SKIN CONDITIONS


pSorIaSIS


cUrrEntlY affEctIng Up to thrEE pEr cEnt of thE UK popUlatIon, pSorIaSIS IS an InflammatorY SKIn DISEaSE that tYpIcallY folloWS a rElapSIng anD rEmIttIng coUrSE. tImothY mcclUrE taKES a cloSEr looK at thIS DIStrESSIng conDItIon… by timothy mcclure


psoriasis is characterised by scaly skin lesions which can be in the form of patches, papules or plaques. Itch is often a feature.2


psychological and


social effects are common and can be profound, though these effects are not necessarily related to the severity of skin involvement.


patients should be given reassurance about psoriasis’ benign, non- contagious nature. It should be emphasised that the condition is chronic and long-term with periods of remission and relapse.1,2


although


there is no cure, it is important to remember that psoriasis can be managed and, with the right treatment and advice, the impact on quality of life can be minimised.


psoriasis can present at any age, but is more likely to first present between fifteen years and 30 years of age. It is uncommon in children, with a prevalence of under one per cent in most studies. While men and women are equally affected, psoriasis is more common in caucasians.2,3


the skin lesions of psoriasis are a consequence of hyperproliferation of the epidermis. Subsequently, the body can take just a few days to replace skin - a process that normally takes around 28 days. this accumulation of skin cells builds up to form raised psoriatic plaques on the skin. psoriasis is also associated with dilation and proliferation of blood vessels in the dermis layer of the skin. In addition, inflammatory cells (particularly neutrophils and t- lymphocytes) increase in number.1,2 the cause of increased cell turnover


38 - pharmacY In focUS


and skin inflammation in psoriasis is not known. genetic factors appear to be involved with around one third of sufferers having a close relative also affected. Several factors are however believed to affect the onset or exacerbation of the disease.


these include: • Streptococcal throat infection • Drugs (examples include lithium, beta-blockers, antimalarials, nonsteroidal anti-inflammatories and angiotensin-converting enzyme inhibitors)


• trauma (known as the Koebner reaction, the development of psoriatic plaques can follow injury to the skin seven to fourteen days post trauma)


• Sunlight (though beneficial in most cases), may exacerbate psoriasis in a small number of people


• psychological stress • post-partum hormonal changes • Smoking • Excessive alcohol intake1,3,5


there are different types of psoriasis:


chronIc plaQUE pSorIaSIS chronic plaque psoriasis (including scalp, flexural psoriasis) is the most common form affecting 80-90 per cent of people with psoriasis. psoriatic plaques are distinctively raised, red in colour, irregular to oval in shape, one to several centimeters in size and are well defined, with sharply demarcated boundaries.


the plaques typically have a dry, thin, silvery-white scale on top. plaques can occur anywhere on the body, but are most often located over the elbows and knees, on the scalp, and lower back. Smaller plaques, especially in


the leg and sacral regions, may coalesce into larger lesions. the face is rarely affected. chronic plaque psoriasis is often itchy but does not usually cause excessive discomfort.1,2


around 50 per cent of those with chronic plaque psoriasis affecting their body will also have psoriasis affecting their scalp; however, it may occur alone in some people. leading to hair loss in severe cases, scalp psoriasis may affect the whole scalp or just a partial area.


pUStUlar pSorIaSIS the second most common form of psoriasis is pustular psoriasis. typically affecting only the palms of the hands or soles of the feet, this form of psoriasis is characterised by patches of very red or dark skin, covered with small yellow/brown pustules. the fluid within the pustules does not contain bacteria and is not contagious. the skin around the pustules is often thick, flaky and prone to cracking.


consequently pustular psoriasis can be painful, making the use the hands or walking difficult. pustular psoriasis localised to the palms and soles is more common in women than in men (ratio of 9:1) and although it can present at any age, it usually occurs in the fourth or fifth decade of life.1,2


generalised pustular psoriasis is relatively rare but is a serious condition and requires urgent medical attention. It presents with rapidly developing widespread redness, followed by the eruption of small pustules on any part of the body. the skin often feels hot to the touch and may be sore, tender or itchy. Systemic illness often occurs. the precise cause


of generalised pustular psoriasis is unknown, but potential triggers are thought to include sudden withdrawal of steroids, infection, certain medications or exposure to ultraviolet light.1


naIl pSorIaSIS nail psoriasis can affect up to fifty per cent of patients with psoriasis. although commonly seen alongside skin psoriasis, nail psoriasis can occur alone and may go through phases of exacerbation. Signs and symptoms can occur on either fingernails, toenails or both.


nail psoriasis can be easy to misdiagnose as a fungal infection as many of the signs are similar. an affected nail will generally lose its natural shape and feel, with pitting occurring across the surface. Yellow/orange discolouration, nail thickening and onycholosis (detachment from the nail bed) are also common features. In moderate to severe cases, nail psoriasis can be painful, making the use of hands and feet difficult.1,2


gUttatE pSorIaSIS owing to its small (<1cm) round or oval plaques, guttate psoriasis is also referred to as ‘drop’ psoriasis. guttate plaques are often bright pink or red on fair skin types. Some fine scaling may also be present.1


plaques are


widespread, usually occurring in large numbers across the torso, back and proximal limbs. lesions can also occur on the face, ears and scalp, but it is rarely seen on the soles of the feet.2


guttate psoriasis can occur at any age, but is more common in children and adults younger than 30 years of


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