Psoriasis

Psoriasis is a long-term immune-driven skin condition in which skin cells are produced far faster than normal. The result is well-defined raised patches covered with silvery scale, most often on the elbows, knees, scalp and lower back. It is not contagious.

It tends to come and go over a lifetime. Current treatments can clear or nearly clear the skin in many people, but they control the disease and do not remove it, so patches usually return if treatment stops. Up to a third of people also develop psoriatic arthritis.

Symptoms

• Thick red or, on darker skin, violet-brown plaques with silvery white scale
• Scalp scaling that extends beyond the hairline
• Itching, soreness or cracking, especially on palms and soles
• Nail pitting, lifting or thickening
• Smooth red patches in skin folds such as the groin and under the breasts
• A shower of small drop-like spots after a throat infection
• Stiff, swollen joints, sausage-like fingers or heel pain

Causes and risk factors

Psoriasis arises from an interaction between inherited risk and triggers. About a third of people have an affected relative. Overactive T cells release signalling proteins, including TNF, IL-17 and IL-23, that speed up skin turnover. Flares are set off by streptococcal throat infection, stress, skin injury, smoking, heavy alcohol use, weight gain, and medicines such as lithium, beta blockers and antimalarials. Stopping steroid tablets abruptly can provoke a severe flare. Psoriasis is also linked with higher rates of heart disease, diabetes and low mood.

How it is diagnosed

• Clinical examination: The pattern of plaques, scalp and nail changes is usually diagnostic. Severity is scored by body area covered and effect on daily life.
• Skin biopsy: A small punch sample under local anaesthetic when the appearance is unusual or eczema, fungal infection or lymphoma needs to be excluded.
• Joint assessment: Questions and examination for psoriatic arthritis, with ultrasound, X-ray or a rheumatology opinion if joints are involved.
• Pre-treatment blood tests: Blood count, liver and kidney function, hepatitis and tuberculosis screening before tablets or biologic injections.

Treatment options

• Topical treatment: Steroid creams, vitamin D analogues such as calcipotriol, and combination foams for limited disease. Moisturisers reduce scale and itching.
• Scalp preparations: Medicated shampoos, steroid lotions and scale-softening oils applied under a routine that the dermatologist sets out.
• Phototherapy: Narrowband UVB two or three times a week for 8 to 12 weeks. Effective, but the visit schedule makes it a local treatment.
• Conventional tablets: Methotrexate, ciclosporin or acitretin for moderate to severe disease, with regular blood monitoring.
• Biologic injections: Drugs that block TNF, IL-17 or IL-23 for severe disease. They can produce clear skin in many people and are given every few weeks to months.
• Oral small molecules: Apremilast or deucravacitinib as tablet alternatives in selected cases.

When it is urgent

Go to a local emergency department if almost all your skin becomes red, hot and peeling, or if sheets of small pus-filled spots appear with fever and feeling unwell. Erythrodermic and generalised pustular psoriasis affect temperature and fluid balance and need hospital care. A hot, swollen single joint with fever also needs same-day assessment.

Travelling to Türkiye for treatment

Psoriasis is a lifelong condition, so the prescribing and blood monitoring belong with a dermatologist near you. A visit can offer a thorough assessment, biopsy if the diagnosis is in doubt, screening for arthritis and a written treatment plan to take home. Some visitors combine this with a short course of supervised sun and spa-based care, which can help for a while but is not a lasting solution.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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