An expert guide to psoriasis

Dr Wanda Robles, a consultant dermatologist at Dr Haus Dermatology on Harley Street, specialises in helping patients with chronic skin conditions such as psoriasis and eczema. To mark Psoriasis Awareness Month, she provides an overview of this common condition and sheds light on the groundbreaking treatment known as biologic therapy, a cutting-edge approach that harnesses the body’s own immune system to combat the disease.

What is psoriasis and what causes it?
Psoriasis is a common inflammatory condition that affects the skin and sometimes the joints. When a person has psoriasis, their skin replacement process speeds up, with skin cells being replenished in just a few hours instead of the usual 21-28 days. This accumulation of skin cells results in the formation of raised ‘plaques’ on the skin, which can be flaky, scaly and itchy. They appear red on lighter skin tones and present as darker patches on those with darker skin.

While some individuals may have a family history of psoriasis, others develop it without any familial link. Flare-ups of psoriasis can be triggered by various factors, including stress, anxiety, skin injuries, hormonal changes, infections or certain medications. It’s important to note that psoriasis is not contagious, so you don’t have to worry about passing it on to others.

Dr Wanda Robles of Dr Haus Dermatology

Who does psoriasis affect?
At least 1 million people in the UK alone are thought to have psoriasis. It affects women and men equally and can occur at any age, but most often develops in adults aged from 20 to 30 years old and from 50 to 60 years old.

It can occur on any area of the body, including the scalp, hands, nails, feet and genitals. Interestingly, while having certain genes can increase the likelihood of developing psoriasis, it’s not the sole factor at play. Some people who experience this condition don’t have any specific genes that make them more prone to it.

What treatments are available?
Sadly, psoriasis is a chronic condition that doesn’t have a cure. But there are a range of approaches to help patients effectively manage their psoriasis, from topical treatments to systemic drugs. 

Topical treatment is something that is applied directly to the skin or body surface – for example, lotions, creams, ointments, gels and shampoos. The aims of topical psoriasis treatment are to remove excess scaly skin and calm the underlying inflammation. Systemic drugs, which are a form of non-biological therapy, include methotrexate, ciclosporin, acitretin and apremilast. 

In recent years, there has been an increased use of biologic therapy. It’s a cutting-edge approach that harnesses the body’s own immune system to combat chronic diseases such as psoriasis, inflammatory bowel disease (IBD) and arthritis. There have been rapid advances in the field in recent years. It signals a shift towards a more personalised approach to care.

How does biologic therapy help?
Biologic therapy is designed to stimulate or restore the ability of the body’s immune system to fight infection and disease. While other drugs are derived from plants or chemicals, biologics are crafted from proteins that target the immune system in a much more specific way. They target the immune response that leads to the rapid skin cell growth characteristic of psoriasis.

A number of biologic drugs – for example, secukinumab, risankizumab and guselkumab – are used for the treatment of chronic psoriasis when conventional treatment options have failed. They are administered via an injection under the skin of the stomach, thighs or upper outer arms.

What is the treatment protocol for biologic therapy?
The treatment protocol is tailored to meet the needs of each patient. The dosage and frequency very much depend on the patient. It is not uncommon for a doctor to prescribe one dose per week for the first five weeks, for instance, and then once a month thereafter. However, for some patients it may just be monthly treatments that are necessary.

Is biologic therapy suitable for everyone?
Biologic therapy is not suitable for every patient, but for many patients it is extremely effective at controlling their psoriasis. If you’ve noticed an itchy, scaly rash, your first step is to book an appointment with your doctor, who may then refer you to a dermatologist who specialises in diagnosing and treating skin conditions.