Psoriasis

What is psoriasis?

Psoriasis is a long-term skin condition that causes red, flaky patches and scales. Unlike eczema, which is characterised by dry, flaky skin, psoriasis patches are typically thicker, scaly and tinged with a silvery white scale.

These patches of skin are called plaques.

Like with eczema, these patches can also be itchy and sore. Psoriasis affects around 2 in every 100 people in the UK and can start at any age. It most commonly starts between ages 15 and 35 or between 50 and 60. (1)

While psoriasis mainly affects the skin, it can also lead to joint pain in some people. The patches are usually found on the elbows, knees, and scalp but can appear anywhere on the body.

What causes psoriasis?

Although the exact cause of psoriasis is not fully understood, it is believed to be linked to the immune system and genetics. In people with psoriasis, the immune system becomes overactive and mistakenly attacks healthy skin cells.

This speeds up the rate of skin turnover, the process where your skin cells are constantly being replaced by new ones.

Skin cells are normally made and replaced every 3 to 4 weeks, but with psoriasis, this process only takes about 3 to 7 days. (2)

This fast turnover causes cells to build up on the skin's surface instead of falling off, leading to the red, scaly patches that help us identify the condition.

Is psoriasis a genetic condition?

Genetics play a role, as psoriasis often runs in families. If a parent has psoriasis, there’s a higher chance their child might have it too. However, not everyone with the genes for psoriasis develops the condition.(3)

More than 80 genes have been linked to psoriasis, and many are involved in how the immune system works.(4)

Is psoriasis contagious?

No, psoriasis is not contagious, you cannot catch it from someone else.

How do environmental factors contribute to psoriasis?

While genetics increase the likelihood of psoriasis, they are only one part of the picture, and environmental factors can play a role in triggering or worsening symptoms.(2)

Common triggers usually stress the immune system in some way, for example:

• Mental and physical stress
• Infections
• Injuries to the skin (cuts, grazes, sunburns, or even insect bites)
• Smoking
• Heavy alcohol consumption

Additionally, cold, dry weather often makes symptoms worse by drying out the skin.(5)

Do immune system disorders affect psoriasis?

In people with psoriasis, the immune system mistakenly targets healthy skin cells, treating them as if they were harmful or “the enemy”.

This ongoing immune activity is why psoriasis is a chronic (long-term) autoimmune condition where the body’s defence system mistakenly attacks its own tissue.

What are the symptoms of psoriasis?

Psoriasis symptoms vary from mild to severe and often come and go throughout life. The main symptoms are red patches of skin covered with silvery scales called plaques.

In addition to skin symptoms, around 1 in 5 people with psoriasis may develop joint pain, swelling, and stiffness. This is called psoriatic arthritis. (3)

Some people with psoriasis also have nail changes, like pitting (small dents), thickening, or discolouration.

What are the most common symptoms of psoriasis?

• Patches of skin covered with silvery scales
• Itchy, sore, or burning plaques that may crack and bleed
• Small, red spots (in guttate psoriasis)
• Thickened, pitted, or discoloured nails
• Pus-filled blisters on the skin (in pustular psoriasis)
• Large areas of red, inflamed skin (in erythrodermic psoriasis)
• Joint pain, swelling, and stiffness (psoriatic arthritis)

What are the different types of psoriasis?

Plaque Psoriasis

Plaque psoriasis is the most common type. It causes red, raised patches covered with a silvery-white scale. These patches, known as plaques, can appear anywhere on the body but are often on the elbows, knees, and scalp.

Plaque psoriasis can range from small areas to larger patches that cover more skin. It may itch, sting, or feel sore.

Guttate Psoriasis

Guttate psoriasis looks like small, red spots or “drops” on the skin. It usually appears on the chest, arms, and legs. This type often starts in childhood or young adulthood and can be triggered by infections, like a sore throat. It may go away on its own or develop into plaque psoriasis.

Flexural Psoriasis (also known as inverse psoriasis)

Flexural psoriasis shows up as red, shiny patches in skin folds, like under the arms, behind the knees, or in the groin area. This type can be uncomfortable, as it often occurs where skin rubs together.

Flexural psoriasis is more common in people who are overweight and can be irritated by sweating or friction.

Pustular Psoriasis

Pustular psoriasis causes white, pus-filled blisters surrounded by red skin. It usually appears on the hands and feet but can occur on other body parts.

This type of psoriasis may be painful and can appear suddenly. Some people experience fever or chills with this form of psoriasis.

Erythrodermic Psoriasis

Erythrodermic psoriasis is a rare, severe type that causes redness and skin shedding over large body areas, almost like sunburn.

This type of psoriasis can be very painful and itchy, making it hard for the body to control temperature. Erythrodermic psoriasis is serious and usually needs treatment right away.

How is psoriasis diagnosed?

In most cases, a visual examination is enough to diagnose a condition. However, if the diagnosis is uncertain, the doctor may take a small sample of skin (a biopsy) to examine under a microscope.

This helps confirm psoriasis and rule out other skin conditions with similar symptoms, like eczema.

What are the available treatments for psoriasis?

Psoriasis treatments aim to manage symptoms, reduce flare-ups, and improve quality of life. As there is no complete cure for the condition, available treatments vary based on the severity and type of psoriasis and may include topical creams, light therapy, and medications.

Topical treatments, like corticosteroid creams, are commonly used for mild cases and help reduce inflammation and itching.

Light therapy, or phototherapy, exposes the skin to ultraviolet light under medical supervision and is often used for moderate cases.

Doctors may prescribe oral or injectable medications for severe psoriasis to target the immune system.

Creams for psoriasis

Moisturisers and Emollients

Regularly applying moisturisers or emollients keeps the skin hydrated and helps reduce dryness, itching, and flaking. These products create a barrier on the skin’s surface, helping to protect it from irritation.

Look for products free from fragrances and alcohol, as these can irritate sensitive skin.

Ointments are often more effective for very dry skin, while creams and lotions are lighter for daily use.

Corticosteroids for psoriasis

Corticosteroids are among the most frequently prescribed treatments for psoriasis. These anti-inflammatory creams or ointments help reduce redness, swelling, and itching and reduce the local immune response.

They come in different strengths, from mild (suitable for sensitive areas like the face) to strong (used for tougher areas like elbows and knees).

The least potent steroid is recommended and usually limited to short periods to avoid side effects like skin thinning. Corticosteroids are effective for many people and can quickly improve plaques, making them a first-line treatment for mild to moderate psoriasis.

Vitamin D Analogues

Vitamin D analogues, like calcipotriol, are synthetic forms of vitamin D that slow down skin cell production and have an anti-inflammatory effect. Topical Vitamin D treatments are not the same as Vitamin D supplements that you might take orally in tablet or liquid form. (6)

These treatments are often used alongside corticosteroids or as a standalone therapy for mild to moderate psoriasis. Improvement is usually seen over a few weeks.

Vitamin D analogues are particularly helpful for people needing daily management without the side effects of steroids.

Coal Tar

Coal tar is one of the oldest treatments for psoriasis and is available in creams, shampoos, and bath solutions. It helps reduce itching, inflammation, and scaling by slowing down skin cell growth.

Coal tar is especially effective for scalp psoriasis, though it can be messy, has a strong smell and can cause skin irritation or sensitivity to sunlight, so users should avoid direct sun exposure after application. (7)

Salicylic Acid

Salicylic acid is a keratolytic treatment that softens and removes the top layer of scales, making plaques less noticeable and other treatments more effective. It’s often used in combination with corticosteroids or coal tar and can be found in shampoos, creams, and lotions.

Salicylic acid is particularly useful for scalp psoriasis, as it helps lift scales and reduce build-up. However, it can cause irritation and excessive drying if used too frequently or in high concentrations, so it’s often applied in moderation.(8)

Calcineurin Inhibitors

Calcineurin inhibitors, like tacrolimus and pimecrolimus, are used to reduce inflammation and are often prescribed for sensitive areas like the face, neck, or genitals.

These block the immune system’s response, helping reduce redness and scaling. Unlike corticosteroids, they do not thin the skin, making them suitable for long-term use on delicate skin areas.

However, they are typically used for short-term or intermittent treatment to avoid potential side effects. Treatment is applied to affected areas once or twice daily during a psoriasis flare-up.

For psoriasis maintenance, treatments can effectively control symptoms when applied twice a week.(9)

What other medications are effective for psoriasis?

Immunosuppressants

Immunosuppressants are medications that reduce the activity of the immune system, helping to manage moderate to severe psoriasis. As these medicines require careful monitoring for safety reasons, they must be started by a specialist doctor and are not available to buy from Oxford Online Pharmacy.

Methotrexate is a widely used immunosuppressant that slows skin cell growth and reduces inflammation. It is effective for long-term management and is often prescribed when topical treatments or light therapy fail. It is taken once a week.

However, regular blood tests are required to monitor liver health and blood cells. Common side effects include nausea and fatigue, and patients are advised to avoid alcohol.

Cyclosporin is another immunosuppressant that quickly relieves severe psoriasis symptoms by suppressing the immune system. It is often used for short-term treatment during flare-ups.

While effective, cyclosporin carries risks such as high blood pressure and kidney damage, requiring careful monitoring. Due to these side effects, it is typically a temporary solution reserved for severe cases where other treatments have not worked.

Acitretin

Acitretin is a type of retinoid (a vitamin A derivative) that helps normalise skin cell growth. It is taken orally and is often used for severe psoriasis, especially pustular or erythrodermic psoriasis. Acitretin can effectively reduce symptoms, but it may take several months to show full results.

To improve its effectiveness, it is often combined with light therapy.

Side effects include dry skin, lips, and eyes, and it’s important for women to avoid pregnancy while on acitretin and for three years afterwards due to the risk of birth defects. Regular liver tests are also recommended.

Apremilast

Apremilast is a newer oral medication that targets an enzyme involved in the inflammatory response. It’s used for moderate to severe psoriasis and psoriatic arthritis and works by reducing the activity of immune cells that cause inflammation. (10)

Apremilast is taken twice daily and generally has fewer serious side effects than some older systemic medications. However, it can cause gastrointestinal issues, such as nausea and diarrhoea, especially when starting treatment.

How do biological therapies work for psoriasis?

Biologics are advanced medications made from living cells that target specific parts of the immune system involved in psoriasis. They should be initiated and supervised only by specialists experienced in the diagnosis and treatment of psoriasis.

Common biologics include adalimumab, etanercept, and infliximab. They’re often prescribed for moderate to severe psoriasis or psoriatic arthritis but, due to their cost, are reserved for cases where other treatments haven’t worked. Biologics are usually given by injection or infusion and can be highly effective, often clearing skin symptoms and reducing joint pain.

Immunosuppressant treatments are not available from Oxford Online Pharmacy.

What non-pharmacological treatments are available for psoriasis?

Light therapy

Non-pharmacological treatments can be key in managing psoriasis and are often used alongside medications. One effective option is phototherapy (light therapy), where the skin is carefully exposed to UVB light under medical supervision. This treatment slows skin cell growth and can help reduce plaques and inflammation.

What lifestyle changes can help manage psoriasis?

Lifestyle changes can also make a difference. Regularly moisturising the skin helps reduce dryness and itching, while managing stress can lessen flare-ups, as stress is a common trigger. Relaxation techniques like meditation, yoga, and breathing exercises may help.

How does diet influence psoriasis symptoms?

Some individuals may benefit from dietary changes, as maintaining a healthy weight and avoiding processed foods, alcohol, and smoking can reduce inflammation.

What role does stress management play in psoriasis care?

Alternative therapies like acupuncture and mindfulness-based therapies can also provide relief, though the evidence is limited.

These non-drug approaches help people with psoriasis feel more comfortable and in control, supporting overall well-being and symptom management.

How to buy psoriasis treatments online from Oxford Online Pharmacy

Oxford Online Pharmacy is regulated by the General Pharmaceutical Council (GPhC) in the UK. Buying treatment online from us is quick, easy, and convenient. Add over-the-counter (OTC) psoriasis treatments, such as moisturisers, salicylic acid products, and coal tar shampoos, straight to your basket.

We also offer stronger topical medicines, such as corticosteroid creams, following a consultation with one of the licensed doctors, who can assess your condition and, if appropriate, issue a prescription. Medicines will be delivered to your door.

Frequently asked questions about psoriasis

Is psoriasis contagious? Can it be spread?

No, psoriasis is not contagious and cannot be spread from person to person. It is an immune-mediated condition, meaning it results from an overactive immune system. Psoriasis is not caused by an infection, so it cannot be caught through touch, close contact, or sharing items.

Can psoriasis be cured?

Currently, there is no cure for psoriasis. It is a chronic (long-term) condition that tends to come and go throughout life. However, many effective treatments are available to help manage symptoms, reduce flare-ups, and improve quality of life.

How does psoriasis affect mental health?

The visible symptoms may lead to self-consciousness, low self-esteem, and anxiety in social situations. Additionally, the chronic nature of psoriasis can contribute to stress, frustration, and even depression.

Is psoriasis itchy?

Yes, psoriasis is often itchy. The itch can range from mild to intense and may feel like burning or soreness. Itching is common in areas with red, scaly patches (plaques), which can lead to discomfort and even sleep disturbances. Treatments and moisturisers can help reduce itching and irritation.

Do sunbeds help psoriasis?

Sunbeds are not recommended for treating psoriasis. While controlled UVB light therapy under medical supervision can help manage psoriasis, sunbeds emit mostly UVA light, which is less effective and increases skin cancer risk. Using prescribed phototherapy guided by a healthcare professional for psoriasis relief is safer.

Is psoriasis an autoimmune disease?

Yes, psoriasis is considered an autoimmune disease. The immune system mistakenly attacks healthy skin cells, speeding up skin cell production and causing red, scaly patches.

References

1. Psoriasis Association [Internet]. [cited 2024 Nov 25]. About Psoriasis.
2. nhs.uk [Internet]. 2017 [cited 2024 Nov 25]. Psoriasis.
3. British Association of Dermatologists [Internet]. [cited 2024 Nov 25]. Psoriasis.
4. Ran D, Cai M, Zhang X. Genetics of psoriasis: a basis for precision medicine. Precis Clin Med. 2019 Jun 1;2(2):120–30.
5. Psoriasis Association [Internet]. [cited 2024 Nov 25]. Tips for managing psoriasis in cold weather.
6. Psoriasis Association [Internet]. [cited 2024 Nov 25]. Vitamin D Based Topicals.
7. Coal tar products | Prescribing information | Psoriasis | CKS | NICE [Internet]. [cited 2024 Nov 25].
8. Salicylic acid | Prescribing information | Psoriasis | CKS | NICE [Internet]. [cited 2024 Nov 25].
9. Recommendations | Psoriasis: assessment and management | Guidance | NICE [Internet]. NICE; 2012 [cited 2024 Nov 25].
10. The technology | Apremilast for treating moderate to severe plaque psoriasis | Guidance | NICE [Internet]. NICE; 2016 [cited 2024 Nov 25].