Psoriasis may affect the individual on various levels, not only physically but also psychologically, emotionally and socially. Medical student Rebekah Camilleri points out the different manifestations of psoriasis and says that although there is no treatment that will make it go away forever, the condition can be controlled.

Most sufferers of psoriasis have plaque-like scaly patches on the skin, which may be itchy or inflamed, usually on the back, elbows, knees and scalp, although they can occur anywhere on the skin.

Knowingly or not, many of us have encountered someone who suffers from psoriasis. It can affect everyone, irrelevant of age, gender, ethnicity or social background. Indeed, psoriasis is found worldwide. Statistics show that one to three per cent of the world’s population suffer from the skin condition.

Psoriasis not only presents itself physically –it often affects the individual psychologically, emotionally and socially.

According to nurses at the Phototherapy Clinic at the Dermatology Department at Sir Paul Boffa Hospital, a large proportion of patients seeking treatment often have a negative body image.

Many sufferers seek to cover up psoriatic plaques to avoid stares and questions. Social stigma can be so debilitating that they may avoid crowds or even going out. In some people, psoriasis may also negatively affect intimate relationships.

Many patients understandably complain of numerous misconceptions regarding this skin condition, especially regarding contagiousness. The misconception that psoriasis is contagious sometimes prevents affected individuals from attending gyms, swimming pools and hairdressers, among others. In actual fact, psoriasis is not contagious at all.

The condition may appear in many ways but the commonest form is referred to as psoriasis vulgaris. Sufferers have plaque-like scaly patches on the skin, which may be itchy and inflamed, usually on the back, elbows, knees and scalp, although they can occur anywhere on the skin.

Other types of psoriasis include flexural or inverse psoriasis – that typically presents itself in folding areas, such as behind the ears, in the groin and underneath female breasts – and palmoplantar psoriasis, that affects the palms and the soles.

Many patients complain of numerous misconceptions, especially regarding contagiousness... Psoriasis is not contagious at all

Affected nails may also show changes, e.g. pitting, thickening or lifting off from the underlying nail bed.

Our skin acts as a physical barrier against the outside environment. Cellular defences in the skin maintain a very delicate balance of activation and inactivation to deal with security breaches. In psoriasis, however, this balance is lost and the skin’s defence mechanisms are abnormally over-activated. Overactivation of the immune system can result in inadvertent damage to the body’s own cells.

In psoriasis, activated T cells (a type of white blood cell) migrate to the skin and induce inflammation. This quickens the growth rate of skin cells that multiply up to 10 times faster than normal. Whereas normally it would take roughly 50 days for skin cells to be born, die, reach the surface and be shed off, in psoriatic skin plaques it only takes three to seven days.

Thus, dead skin cannot slough off quickly enough and builds up in thick scaly red plaques. This longlasting pro-inflammatory state may also affect other areas of the body. Indeed, it is estimated that about a third of psoriasis sufferers also experience inflammation of the joints (psoriatic arthritis). Psoriasis has also been correlated with cardiovascular disease.

The causes of psoriasis are most likely multi - factorial – dependent on genetic and environmental factors. Triggers of psoriasis include psychological stress, a bacterial sore throat, changes in weather, skin injuries and sunburn.

Some types of prescriptive drugs may also exacerbate psoriasis. Many patients with psoriasis note that their psoriasis clears in summer due to the immunosuppressive effect of sunlight.

Psoriatic plaques can be managed and reduced slowly using anti-inflammatory creams and ointments as prescribed by a physician. Coal-tar shampoos can also be helpful for plaques in the scalp.

More extensive psoriasis can be managed by phototherapy as is done at the Phototherapy Clinic, where skin is exposed to narrowband UVB light two to three times a week, for several weeks or months.

This usually leads to complete clearing of the exposed skin.

Other treatment options include immunosuppressive tablets. For those patients whose psoriasis is not well controlled with these tablets or with photo - therapy, newer, more expensive treatment in the form of injections or infusions may be prescribed. The results are usually successful.

It is important for patients suffering from psoriasis to know that, although there is no treatment that will make it go away forever, there are many treatment options that will provide excellent control of their skin condition.

It is also indeed crucial that psoriasis sufferers, especially teenagers, get social reassurance and support from family, friends and the community.

Factbox

■ Psoriasis is an immune-mediated, inflammatory condition.
■ Psoriasis affects nearly three per cent of the world’s population.
■ It is not contagious: it cannot be spread from one person to another.
■ It affects both females and males of all ages, genders and ethnicities.
■ People who get psoriasis exhibit a wide range of symptoms that vary in severity.
■ Psoriasis may be physically painful. Inflamed lesions can crack open and bleed. Itching may be a constant problem. On the other hand, psoriasis may not be painful or debilitating at all.
■ There are various treatments to manage the symptoms but no one treatment is effective for everyone.
■ Psoriasis goes through cycles: sometimes better, at other times worse.
■ People need support to help them cope with living with psoriasis.
■ It is important that people who have psoriasis understand that it is a medical problem and seek medical advice.

(Source: International Federation of Psoriasis Associations)