Private psoriasis clinic in London, same-day dermatology.

Recognising it

• Plaque psoriasis — well-defined raised patches with silvery scale, typically on elbows, knees, lower back and scalp. On darker skin plaques often look violet, grey or dark brown rather than red, and are frequently missed or misdiagnosed.
• Scalp psoriasis — thick scale along the hairline, often mistaken for dandruff.
• Nail changes — pitting, thickening, or the nail lifting from its bed. Nail involvement is strongly associated with joint disease.
• Guttate psoriasis — a shower of small drop-like spots, classically two to three weeks after a streptococcal throat infection, often in teenagers.
• Flexural psoriasis — smooth, shiny red areas in skin folds, without scale.

What triggers flares

• streptococcal throat infection, particularly for guttate psoriasis
• stress, and poor sleep
• skin injury — cuts, sunburn, tattoos — where plaques appear in the damaged area
• smoking and alcohol, both of which worsen it and reduce treatment response
• medicines including lithium, beta-blockers, antimalarials, and withdrawal of oral steroids
• cold, dry weather; most people improve in summer

Treatment

• Emollients, used generously and consistently, to soften scale and reduce itch. The foundation of everything else.
• Topical steroid plus vitamin D analogue — the standard first-line combination, usually applied once daily for up to four to eight weeks, then reviewed.
• Coal tar and salicylic acid preparations, particularly useful for the scalp and for thick scale.
• Phototherapy — controlled ultraviolet light in a hospital unit — for widespread disease not responding to creams.
• Oral treatments such as methotrexate or ciclosporin for moderate to severe disease, with blood monitoring.
• Biologic injections for severe psoriasis, which have transformed outcomes for people who previously had none.

Beyond the skin

Up to a third of people with psoriasis develop psoriatic arthritis, often years after the skin disease. Early treatment prevents permanent joint damage, so tell us about joint pain and stiffness lasting more than 30 minutes in the morning, swollen fingers or toes, or heel and lower back pain — do not wait to be asked.

Psoriasis is also associated with a higher risk of cardiovascular disease, type 2 diabetes, fatty liver and depression. Annual review of blood pressure, cholesterol, glucose and mood is part of proper care, not an add-on.