Serie English for PTA: Psoriasis

Psoriasis affects around two percent of the general population and most often starts in young adults. The symptoms may vary between minor irritation and wide-spread patches covered with silvery scales . Furthermore, the skin disease is often visible to others and may consequently cause considerable social stress for those affected by it.

Psoriasis is a systemic disease that cannot be cured but most often treated successfully. A genetic predisposition has been shown however it is not clear why some people with the disposition get ill and others do not.

Causes and Symptoms

Psoriasis is caused by an increased and accelerated production of skin cells. While skin cells are normally replaced within three to four weeks, in psoriasis this process is shortened to three to seven days. This leads to an overabundance of cells resulting in the characteristic patches. The pathological process has not yet been completely understood but it is definitely related to a disturbance of the immune system.

There are several forms of psoriasis depending on where the patches are located and which symptoms occur. About 20 to 30 percent of the patients also have psoriatic arthritis and in 70 to 80 percent of the cases there are symptoms affecting the finger and toe nails.

General Treatment

In most cases, the first treatment used will be topical treatment, such as vitamin D3 analogues or topical corticosteroids. Moreover, phototherapy may be used, in other words: exposing the skin to certain types of ultraviolet light. In severe cases, where the above forms of treatment are insufficient , systemic treatment may be administered. This consists of oral or injected medicines that work throughout the whole body. It is often necessary to apply a combination of different types of treatment.

Topical Treatment

Steroids for external use are commonly used to treat mild to moderate psoriasis in most areas of the body. The treatment works by reducing inflammation. It slows the production of skin cells and minimizes itching . Topical corticosteroids range in strength from mild to very strong in the classes I to IV. They are applied once or twice a day during the first three weeks, then their use is gradually reduced. Another important group of substances are the vitamin D3derivates. The substance most often used is calcipotriol. Theaccelerated growth of the skin cells is slowed down and photosensitivity increased, which leads to an improvement in phototherapy.

The third group of substances used in topical treatment are the calcineurin inhibitors, such as tacrolimus and pimecrolimus. These interfere with the immune system by slowing down its activity thereby reducing inflammation. These medications can cause skin irritation or a burning and itching sensation when they’re started, but it usually improves within a week. This information is often helpful for the patients.

The Base: Consistent Skin Care

Most important for a long-lasting improvement of the skin condition is thorough and adequate skin care using suitable formulas. Besides the basic foundation these products often contain urea and salicylic acid. The pharmaceutical team can support patients by recommending appropriate creams, ointments or lotions depending on the individual stage of disease and the time of the year.

Jane Funke ist geborene Britin und erstellt als Native Speaker gemeinsam mit Apothekerin Hannelore Gießen seit vielen Jahren die Serie „English for PTA“, die sich mit klassischen OTC-Themen befasst.

Dialogue

Customer: Good afternoon, I’d like some cream for my elbow. It’s dry, itchy and scaly. My scalp is itchy too. I have often had dry itchy skin but having recently read an article about it, I am now a bit worried that it could be psoriasis. What do you think?

PTA: Would you mind showing me?

Customer: Not at all.

PTA: Yes, the scale is silvery. You could be right. How long has it been like this?

Customer: A few weeks. Do you think some- one has passed it on ?

PTA: Psoriasis is not contagious but it does need treatment. Is there any history of skin problems in your family?

Customer: I know that my grandfather wouldn’t wear short trousers because of a skin condition. Is it hereditary ?

PTA: Research is ongoing but as yet little is known about the genetics of psoriasis. It is thought to be a multi-system disease as many patients show signs of other disorders at the same time. You should definitely arrange an appointment with a dermatologist. Do you smoke or drink?

Customer: I don’t smoke but I do like a glass of wine in the evening.

PTA: A healthy lifestyle is always advisable. Fresh fruit and vegetables, and omega-3 fatty acids may be beneficial. Alcohol and any kind of junk food are likely to trigger an attack of psoriasis.

Customer: So, what should I do?

PTA: The first thing to try is an emollient.

Customer: What’s that?

PTA: It’s a moisturiser with a soothing effect on the skin. It will coat it with a protective film to prevent dehydration and itching and scaling should be re- duced. You dot it onto the skin and then apply it with long downward strokes. This is basic proce- dure and is helpful in any case. Furthermore, it’s important to resist picking and scratching .

Customer: Okay, what will the doctor do?

PTA: Generally, psoriasis is not difficult to diagnose. A skin sample may be taken but only if the case is unclear. Other symptoms you may have, will be dis- cussed and it’s also important to check for psoriatic arthritis which affects the joints and can be very painful. Good disease control can also prevent future flare-ups .

Customer: What about my scalp?

PTA: Descaling may be necessary in order for topical treatment to work. You could try warm oil and preparations containing salicylic acid may be helpful. I would recommend that you use this until your doctor has reached a diagnosis.

Customer: That’s been very helpful. Could you show me an appropriate cream and a shampoo, please?

PTA: Certainly.