Dr Jennifer Crawley on psoriasis

Psoriasis is a very troublesome skin condition with patches of red itchy plaques on the skin, sometimes associated with arthritis, and can be socially very embarrassing. However, we can treat (but not cure) psoriasis with a combination of creams, drugs and light therapy.
Miss Jane Olver: Another area that I know interests you, because you are a dermatologist and you work with a lot of drugs that are quite modern and new, and you treat a lot of patients with psoriasis.
Dr Jennifer Crawley: Yes, I do.
Miss Jane Olver: Tell me a little bit about what you personally, Jennifer, do with that group of patients.
Dr Jennifer Crawley: Of course.
Miss Jane Olver: What are their concerns and how you can help them?
Dr Jennifer Crawley: Psoriasis is a very complicated skin condition Jane, and there are many genetic causes plus a lot of environmental influences as well. We know that psoriasis tends to run in the family so we do see it running through generations and it can be devastating for patients especially if they have very widespread psoriasis. We know that the main areas that are affected include the extensor sites.
Miss Jane Olver: What does that mean “extensor site”?
Dr Jennifer Crawley: Extensor sites of the skin like elbows and knees.
Miss Jane Olver: I see it on the front of people’s shins. And also I have seen psoriasis in the hairline.
Dr Jennifer Crawley: Yes, you can indeed Jane find psoriasis on the shins and the hairline and in the scalp. The other site that is very common, and the other sites I have always examined for evidence of psoriasis are…..
Miss Jane Olver: …the tummy?
Dr Jennifer Crawley: Yes, exactly, around the abdomen, mainly around the umbilicus, buttocks, natal cleft and also in the nails.
Miss Jane Olver: What is the natal cleft?
Dr Jennifer Crawley: So the natal cleft is between the buttocks.
Miss Jane Olver: Oh, right. What happens in the nails?
Dr Jennifer Crawley: So in the nails can display pitting, ridging, onycholysis and discolouration of the nail.
Miss Jane Olver: Does that hurt?
Dr Jennifer Crawley: It can hurt Jane, and you can get infections, especially fungal, that can cause thickening of the nail. Also, it can also affect people from a cosmetic point of view as it can look unsightly. Furthermore, it can be a painful and, as mentioned previously, if one of the nails is lifted from the nail bed you can get infections under the nail.
Miss Jane Olver: Before you go on to treatments, what do the patients complain of? What are they seeking to have put right apart from the physical appearance of these unpleasant lesions?
Dr Jennifer Crawley: So psoriasis can be itchy and uncomfortable Jane. Patients can complain of itch and discomfort. Sometimes this can be underestimated, but it can affect every part of their life. They do not sleep; they cannot concentrate at work. Children and young adults cannot focus on school and college and remember in psoriasis, in addition to the redness, you can also get marked scaling of the skin.
Miss Jane Olver: They must lose those scales around them all the time?
Dr Jennifer Crawley: Absolutely and patients don’t like it if there is scaling on their clothing and bedding for example. You know a common thing people will say, Jane.
Miss Jane Olver: It affects their relationships.
Dr Jennifer Crawley: Absolutely and also Jane people will say that they can be embarrassed when they go to stay with friends or family that these scales can fall from the skin to the floor, bedding, surfaces etc. and this is debilitating and very upsetting for patients.