Psoriasis: Why It's Not Just a Skin Problem

[00:00:00]Did you know that psoriasis can be more than just skin deep? One in 50 people live with this chronic skin condition that can affect their confidence, their relationships, and even their overall health. In today's video, we'll explore what psoriasis is, its effects on the body and the mind, the causes, symptoms, diagnosis, and various treatment options. I'm Dr. Fimbar. I'm a family doctor specializing in dermatology. And on this channel, I provide insights and tips to help you cur.

[00:00:31]Psoriasis is a chronic, meaning a long-term condition which causes symptoms on the skin, but can also cause inflammation in the joints. Now, skin psoriasis can occur on any area of the body. And many people know about the silvery plaques on the elbows and the knees, but it's also common on the scalp in and around the ears, on the face, the hands, the feet, and the flexular areas, including even the genitals. There's quite a few different types of psoriasis, and it can range from not causing any symptoms at all to being itchy and painful. Psoriasis is equally common in both men and women and can occur at any age. However, there are a couple of uh peak ages where it seems to show itself more often from the late teens to the early 30s and then again between the ages of around 50 and 60.

[00:01:24]It's important to know that psoriasis is not contagious. So, you can't catch it from someone else. But many people living with psoriasis feel a stigma attached to it and they're often afraid to show any skin in public. Now this means they can miss out on many healthy activities like swimming for example.

[00:01:42]The psychological impact of this shouldn't be underestimated.

[00:01:47]Normally a skin cell matures over 3 to 6 weeks and during this time it travels from the deep levels of the skin to the very surface of the skin where it's lost in a constant invisible shedding of dead cells and this is what causes a lot of dust around the house in patches of psoriasis. This turnover of skin cells is much much faster at around four to seven days rather than that 3 to six weeks. And this means that the live cells reaching the surface can accumulate up with dead skin cells already there and that causes a thickening of the skin. Recent research has also found that psoriasis begins in the immune system when certain immune cells known as tea cells uh are triggered and become overactive. These overactive tea cells act as if they were fighting an infection or healing a wound which leads them to produce lots of inflammatory chemicals causing soriatic plaques to form. As the immune system is majorly involved in psoriasis, you may hear of psoriasis being described as an autoimmune disease or an immune mediated condition.

[00:02:55]Flare-ups and psoriasis can be triggered by a number of factors such as certain infections like a streped throat or chest infection or they can be triggered by an injury to the skin, hormonal changes within the body or even some medications like uh beta blockers or lithium. But in my experience, it's unusual for me to see a flare of psoriasis in a patient where stress isn't also a major factor. These stressors can be wide ranging from work rellated stress to family or relationship issues to not getting enough sleep or poor diet causing internal stress and inflammation and we'll delve into that uh later. This stress can both trigger psoriasis and exacerbate the psychological distress already associated with living with the condition.

[00:03:44]Psoriasis can also lead to a type of arthritis called seroriatic arthritis.

[00:03:49]Now, this image is taken from a video released by the Psoriasis and Seroriatic Arthritis Alliance, which I have linked to in the description below. In the UK, around a quarter of those with psoriasis, that's about one in 200 people, will also have seroriatic arthritis. Soriatic arthritis causes pain and swelling in the joints and tendons and is accompanied by stiffness, particularly in the morning. The most commonly affected sites are the hands and feet, the lower back, the neck, and the knees. Now, if you have psoriasis and experience joint stiffness or swelling or pain, it may indicate a seroriatic arthritis.

[00:04:30]Psoriasis is also associated with an increased risk of cardiovascular disease. Uh, and by that I mean angina or chest pains, heart attacks, or a stroke. It's not certain if the psoriasis is directly causing this or if it's a result of increased inflammation in the body, but research is still ongoing in this area. Anyway, until it's known for certain, I still recommend to my patients who have psoriasis to look after their heart health with regular exercise, healthy diet, and making sure that their cholesterol and blood pressures are checked regularly and treated if abnormal.

[00:05:08]When I make a diagnosis of psoriasis in one of my patients, the most common question I get asked first is why did I get it? Well, I tell my patients that there are two main factors at play in why they have developed psoriasis.

[00:05:23]Firstly, there's a genetic component.

[00:05:24]Psoriasis runs in families and it's known that the disease is multigenetic.

[00:05:29]This means that there are several genes responsible and each may have different roles contributing to specific characteristics of the disease. As I've mentioned, there's lots of different types of psoriasis and different ways it presents. There'll be a family history usually somewhere via one or both the parents. The second factor that I go into more detail on is the immune involvement that I've already mentioned.

[00:05:53]This then leads to me explaining to my patients the importance of maintaining a healthy lifestyle. I regularly discuss good sleep habits, uh, good nutrition, and stress management, and I'll be making more in-depth videos on each of these in the future. So, be sure to subscribe to the channel so that you can see and get access to those videos.

[00:06:15]Diagnosis of psoriasis is typically based on how the rash looks and how it's spread out over the body. Now, sometimes it can be difficult to tell psoriasis apart from other skin disorders such as eczema. And this is where dermoscopy can be helpful. You may have seen me mention it before in some of my videos on a session um skin lesions. Dermoscopy can also be very helpful in diagnosing rashes. If dermoscopy doesn't give us the answer, then in some cases a skin biopsy may be performed. And if you want to learn more about that, I've made a video demonstrating different biopsy techniques. And I'll put a link to that in the description below. Despite the claims that you may see online advertising products that promise to cure psoriasis, there currently is no cure. However, I don't want to be all doom and gloom here. There are many ways that you can help yourself and there are many great medical treatments that can be used to drastically improve or even clear your psoriasis. Managing psoriasis involves a multiaceted approach which I'll summarize now. I'll do this now in four parts, including lifestyle modifications, topical treatments, phototherapies, and systemic medications.

[00:07:29]Psoriasis is often irritated by contact, particularly with tight clothing such as elasticated waistband, socks, tights, and underwear. So, it may be useful to wear looser clothes where psoriasis is likely to be irritated. We need to manage those risk factors for heart disease and stroke, which can be higher in people with moderate to severe psoriasis. And that includes keeping the weight under control, having normal blood pressure, normal cholesterol, and checking for diabetes. A balanced diet.

[00:07:57]This is a massive area of contention.

[00:08:00]I'll go into more detail in another video, but basically in relation to psoriasis, the best evidence we currently have is to reduce your intake of refined sugary foods and ultrarocessed foods. You know those foods with packages on the label with a list of ingredients that chemical names and no one can even pronounce them. Make sure you get lots of high quality omega-3 oils from fish or supplementation. Another great source of omega-3 is extra virgin olive oil. It contains polyphenols which contribute to its antioxidant and anti-inflammatory properties. This combination of fish oils and extra virgin olive oil seems to add even more benefits. You could consider adding vitamin D into your supplement mix, especially during the winter months. Although the research into whether vitamin D supplements helps is kind of mixed. Some studies say it benefits and some say it doesn't.

[00:08:53]Vitamin D is essential for bone and general health. And the Department of Health in the UK now advises everyone to consider a 10 microgram or 400 unit dose of uh vitamin D every day, especially during the winter and autumn months.

[00:09:08]Perform regular exercise. The main thing to do with exercise is something that you enjoy and do it consistently. But to get better benefits, it's best to mix aerobic and resistance exercise. Don't smoke and avoid excess alcohol consumption. There's a big link between alcohol and psoriasis. Alcohol can flourish psoriasis, but sometimes people use alcohol temporarily to alleviate the discomfort or the stress that psoriasis causes. So you can end up in this vicious cycle. The last lifestyle modification I'm going to mention is to reduce your stress as much as possible.

[00:09:44]For some people, talking therapy such as cognitive behavioral therapy or CBT can help them understand the psychological impact of psoriasis and provide a safe therapy which may help them cope with their psoriasis. The psoriasis and seriatic arthritis alliance in the UK run a free web-based CBT program and I'll link to that in the description below.

[00:10:07]I'm going to summarize the medical and prescription treatments and not go into too much detail in any one specific treatment in this video because it's getting long enough already. There basically three modes of medical treatments we're going to look at.

[00:10:19]Topical treatments, phototherapies, and systemic treatments. Here's the gist of the topical treatments. These include creams, ointments, gels, and lotions applied directly to the skin. These range from firstly emollients or moisturizers and their main function is to moisturize the skin, reduce the flakes and soften any cracked areas. You apply them as often as needed until your skin's no longer dry. Also, it can be used if you put it on about 30 minutes before some of the other more active treatments. It can enhance those treatments effectiveness. Second up, we have topical corticosteroids and they reduce inflammation in and redness.

[00:10:56]Although these can be very beneficial, their long-term use should be monitored to avoid uh thinning of the skin. Next up, we have vitamin D analoges like calcatriol.

[00:11:05]These slow down the skin cell growth.

[00:11:08]Next, we have topical calcs and urine inhibitors. These uh reduce inflammation a bit like the steroids again, but they don't seem to have the same problem with thinning of the skin. They can sting a little bit when you put them on, especially onto an inflamed area. Next, we have salicylic acid. And this helps reduce the scale. That's a big problem in psoriasis. It's best used on thick plaques, but it can be quite irritating to the surrounding skin. Or it can be used in combination with some other drugs. Talking about combination products, the main ones we use are combining steroids with vitamin D or steroids with salicylic acid and they enhance the effectiveness by tackling multiple symptoms at the same time. Next up, we have tar preparations. And these can come in bath oils, creams, and ointments, and shampoos. And they reduce the plaque thickness. They have quite a distinctive smell. And anybody's ever used them, they can be quite messy. XRX is a milder, more tolerable form that can be used like a moisturizer. Dithanol can also be used for stubborn plaques, typically for short contact therapy. It can stay in clothes and it needs to be handled with care. It's been quite difficult to get since uh the pandemic, so it's not really widely used anymore.

[00:12:23]Next, we're going to talk about phototherapy.

[00:12:26]Most people who have psoriasis find that the sun can help improve their condition. But phototherapy uses specific wavelengths of light to manage and alleviate psoriasis symptoms. It's a controlled exposure to ultraviolet light, mainly UVB, but also UVA, uh used along with a chemical compound called soralins. Phototherapy is usually conducted in a medical setting over several weeks. It's not without risk. It can still lead to increase in risk of UV damage like aging and skin cancers. Now, I'll be uploading a video next week on how light therapy benefits. So, make sure you subscribe to the channel so you don't miss that. I'll be looking at sunlight, phototherapy, sunbed use, and LED red light photo biomodulation.

[00:13:15]The third modality is systemic treatments. Systemic treatments can really change people's lives.

[00:13:22]Debilitating nasty psoriasis and even seriatic arthritis can be melted away by these oral or injectable medications.

[00:13:30]The orals include acetin, cycllosporin, methatraate. These systemic drugs like methtoresate treat psoriasis by slowing down the immune system and reducing inflammation throughout the entire body.

[00:13:43]Think of it like a dimmer switch that turns down the activity of the immune system. This helps to prevent the rapid skin growth and inflammation that causes the red scaly patches on the skin. The neurobiological drug treats psoriasis by targeting specific parts of the immune system. They act like a specialized key that locks up certain proteins or cells in your immune system that are responsible for the inflammation and the rapid cell growth seen in psoriasis. By turning off these specific parts, biological therapies help reduce the symptoms and clear up the skin. However, at least in the UK, these systemic and biological therapies are usually only available in a hospital setting and prescribed by a consultant dermatologist or someone working as part of that team.

[00:14:33]Side effects need to be monitored carefully and there are is often a requirement for regular blood testing.

[00:14:41]Sometimes the combination of the different modalities of topical phototherapy and systemic treatments are needed at different stage on someone's journey living with a more severe form of psoriasis. But the lifestyle measures should be done throughout all of those treatments. As you've now learned, psoriasis is a complicated condition that can be unique to each individual.

[00:15:03]The type of psoriasis and the amount of skin affected by psoriasis can differ greatly from person to person. Everyone has different ways in which they cope with their psoriasis. And it's important that the physical signs of psoriasis and the psychological impacts of psoriasis are addressed. The psychological impact is not always related to the clinical severity of the physical psoriasis. So don't be afraid to tell your health care professional how you're feeling.

[00:15:30]For more information and support, you can visit the following organizations.

[00:15:34]in the UK, the Psoriasis Association and the Psoriasis and Seroriatic Arthritis Alliance, and in the United States, the National Psoriasis Foundation. These organizations offer valuable resources and support for individuals living with psoriasis. So, if you're finding it difficult to cope with your psoriasis, either contact your GP or primary care provider or get in touch with one of those organizations. I've included those links in the description below. I think you'll find this next video very interesting.