Psoriasis

An immune condition causing skin cells to build up in plaques. Not contagious, and not just a skin problem.

What it is

Psoriasis affects around 1.1 million people in the UK. The immune system speeds up skin cell production, so cells build up faster than they can be shed, forming raised plaques.

It is not contagious, and saying so is necessary because people with psoriasis are asked to leave swimming pools and gyms with depressing regularity.

It is also not only a skin condition. Around one in three people with psoriasis develops psoriatic arthritis, and psoriasis is independently associated with cardiovascular disease, type 2 diabetes and depression.

Signs you might notice

Raised patches of skin with silvery scale, classically on elbows, knees, scalp and lower back. On darker skin they often look purple or grey rather than red.

Itching, and sometimes soreness or cracking.

Nail changes: pitting, thickening, and separation from the nail bed.

Joint pain, stiffness and swelling, particularly in the fingers and toes, which may be psoriatic arthritis.

Flares triggered by stress, infection, injury to the skin, alcohol, and certain medicines.

How it can affect day-to-day life

The psychological impact is heavily underestimated. Studies consistently find quality-of-life effects comparable with major physical illnesses, and it correlates poorly with how much skin is affected. A small patch in a visible place can matter more than extensive covered disease.

Psoriatic arthritis is the thing to catch early. Joint damage from it is permanent, and treatment within the first months prevents it.

Treatment fatigue is real: creams take time, they are messy, and adherence falls away without support.

Supporting someone well

Use emollient generously and constantly. It reduces itching and scale, and it makes active treatments work better.

Apply treatments as directed and for long enough. Most topical treatments need several weeks, and stopping early is the commonest reason people conclude nothing works.

Ask about joint symptoms at every review. Any joint pain or stiffness in somebody with psoriasis deserves a rheumatology opinion.

Manage cardiovascular risk actively: blood pressure, cholesterol, smoking, weight.

Ask for referral to dermatology if topical treatment is not controlling it. Phototherapy and biologic drugs are effective and under-offered.

Address the psychological side directly rather than treating it as vanity.

Where to get help

A GP manages most psoriasis and can refer to dermatology.

Psoriasis UK run a helpline on 01604 251620.

New joint pain and stiffness needs an urgent rheumatology referral.