Psoriasis web chat transcript 

This one hour web chat took place at:
3 - 4pm on Wednesday 6 November 2013.

To mark psoriasis awareness week (1 – 7 November 2013) consultant dermatologist Dr Claire Martyn-Simmons was online to answer your questions about psoriasis in our webchat.  Dr Martyn-Simmons leads the dermatology service for both adults and children and adolescents at UCLH and specialises in diagnosing and treating chronic inflammatory skin diseases including psoriasis. 

This is a text only transcript of the web chat. Please click here if you wish to view the interactive web chat page. 

2:36  UCLH: Good afternoon and welcome to our web chat. We will begin at 3pm but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 3pm.

Dr Claire Martyn-Simmons will be joining us to take your questions on ‘psoriasis’ and will try to answer as many questions as possible within the hour long web chat.

2:59  Claire Martyn-Simmons: Welcome to our web chat on the subject of psoriasis. My name is Claire Martyn-Simmons, Consultant Dermatologist and I am ready and waiting to take your questions.

3:00  [Comment From Vasu]
What food should I take to cure psoriasis..what lotion you recommend? 

3:01  Claire Martyn-Simmons: Hello Vasu, thank you for your question. Unfortunately there is no cure for psoriasis. The reason people develop psoriasis is down to, in part your genes. With regards to life style, smoking and alcohol can make psoriasis worse.
There are many topical treatments for psoriasis and it will depend on the location and severity of the disease. Often, a visit to your GP is a good place to start to discuss the different lotions or creams that are available.

3:01  [Comment From Lindsey]
Good afternoon, I have had psoriasis since nov 2001, I have the itchy form of guttate psoriasis, it first was widespread over 80% of my body (except my face & private parts). For 3 years I received treatment of creams, ointments & lotions & finished with a course of light treatment 2 x per week. When the treatment finished, it still remained on my legs. At the time I was told there was no further treatment I could have as I have had the maximum amount of light treatment & a nurse said on the quiet just use commercial sun beds, as I have done ever since, least often as possible. I am worried that I will get skin cancer as especially in the winter I have to have a sun bed 1 or 2 x a week as the itching is unbearable (my biggest problem) whereas in the summer I can sit in natural sunlight as much as possible without burning & hardly use sun beds. Since I received treatment there is now injections & tablets that are available. I have tried to not visit my doctors for treatment for 5 yrs to be covered privately to now be told after 5 yrs I will never be covered as it's an ongoing condition, I have now gone to my doctor who has advised that unless I allow my skin to get really bad no one will treat you? I tried recently for 2 months to just let it all come out to the point that I couldn't take it anymore, I had spots everywhere & the itching was unbearable. I now have a 9 mth old baby who sleeps through the night & has done for the last 6 mths, but I don't sleep because of the constant itching. A friend of mine who has the same type of psoriasis received treatment privately for her psoriasis covered by her private health care & she said it changed her life & completely helped get rid of all of her psoriasis & her skin doesn't itch. She had the tablet treatment - not sure which? I feel like unless I let my psoriasis come out & cover 80% of my body again no one will help me & it will again take 3 years to get to where I am today & with a new baby I don't feel like I can go through 3 yrs of hell again. I just need something to switch off my skin from reproducing so it stops itching & no more psorasis. That's all I want! That's what will change my life for the better but no one will help me! Why is this and can you help? 

3:04  Claire Martyn-Simmons: Hello Lindsey, thank you for your question. I will try to answer as much as I can. You mention that you have had light treatment in hospital but have reached your maximum dose. For all patients receiving light therapy, there is a maximum dose that one can safely receive to reduce the risk of skin cancer. For patients that have reached their full dose, the next option may be tablets as you mention. This would depend on the severity of your disease and there are guidelines that we follow to safely treat patients with tablets.
You also mention that you have been told your psoriasis needs to affect at least 80% of your body, in my experience patients may require a tablet with less of their body affected as we assess each patient and discuss their treatment options.

3:06  [Comment From Joey]
Why can't UVB treatment be undertaken as a preventative measure from first signs of re-occurrence of psoriasis if that form of treatment has worked previously for psoriasis patients? Has this area been studied? 

3:08  Claire Martyn-Simmons: Hello Joey, thank you for your question. UVB light therapy can be a very effective treatment for psoriasis, however there is a safe limit that a patient can receive in their lifetime, therefore UVB is only used when topical treatments have failed and cannot be used as a preventative treatment.

3:14  [Comment From Mabel]
How close are doctors to finding a cure? 

3:14  Claire Martyn-Simmons: Hello Mabel, thank you for your question. There has been a lot of research on psoriasis which is still ongoing looking into the causes and treatments of the condition. There is no cure, however treatments have come along way in the past decade and there are many more options available, especially for patients with severe disease.

3:17  [Comment From Fiona Catcher]
My daughter has been subscribed fluocinolene acetonide 0.025 percent strength. It helps a bit but when she stops using it symptoms simply return. It also is taking the pigment out of her surrounding skin. It there anything else she could be subscribed / ask for? She is being very brave but I know her skin condition upsets her dreadfully. Thanks 

3:20  Claire Martyn-Simmons: Hello Fiona, thank you for your question. The treatment that you mention is a cream that contains a steroid, sometimes this can cause lightening of the skin. If your daughters psoriasis returns as soon as she stops the treatment, it maybe that she needs a different form of treatment and I would suggest she discusses an alternative with her doctors.

3:21  [Comment From Lindsey]
I also keep getting told by Doctors that Psorasis is not itchy, like I'm talking rubbish? I have had this condition for years & it has always been itchy, why do they keep saying this? 

3:23  Claire Martyn-Simmons: Hi again Lindsey. Generally psoriasis does not tend to itch, however for some patients, itch is a symptom. The itch should settle once your psoriasis is adequately treated.

3:23  [Comment From Mabel]
I heard that having a Gluten free diet is really good and can clear psoriasis? is this true?? 

3:26  Claire Martyn-Simmons: Hello again Mabel. There is no conclusive evidence that a gluten free diet can clear psoriasis. It is always advisable to have a healthy diet and avoid alcohol as much as possible as this can cause psoriasis to flare.

3:27  [Comment From sophie]
I went on holiday for a week and most of my psoriasis went, however where the psoriasis was there is now lighter marks. Is this skin pigmentation (as i did use dovobet cream) or is this because i had a tan and the areas where i had psoriasis didnt get a tan? 

3:32  Claire Martyn-Simmons: Hello Fiona, thank you for your question. With any type of inflammatory skin disease, like psoriasis, the natural pigment in the skin can decrease and hence, when you have a tan, the areas that were affected with psoriasis will be lighter compared with your normal skin. As the tan fades, the pigmentation tends to even out.

3:32  [Comment From Ives]
I have Guttate psoriasis for the most part which has in the past cleared when on Methotrexate or Ciclosporin. Neither drug however has had a positive effect on the inverse psoriasis which I have in the groin area. What can you suggest I use to treat the psoriasis there? I am also prone to psoriasis on my face which I can successfully treat with Protopic but it remains clear only for a short period. I know it is not recommended that you use Protopic indefinitely so what else can I safely use to treat the psoriasis on my face? I appreciate you taking the time to do this webchat and look forward to your reply. 

3:39  Claire Martyn-Simmons: Hello Ives, thank you for your question. Inverse psoriasis, or flexural psoriasis i.e. psoriasis affecting your skin creases such as groin or armpits, can be very difficult to treat. Sometimes adding in a cream can be helpful or alternatively, you may need to move up the treatment ladder and discuss with your doctor other alternative systemic treatments (i.e. tablets or injections).
Providing you are using protopic intermittently and not as a continuous treatment, it can be very effective at treating facial psoriasis. It is also recommended that you do not use protopic if you are out in the sunshine.

3:40  [Comment From Judith]
My father who is in his nineties has recently developed psoriasis and is finding it very difficult to cope with. He has been used to swimming every day for all of his life. Do you think the chemicals in the water could have caused it? 

3:45  Claire Martyn-Simmons: Hello Judith. I am sorry to hear your father is finding it difficult to cope with his psoriasis, this is unfortunately the case with many patients. There is no evidence to suggest that psoriasis can be caused by chemicals in a swimming pool. I would however suggest that he applies plenty of moisturiser once he comes out of the pool as the chlorine can cause dry skin which may make his psoriasis more uncomfortable.

3:45  [Comment From Pauline]
I got psoriasis on my face. What is the cream that available that is safe to apply on face. Thanks 

3:49  Claire Martyn-Simmons: Hello Pauline, thank you for your question. Psoriasis can often affect the face. There are many creams available for the face and your GP would be a good place to start to discuss your options. In general terms, steroids used on the face should be mild in strength and should be used on an intermittent basis, there are also steroid free creams available.

3:50  [Comment From Sam]
Hi I have psoriasis under my breast. Can I use dovobet? 

3:52  Claire Martyn-Simmons: Hello Sam, thank you for your question. Dovobet contains a potent corticosteroid and should ideally be avoided in the skin creases such as under the breasts. There are alternative that are safe to use in that area and it would be worth chatting to your GP to discuss other treatment options.

3:53  [Comment From Judith]
Do you think that swimming in the Dead Sea actually helps or is that just a myth? 

3:55  Claire Martyn-Simmons: Hello again Judith. Many people find that a visit to the Dead Sea can help their psoriasis. It is probably a combination of the sun, sea and relaxation that helps psoriasis.

3:57  [Comment From Emma]
Dear Dr Martyn-Simmonds, thank you very much for all your very helpful comments so far. For individuals who have suffered from chronic dermatitis/eczema in various parts of the body all their lives, and been prescribed a variety of different medications over the years, is there anything they can do from a lifestyle/dietary point of view which might ameliorate their condition? I appreciate every case is different and apologise that this is a very general question! And is there a particular moisturiser/emollient you would recommend please? Finally, are there any "safe" medications, for those who are reluctant to be taking too many medicinces on a long term basis? Very many thanks. 

3:59  Claire Martyn-Simmons: Dear Emma, Thank you for your question. Your question was around chronic eczema/ dermatitis. This is a different condition to psoriasis and unfortunately not one I can easily answer today.

4:00  Claire Martyn-Simmons: Thank you for joining us today in our live web chat. We hope you found the chat useful and some of your questions have been answered.

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