Skin Diseases

Is Psoriasis common?

Yes, it affects 2% of population. If you have psoriasis, you are not alone. Millions pf patients live with this long- lasting condition.

How did I get Psoriasis?

Researchers have found that to have psoriasis one must inherit the right mix of genes and be exposed to a certain trigger. The possible triggers include infection (such as a sore throat or tooth), increased stress level or trauma to the skin. Some medications are also capable of inducing psoriasis, including beta blockers, lithium and some anti- malarial tablets.

Is Psoriasis contagious?

No, Psoriasis is an inflammatory disease in which skin cells are made too quickly and build up into raised pink, scaly plaques. You cannot infect anyone with psoriasis, it cannot spread from person to person.

Can Psoriasis be cured?

There currently are a number of treatments available, which allow to control psoriasis completely. The disease has its own course and can sometimes go into a spontaneous remission, which may last for many years. It is not however possible to cure Psoriasis completely. It may recur albeit in a different, frequently much less severe, form.

Is Psoriasis a skin disease only?

Having Psoriasis increases one’s risk for certain other diseases such as high blood pressure, heart disease, diabetes and high cholesterol. Psoriasis is now recognised as an inflammatory disease of the whole body, it is therefore important to monitor your health very closely for any signs of these diseases, particularly in patients who have a severe form of psoriasis.

My Psoriasis clears after sun exposure, can I use sun beds to treat it?

Although phototherapy (UV radiation) may be used to treat psoriasis it is absolutely contraindicated to use artificial tanning devices (sun beds) on your own to treat it. The treatment with UV radiation (narrow band UVB or UVA) has to be administered in a specialized setting, by experienced dermatology staff. The number of phototherapy treatment sessions has to be calculated carefully, to avoid a possible risk of developing skin cancer and skin UV induced damage. Because psoriasis is a life-long disease, one has to bear in mind that a limited number of light treatment sessions is safe. Phototherapy should not be repeated too frequently, as there is a certain amount of UV radiation which can be administered safely throughout a patient’s lifetime. Light treatment should not be repeated for the next 12 months after a course of treatment. This is especially important in Jersey, where there is a high UV exposure all year round.

Can certain injections be used to cure Psoriasis? I heard that my friend had them and now he is completely free of the disease, could I have these prescribed?

There are different types of Psoriasis, each type appears differently on the skin. Also – the patients are different and the treatment for psoriasis has to be tailored to suit a particular patient’s needs.

Bearing in mind that Psoriasis is a chronic skin disease, one has to go stepwise – to use a therapeutic ladder. It is worth remembering that every form of treatment may be related to certain risks and side effects. My approach and duty as a physician is to try and help a patient to find the best treatment that would be suitable, acceptable and effective for them. For limited forms of the disease such as plaque Psoriasis, which is the most common form, with scaly red patches occurring on the skin, many different types of topical medications, applied to the skin can be used. Systemic medications (tablets) which work throughout the body, are used to treat moderate to severe psoriasis. Some of these treatments, such as tablets, can be used long-term, some can be only used for a limited time and may be combined and rotated to minimise side effects. In patients who suffer from moderate to severe psoriasis, and other treatments have not been successful, a biologic may be a suitable and effective treatment option.

British Association of Dermatologists – PSORIASIS

British Association of Dermatologists – PSORIASIS – TOPICAL TREATMENTS

British Association of Dermatologists – TREATMENTS FOR MODERATE OR SEVERE PSORIASIS

British Association of Dermatologists – PSORIASIS – TREATMENT IN CHILDREN AND YOUNG PEOPLE

British Association of Dermatologists – ACNE

British Association of Dermatologists – ATOPIC ECZEMA

British Association of Dermatologists – ROSACEA

British Association of Dermatologists – SEBORRHOEIC KERATOSIS (AGEING WARTS)

British Association of Dermatologists – URTICARIA AND ANGIOEDEMA (HIVES)

What is Onychomycosis?

Onychomycosis is a fungal nail infection. If you have a fungal infection on your foot, the fungus can spread to one or more of your nails. This is quite common.

You can also catch a fungal nail infection in a warm, moist place such as a swimming pool deck or locker room. If someone else has a fungal infection and walked barefoot there, all you have to do is walk barefoot in the same area.

Having wet nails for a long time can also lead to Onychomycosis. Some people develop it when they wear the same pair of sweaty shoes or boots every day. Fingernails that are wet for hours at a time due to a job or hobby are also susceptible.

What you see on infected nails will vary with the type of fungus causing the infection.

Most people see some nail discoloration. The nail may have a white spot. Some nails turn yellow, brown, or green. As the infection worsens, infected nails can thicken, lift up from the finger or toe, or crumble. Some nails become thinner.

Having Nail Fungus is usually painless. At least, it’s painless in the beginning. However, if you put off getting treatment, the fungus can grow. When the fungus worsens on toenails, wearing shoes can become painful.

If you have diabetes or a weakened immune system, treatment is especially important. After getting a fungal nail infection, people who have diabetes have an increased risk of developing sores that do not heal. Such sores can lead to a serious health problem. It’s important to see a dermatologist (or other doctor) at the first sign of a nail problem if you have a diabetes.

Early diagnosis and treatment are recommended for everyone who has Nail Fungus. Diagnosed early and treated, Onychomycosis is likely to clear and you’ll regrow a healthy nail. Treatment can also prevent the fungus from spreading to other parts of your body and to other people.

Who gets Nail Fungus?

Nail Fungus is common, and anyone can get it. However, some people have a higher risk of developing a fungal nail infection. Your age, health, and even your lifestyle can increase your risk.

Age – The risk of developing a fungal nail infection increases with age. It’s most common in old age and least common in children.

Climate – Living in a hot, humid climate increases the risk.

Health problems – You have an increased risk of developing a fungal nail infection if you have one or more of the following:

– Athlete’s foot (or another skin infection caused by fungus)
– Cancer and are receiving chemotherapy
– Diabetes
– Had a nail infection before
– Injured a nail or recently had nail surgery
– People in your family frequently get nail infections
– Poor blood circulation
– Psoriasis
– Received an organ transplant
– Weakened immune system due to a disease like human immunodeficiency syndrome (HIV)

Lifestyle – Your risk of getting a fungal nail infection increases if you:

– Have wet feet or hands frequently throughout the day
– Smoke
– Spend a lot of time in water
– Walk barefoot in a hot, humid place like a pool, public shower, or locker room
– Wear tight-fitting, closed-toe shoes, especially if you have sweaty feet
– Wear plastic gloves for hours every day

What causes Onychomycosis?

Microscopic organisms called fungi cause a fungal nail infection.

Many people pick up the fungi when they have skin-to-skin contact with someone who has a fungal infection such as athlete’s foot or ringworm on their hands.

Another common way to get a fungal nail infection is by walking barefoot in a warm, moist area such as a pool deck or locker room. These fungi thrive in warm, moist areas.

You can also get a fungal nail infection by sharing an infected nail clipper or towel.

But you don’t have to catch it from someone. You can get it if your nails are frequently moist or you often wear sweaty socks and shoes.

The fungi usually infect a nail by getting into a:

– Small cut in the skin surrounding your nail
– Crack in your nail
– Separation between the nail and finger (or toe)

The area under a nail gives fungi a warm, moist place to grow. The infection can then spread to other nails and even your skin.

How do we diagnose Onychomycosis?

To find out if a patient has nail fungus, a dermatologist examines your nails and nearby skin. It’s important to check the skin because the fungus can spread. You may already have a skin infection caused by fungus like athlete’s foot.
To get rid of the infection, you will need to treat all infected areas.
Before giving you the diagnosis, your dermatologist may also take some samples. Collecting a bit of debris from beneath a nail, trimming off part your nail, or scraping off a bit of skin can be very helpful. In a lab, these samples can be examined under a microscope to find out what’s causing the problem.

How do we treat Onychomycosis?

Treatment usually begins with trimming of your infected nail(s), cutting back each infected nail to the place where it attaches to your finger or toe.

To completely get rid of the infection, most people also need one or more of the following treatments:

Medicine you apply to the nail -If you have a mild infection, a medicine that you apply topically to your nails may get rid of the infection. This treatment helps keep new fungus out while the nails grow. Fingernails typically grow out in four to six months. Toenails take longer, usually takes 12 to 18 months.
Probably the most difficult part of this treatment is remembering to use it as often as prescribed. Some treatments must be applied every day. Others you apply once a week. To get the best results, it’s essential that you apply these medicines exactly as directed.
Side effects from these medicines are generally mild. Possible side effects include redness and swelling, an ingrown toenail, and stinging or burning when you apply the medicine.

Medicine you take orally – If you need more-aggressive treatment, your dermatologist may prescribe antifungal pills. These have a higher cure rate than medicine you apply to your nails. Antifungal pills also work more quickly than medicine applied to the nails. Taking antifungal pills for two months can cure an infection under the fingernails. Usually, three months of treatment cures a toenail onychomycosis.
Antifungal pills, however, can cause side effects. Your dermatologist will watch you closely. You’ll also need to have blood tests.
The following systemic (works throughout the body) medicines are used to treat onychomycosis:
– Itraconazole
– Terbinafine
– Fluconazole
-Griseofulvin

Combination therapy – Sometimes, nail fungus is hard to clear. Studies show that taking antifungal pills and applying topical medicine to your nails can be more effective than using either treatment alone.

Nail removal – If you have a severe infection or other treatments just don’t work, your dermatologist may recommend removing the nail(s) to get rid of the infection.

Ways to prevent another nail infection

– Wear flip flops or shower sandals when walking in warm, moist areas like gyms, locker rooms, spas, public showers, and pools. This can prevent you from catching nail fungus and athlete’s foot.

– Put on a clean pair of socks every day and whenever your socks get sweaty.

-Wear shoes that:
Fit well (not tight), Are made of leather, canvas, or mesh, Keep your feet dry and prevent overheating, and Alternate shoes. Fungi thrive in moist places like damp shoes. You can reduce this growth by giving shoes 24 hours to dry out before wearing them again.

– Sprinkle antifungal powder in your shoes. These products cannot treat a fungal nail infection, but they can help prevent fungus from growing in your shoes

– Keep your nails short

– Sanitize your nail clipper before using it – wash it with soap and water and then wipe it with 70% alcohol

– If you go to a salon for nail care, ask how often they disinfect nail clippers, emery boards, and other equipment. They should sanitize these after every client. If not, the equipment can spread a fungal infection from one client to another

– Never share nail clippers, shoes, skates, towels, and other personal items

– Keep your feet clean and dry. Carefully wash your feet with soap and water every day, taking care to wash between your toes. Dry your feet well after washing them

– Avoid having damp or sweaty feet for too long

– Moisturize dry skin. Fungi can get in through small cracks in your skin. To ease dry skin, moisturize within 5 minutes of bathing and after washing your hands

– If you get athlete’s foot, treat it right away. Fungi also cause athlete’s foot. This fungal infection can spread to your nails

– Check your nails to find early signs of infection

Hair Loss Female Pattern (Androgenetic Alopecia)

Hair Loss Male Pattern (Androgenetic Alopecia)

Hirsutism

Tinea Capitis

Frontal Fibrosing Alopecia

Central Centrifugal Cicatricial Alopecia

British Association of Dermatologists – ACTINIC KERATOSIS