Psoriasis: More Than Just Dry, Scaly Skin By Dr Colin McTari | SKEEN, Brisbane

Psoriasis is a common question we see in skin clinics: “Why do I keep getting these red, dry and scaly patches?”

Psoriasis is a chronic immune-mediated inflammatory condition. In simple terms, the immune system becomes overactive and sends inflammatory signals into the skin. This causes skin cells to grow and move towards the surface much faster than normal, while the skin barrier does not mature normally. The result is the characteristic red, thickened and scaly plaques.

Under the microscope, psoriasis is much more than surface dryness. There is accelerated growth of the epidermis, abnormal maturation of skin cells and significant inflammation, with immune “soldier cells” accumulating within different layers of the skin.

Where does psoriasis occur?

Psoriasis commonly affects the extensor surfaces, particularly the elbows and knees, but it can also involve the scalp, trunk, hands, feet, nails and skin folds. Some people have only a few small plaques, while others develop widespread disease affecting large areas of the body.

Importantly, psoriasis is not always limited to the skin. Some patients develop psoriatic arthritis, causing painful, swollen or stiff joints.

Psoriasis is also associated with other inflammatory conditions. These include inflammatory bowel disease and inflammatory spinal conditions such as ankylosing spondylitis. Eye inflammation, including episcleritis, scleritis and uveitis, can also occur in people with inflammatory diseases and may cause redness, discomfort, pain or visual symptoms.

What can trigger psoriasis?

Psoriasis can fluctuate considerably. Common triggers or aggravating factors include:

• Psychological stress

• Skin injury or irritation

• Infections

• Smoking and excessive alcohol consumption

• Some medications, including lithium, beta-blockers and certain antimalarial medications

• NSAIDs such as ibuprofen may aggravate psoriasis in some people

• Starting or stopping certain medications, particularly systemic corticosteroids, can occasionally affect disease activity

Not every trigger affects every patient, so identifying an individual’s pattern is important.

How is psoriasis diagnosed?

Diagnosis starts with a careful medical history and thorough skin examination. Dermoscopy can provide additional information and help distinguish psoriasis from eczema, fungal infections and other inflammatory skin conditions.

In unusual or difficult cases, a skin biopsy may be required to confirm the diagnosis.

For patients with extensive disease, Vectra 3D total-body imaging at SKEEN can also assist us in documenting the distribution of psoriasis and objectively following changes across different areas of the body over time.

How is psoriasis treated?

Treatment depends on the type, location and severity of psoriasis. Many patients can be managed with topical treatments, appropriate moisturising and skin-barrier care, lifestyle modification and avoidance of recognised triggers.

More extensive or resistant psoriasis may require oral medications, phototherapy or biologic treatments, depending on the individual patient’s circumstances and associated conditions.

Most psoriasis can be assessed and managed as an outpatient, without hospital admission. However, severe widespread psoriasis, significant systemic symptoms, serious eye involvement or severe joint disease may require specialist or hospital-based care.

The important point is that persistent red, scaly skin should not simply be assumed to be “dry skin.” Establishing the correct diagnosis is the first step towards choosing the right treatment.

Dr Colin McTari

SKEEN, Brisbane