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Betamethasone Cream from £20
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Advice for Psoriasis
Psoriasis is a chronic skin condition that can cause red and flaky patches of skin that are covered with silvery scales, leaving the skin feeling dry, itchy and irritated. Around 2% of people in the UK are affected by psoriasis. It can develop at any age but it is a long-term condition so once you have developed it you will most likely continue to have intermittent episodes of the condition (flare-ups) throughout your life. Episodes of psoriasis or flare-ups affect people differently, they can vary in severity and length of time.
Psoriasis is an immune-mediated condition that is triggered by your body's inflammatory response causing your skin cells to be overproduced. Some factors that can contribute to psoriasis flare ups are genetics, lifestyle or some drugs.
The most common areas of skin affected by psoriasis include the scalp, elbows, knees and the lower back, but they can appear anywhere on the skin, with some people also developing symptoms that affect their nails and joints. The condition not only leaves you feeling uncomfortable but it can also make some people feel embarrassed or self-conscious, which can be detrimental to your psychological health.
There are different types of psoriasis defined by areas of the body they affect and how they present.
- Plaque Psoriasis: This is the most common type of psoriasis, affecting around 9 out of 10 psoriasis sufferers. The most commonly affected areas include the skin around the knees, elbows and lower back. It presents as large patches or ‘plaques’ of itchy, red, sore skin with white or silver scales. The skin becomes thick and dry due to the overproduction and build-up of skin cells.
- Scalp Psoriasis: Around 50% of plaque psoriasis sufferers develop scalp psoriasis. The whole scalp or just patches of skin, similar to plaques, may be affected. Scalp psoriasis can also affect the skin on the face, around the hairline, down the back of the neck and behind the ears. It causes the skin to thicken causing red, scaly and flaky skin. It can be particularly unpleasant, causing the skin to feel increasingly tight, itchy and sore.
- Guttate Psoriasis: Guttate Psoriasis presents as a widespread rash that looks similar to drops of rain. The spots are small red, scaly spots that may be very itchy and sore. The rash often develops over the trunk of the body, limbs, neck and scalp. It is most commonly triggered by an infection, typically a throat infection. It is more likely to occur in children, teenagers or young adults.
- Inverse Psoriasis: This affects folds or creases in your skin, such as the armpits, groin, between the buttocks and under the breasts. It can cause large, smooth patches of skin in some or all these areas. Inverse psoriasis is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather.
- Nail Psoriasis: This type of psoriasis affects around half of all people that suffer from psoriasis. It is possible for Nail Psoriasis to affect just the fingernails or toenails, but can also affect both at the same time. Symptoms include; nails coming away from the nail bed (onycholysis), thickening, crumbling, discolouration, as well as pitting and dents in the surface of the nail.
- Pustular Psoriasis: Only around 3% of all people who have psoriasis develop Pustular Psoriasis and is most commonly seen in older adults. It very rarely affects any area of the body other than the palms of the hands and soles of the feet.
All types of psoriasis can be diagnosed by your GP without the need for invasive investigation or referrals. They will thoroughly examine your skin and get a full picture of your symptoms and medical history. In exceptional circumstances, some GPs may want to take a small sample of your skin, called a biopsy. This is so that they can accurately diagnose the type of psoriasis you are suffering from and ensure they have ruled out any other possible skin conditions. On rare occasions, you may be referred to a dermatologist if a diagnosis is not no clear.
There is currently no cure for psoriasis, however, with the correct management, most people will be able to control their flare-ups, meaning they are less frequent and less severe. Topical treatments are usually the first treatments used for mild to moderate psoriasis. These are creams and ointments you apply to affected areas. Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. It is usually prescribed alongside other topical treatment. Soap substitutes are also generally recommended for chronic plaque psoriasis along with bath additives.
The symptoms of psoriasis vary depending on the type you have. However, there are some symptoms that are more prevalent than others:
- Red patches of scaly skin
- Itching, sore and burning sensations
- Stiff and swollen joints
- Dry skin
- Bleeding skin
Psoriasis typically causes patches of skin that are dry and covered in scales. On brown, black and white skin the patches can look pink or red, and the scales white or silvery. On brown and black skin the patches can also look purple or dark brown, and the scales may look grey.
Some types of psoriasis may present very differently. For example, symptoms of nail psoriasis include discoloured nails and abnormal nail growth. Alternatively, pustular psoriasis is a condition that causes pus-filled blisters in patches on your hands and feet.
If you have psoriasis, you may also experience psoriatic arthritis. This is the inflammation of the joints and can be mild to severe. More serious cases can cause long-term complications.
Many people have only one type at a time, although you can have two different types together. One type may change into another or become more severe. Most cases of psoriasis go through cycles, causing problems for a few weeks or months before easing or stopping.
Psoriasis can run in families and flare-ups can be triggered by changes in the environment, injury or illness. Lifestyle factors can also play a role in the severity of psoriasis and trigger flare-ups. Psoriasis can also become worse in the winter or when you’re stressed. Psoriasis can also be affected by pregnancy and get worse after pregnancy. The most common triggers include:
- Stress - the first episode of psoriasis often follows a significant period of stress.
- Alcohol - is dehydrating, which can increase the severity of psoriasis.
- Injury - scratches, cuts, piercings, injections.
- Infections - any form of illness, but particularly throat infections.
- Medication - including lithium, antimalarials, Ibuprofen and blood pressure medication.
- Hormones - in women puberty, pregnancy and menopause.
Psoriasis treatment varies slightly depending on what type or types that you are suffering from, whereabouts on your body your skin is affected and the severity of your condition.
Topical treatments fall into the following categories, but are often used in conjunction with one another:
- Emollients & Moisturisers
- Vitamin D Preparations
- Topical Steroids
- Coal Tar Preparations
Emollients & Moisturisers
Emollients and moisterisers help to hydrate and protect dry, flaky skin. They can be applied liberally to the skin as part of your daily skincare regime to prevent and reduce symptoms, such as itchy and irritation. Some emollients such as Dermol and Cetraben bath additives can be used as a substitute for soap or shower gel to help prevent your skin from drying out further while bathing. For all other emollients, it is advised that they are applied immediately after bathing to ensure maximum hydration is achieved.
Emollient Creams are often preferred for use in the daytime as they are generally designed to be lighter non-greasy formulas, for more natural feeling hydration. Example emollient creams include: Cetraben Cream, Diprobase Cream, E45 Cream and Zerobase Cream.
Emollient Ointments are intensely moisturising but tend to be more greasy than creams so are generally favoured for overnight use. Examples of ointments include: Cetraben Ointment and Diprobase Ointment.
Emollients and moisturisers are the first line over-the-counter treatment for symptoms of psoriasis. For those people who emollient creams have not worked or for those suffering from moderate to severe cases of psoriasis prescription creams, ointments, lotions, gels and foams would be the next treatment option.
Topical Steroids
Corticosteroids are a common treatment for psoriasis as well as other skin conditions such as eczema and dermatitis. They are applied directly to the affected areas of the skin to reduce inflammation and thickening. Depending on the severity of your psoriasis, there are varying strengths or potencies of topical steroids that can be prescribed. Mild or low strength steroids can be bought without a prescription. Steroids are only suitable for short-term use because they can cause certain side effects that can cause the skin to become fragile and irritated.
For psoriasis of the body and trunk, steroids are usually recommended for use in the morning to reduce inflammation. Examples include Betnovate (betamethasone) cream and Elocon (mometasone) cream.
For scalp psoriasis, commonly noticeable patches on the neck can be treated with mild or steroid scalp treatments. Examples include Betacap (beteamethasone) scalp application and Dermovate (clobetasol) scalp application. Sometimes a treatment with scale removing agents can be used such as Diprosalic Scalp application.
For psoriasis of the face, flexures and genitals, it should be treated with a mild or moderately potent steroid for one to two weeks. Examples include Eumovate cream (Clobetasone), and Hydrocortisone 1% cream.
Vitamin D Preparations
Vitamin D gels, ointments and foams are only available on prescriptions and are either used alone or in conjunction with a topical steroid. With correct use, they can reduce inflammation and reduce redness, scaling and dry skin within a matter of weeks. For best results, topical Vitamin D should be applied to the skin half an hour after thoroughly moisturising the affected skin with an emollient.
They are not recommended for use of delicate areas such as the face and should not be used long-term as they can cause a build-up of calcium levels in the blood and when combined with steroids can cause thinning of the skin. Vitamin D (calcipotriol) only formulas include Dovonex Ointment, Vitamin D (calcipotriol) and steroid (betamethasone) combined such as Dovobet Gel & Ointment.
Coal Tar Preparations
Coal tar is most commonly used to treat scalp psoriasis and so often comes as a shampoo. Coal Tar has anti-inflammatory and anti-scaling properties that help to settle and soothe symptoms of psoriasis. Examples of products that contain just coal tar extract include Polytar Shampoo, Capasal Shampoo and Cocois Ointment.
Phototherapy
Phototherapy uses natural and artificial light to treat psoriasis. Artificial light therapy can be given in hospitals and some specialist centres, usually under the care of a dermatologist. These treatments are not the same as using a sunbed.
UVB phototherapy uses a wavelength of light invisible to human eyes. The light slows down the production of skin cells and is an effective treatment for some types of psoriasis that have not responded to topical treatments. Each session only takes a few minutes, but you may need to go to hospital 2 or 3 times a week for 6 to 8 weeks.
Psoralen plus ultraviolet A (PUVA) is where you'll first be given a tablet containing compounds called psoralens, or psoralen may be applied directly to the skin. This makes your skin more sensitive to light. Your skin is then exposed to a wavelength of light called ultraviolet A (UVA). This light penetrates your skin more deeply than UVB light. This treatment may be used if you have severe psoriasis that has not responded to other treatment.
Combination Light Therapy
You may be offered creams or ointments (topical treatments) alongside light therapy if:
- Your psoriasis is not responding to light therapy alone
- ou cannot, or do not want to, take medicines for your psoriasis
Non-Biological Medications
Methotrexate
Methotrexate can help control psoriasis by slowing down the production of skin cells and suppressing inflammation. It's usually taken once a week. Methotrexate can cause nausea and may affect the production of blood cells. Long-term use can cause liver damage.
Methotrexate can be very harmful to a developing baby, so it's important that women use contraception and do not become pregnant while they take this drug and for at least 6 months after they stop. Men are advised to delay trying for a baby until at least 6 months since their last dose of methotrexate.
Ciclosporin
Ciclosporin is a medicine that suppresses your immune system (immunosuppressant). It was originally used to prevent transplant rejection but has proved effective in treating all types of psoriasis. It's usually taken daily. Ciclosporin increases your chances of kidney disease and high blood pressure, which will need to be monitored.
Acitretin
Acitretin is an oral retinoid that reduces skin cell production. It's used to treat severe psoriasis that has not responded to other non-biological systemic treatments. It's usually taken daily. Acitretin has a wide range of side effects, including dryness and cracking of the lips, dryness of the nasal passages and, in rarer cases, hepatitis.
Acitretin can be very harmful to a developing baby, so it's important that women use contraception and do not become pregnant while taking this drug, and for at least 3 years after they stop taking it. However, it's safe for a man taking acitretin to father a baby.
Other drugs
Apremilast and dimethyl fumarate are medicines that help to reduce inflammation. They are taken as daily tablets. These medicines are only recommended for use if you have severe psoriasis that has not responded to other non-biological treatments.
Biological Treatments
Biological treatments reduce inflammation by targeting overactive cells in the immune system. They are usually used if you have severe psoriasis that has not responded to other treatments, or if you cannot use other treatments.
Etanercept
Etanercept is injected twice a week, and you'll be shown how to do this. If there's no improvement in your psoriasis after 12 weeks, the treatment will be stopped. The main side effect of etanercept is a rash where the injection is given. However, as etanercept affects the whole immune system, there's a risk of serious side effects, including severe infection.
Adalimumab
Adalimumab is injected once every 2 weeks, and you'll be shown how to do this. If there's no improvement in your psoriasis after 16 weeks, the treatment will be stopped. The main side effects of adalimumab include headaches, a rash at the injection site and nausea. However, as adalimumab affects the whole immune system, there's a risk of serious side effects, including severe infections.
Infliximab
Infliximab is given as a drip (infusion) into your vein at the hospital. You'll have 3 infusions in the first 6 weeks, then 1 infusion every 8 weeks. If there's no improvement in your psoriasis after 10 weeks, the treatment will be stopped. The main side effect of infliximab is a headache. However, as infliximab affects the whole immune system, there's a risk of serious side effects, including severe infections.
Ustekinumab
Ustekinumab is injected at the beginning of treatment, then again 4 weeks later. After this, injections are every 12 weeks. If there's no improvement in your psoriasis after 16 weeks, the treatment will be stopped. The main side effects of ustekinumab are a throat infection and a rash at the injection site. However, as ustekinumab affects the whole immune system, there's a risk of serious side effects, including severe infections.
Other Biological Treatments
There is an increasing number of biological treatments that are given as injections. These include guselkumab, brodalumab, secukinumab, ixekizumab, bimekizumab and risankizumab. They're recommended for people who have severe psoriasis that has not improved with other treatments or when other treatments are not suitable.
Other Methods
Diet – some studies have shown that alcohol and dairy may lead to flare ups, reducing these can help with symptoms
Relaxation techniques – stress is a big factor so meditation and relaxation techniques may improve your symptoms
Antibiotics & Antifungals - You may require a prescription of antibiotics or antifungal tablets or creams if your skin is infected. These include Fucidin Cream and Clotrimazole 1% Cream.
Frequently Asked Questions
Psoriasis is a long-term condition and there is no way to completely prevent flare-ups, however, the most reliable way of reducing flare-ups of psoriasis is to try and identify and avoid certain triggers that are relevant to you and your condition.
Stress, Hormonal changes, Medication, Alcohol, Smoking, Throat infections, Injury to the skin It may take several flare-ups of psoriasis for you to become familiar with what factors are triggers for you.
Psoriasis is not contagious, it cannot be caught by person-to-person contact, or by sharing of bodily fluids (such as by kissing or sharing food or drinks). It also cannot be caught by others in close contact public areas, such as in swimming pools or in saunas. It is an auto-immune disease, which means flare-ups occur due to the body’s own immune system targeting itself, causing an inflammatory response that triggers an overproduction of skin cells.
Like other auto-immune conditions, once you have psoriasis you will always have it. There is no cure. It is likely that you will continue to experience sporadic episodes of psoriasis for the rest of your life.
There is evidence to suggest that there may be some links to the condition being passed down genetically within families. This does not necessarily mean, however, that if someone in your family suffers from psoriasis that you will also develop the condition.
Scalp psoriasis and eczema of the scalp are two conditions that affect the same area and share similar symptoms. Eczema of the scalp causes inflammation of the skin. Typically, the condition will cause the scalp to feel itchy and sore, which will lead to dry skin developing on the scalp. In more severe cases, eczema of the scalp can cause blistering and weeping lesions to form. Psoriasis of the scalp usually develops in patches. It presents as red, flaky areas of skin that are covered with grey/silvery scales.
Iin order to get diagnosed with chronic plaque psoriasis, or any other type of psoriasis, you will need to see a doctor. Your doctor will examine you and give you a diagnosis.
Psoriasis symptoms may come and go and these may be referred to as ‘flare ups’. Flare ups can happen in response to ‘triggers’ which are situations that cause your symptoms to happen. These can be things such as high levels of stress or cold weather.
It is not brought on by poor hygiene, and the presence of psoriasis does not mean that a person’s hygiene is poor.
People with psoriasis often suffer with low confidence and self esteem, which in turn impacts on their relationships and social lives. Psoriasis on the hands or feet can make everyday activities difficult, and psoriasis on areas such as the groin or buttocks can make even sitting down or going to the toilet quite painful. Psoriasis is also linked to the development of psoriatic arthritis, although not everyone with psoriasis will develop this condition.
Certain dyes can be quite harsh to the scalp, and can irritate open lesions, but if milder dyes are used, patch tests carried out, and reputable hairdressers consulted, there is no reason why someone with psoriasis should not dye their hair. This also applies to the use of other hair products. However, like with hair products, if a patch test is carried out and no irritation occurs, there is no harm in applying makeup.
People with psoriasis anywhere on their body may feel self conscious when it comes to sex, and this is likely to be increased if psoriasis is actually in the groin or genital area. Also, people with psoriasis in these areas may find that sex can irritate the psoriasis. However, neither of these potential problems means that someone with genital psoriasis should not have sex.
People taking certain medications for psoriasis or psoriatic arthritis - such as methotrexate or acitretin - should avoid alcohol, or limit alcohol consumption. This is because it can influence the way in which the medications are broken down in the body, or raise the risk of potential side effects. There are plausible arguments for why drinking might affect psoriasis (alcohol is dehydrating, and therefore could dry skin out even more), but research has been undecided about whether alcohol significantly affects psoriasis or not.
Many people with psoriasis have little or no problem with their ability to work, and most can and do have jobs and successful careers. In certain areas of work, environmental conditions, the use of chemicals, gloves, and frequent hand washing might make psoriasis worse.
The National Institute for Health and Care Excellence (NICE) guideline on the assessment and management of psoriasis (CG 153) recommends that doctors should discuss cardiovascular risk factors with all people who have psoriasis, and support any lifestyle changes (such as weight loss, quitting smoking ,etc) that might be needed. It also recommends that people with severe psoriasis should be offered a cardiovascular risk assessment every five years. This is because recent scientific research has suggested that people with psoriasis could be more likely to develop certain other conditions, including heart disease.
Scientific research has not yet found a definite link, or found a diet that works for everybody. Some people do say that they’ve noticed an improvement when they cut something out of their daily diet, and if you think you might be eating something that makes your psoriasis worse, then keeping a food diary is an easy way to spot any patterns.
You will need to have a referral from your GP in order to see a Dermatologist, whether this is via the NHS or if you chose to be seen privately.
Treating psoriasis and/or psoriatic arthritis is often a case of trial-and-error, and many people try a number of different things before they find a treatment, or combination of treatments, that works for them. Because of this, it is not uncommon to find yourself using a treatment that is not working as well as you’d hoped, or that has gradually become less effective. If your treatment doesn’t work, or stops working, you should make an appointment to see your doctor (Dermatologist or GP) to discuss your other options.
One of the active ingredients in Dovobet is a corticosteroid called betamethasone. The amount of betamethasone in Dovobet means it’s considered a strong steroid. This means you should take care not to apply too much or use the treatment for longer than recommended by your doctor.
Dovobet ointment can be used to treat plaque psoriasis in adults. Dovobet Gel is also used for plaque psoriasis as well as scalp psoriasis.
Dovobet, in the UK, is a prescription-only medicine and you cannot buy Dovobet ointment at your local pharmacy. You will need a prescription from a doctor or qualified health care professional to obtain it.
Eumovate cream is sometimes prescribed for psoriasis, but you should check with your doctor before using it as it may not necessarily be the best treatment for you. One of the possible side effects of Eumovate can be a slight rash, so it is likely not the best option for a heat rash either.
