I have been asked this question a few times recently and the
honest answer for a long time was… I don't know!
Psoriasis is just psoriasis, right? Wrong.
I was recently asked to take part in a survey about my
condition, where once again I was asked this question and the different types
were listed out in a series of tick boxes... whilst some were pretty obvious,
others were not and it shocked me at how severe some were.
What I learnt was that over the years I've actually had
several types of psoriasis, which I will go on to explain below, but it's
probably easiest to start at the beginning.
When I was five I caught chickenpox from a kid in my
nursery. As an older sister this was a double nightmare from my mum as Danielle
also caught it a few days after. Whilst Danielle was lucky enough to only catch
a few spots which cleared pretty quickly, I was covered from head to toe! After
a couple of weeks Danielle was back in school but I was still home with an
increasing amount of spots. After a visit to the doctor, he told us that he was
fairly certain these spots were actually psoriasis and a few weeks later a
dermatologist confirmed that it was indeed guttate psoriasis.
Over the years my condition worsened, the spots grew and
joined to make larger plaques, they became red and angry sometimes bleeding and
I became more aware of it. It had developed into the most common form, plaque
psoriasis.
At the same time I also noticed patches of psoriasis
appearing on my scalp and neck, forehead, behind and inside my ears and worst
of all, under my nails. Some research class these as part of plaque psoriasis,
but for the sake of treatment I class them as separates.
And that's where I am now - I currently have widespread
plaque psoriasis covering most of my torso and parts of my arms and legs. I
also have it on my scalp, forehead, ears and neck and most recently my eyelids,
as well as my finger and toes nails.
So here's what I now know about the different types of
psoriasis that I've had and a couple of typical treatments have been offered and have worked -
Guttate psoriasis often starts in childhood or
young adulthood. It appears as small, red, separate spots on the skin,
usually on the trunk and limbs. They can sometimes appear on the scalp, face
and ears. The lesions do not tend to be as thick as those of plaque psoriasis.
This form can precede or appear alongside other forms of psoriasis such as
plaque.
This type of psoriasis often comes on quite suddenly, with
known triggers including:
- Upper
respiratory infections
- Streptococcal infections - such as chickenpox and tonsillitis
- Stress
- Injury
to the skin
Suggested treatment: Topical creams (I've tried millions
over the years, none have had a lasting effect), Sun treatment (have had two
rounds that have cleared it for six month periods)
Plaque psoriasis is the most common form of
psoriasis and appears as raised, red patches covered with a silvery white
buildup of dead skin cells or scales (often referred to as scabs). These
patches most often appear on the scalp, knees, elbows and lower back. They're
itchy and painful, and they can crack and bleed.
This type of psoriasis often comes develops over time, with
known triggers including:
- Inheritance
- Sunlight:
psoriasis is often much better and more manageable in the summer when
exposed to sunlight, and worse in the winter without
- Stress
- Streptococcal
infections
- Hormonal
changes (particularly after childbirth)
- Smoking
and alcohol.
- Trauma
- psoriasis may be spread to uninvolved skin by various types of trauma
Suggested treatments: Topical creams (the majority I have
been prescribed have been steroid based and whilst they work short term, the
cause havoc when trying to come off them) Sun treatment (again, has completely
cleared it for 6 month periods but can be difficult to find time to do this
around a full time job)
Scalp psoriasis makes raised, reddish,
often scaly patches on your scalp and can often spread to your forehead, the
back of your neck, or behind your ears.
Symptoms of scalp psoriasis include; scaly, red, bumpy
patches, silvery-white scales, dandruff-like flaking, dry scalp, itching,
burning or soreness and in some cases hair loss.
Scalp psoriasis itself doesn’t cause hair loss, but
scratching a lot or picking at the scaly spots, harsh treatments, and
the stress that goes along with the condition can lead to temporary
hair loss. Fortunately, your hair usually grows back after your skin clears.
This type of psoriasis can appear with or without other
types, with known triggers including:
- Inheritance
- Stress
- Streptococcal
infections
- Smoking
and alcohol
Suggested treatment: Coal tar based shampoos (I have
tried lots over the years, the one that I find works best is Alphosyl
2in1, medicated creams, gels, oils (have tried a few but none have been as
effective as the shampoo and are a real pain to wash out)
Nail psoriasis - psoriasis can affect fingernails and
toenails. You can usually spot it easily, but it can sometimes be mistaken for
a fungal infection.
Common traits include;
- Pitting
of the nails - small pits appear on the surface of the nail
- Onycholysis
- the nail separates from the skin underneath the nail. At first this
looks like a white or yellow patch at the tip of the nail. This patch
gradually gets bigger and reaches the base of the nail. The gap between
the nail and the skin underneath the nail can become infected and change
colour.
- Subungual
hyperkeratosis - chalk-like material builds up under the nail. The nail becomes
raised and often tender.
- Discolouration
of the nail, turning to yellow-brown
- Thickening
of the nail
There are steps that you can take to reduce the discomfort
and prevent the condition from worsening, such as;
- Keeping
your fingernails and toenails short
- Keeping
your nails as dry as possible
- Protecting
your nails by wearing gloves when doing any manual work
- Avoid
a manicure of the base of the nail. This may cause an infection
- Avoid
false nails or varnish containing acetone as it can cause damage to the
nail
Treatments for severe nail psoriasis include:
- Antifungal
treatment - this may be required for fungal nail infection if this is
also present.
- A
steroid injected into the nail - this may be effective for some types of
nail psoriasis but it is painful
- Phototherapy
(light therapy)
- Removing
an affected nail (in extreme cases)
So, the next time somebody asks me that question I can
confidently say I have several types of psoriasis, each of which should be
approached and treated differently!
Has this been helpful? I’d love to hear your thoughts –
please do get in touch!
