Lifestyle Choices

Holidays and sun

Many people find their psoriasis improves in the summer, particularly when on holiday. The beneficial side effects of ultraviolet light contribute to this improvement as do relaxation, exercise and decreased stress. Take all the holidays you are allowed.

General skin care

It may help to use a bath oil to get a film of oil onto your skin. Moisturizers help – E45, emulsifying ointment, aqueous creams are all good. Something stickier like Vaseline may be useful on plaques at times.

Scalp involvement is a nuisance and frequent hair-washing may be necessary – a short style makes this easier to cope with.

Clothing has to satisfy conflicting interests. Anything too thick and heavy will make you hot and may irritate the psoriasis. Most sufferers wear clothes that will cover the plaques, but you have to choose materials which do not become stained or greasy from contact with ointments.

Ultraviolet light or UV is divided into A, B, and C but only the first two are important here. UVA and UVB can have harmful effects but here we look at the beneficial ones. Many psoriasis sufferers notice an improvement in the sun and this effect can be reproduced by artificial UVB sources at home or in hospital. The effects are not readily explained. A low dose is given initially and gradually increased over a four to six week period. Slight redness may develop but is not essential for a good result.

UVA is less effective by itself but is usually combined with some pills called psoralens and the treatment is then named PUVA. The pills are taken two hours before exposure to UVA and this is repeated two or three times a week. Polaroid glasses must be worn for twenty-four hours after taking the pills to avoid damage to the eyes. This form of treatment is popular because it gets away from all the messy ointments. Caution is necessary whenever UV is used over a long period of time as it is known to age the skin and possibly increase the risk of developing a skin cancer later in life.

Admission to hospital

Most people with psoriasis never attend the hospital outpatient department and only very few ever require an admission to hospital. If, however, you have had psoriasis for a long time and simply cannot clear it at home despite intense effort and feel uncomfortable and miserable, then admission may be a welcome relief. The treatment is intensive, changes can be made on a day-to-day basis and the kind, knowledgeable approach of the nurses and doctors all help to speed up the clearance of the skin problems. It is possible to learn a lot about the treatment of psoriasis in a few weeks and this knowledge can stand you in good stead for years to come. Another reason for going into hospital is the very acute onset of sore psoriasis all over the body.

Tablets and injections

This is never the first line of treatment because psoriasis nearly always responds to ointments. Some people, however, have stubborn disease which never clears properly or it returns as soon as treatment is finished. Another group of people tend to get widespread pustular psoriasis. In these situations a pill or injection may be recommended and this form of treatment will normally be continued for months or years. The advantages are obvious, no time-consuming or messy treatment; no hospital admission; peace of mind that the disease is under control. The disadvantages are less obvious: repeated blood tests; several hospital attendances; some side effects.

Methotrexate is widely used. It can be given as a tablet or injection and is only taken once a week. Slight nausea may be a problem and a careful watch must be kept on blood tests to ensure that the bone marrow and liver are not damaged. Retinoids, in particular etretinate (Tigason) have been available for about eight years. Everyone will develop some dryness of the skin, lips and eyes, but other side effects are less common. The psoriasis gets much thinner and less noticeable but may still be visible as red patches. Blood tests must be checked for cholesterol and other fats and if they show a big rise, a change must be made in the diet or the dose of etretinate. Cyclosporin is the most recent addition to the list of useful drugs for psoriasis. The main side effect here is damage to the kidney. But, just as with methotrexate and etretinate, if the doctor keeps an eye open for side effects, there should be no long-term dangers from the use of this drug.

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