I was first diagnosed with psoriasis when I was 18. I’d never even heard of the autoimmune disease before a GP took one look at the red, raw, flaky patches that were covering over 80% of my body. 

Nobody knows exactly what causes a flare-up. We can try to put it down to stress or anxiety — but frankly, anything that triggers a response from the immune system has the potential to cause a flare-up.

Everyday pain

My current flare-up is my worst to date. It’s covering almost the same amount as the first; but unlike the first, there’s little hiding this one for a few reasons. One reason being it was very visible on my face for the first time.

I’ve gotten patches in really irritating places like my inner thighs and the backs of my knees. Unlike other times when psoriasis was causing more of a discomfort due to itching and affecting my self-esteem, this time, my self-esteem is perfectly fine, but I’m in physical pain daily.

Facing judgement

This time, I can’t hide it. That’s also partly due to my social media presence. I didn’t slow down the daily uploads of my outfit videos to almost 1 million followers. My skin is on full display, and of course — the questions come in, and so do the nasty comments.

In fairness, some are based on ignorance — people who haven’t heard of it or never seen it to this extent. I patiently respond to every comment trying to educate or enlighten people on what psoriasis is.

Over 125 million people worldwide suffer from psoriasis.

Overcoming challenges

I consider myself very lucky that my typically imperfect skin doesn’t affect my self-esteem or confidence. I went five years between flare-ups, so I know that what I’m suffering now isn’t how it’s always going to be for me.

Now, more than ever, I feel responsible to show my skin, be the person taking the brunt of those comments — the good and the bad — and using my platform to try and normalise psoriasis.

Be unapologetically you

Over 125 million people worldwide suffer from psoriasis. In Ireland alone, there are about 6,000 people diagnosed with it each year. In 2015, a report showed that approximately 75,000 work days were missed annually by those suffering.

My advice as someone who’s suffering and will suffer again is to see a dermatologist, use a good quality moisturiser and try not to scratch. Also, be unapologetically YOU! You dictate your life. Psoriasis should never define who you are or what you do.

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For many people living with psoriasis, access to specialist dermatology care is a critical step in taking control of their condition, but many are experiencing significant delays.

People living with skin conditions, including psoriasis, are experiencing some of Ireland’s longest delays to access the specialist care they desperately need. There are 39,324 people waiting to access dermatology services, with 30% (12,118) waiting more than 12 months, according to the latest figures from the National Treatment Purchase Fund.

Finding psoriasis support

Psoriasis is a chronic, systemic inflammatory skin disorder that affects at least 73,000 people in Ireland. It is an immune condition that causes symptoms on the skin and, sometimes, the joints. PsO Let’s Talk Psoriasis, a video and podcast series by Janssen Sciences Ireland UC, aims to support and empower people living with psoriasis as they await access to vital healthcare services.

Hosted by broadcaster Dr Ciara Kelly, PsO Let’s Talk Psoriasisis the first series of its kind designed to bridge this gap in support, by providing access to expert guidance from leading Irish dermatologists and healthcare professionals to help people manage their psoriasis while they wait to access specialist care.

Psoriasis is a chronic, systemic inflammatory skin disorder that affects at least 73,000 people in Ireland.

Hear from professionals

Professor Brian Kirby, Consultant Dermatologist, St. Vincent’s University Hospital, who features in the series,says: “The key for a person who is newly diagnosed with psoriasis is to understand that with access to modern therapies, 99% of psoriasis patients can have their disease controlled adequately. While waiting lists continue to be an issue that has worsened through the Covid-19 pandemic, people living with psoriasis can take steps to manage their condition while they wait. This video and podcast series can provide vital information — in an accessible format — from the healthcare professionals they are waiting to see.”

Content for the four episodes has been informed by feedback from people living with psoriasis in Ireland who highlight the need for information and support during the long waiting times. It also highlights the need for greater education on the associated possibility of developing a related inflammatory form of arthritis — psoriatic arthritis.

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Skin cancer is the most common cancer in Ireland, yet arguably the most preventable. As we head into winter, many things hibernate — but skin cancer does not.

It is as important to protect your skin during the winter as much as the summer. As altitude increases, so does skin cancer risk. The strength of solar ultraviolet (UV) radiation may be less in winter, but it still increases your overall skin cancer risk — as does sunbed use.

Skin cancer in Ireland

Each year, almost 13,000 people are diagnosed with skin cancer in Ireland. Nine out of every ten skin cancers are caused by UV rays from the sun or sunbeds.

What is skin cancer?

There are two main types of skin cancer: non-melanoma and melanoma skin cancer. Non-melanoma skin cancer is much more common but less aggressive than melanoma skin cancer. It accounts for 11,763 cases, yearly, in Ireland.

Nine out of every ten skin cancers are caused
by UV rays from the sun or sunbeds.

Melanoma skin cancer

Melanoma is the least common but most serious form of skin cancer. The most common sign is the appearance of a new mole or a change in an existing mole. The majority (70.9%) of melanomas develop from new growths, and only a minority (29.1%) arise from an existing mole or nevus. Everyone needs to check their skin for new moles and not just changes to existing moles.

Use the ABCDE guide to check mole changes

Asymmetry – If you draw a line down the centre of your mole, is it larger on one side?

Border – Are the borders of your mole uneven, jagged or notched?

Colour – Has your mole changed colour over time, or does it contain different colours?

Diameter – Is the circumference of your mole larger than the top of a rubber on a pencil (larger than 6mm)? However, melanomas can be smaller.

Evolving – Do you notice any changes within or around your mole (eg. height or appearance)?

Ultraviolet (UV) radiation

Exposure to UV radiation is the main risk factor for skin cancer. It is emitted from the sun, sunbeds and sun lamps. You can’t feel UV rays — the heat from the sun comes from infrared rays, which can’t burn you. It’s the sun’s UV rays rather than the sun’s heat which causes the skin to burn or tan. Therefore, it does not have to be sunny for UV rays to damage the skin. When the UV index is three or above, you must protect your skin.

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Eczema is a complex, relapsing medical condition that occurs when the skin is red, dry and irritated. Typically there is a family history of hay fever, asthma or allergic rhinitis (atopic illness). Eczema affects 20% of children and less than 10% adults.

Most children will grow out of eczema by late childhood but may flare again in adulthood. Eczema accounts for one in 30 general practice consultations and about 15% of dermatology referrals. Although the majority is mild, it can have a significant psychological effect on the individual.

Eczema often presents where you flex your joints and on the face

Eczema can occur anywhere but common sites are the flexural areas (behind knees, wrists and front elbows) and face. It is initially itchy then the skin becomes scaly, red, dry and inflamed.

In fair-skinned patients, these areas may be red. Among darker-skinned people it appears light grey or black. If untreated, the skin can become weeping, blistered, scaling and lichenified (thickened).

The cause of eczema is unknown

The exact cause of eczema is unknown but it may be due to an immune response to any irritant (such as pets, paints, pollens, dust) due to a defect in the skins barrier. This barrier allows moisture out, therefore the epidermis is vulnerable to bacteria, viruses or even fungus.

Moisturisers are the best form of management

As most patients present with itch, the treatment is geared towards relieving and preventing itching, which can lead to infection. As the skin is dry and itchy (itch-scratch cycle) lotions and creams are recommended to keep the skin moist. It is best to use these emollients and washes when the skin is damp to keep the skin moist. Applying emollients should be in the direction of hairs as this will prevent blocked pores/infection.

Eczema can be kept under control by knowing triggers and applying emollients, washes and cold compresses for itch. If emollients are stored in the fridge, they are effective for itch management.

Treatment

If Eczema does not settle, you should see your general practitioner for stronger topical steroids +/- a topical or oral antibiotic or antifungal. Good communication between the GP and the patient is essential as treatment failure due to poor adherence is common. Education and communication is very important and information should be provided with regards to steroids, the management of flares and recognising infected atopic eczema.

Education provides better treatment adherence. HCPs (health care professionals) need to take time to educate the affected individual and families and provide information leaflets, feedback and follow up at regular intervals.

New product feedback pathways should be provided by HCPs in order to assess compliance, autonomy and progress.

Referrals

Few patients will need a dermatology referral. They may require potent steroids, phototherapy or immunomodulators.

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Acne is one of the most common disorders treated by dermatologists. The prevalence of acne vulgaris globally was 681.2 million in 2016, an increase of 10% from 612 million in 2006 (1).

Acne is a common, chronic, inflammatory disease of sebaceous follicles, the glands that produce sebum. Approximately 80% of people are affected by acne between the onset of puberty and 30 years of age (1).

Psychological impacts of acne

Acne can range in severity from person to person and can lead to prominent emotional and psychological issues.

Acne is more than just a cosmetic nuisance – it can cause anxiety, depression and other psychological problems that affect lives in ways comparable to arthritis or other disabling illnesses (1).

Your pharmacist is here to help

Pharmacies are usually the first port of call when a person begins to show symptoms of mild acne. Most people will require advice as the sheer number of products to choose from can be bewildering.

Approximately 80% of people are affected by acne between the onset of puberty and 30 years of age.

A good skincare regime, especially in the early stages, can really help to keep acne under control, and many options are now available over the counter without prescription.

The use of salicylic acid to treat acne

Salicylic acid helps shed cells from the surface of the skin and can decrease redness and swelling. This decreases the number of spots that form and encourages healing.

Salicylic acid can dry out the skin, however, so it is important to get the correct advice about maintaining skin’s integrity.

I myself suffer with hormonal cystic breakouts and find that a good skincare regime, with products containing alpha hydroxy acids as active ingredients, has really helped control my acne.

It is imperative to start on very low percentages of these active ingredients and work your way up to the more concentrated versions to allow your skin to build tolerance. The same instructions apply to retinol products, which are usually associated with anti-ageing, but work excellently for breakout-prone skin too.

If the problem persists, consult your GP

If a good skincare regime is not giving you the results that you want, a visit to your GP is always a good idea.

Your GP can prescribe you a variety of treatments such as antibiotic creams and tablets which help with the more stubborn acne.  For example, the oral contraceptive pill is sometimes all a woman requires to get her acne under control.

If all else fails, your GP can refer you to a consultant dermatologist who can prescribe more potent products such as isotretinoin. Laser can also be prescribed to help reduce acne scars.

Help and support is available

It is important to seek help for your acne and never suffer in silence. There are so many treatments available nowadays. Treating your acne will result in clearer skin and a more confident you. Just ask for help.

(1) Global acne market report for 2016-2026, Dec 2011

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Atopic dermatitis is considered a severe form of eczema. It is a chronic, long-lasting skin condition that causes the skin to become inflamed and irritated, making it extremely itchy.

Atopic means a sensitivity to allergens. It can run in families and often develops alongside other conditions like asthma and hay fever.

Atopic dermatitis occurs when a substance from outside or inside the body triggers the immune system to overreact, causing inflammation. It is this inflammation that causes the skin to become red and itchy. Scratching inflamed skin can lead to redness, swelling, cracking, scaling, weeping and crusting.

Why do we get atopic dermatitis?

Atopic dermatitis is considered a genetic condition, meaning that some people may be born with an increased likelihood of developing it. Research has shown that children with one parent with this condition can have a 50% chance of developing it. That figure can increase to 85%, if both parents are affected.

Sometimes, when your skin comes into contact with a substance in the environment that you are allergic to, it may react by starting to itch and become red. This is called contact dermatitis.

Research shows that some people with eczema, especially atopic dermatitis, have a mutation of the gene responsible for creating a natural protein called filaggrin. Filaggrin is found in our bodies and helps maintain a healthy, protective barrier on the very top layer of our skin.

Without enough filaggrin to build a strong skin barrier, moisture can escape from the skin and bacteria, viruses and more can enter. That is why babies, children and adults with atopic-prone skin can have skin that is more vulnerable to infection.

Flare ups in atopic-prone skin

In some cases, the condition fluctuates between very severe, commonly known as flare ups, and times when the condition improves, known as remission.

Some people only have small patches of dry skin, while others can experience widespread inflamed skin all over their body.

Babies will have dry, scaly, and itchy patches on their skin: most commonly scalp, forehead and face, especially the cheeks.

Children aged two and up will often have a rash and scaly, itchy patches: most commonly in the creases of the elbows or knees, neck, wrists, ankles, and the creases between the buttocks and legs.

In adults, it most often affects the hands, feet, face or scalp.

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Emollient therapy plays a crucial role in protecting and restoring the skin barrier as part of the over-all management strategy to achieve long-term control.

Managing your child’s eczema

The main aim is to improve symptoms and achieve long-term control. In atopic eczema, the skin’s protective barrier is weakened, which allows moisture to be lost and irritants and allergens to pass through the skin more easily. Some common everyday substances, like soap, contribute to the weakening of the skin’s barrier and should be avoided.

It is important to remember that on-going (daily), frequent and generous use of emollients and the avoidance of trigger factors form the basis of eczema management. However, when your child’s eczema flares up, other treatments, such as topical steroids, are needed and are usually prescribed by your healthcare professional. If your child’s skin is not improving, see your doctor to establish if infection is present, which would need additional treatment.

The importance of emollient treatment

Emollients are an essential part of daily care, even when skin is clear. Emollients are moisturisers that are used in two ways – applied directly to the skin as a leave-on moisturiser, and as a soap substitute instead of soap or shower gel.

Used several times a day, emollient therapy helps to soothe dry, itchy skin and repair the skin’s barrier, thereby preventing entry of irritants and allergens, which can trigger eczema flares.

Remember no bubbles!
Choose soap substitutes/emollient wash products

Ordinary soaps, bubble baths and shower gels should be avoided as they dry out the skin by stripping away its natural oils. Instead, choose emollient wash products when bathing, which leave the skin coated with a protective film afterwards.

Choosing an emollient

Emollients come as lotions, creams and ointments. Finding the right emollient is often a matter of trial and error, but the best are ones that you (or your child) prefer to use and will continue to use every day. Remember, a higher price doesn’t necessarily indicate a better product – ask your healthcare professional for advice.

10 tips for emollient therapy

1. Establish a good daily skin care routine and try to stick to it.
2. Don’t stop moisturising when your child’s skin is clear.
3. A child with atopic eczema often needs 250g of ‘leave-on’ emollient per week, minimum.
4. Apply emollients in a smooth, downward motion, in the direction of the hair growth. Circular rubbing, particularly with heavy moisturisers, can block pores, especially in hot weather and cause acne-like spots, called folliculitis. If this happens, use the correct technique and a lighter moisturiser until they clear.
5. Empower your children – teach them how to apply their emollients correctly from a young age.
6. While heavier moisturiser can be very effective, some children don’t like the feel of it under clothing. In this event, consider using a lighter moisturiser during the day and a heavier one at night.
7. Remember – avoid soap, bubble bath and shower gel! Use soap-free products for bathing and specially-formulated shampoos.
8. Bathwater should be a lukewarm temperature; five minutes with an emollient bath additive is sufficient.
9. After bathing, gently pat skin dry. A great time to apply emollient therapy all over is when the skin is still ‘slightly humid’.
10. Change your tub of emollient at least every six weeks, as it can become contaminated, or use a pump dispenser. If using a tub rather than pump dispenser, remove what you need with a clean spoon to hand contamination.

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Psoriasis is a common, chronic skin condition, affecting at least 100 million people worldwide, including more than 73,000 people in Ireland. Almost 80% of people with psoriasis will have scalp involvement at some point in their lives.

Psoriasis mainly involves the skin and nails. The most common form is plaque psoriasis, which affects 90% of people with psoriasis. Red, raised scaly patches with well-defined edges characterises plaque psoriasis. The plaques can vary in number and size and affect any part of the skin surface, including the scalp.

People with scalp psoriasis is common

The scalp is one of the most common sites to be affected by psoriasis, with red, raised, scaly plaques extending beyond the hairline and behind the ears, with the entire scalp covered in the most severe cases.

Symptoms of people with scalp psoriasis

Psoriasis can be dry and itchy, making the scalp feel tight and uncomfortable. Other symptoms include flaking of the scalp, a burning sensation and soreness. Some people with scalp psoriasis report a persistent itch, which, when scratched, can lead to bleeding. In very severe cases there may be mild temporary hair loss. Scalp psoriasis can cause social embarrassment due to the visible flaking, which often makes people feel self-conscious about their condition.

Diagnosis of scalp psoriasis

In any event, getting a diagnosis is important. In fact, most cases of psoriasis are diagnosed by GPs, who are best placed to give advice on how to manage and treat your condition. Sometimes, however, referral to a dermatologist may be necessary.

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Unfortunately, psoriasis treatments do not cure, but treat. However the combination of the treatments mentioned below may help relieve the itch and calm flare-ups when used as directed.

Scalp psoriasis treatments: how to correctly treat it

It is important to remove the scale before you apply any prescribed treatment.

Soften the scale

Coconut oil, olive oil, or almond oil all soften the scale. For best results leave oil on scalp overnight. Topical tar preparation such as Cocois® can be effective at softening and removing scale (use as directed).

Gently remove scale

Try to locate the scale with your fingertips and use a plastic, fine-toothed comb, flat against the scalp and slowly move the comb in an upward motion so that the teeth of the comb loosen the scale. Take care not to remove scales too forcefully as this can damage the skin and flare your psoriasis.

Wash hair

To remove the coconut/olive/almond oil, it may be useful to apply shampoo before wetting your hair and massage it in. Then use warm water to wash your hair and get rid of any loose scale. Tar-based shampoos are useful for treating the scale that is present in scalp psoriasis. Your doctor, nurse or pharmacist can recommend a suitable shampoo.

Apply prescribed treatment

Topical steroids are often prescribed to settle psoriasis flares. These are absorbed better and are more effective when the thick scale is removed. Apply topical steroids as directed by your doctor/nurse. When applying scalp treatments, it is useful if someone can help you apply scalp treatments so that the treatment is applied to the scalp and not the hair. If your whole scalp is affected, part the hair into sections and gently massage treatment into affected areas. Wash your hands after application of treatment.

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Thousands of people suffering with acne and psoriasis in Ireland also experience negatively impacting psychological distress on their personal and professional lives.

Psoriasis in Ireland is a chronic skin disease that affects about 2-3% of the population. It causes skin irritation, itching and joint pain in up to a quarter of patients. But more importantly, it can cause significant psychological morbidity and relationship difficulties.

Sometimes patients spend too long trying to solve the condition themselves before seeking medical help.

Psoriasis in Ireland

Consultant Dermatologist, Professor Caitriona Ryan from the Blackrock Clinic in Dublin, has published a textbook on psoriasis. She reports that psoriasis patients can suffer from depression, anxiety and low self-esteem. Professor Ryan published a textbook on psoriasis. She reports that psoriasis patients can suffer from depression, anxiety and low self-esteem.

“The onset of psoriasis is typically in the second or third decade. This can be a formative period in the life of a patient. This is a time when patients are getting into relationships and choosing careers. Psoriasis in Ireland can have a detrimental impact on their psychological state, social life and quality of life,” she says. “They often recall the difficulties they have faced since childhood. For example, the embarrassment they felt at the swimming pool or when playing with friends.”

Severe acne can also cause significant psychological distress in teenagers and young adults. Without appropriate treatment, irreversible scarring can occur, which further impacts the patient.

Intimacy issues with psoriasis in Ireland

She adds that psoriasis can affect a person’s confidence and how intimate they want to be with people they love. Especially if the condition also affects their genitals. “It can impact their sexual health and often their sexual frequency.”

Some people with psoriasis can struggle at work

Psoriasis in Ireland can also affect the career choices of sufferers. Some patients admit to choosing job where they don’t have to deal with the public due to the visible nature of their disease. Absenteeism and the chances of unemployment can also increase.

“There are compelling reasons to make psoriasis and acne treatment a priority when it affects the mental health of young people, especially if the condition is visible on the face, neck, on intimate parts of the body in the case of psoriasis or is causing scarring in acne patients,” says Ryan.

She points out that skin conditions can also cause additional stress because people feel so self-conscious and anxious, and this stress can make the psoriasis or acne worse.

Seek professional help

“I urge people to visit their GP or dermatologist and let their doctor know how their condition is impacting their mental as well as their physical health,” says Ryan. “Sometimes patients spend too long trying to solve the condition themselves before seeking medical help.” Psoriasis in Ireland is a treatable but serious condition.

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