Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Psoriasis

Dear Dr Margaret
I have a question on psoriasis. Can it ever be cured? It has been bothering me for several years already and it seems to me it was controlled at one time but came back on and off. Can any medications cure it? I have consulted my dermatologist for assistance without much result.

Psoriasis (pronounced sor-eye-a-sis) is a condition in which there are patches of thickened, scaly skin. The scales have a silvery colour. The skin beneath the scales, and at the edge of the patch, is purplish-red. It’s good that you have a proper diagnosis from a dermatologist, because not all scaly skin conditions are psoriasis. On the genitals (such as the head of the penis), it may not be scaly, but may just look like a shiny red patch.

There is no magic cure for psoriasis, but this does not necessarily mean that you will have it forever. If you had no treatment, after some time (weeks, months or even years) it might go away for no apparent reason. Then, after a variable period of time, it might come back again. The aim of treatment is to deal with the psoriasis that you have at present. So a treatment will improve your skin, but cannot guarantee that psoriasis will not come back in the future. If and when it does return, the same or other treatments can be used again. Fortunately, the skin changes in psoriasis are all potentially reversible, even if your psoriasis seems really severe, so your skin can clear completely without any scarring.

In fact, psoriasis is a very unpredictable disorder. Suppose a teenager with psoriasis sees a doctor. There is no way the doctor can predict whether it will be a one-off event, or whether it will be a recurring problem for many years. If it turns out to be a recurring problem, no one can predict how many episodes there will be, and how frequently they will occur.

You may be wondering why you have psoriasis. The cause is not known. It may be partly in your genes; about one in three people with psoriasis have relatives with the same problem. If your genes have given you a tendency to psoriasis, it may be triggered by some medications (such as lithium or antimalarials), by infections (such as a throat infection) and possibly by stress. It is not an infection (although it can be triggered by infections), and therefore you did not catch it from someone else and other people will not catch it from you.

You may also be wondering about what is actually happening in your skin. Our tattoos section describes how the skin is constantly renewing itself. In psoriasis, this process is speeded up to about seven times faster than normal. Therefore the cells do not have time to mature normally, and the silvery scales develop.

I hope your doctor is sympathetic to your concerns. He or she should be, because there has been a lot of research lately about how upsetting even mild psoriasis can be.

You might like to look at the website of the National Psoriasis Foundation, a US not-for-profit organization www.psoriasis.org. The American Academy of Dermatology also has a good illustrated psoriasis website www.derm-infonet.com/psoriasisnet/index.htm.

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