World Psoriasis Day

So I have a few patients who come into my clinic with psoriasis.

Such a small amount that it represents a tiny drop in the ocean of 125 million people globally, which have the condition.

In the UK alone, that's 1.8 million, which is roughly 2% to 3% of the population.

Whilst the physical signs of psoriasis are considered, often the social, financial, and psychological effects are not obvious to the naked eye.

What exactly is psoriasis?

So psoriasis is an autoimmune condition,which affects the skin and the nails.

There are many different types too.

It's characterised by an increased skin cell turnover leading to an accumulation of skin cells or plawues on the superficial layer of the skin.

Often these are red and inflamed and sometimes itchy.  They can also bleed. They often have a silvery sheen to them, which is easier to note when providing a diagnosis.

Psoriasis can affect people of any age, however, there are two peaks where it tends to be more noticeable: the first is between the late teenage years and the 30s; the second is between the 50s and the 60s.

The causes of psoriasis are multifactorial with numerous causes implicated – stress, anxiety and medication are all cited, along with environemtnal and inherited factors.

As podiatrists, we see the effects on the skin and nails, but if they have no outward signs, how do we know it’s even there?

Now, for most of us, we'll pick this up during the history, the questioning and examination.

But we also tend to spot lesions on other parts of the body during treatment.  This may be further up the leg or, in the case of summer, we may spot lesions when short sleeves are worn.

Whilst the skin effects are more obvious, changes to the nails can be less so.

The most common nails changes in psoriasis are the presence of small punched out holes on the surface of the nail.

These can be confused with a fungal nail infection, but treatment would be very different.

The presence of psoriatic changes in the nail can be suggestive of an underlying effect on joints.

And this psoriatic arthritis is present in around 80% of people with nail changes, so we become very attuned to seeing these changes and make an appropriate referral to a rheumatologist.

For most people, although psoriasis is not curable, it is treatable and wide range of approaches are available.

From topical medications, through sunlight based therapies to biologics to control the inflammatory process.

For me, one of the most important things to remember about psoriasis is it is not contagious or infectious.

You are not going to catch psoriasis off somebody who has psoriasis, and that was something which was taught to me a long time ago by a very good friend of mine who really knows her dermatology.

If you've got somebody who comes to you in a clinic with psoriasis, and they offer their hand out shake it, you can shake it. You're not going to catch anything.

Patients with psoriasis are already worried about the appearance – why make it worse?

Today is World Psoriasis Day, raising awareness of the condition and ways to manage it.