Psoriasis affects approximately 1.8 million people in the UK, around 2% of the population. Red, flaky patches of skin covered in silvery scales are typical of the condition, which comes and goes throughout life. Its frequency and severity can vary greatly from person to person, from causing minor irritation to seriously affecting their quality of life.
Psoriasis causes inflammation and an increased production of skin cells. Rather than being replaced every 3-4 weeks, skin cells are replenished in 3-7 days, causing characteristic plaques often found on the knees, elbows, scalp and lower back (although they can appear anywhere on the body).
The psychological toll of psoriasis
The World Psoriasis Happiness Report explores the impact of living with self-reported psoriasis on subjective happiness. It suggests 36.7% of those affected by psoriasis in the UK live in misery, second only to people with the condition in China. The report, commissioned by the Happiness Research Institute and Leo Innovation Lab, found 77% of sufferers describe psoriasis as a 'problem' or 'significant problem' which impacts their quality of life. A third also say they experience depression or anxiety because of it.
"Psoriasis can have a varied impact on quality of life depending on the patient, areas of the body affected and the extent of the disease," explains Dr Anton Alexandroff, consultant dermatologist and British Skin Foundation spokesperson.
"Whilst some patients may not pay too much attention to their condition, others are severely affected by it, especially if it presents in visible areas such as the face or hands, or in areas that can affect intimacy and relationships such as the genitals. In general, because of its high visibility, psoriasis has a huge impact on quality of life. Patients are often depressed as their social, professional and intimate lives are affected."
"I felt let down by my body"
Leonie Parker developed psoriasis following an operation, aged 23. As a former model, the diagnosis was a tremendous blow and shattered her self-esteem:
"I always knew I was very lucky with my skin so when I got psoriasis, I felt like I had lost a part of my identity or a part of myself that I saw as positive in my eyes. Being a young woman, we can find so many flaws with ourselves, but my skin was never one of them until psoriasis came along.
"When you first get 'it', you feel as if your whole body has let you down. I was covered from head to toe in patches of psoriasis, which were very itchy, whilst my scalp felt sore and tender. As my skin started to heal I was left with noticeable scars and psoriasis on my body. I remember wearing a bikini while on holiday with a friend who was so shocked to see my skin that she commented on it. If she freaked out like that and she knows me - then what would others think of me?"
Anne Trigg suffered a breakdown in her thirties after developing psoriasis at 17. Various triggers - teenage stress, post knee-op surgery and her career in teaching - have resulted in severe flare-ups:
"Any type of physical or emotional stress was the key trigger for my worst bouts of psoriasis which were sometimes so bad that I've been hospitalised. An operation in my twenties caused a response on my knees, legs and abdomen, which was really severe. Before that I'd also suffered with painful plaques behind my ears and scalp which were noticeable and a great source of further stress."
Trigg's case is by no means unusual, and many people find themselves in a catch-22 situation. While psoriasis is very much a physical disease, flare-ups are often triggered by stress. That means that worrying about a potential flare-up in the run-up to an important life event can actually make it more likely to happen, just when you are most desperate to avoid it.
There is no cure but psoriasis can be managed through a range of treatments depending on severity, says Alexandroff.
"When treating psoriasis, always seek advice from your GP or dermatologist. Common plaque psoriasis can be treated with a potent topical corticosteroid with added vitamin D, mild steroid creams or coal tar cream. In severe cases, patients can require potent medicines or injections. Sensible sunlight may help psoriasis - again only under the direction of your GP or dermatologist - but avoid sunburn which can trigger psoriasis on sunburnt areas. If the psoriasis is itchy, use chilled moisturisers frequently (creams rather than ointments)."
While living in Australia, Parker found her psoriasis cleared up thanks to increased exposure to UV, and worsened on her return.
After five years living with the condition, and trying lots of different remedies, Parker now feels she has her psoriasis under control. A moisturising routine to soften plaques - which Parker advises you stick to religiously - and coconut oil in a warm bath really help her, as does avoiding certain foods: tomatoes, peppers and red meat, along with alcohol and smoking. Although there's currently no evidence that avoiding certain foods or following a specific diet will help psoriasis, some sufferers do notice a difference when they make a dietary change.
Like Parker, Trigg has tried many treatments over the years but nothing had ever really got to grips with her psoriasis. But she recently came across HelloSkin (a website where dermatologists recommend products for specific skin conditions) which led her to try Sorion, a non-steroidal cream which she has found particularly helpful.
Other tips to help cope with the disease include avoiding stress where possible, ensuring you get enough sleep and exercise, and sticking to your routine.
Unfortunately, what works for some won't work for others, and it can take a lot of trial and error before an effective treatment is found. If you feel that a particular treatment isn't working for you or your psoriasis is affecting your quality of life, speak to your GP or healthcare team. Even just talking about the condition is cathartic for some, and support can be found online in various forms, such as websites and support groups including the Psoriasis Association and the British Skin Foundation.