Psoriasis Awareness Week – How to manage psoriasis and how it is linked to PCOS

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Recent research shows that there is a connection between PCOS and Psoriasis, particularly scalp Psoriasis. In a study published in the Journal of Clinical Medicine, patients with polycystic ovary syndrome (PCOS) were found to have a higher risk of developing psoiasis, according to a study published in the Journal of Clinical Medicine. So, in light of Psoriasis Awareness Week we asked Trichologist, Lisa Thomas, to tell us more about the condition and to explain how we can manage and treat it.

What is psoriasis?

Psoriasis is a common, inflammatory, skin condition which can affect any part of the skin surface.  It most commonly appears on the elbows, knees and scalp.  The condition is characterised by patches of red, inflamed skin which is covered by silvery-white scale.  These are also known as plaques.  Psoriasis is not contagious and it is thought that around 2% to 3% of people worldwide have this condition.  It can be a very embarrassing condition to live with if there is a lot of visible scale.  

What causes psoriasis?

It is not known what causes psoriasis and, for this reason, there is currently no cure.  It can, however, be managed well.

It is understood that the psoriatic plaques are made by a defect in the auto-immune system.  This causes skin cells to grow too quickly and then to build up into plaques on the skin surface.  There is a genetic link to psoriasis and you are more likely to have it if one or both of your parents also have the condition.  

Although sufferers have a genetic predisposition, you still need a trigger to start the condition.  Psoriasis can be triggered by a number of things:

  • Food allergies – research has found an increased incidence of psoriasis in those who are sensitive to gluten
  • Low levels of vitamin D – research has shown a link to low levels of vitamin D and auto-immune conditions
  • Stress
  • Essential fatty acid deficiency – essential fatty acids, in particular omega-3, are needed to create healthy skin cell membranes and reduce inflammation
  • Long-standing infections – people with compromised immune systems and persistent infections have a higher risk factor for psoriasis (for example Helicobacter pylori, a bacteria which lives in the stomach lining, should be eliminated as a possible trigger)
  • Obesity
  • Skin infection or skin injury
  • Certain medications can cause psoriasis – such as lithium, beta-blockers, antimalarial drugs and iodides
  • Studies have shown that psoriasis can be worsened by smoking and excessive alcohol intake

Symptoms of scalp psoriasis 

When psoriasis appears on the scalp it can present in a number of ways.  It can be mild and almost unnoticeable.  However, more severe cases will be extremely bothersome, causing itching, bleeding and crusting that can be a challenge to control.  

  • Red patches covered with silvery-white scale
  • The scale can resemble dandruff-like flakes
  • The scalp can be itchy
  • The scalp may feel tight and uncomfortable
  • The plaques may bleed easily when scratched, which may lead to a skin infection
  • Hair loss

Mild psoriasis of the scalp has fine flakes, whereas severe psoriasis is characterised by thick, crusted plaques covering most of the scalp.  These plaques can be difficult to remove and some hair loss can be experienced.  The hair will usually grow back, however, once the inflammation and scale have eased.  

What treatments are there?

Although psoriasis cannot be cured, it can be brought under control with the right therapies and it is important to work with your doctor and trichologist to manage your condition.  

There are various different types of treatments and a treatment plan will be very individual to the sufferer.

Types of treatment for scalp psoriasis include:

Topical steroid treatments

These are the most commonly prescribed treatment for scalp psoriasis and are usually used for a few weeks at a time to bring psoriasis under control.  These should not, however, be used on the face or around the ears as the skin in these areas is very thin and more prone to sensitisation, thinning and damage.  

Steroid applications containing betamethasone valerate 0.1% are typically prescribed. (Betacap scalp application, Betnovate scalp application, Betnovate scalp lotion and Bettamousse foam are some examples).

A very potent topical steroid containing clobetasol propionate 0.05% may be prescribed for you if first-line topical steroids have failed to get your condition under control.  Dermovate scalp application is once such very potent steroid and must be used under the guidance of your GP.

Occasionally the steroid that you use can become less effective and you may need to try an alternative formulation or treatment for a while.  

A rebound effect can sometimes follow the cessation of treatment with steroids so always take the advice of your doctor when using these. 

Steroid shampoo

A prescription shampoo containing the steroid clobetasol propionate 0.05% (also known as Etrivex shampoo) can be useful in reducing inflammation.

Vitamin D derivatives

These can be prescribed and used to bring scalp psoriasis under control and also for maintenance.  They are available as an ointment, gel or lotion and are usually applied once or twice a day and often do not need to be washed out.  Calcipotriol and tacalcitol are two examples.

There are two products which combine a vitamin D derivative (calcipotriol 50mcg/gram) with a strong steroid (betamethasone dipropionate 0.05%) which can be used to control scalp psoriasis but these must not be used on the face or behind the ears.  These two products are called Dovobet gel and Enstilar foam.  

Calcineurin inhibitors

These are creams which reduce the activity of the immune system and bring down inflammation.  Two types are tacrolimus and pimecrolimus.

Coal tar preparations

Coal tar has been used for many years in the treatment of scalp psoriasis and can be used on the hairline, forehead and around the ears.  (Exorex lotion, Psoriderm scalp lotion).  

Coal tar may be combined with salicylic acid or coconut oil to help remove scale.   Two preparations containing 12% coal tar, 2% salicylic acid and 4% precipitated sulfur in a coconut oil base are marketed as Sebco ointment and Cocois ointment.  Just be aware that coal tar can stain clothing or can temporarily discolour blonde hair.

Medicated shampoos

There are a number of medicated shampoos readily available from your local chemist.  Popular ones to try are Neutrogena T-gel, Alphosyl and Polytar.  Leave the lather on your scalp for 5 – 10 minutes to get the best out of the shampoo.  Sometimes coal tar based shampoos can make your hair feel a bit dry, so you might like to use a conditioner.  

How to remove thick scale

Sometimes you might need a little extra help to remove the thick scale and this must be done with patience and care in order not to damage the scalp or the hair.  

I have found that a special formulation containing allantoin is very effective at softening and removing the scale.  I find allantoin to be as effective as salicylic acid but is much kinder to the scalp and the hair.  It is especially useful for patients who do not want to use steroids or other strong chemicals on their scalp. 

Using a scalp steamer or infrared lamps can also really help and I have great results with these in my clinic.  Also, treatment with ultraviolet light helps.  Of course, these will not cure the psoriasis but are useful at managing it.  

What other treatments are there?

PUVA

PUVA is a prescription treatment that has been used in the treatment of psoriasis since 1976.  It is a combination treatment of two therapies.  

First you take an oral medication of psoralens.  (Alternatively you may be able to soak in a bath of water with psoralens added to it).  Psoralens are chemicals which are found in many plants, and these make the skin sensitive to UVA.  

Secondly, the skin is then exposed to (UVA) long wave ultraviolet radiation.  You would stand in a special cabinet containing 6 foot long UVA fluorescent bulbs.  This treatment is usually carried out in the physiotherapy department of hospitals and your GP would need to refer you for this treatment.  

Other things you could do: 

  • Ensure your vitamin D levels are adequate by taking a simple blood test – some private labs offer this as a simple finger prick blood test
  • Ensure you are getting enough intake of essential fatty acids – supplements of fish oil or flaxseed oil may be useful
  • Work to eliminate any factors which may trigger psoriasis, such as any food sensitivities or malabsorption issues you may have
  • Try to manage stress levels well
  • Ensure a healthy lifestyle

How to treat severe and more extensive psoriasis?

If your psoriasis is severe and more extensive your doctor and/or dermatologist may prescribe systemic oral medications for you.  These include drugs such as retinoids, methotrexate, ciclosporin and biologics to name just a few.  

I hope I have given you a little insight into how to manage your scalp psoriasis.  Work with your GP, dermatologist and your trichologist to really get your condition under control.  There is so much that can be done to help you.  

With my very best wishes,

Lisa

Lisa Thomas, IAT WTS, Consultant Trichologist at Hair Clinical, Pembrokeshire

Lisa Thomas, IAT WTS, Consultant Trichologist at Hair Clinical, Pembrokeshire

 

 

 

 

 

 

 

 

 

For more information on psoriasis please visit the Psoriasis Association for more advice. 

If you are interested in sharing your expert advice with us and would like to write a guest blog please email our Information Production Manager, Laura Faulkner, at laura@verity-pcos.org.uk