Psoriasis: Symptoms, Causes, Treatment and Living With It

What does psoriasis look like, and what types are there?

Psoriasis appears in different forms, and one patient can have more than one type:

• Plaque psoriasis: the most common type, with raised, well-defined scaly plaques that may itch or hurt.
• Scalp psoriasis: thick scale that can look like severe dandruff, sometimes spreading behind the ears and along the hairline.
• Nail psoriasis: small pits in the nails, discolouration, or the nail lifting from the skin underneath.
• Guttate psoriasis: small scattered spots that appear suddenly, often after a sore throat in children and young adults.
• Inverse psoriasis: smooth, shiny red patches in the armpits, under the breasts and in body folds.
• Rare severe forms, such as pustular psoriasis or psoriasis covering most of the body, which need urgent medical care.

What causes psoriasis, and is it contagious?

Psoriasis is not contagious and does not spread through touch, sharing items or swimming. It is caused by an immune system imbalance that sends inflammatory signals making the skin renew too quickly. Genetics play a role, and another family member is often affected.

In some people psoriasis flares because of triggers, including stress, infections such as a sore throat, cuts and scratches (psoriasis can appear at the site of an injury), smoking, obesity, dry weather and air-conditioning, and certain medicines. Any medicine should only be stopped on the advice of the doctor who prescribed it.

Does psoriasis affect the body beyond the skin?

Sometimes, yes, which is why doctors now treat it as a condition of the whole body, not just the skin. Some patients develop psoriatic arthritis, with joint pain, stiffness and swelling, especially in the morning, or a whole swollen finger. Finding it early matters to protect the joints from damage.

Moderate to severe psoriasis is also linked to a higher chance of obesity, high blood pressure, diabetes, abnormal cholesterol and heart disease, as well as anxiety and depression. Patients are therefore advised to have regular check-ups, follow a healthy lifestyle and talk openly with their doctor about their mood.

What are the treatment options for psoriasis?

A dermatologist chooses treatment based on the type of psoriasis, how much skin it covers, where it is and how it affects the patient's life, often combining more than one option:

• Topical treatments: cortisone creams and ointments, vitamin D analogues and scalp preparations, prescribed and used as your doctor directs.
• Phototherapy: regular narrowband UVB sessions under medical supervision.
• Oral medicines for moderate to severe cases, prescribed and requiring blood tests and monitoring.
• Biologics: injections that target specific signals in the immune system, an effective option for many severe cases, after an assessment and tests set by the doctor.
• Rich moisturisers every day, an essential part of any treatment plan.

Tips for living with psoriasis

Daily care reduces flares and helps treatment work better: moisturise straight after showering, use lukewarm rather than hot water, and avoid scrubbing or forcibly removing scale. Scratch as little as possible and keep your nails short.

Some patients' skin improves with short, moderate sun exposure, but sunburn makes psoriasis worse, so do not use the sun as self-treatment. Stopping smoking, keeping a healthy weight, getting enough sleep and managing stress all help. If you fast in Ramadan and take medicines, discuss their timing with your doctor in advance.

If you are pregnant or planning a pregnancy, tell your doctor, because some psoriasis medicines are not suitable in pregnancy and need planning ahead.