Wednesday 21 August 2019

Why summer is a real pain when you have psoriasis

The chronic skin condition can cause discomfort and embarrassment, but sufferers can take measures to alleviate symptoms, writes Arlene Harris

Stephen Daly, who has struggled with psoriasis since he was a teenager, pictured near his home in Stepaside, Dublin. Pic: Damien Eagers
Stephen Daly, who has struggled with psoriasis since he was a teenager, pictured near his home in Stepaside, Dublin. Pic: Damien Eagers

Arlene Harris

Living with a chronic skin condition can be very difficult as although it may not be life threatening, treatment can be all-consuming and the anxiety caused by such a visible disorder can take its toll.

Around 78,000 people in Ireland suffer from psoriasis, an autoimmune disorder which causes the skin to reproduce at a rapid pace resulting in itchy, painful scales all over the body, including the scalp and nails.

According to the Irish Skin Foundation, normally, skin cells reproduce and mature as they move from the deeper layers of the outermost layer of the skin to the surface - but this is not the case with psoriasis.

"In psoriasis, this process is accelerated; the new skin cells reproduce too quickly and move toward the skin surface in an immature form, causing a build-up of white and silvery scales [dead skin cells]," explains David McMahon, CEO of the Irish Skin Foundation.

"There is also an increased blood flow to the skin and a thickening of the epidermis, leading to the development of red, raised plaques or patches of skin, often covered with this white and silvery build-up of scale."

As well as being physically irritating, itchy and often painful, it can also have emotional side effects on the self-esteem and confidence of sufferers, who will go to great lengths to try and disguise the scaly patches. And while this is distressing at any time of the year, it can be particularly difficult during the summer months when not only do you want to feel the fresh air and sunlight on your skin, but also remaining covered up will make you feel hot and uncomfortable.

Professor Anne Marie Tobin, consultant dermatologist at Tallaght University Hospital, says this can lead to feelings of despair.

"The psychological burden of psoriasis is significant as it is a highly visible disease and patients can suffer stigma and considerable psychological distress," she says. "It may restrict sport, clothing choices and social activities, so significantly impact quality of life. People who have psoriasis should seek medical treatment as they can look to have clear skin. Techniques such as mindfulness, exercise and maintaining a healthy weight can also help."

Stephen Daly from Dublin knows only too well the way psoriasis can impact your life as he has suffered with it since he was a teenager.

"I first developed psoriasis when I was studying for exams at the age of 17 - and I think it was the nerves which brought it on," says Stephen, who works as a roofer. "Over the years, I've had it on my arms, hands, elbows and legs. It's a very debilitating condition as it makes you really self-conscious and takes away your self-confidence. You can walk down the street and put a mask of a smile on your face as if you don't care about it, but inside you really do.

"I had a good physique when I first developed the condition and I took a sun tan very well, but I just covered up completely, especially in the summer. I would never wear t-shirts or shorts and I found it difficult to have relationships with girls. I was too embarrassed to show them my skin."

There is no cure for psoriasis yet, but the Irish Skin Foundation's David McMahon says there are a range of effective treatment options available.

"Treatment depends on its severity and location but psoriasis can sometimes be a challenging condition to treat as no single medication is effective for everyone affected," he explains.

"It's important to talk with your doctor to find a treatment which is suitable for you and he or she may prescribe a number of different treatments before finding one that works - this is usually done in a step-by-step process."

Treatment options include topical treatments, which are creams, ointments and lotions applied directly to the skin; phototherapy, a form of artificial ultraviolet light, delivered in hospital dermatology departments; systemic treatments, drugs (liquid, tablet or injection) which work throughout the body; and biologic treatments, which are targeted medicines used to inhibit the part of the immune system which drives inflammation.

Professor Tobin agrees and says there are a number of different options open to sufferers.

"Fortunately excellent treatments have become available in recent years," she says. "For mild psoriasis, topical treatments with mild-mid potency steroids, coal tar preparations and vitamin D analogues are available. And for more extensive psoriasis, phototherapy is provided in 13 dermatology centres regionally.

"Those patients with moderate to severe psoriasis or patients with joint involvement [such as psoriatic arthritis] can avail of systemic medications such as methotreaxte or Skilarence or biologics. Treatment is individualised to suit each person and patients can look forward to having clear skin. I would advise people who have psoriasis to first visit their GP and then a dermatologist if required as treatment of the condition has advanced so much."

Stephen Daly can relate to this as throughout his life, the Dublin man tried everything to try and alleviate his symptoms. And as well as visiting doctors and trying various types of medicines, he also searched further afield in his quest to find something which would reduce the inflammation and give him some relief from the condition.

"I was treated with the usual steroid creams and while some would work for a bit, the relief didn't last for long and to be honest, I didn't have much faith that anything would get ever get rid of it," he says. "Some people become very depressed because of the condition and turn to drink or drugs and I really can understand why.

"But then about 10 years ago, a friend of mine heard about a treatment coming out of Australia called 'Dr Michaels'. I had never heard of it but I now know it was named after Dr Michael Tirant, an Australian biochemist who developed a cream which is marketed as 'Soratinex' in Europe [and sold in Ireland under that name].

"I had some shipped over and my psoriasis began clearing up very quickly. I couldn't believe the results and mostly it has never returned. You have to use the treatment correctly and you have to persevere with it [as it doesn't work immediately] but for me, it has been unbelievable, an absolute revelation which has changed my life. And the best thing about it is that it doesn't contain steroids, which I'd rather not use."

According to David McMahon, the summer can be very helpful for psoriasis sufferers and symptoms can be reduced by exposure to sunlight, but too much sun can also be problematic. So protection is important for everyone, with or without the condition.

"Many people who have psoriasis find that sunlight can help their skin to clear," he says. "However, being sensible in the sun is important and sunburn must be avoided at all times. While sunburn increases the risk of skin cancer, it can also bring about the Koebner phenomenon - this is where psoriasis can develop at the site of an injury, such as a sun burnt site.

"Even in Ireland it's important to protect yourself - from March to September in particular - when the intensity of sunburn-producing UV radiation is greatest. No sunscreen can provide 100pc sun protection. And always remember the five S's of sun safety: Slip on a t-shirt, Slop on (broad-spectrum) sunscreen factor 30+, Slap on a hat, Slide on sunglasses, Seek shade."

 

Psoriasis: the facts

⬤ Psoriasis is a common, non-contagious, long-term, inflammatory skin condition in which there is an increase in the rate at which skin cells are produced and shed from the skin.

⬤ The inflammatory skin disease which results in red, scaly plaques on the scalp, elbows and knees can affect any part of the skin.

⬤ It affects approximately 3pc of the population and there are estimated to be 78,000 patients with psoriasis in Ireland (The Burden of Psoriasis report).

⬤ In addition to the skin, up to 40pc of patients with psoriasis develop psoriatic arthritis, and nails may also be affected.

⬤ In 2014 the World Health Organisation recognised psoriasis as a serious non-communicable disease.

⬤ Be sure to talk to your doctor about your symptoms and progress, and if necessary alternative treatment options or onward referral to a consultant dermatologist.

⬤Visit the Irish Skin Foundation's website, irishskin.ie, for more information on psoriasis, to download the information booklet, What you need to know about Psoriasis, or contact the ISF Helpline on (01) 486 6280 for one-to-one information and support.

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