Monday, 28 September 2009
Who are the guests?
Dr. Rosemary Coleman, Dermatologist
Rosemary is one of Irelands leading dermotologists. She is married with three sons. Rosemary graduated from Trinity College, Dublin in 1987 with Honours Degree.
Membership of the Royal College of Physicians 1990. MD Thesis in Genetics of exzema, Trinity College 1993. Fellowship of Royal College of Physicians 1998. Began Dermatology career in Addenbooks Hospital Cambridge in 1990, then 2 years in Great Ormond Street Hospital for sick Children and the Institute for Child Health, London, Univsersity Presbyterian Hospital Pittsburgh (1 year visiting Fellow), Registrar and Senior Registrar St John's Hospital of Dermatology. Guys Hospital London 1993 - 1997. Locum Consultant Childrens Hospital Temple St 1997 - 2001. Full time private practice since in Blackrock Clinic and Mount Carmel Hospitals.
Ger Donnelly, has Psoriasis
Ger is 43 and from Glasnevin in Dublin. He has two children and works as a builder.
To Dr. Coleman
All of the content below, except for case studies story is sourced from, www.nhs.uk
What is psoriasis?
Psoriasis is a skin condition in which skin cells reproduce too quickly. It affects around 100,000 people in Ireland. It can start at any age, but most often develops between 11 and 45 years old, often at puberty. Skin cells have a life-cycle. Your body produces new cells in your lowest skin level and these skin cells gradually move up through the layers of your skin until they reach the outermost level. Then they die and flake off. This whole process normally takes around 21 to 28 days.
In psoriasis this process is speeded up so it only takes two to six days. As a result, cells build up rapidly on the surface of the skin, causing red, flaky, crusty patches covered with silvery scales. These patches are then shed easily. It can occur on any part of your body although it's most commonly found on the elbows, knees, lower back and the scalp. It can also cause itching and burning. The condition is not contagious and most people are affected only in small patches of their body.
The severity of psoriasis varies greatly from person to person. For some people it's just a minor irritation, but for others it has a major impact on quality of life. Psoriasis is a long-lasting disease (chronic) that can return at any time. You may have times when you have no symptoms or times when you have very mild symptoms followed by times where the symptoms are severe.
There is no cure for psoriasis but there is a range of treatments that can help improve your symptoms.
What are the symptoms of psoriasis?
The symptoms of psoriasis vary from person to person.
Most people find that their psoriasis goes through cycles - it causes problems for a few weeks or months, and then the symptoms ease or stop.
There are several different type of psoriasis. Typically, people have only one form of psoriasis at a time, although sometimes two different types can occur together. One type may change to another type, or one type may become more severe.
Common types of psoriasis are:
. Plaque psoriasis - the most common form of psoriasis. Around 80% of people with psoriasis have plaque psoriasis. Its symptoms are dry, red skin lesions - known as plaques - that are covered in silver scales. They normally appear on your elbows, knees, scalp and lower back but can appear anywhere on your body. The plaques are normally itchy, sore, or both. In severe cases the skin around your joints may crack and bleed. (S/S Plaque psoriasis)
. Nail psoriasis - this affects your nails, causing them to pit, become discoloured and grow abnormally. Often nails can become loose and separate from your nail bed. In some severe cases, your nails may crumble. (S/S Nail psoriasis)
. Guttate psoriasis - this normally occurs following a throat infection (streptococci) and is more common among children and teenagers. This causes small (less than 1cm - one third of an inch) water-drop-shaped sores on your chest, arms, legs and scalp. There is a good chance that guttate psoriasis will disappear completely, but some young people go on to develop plaque psoriasis.
. Scalp psoriasis - this normally affects the back of your head, but it can occur in other parts of your scalp, or on the whole scalp. This causes red patches of skin covered in thick silvery-white scales. Some people find scalp psoriasis extremely itchy, while others have no discomfort. In extreme cases it can cause hair loss, though permanent balding is vey rare. (S/S Scalp psoriasis)
. Inverse psoriasis - this affects areas of the skin that are in folds or creases, such as the armpits, groin, and the skin between the buttocks and under the breasts. This can cause large smooth red patches to occur in some or all of these areas. Inverse psoriasis is made worse by friction and sweating, so it can be particularly uncomfortable in hot weather. Inverse psoriasis is more common in overweight people.
When did your psoriasis first flare up?
It initially flared up when I was 21. It broke out very quickly on my arms and knees. I hadn't a clue what was causing it and wasn't too sure exactly what it was so I went to a doctor in Beaumont hospital who diagnosed psoriasis. Gers psoriasis appears on his knee and elbow. Ger describes his psoriasis as being "angry" when it flares up.
How did you feel when it first flared up?
Well I didn't really think anything of it, it was there and there was not a lot I could do with it. My thought was to just get on with it and I have done so. It doesn't affect me in my work as a builder because I don't let it affect me.
What triggers your psoriasis?
My psoriasis is triggered by stress so I can certainly identify with people identified in the survey. I find that when I am stressed out my psoriasis will flare up and get worse. An additional trigger sometimes is alcohol but very rarely would that cause a flare up. When it flares up my skin tends to feel tight and sore.
Do you tend to hide your psoriasis?
No it doesn't really bother me too much in that sense. The only people who tend to point are kids as they're inquisitive about what psoriasis is. I occasionally would wear long sleeves if I was going to a formal function such as a dinner or a meeting but other than that I've no real problem with wearing short sleeves.
How do you treat your psoriasis?
I treat my psoriasis with creams from my doctor. I feel pretty good about my psoriasis at the moment, it's not too bad at all.
Is stress quite a common trigger?
Yes it is, it is one of many. Many people with psoriasis find that symptoms start or become worse because of a certain event - a trigger. Identifying a trigger may allow you to avoid a flare-up of psoriasis. Common triggers include:
. An injury to your skin such as a cut, scrape, insect bite, or sunburn (this is known as 'the Koebner response'),
. Certain medicines like lithium, antimalarial medicines, anti-inflammatory medicines (used to treat hypertension) and beta blockers (used to treat congestive heart failure)
What causes psoriasis?
The exact cause of psoriasis is unknown but it is known that your immune system plays a part. Your immune system is your body's defence against disease - it produces proteins (antibodies) that attack germs and viruses. For some reason, if you have psoriasis, one of these antibodies called T cells start attacking healthy skin cells by mistake. This triggers other immune responses that cause an increase in the production of new skin cells and also T cells.
This results in a cycle of skin cell production becoming faster and faster - skin cells are created and then die in the space of five to six days, rather than the normal 28 days. The dead skin cells then build on the surface of your skin in thick scaly patches.
Psoriasis runs in families - one in three people with psoriasis has a close relative who also has psoriasis. However, the exact role that genetics plays in causing psoriasis remains unclear. There are three genes that are linked to psoriasis- known as SLC9A3R1, NAT9 and RAPTOR. However, a large proportion of people with these genes never develop skin problems. Streptococcal throat infections are involved in guttate psoriasis developing, usually in children and young adults. However, most people with who have streptococcal throat infections do not develop psoriasis.
Diseases of the immune system such as the HIV infection can cause psoriasis to flare up or to appear for the first time.
What treatments are there out there for people who are suffering with psoriasis?
There is no cure for psoriasis. However, treatment is usually effective and will control the condition by clearing or reducing the patches of psoriasis. Most people with psoriasis can be treated by their GP. Your GP may refer you to a dermatologist (skin specialist) and their team based in a hospital if symptoms are particularly severe or have not responded well to previous treatments.
Treatments are based on the type and severity of your psoriasis and the area of the skin affected. Your GP will probably start with a mild treatment - such as topical creams - and then move on to stronger treatments if necessary. There are a wide range of treatment options for psoriasis but identifying what treatment is most effective can be difficult. You should talk to your GP if you feel a treatment is not working, or you are experiencing uncomfortable side-effects.
Treatments fall into three categories:
. Topical - creams and ointments are applied to your skin
. Phototherapy - your skin is exposed to certain types of light, and
. Oral and injected medication - medicine is used to reduce the production of your skin cells.
Source for all of above except for case study story, www.nhs.uk
For More Information on Psoriasis, www.psoriasisireland.ie