there are now many excellent treatment options to maintain effective control of psoriasis.
Psoriasis does not just affect the skin, it can also involve the nails and the joints. A type of the condition is known as psoriatic arthritis and this is known to exert its effects
Psoriasis can affect the nails and the joints as well as the skin. Psoriatic arthritis produces swelling and stiffness in the joints or stiffness in the lower back and should be managed by a rheumatologist who works closely with your dermatologist and/or your GP.
Psoriasis, particularly moderate to severe psoriasis, is associated with an increased risk of anxiety, depression and harmful use of alcohol. Moderate to severe psoriasis increases the risk of heart disease and stroke and treatment of psoriasis may reduce this risk. Psoriasis can also be associated with diabetes, obesity, venous thromboembolism, high cholesterol and high blood pressure. Psoriasis is also associated with inflammatory bowel disease and there is a small increased risk of skin cancer in longstanding cases of psoriasis.
Causes of psoriasis
Psoriasis is a very common dermatological condition and affects about 2% of the UK population. Although the causes of psoriasis are not exactly elucidated, it is well known that hereditary factors along with immunological factors play a key role which are often potentiated by environment triggers.
Known associations with psoriasis:
- Psoriasis tends to run in families and so there is a strong genetic influence
- Psoriasis is most commonly found in those of Caucasian extraction
- Immunological factors are thought to play a part in the development of psoriasis as hyperactive white blood cells have been shown to exert an effect on the skin cells which leads to an increase in cellular turnover and this is what gives rise to the over proliferation of skin at the sites of psoriasis
- Psoriasis is not known to have the ability to be passed between individuals – it is non-contagious
- Some patients may possess genetic code which predisposes them to develop psoriasis
Environment triggers are known for being preciptants of flare-ups of psoriasis and these include:
- Certain medications such as steroids or medicines for mental health conditions
- Disruption to skin integrity such as caused by traumatic injury
- Tobacco and alcohol intake
- Low ambient temperatures with low humidity
- Stressful lifestyle
Causes of exacerbations of psoriasis
- Infection – both bacterial and viral infections including sore throats caused by streptococcus bacteria
- Cold and dry weather conditions
- Traumatic injury to the skin – these include cuts, grazes and insect bites
- Smoking and excessive alcohol intake
- Stressful life events
- Certain medications such as steroid use or medicines used to treat mental health conditions
- Excessive sunlight exposure result in sun burn and also inadequate exposure to sunlight
Clinical features of psoriasis
Psoriasis can present in many different ways depended on the specific type of psoriasis. Some common clinical features are listed below:
- Thickened raised skin
- Silvery scaly skin over well demarcated plaques
- Scalp hair loss
- Red inflamed skin with scaly skin texture
- Skin blistering
- Nail involvement – pitted nails which in some cases lift up from the underlying nail bed
By far the most common presentation of psoriasis in over 80% of cases is plaque psoriasis in both men and women. Plaque psoriasis most commonly appears as thickened, and silvery skin in often well demarcated areas with a number of associated smaller plaques which often coalesce to form larger plaques with time. Most patients often report a great deal of itchiness arising from these psoriatic plaques, however patients should resist the urge to scratch them as this could make it worse. A number of topical agents are available to reduce the itching sensation as part of a comprehensive psoriasis treatment plan.
Less common presentation of psoriasis which comprise about 20% of cases include:
- Guttate psoriasis
- Localised pustular psoriasis
- Generalised pustular psoriasis
- Erythrodermic psoriasis
- Psoriasis affecting the nails. The nails often develop small pits and may develop discolouration. In some cases, the nail may lift up from the nail bed.
Psoriasis can also present as part of a psoriatic arthritis which may also require joint input from a rheumatologist for adequate control.
Where does psoriasis most commonly develop on the body?
Psoriasis can also be found on other areas of the body depending on the type of psoriasis and in severe cases, psoriasis can present in a diffuse widespread pattern with involvement of much of the surface of the skin.
Treatment for psoriasis
Psoriasis is a chronic skin condition which means it cannot be cured completely and often waxes and wanes in severity. Despite there not currently being a definitive cure for the condition, there are a number of effective psoriasis treatment options available for proper control of the condition.
Psoriasis Treatment options for optimal symptom control include:
- Topically applied skin creams and gels
- Targeted light-based therapies
- Systemic medications which are both orally administered and in severe cases by intravenous injection
The treatment strategy for psoriasis involves the use of topical therapy and light-based treatments for the milder forms of psoriasis with systemic medications reserved for the most severe cases of psoriasis where both topical and light treatments have proven ineffective in disease control.
At your consultation for psoriasis treatment in London, your specialist dermatologist will formulate a treatment plan for optimal management of this common skin condition.
Why have psoriasis treatment in London at Centre for Surgery?
- Improvement in symptoms
- Increased levels of confidence and ability to engage fully with activities of daily living
- Enhanced levels of emotional well-being with reduced levels of stress
How to find us
Centre for Surgery is located at 106 Crawford Street in Marylebone. Crawford Street is just off Baker Street. We are easily accessible by all major bus routes that pass through Baker Street as well as Baker Street underground station.
From the tube station, we are just a 5 minute walk southwards down Baker Street followed by a right turn onto Crawford Street. The clinic is about 200 yards on the left.
There is ample local pay & display parking in the surrounding area and an NCP car park is located further west along Crawford Street. Our local residential parking zone is the City of Westminster.
Address: 106 Crawford Street, Marylebone, London, W1H 2HY
What are the causes of psoriasis?Psoriasis is a chronic inflammatory condition of the skin and affects around 2% of the UK population. In psoriasis, the skin exhibits a hyperactive rate of cell renewal. In normal conditions, the accepted normal rate of cell renewal is about 28-30 days. This timespan is markedly reduced in psoriasis where the time period can be as short as 4-5 days. This result is a over accumulation of dead skin cells which are unable to be removed from the skin in the normal way. The resulting areas of over activity appear as well circumscribed erythematous or reddish plaques with a characteristic silver-like scale on the surface.
The psoriatic plaques exhibits a degree of symmetry in their location as well demonstrated on the backs of the elbows or front of the knees. Psoriasis can however occur on the skin surface. The nails can also be involved in psoriasis and there characteristic sign are small pits on the nail plate with detachment of the end of the nail from the nail bed beneath. Involvement of the joints can also occur and this can present as joint pain or psoriatic arthritis.
The pathogenesis of psoriasis is related to a malfunction of components of the body’s immune system. Psoriasis is not infectious and cannot be passed from person to person. The immune system component affected are the T-cells which are a type of white blood cell involved in the response to infectious or inflammatory processes such as bacterial infection or a viral infection. In psoriasis, the T-cells target the normal components of the skin and these leads to a over proliferation of new skin cells which leads to the typical clinical features. The immune system defect in the T-cell white blood cells may be genetic in origin and also be caused by environmental triggers. In many cases of psoriasis, often a parent of sibling has the condition also. The common environmental triggers include:
- Stress - this can precipitate or worsen psoriasis
- Medicines - certain prescription medication such as lithium or blood pressure medication can be associated with psoriasis
- Infection - streptococcal infection which is often associated with a sore throat can precipitate psoriasis .
- Alcohol - severe forms of psoriasis are linked with heavy alcohol intake
- Traumatic injury - psoriasis can localise to traumatic skin wounds and this is referred to as the Koebner effect.
Like eczema, psoriasis is a chronic skin condition that waxes and wanes in its severity with episodes of flare-ups followed by a period of remission. Although there is no definitive curative treatment, thanks to modern medicine, there are now more effective ways than ever to effectively control the condition.
What topical treatments are available for psoriasis?The use of topical treatments is ideal for psoriasis of mild or moderate severity and include topical agents such as gels ointments or creams. In many cases topical treatment is used to supplement more powerful acting agents for the more severe grades of psoriasis.
Examples of commonly used topical treatments include:
- Moisturisers for the relief of dry skin and to reduce itchiness and excessive skin scaling. Moisturisers are usually used as a first-line treatment options to be used alongside other treatments for psoriasis.
- The use of topical steroids is warranted four areas of skin inflammation. Most commonly topical steroid creams are used for psoriasis affecting skin creases for example on the back of the elbows or front of the knees however their use needs to be monitored as there are a number of undesirable side-effects of excessive steroid use.
- Vitamin D analogues are an effective treatment for areas of plaque psoriasis affecting the body
- Coal tar is a well known treatment for psoriasis and functions to reduce cellular activity. There are however a number of undesirable side-effects including an unpleasant aroma, and the staining of clothing. Its use is now reserved for diffuse areas of plaque psoriasis or guttate psoriasis associated with areas of skin inflammation
- Dithranol is also another well-known treatment commonly used for treating plaque psoriasis on the arms or legs. Dithranol also has the undesirable side-effects of staining clothing.
- Tacrolimus is most commonly used to treat areas of psoriasis on the knees and elbows. It can also be used to treat eczema.
Is light therapy effective for the treatment of psoriasis?Psoriasis tends to run an unpredictable course however there are a number of factors which may improve the condition. Symptoms are often less in the summer and when exposed to direct sunlight.
LED phototherapy combined with topical treatment may have positive effects on psoriasis.
Examples of phototherapy for the treatment of psoriasis:
- Ultraviolet B (narrowband)
- Psoralens combined with ultraviolet A. This Involves the prior administration of a medication with photosensitising affects which is then combined with the application of ultraviolet A phototherapy.
What treatments are available for severe psoriasis?When topical treatments or topical treatments combined with light therapy have failed to work then your dermatologist may decide to introduce systemic therapy is for psoriasis. This is usually not a first-line option as there are a number of undesirable side-effects from oral medicines or injected treatments for psoriasis.
These treatments are often used for short periods to achieve rapid disease control and then supplemented with topical treatments or phototherapy for maintenance treatment.. When you see one of our dermatologists at consultation a customised treatment plan will be designed for you.
Examples of medications which may be used for psoriasis include:
- Methotrexate taken orally
- Cyclosporin taken by mouth
- Newer biological therapies usually given intravenously
Does alcohol cause psoriasis?There is evidence to suggest that excessive alcohol consumption can precipitate the onset of psoriasis and in those who have psoriasis, it can lead to flare-ups of the condition.
However it is not always a simple case of cause and effect and psoriasis is multifactorial and can be caused by a number of potential triggers including medical conditions, environmental factors and stress.
In common with many other chronic skin conditions, it is also the case that patients who have never drunk alcohol can still develop psoriasis.
Is psoriasis hereditary?There is solid scientific proof to demonstrate that psoriasis has a genetic component and psoriasis sufferers often have a first degree relative affected by the condition. Despite this, environmental factors may play a bigger part in both the incidence and severity of the condition.
Psoriasis is a very common skin condition which affects roughly 2 to 3% of the UK population .
Is psoriasis dangerous?In most cases, psoriasis is not a serious condition when it is well controlled and remains as a mild condition. In some cases psoriasis can be serious when left untreated and this can lead to the development of generalised symptoms which can be potentially life threatening.
In all cases it is best to consult with a highly skilled dermatologist at Centre for Surgery for optimum management of your condition.
Can psoriasis be passed to other people?Psoriasis is not an acutely infectious condition with the potential of spread to other people. Psoriasis is due to an exaggerated immune system response and which does not lead to spreading of the condition between people.
Does psoriasis get better on its own?Unfortunately, psoriasis is a chronic skin condition and although symptoms may improve without any active treatment, most patients can expect occasional flareups often caused by specific factors such as cold weather.
Is there a permanent cure for psoriasis?Currently there is no permanent cure for psoriasis. Optimum disease control can occur with proactive medical treatment but the condition will not be eradicated completely.
Does psoriasis treatment give permanent results?Although effective treatment given at the right time may lead to significant improvement in symptoms, current treatment strategies are not able to lead to a permanent cure.
It is impossible to predict at the outset whether treatment for psoriasis will result in a significant improvement in symptoms.
How can I tell the difference between psoriasis and eczema?
Both psoriasis and eczema are chronic skin conditions and it can be challenging to distinguish between the two conditions.
The best approach is to consult with an expert dermatologist at Centre for Surgery who will be able to accurately diagnose your skin condition followed by the recommendation of the correct treatment.
What To Expect
The psoriasis consultation
You will be booked in to see one of our expert dermatologists at Centre for Surgery on Crawford Street for your psoriasis consultation.
The dermatologist will perform a thorough clinical examination of your skin and will discuss a number of aspects with you:
- Treatment options based on the type of psoriasis you have and what kind of results can be expected with the proposed psoriasis treatment
- What the psoriasis treatment involves including how often to apply the medication to the skin
- Review your medical history including any medicines you be taking
- Answer your questions about any aspect of the psoriasis treatment
Patient journey summary:
- Arrange a consultation at our dermatology clinic at 106 Crawford Street, Marylebone for a face to face consultation with an expert dermatologist
- Commence a course of treatment based on your needs and preferences
- Arrange a follow-up appointment if required to be seen by your dermatologist to review the effectiveness of treatment