Daily problems and how to cope

Psoriasis is a chronic, recurring skin disease. Its scope can vary considerably; from mild outbreaks, where the person may not even be aware they have psoriasis, to severe cases, which can be socially disabling and, in rare instances, life-threatening. Around 2 per cent of the population have psoriasis to a greater or lesser degree. Psoriasis is not contagious. What causes psoriasis?

Psoriasis is a condition which runs in families, but the exact way in which the disease moves from generation to generation has not yet been established. Although the tendency to contract psoriasis is stored in a person's genes, it is by no means certain that it will ever develop.

However, exposure to certain stimuli (such as a streptococcal infection in the throat, alcohol, medicines and local irritation) or damage to the skin, may cause an outbreak of psoriasis in persons who have this genetic predisposition.

Around 6 per cent of the people who have psoriasis also get psoriatic arthritis in the joints. Psoriatic arthritis primarily occurs in fingers and toes, but is also quite common in the back bone.

What can be done?

• It is important to accept that psoriasis is a chronic, long-lasting condition. The disease is usually characterised by alternate good periods and periods with outbreaks.
• If you discover that certain things make your psoriasis worse, try to avoid them.
• It should be noted that all degrees of psoriasis can be treated effectively. The treatment is not a cure, but it will ensure a better quality of life.

What is the treatment?

The treatment, which should be carried out in close collaboration between patient and GP or dermatologist, consists of various local and systemic treatments. It depends on the patient's age, state of health and on the nature of the psoriasis.

Local treatments include creams and ointments containing tar, dithranol, salicylic acid or vitamin D-related compounds. Occasionally, corticosteroid-containing ointments are used for a short time. Special lotions are available for scalp treatment.

Phototherapy (ultraviolet B, UVB) and photochemotherapy (psoralent ultraviolet A, PUVA) are both used for widespread psoriasis. Many patients find that natural sunlight also helps.

Systemic (oral) treatment with immunosuppressants such as ciclosporin, or methotrexate or the vitamin A derivative acitretin may be used for patients with severe, widespread or unresponsive psoriasis.

Intensive research is being carried out to find better treatments for psoriasis and new treatments are regularly introduced which improve the condition in some patients.

I have a friend who has had severe psoriasis for all of her adult life. She has learnt the importance of living with it without making it a problem that she has to share with everybody. When she has her outbursts, she dresses to cover most of her body. When she has good periods, she dresses more lightly. She always has to make sure her skin is kept miost, and I know that she uses lots of cream to keep her skin supple. My friend lives in Norway, and for many years she travelled to countries with sunshine twice a year to expose her body to salt water and sunshine.

When in Norway, she takes baths with oils and herbs several times a week. I also know that she has tried homeopathic medication with variable results. She does tai chi and similar methods to keep away from stress.

Most of all she has learnt that the condition varies a lot, and when it is bad, she knows that soon it will improve.