Get help when you feel flaky; Dear Miriam.

Byline: MIRIAM STOPPARD

I've treated hundreds of people who've suffered from the flaky skin condition psoriasis, so I'm keen to hear about new findings that help us understand it better.

The more we discover about this distressing disorder, the better we can give support to those suffering from the red, scaly skin patches.

We once thought it was just a skin problem, then we found that the immune system is involved. Now it's come to light that women who suffer from the condition could be at increased risk of other problems.

Harvard Medical School research on 78,000 women showed those with psoriasis were nearly two-thirds more likely to develop type 2 diabetes and nearly a fifth more likely to have high blood pressure than other women.

Don't panic - these risks are still relatively small and more research is needed - but if there's high blood pressure or diabetes in your family, it may be as well to have checks at your GP's surgery.

All of us should have our blood pressure tested regularly anyway - high blood pressure is a major risk factor for heart disease and strokes, and usually has no symptoms.

Summer dilemma

If you have psoriasis, you probably know that sensible sun exposure can help the patches heal but you may feel self-conscious about showing your skin in public.

Psoriasis may be sore, itchy and unsightly but the emotional effects are often hardest to deal with - mainly triggered by the reactions of other people who wrongly believe that it is catching. Some of my patients would complain that people avoided sitting next to them on the bus or that strangers had come up to them and demanded to know what they'd got.

Children are bullied or shunned at school, with other kids often refusing to sit next to them.

A third of sufferers recently questioned by market research company GfK Healthcare said they felt they'd been discriminated against because of their condition.

The real problem

Let me emphasise again that you can't catch psoriasis.

The condition happens when the body's immune system gets confused and mistakenly attacks healthy skin cells.

As a result, skin cell production gets faster with cells replacing themselves in just two to six days compared to the normal 21 to 28 days.

The skin can't shed the dead cells fast enough, which is why scales build up in raised, itchy clumps, known as plaques.

We don't know exactly why some people get it but we know it runs in families - three genes have already been linked to the condition, and one in three sufferers has a relative who also has psoriasis.

Flare-ups come and go but the condition can return at any time and its severity varies widely - it mostly affects the elbows, knees, lower back and the scalp but some people are unlucky enough to get it over large areas of their body.

It can also affect the nails and about one in 10 sufferers get a complication called psoriatic arthritis, which causes painful swollen joints.

Although there's no outright cure, in most cases with the right treatment, skin can be kept clear for months and even years - it's a case of finding what works for you.

8 WAYS TO FIGHT FLARE-UPS

(1) Take it easy

The first thing I'd do with my patients was help them find ways to relax.

In my experience, there's no point in treating psoriasis if the sufferer is stressed as we know stress and anxiety make symptoms worse. Get plenty of sleep and find a good method of relaxation that works for you - try working out, breathing exercises or just enjoy some time to yourself each day listening to music, watching TV or reading.

(2) Avoid triggers

Smoking, alcohol and anti-inflammatory ibuprofen can trigger flare-ups.

Not only do smokers have a higher risk of developing psoriasis, studies show it makes symptoms worse, probably due to the effect toxins in cigarettes have on the immune system.

Heavy drinking may also interfere with the effectiveness of your treatment.

(3) Seek out the sun

The sun's UV rays slow down skin cell turnover so try brief, daily exposure to small amounts of sunlight. Ask your still need to avoid midday sun and care not to burn.

However, a few people find the sun makes it worse.

(4) Moisturise

Use a strong, non-perfumed moisturiser to help alleviate dryness, cracking, soreness and itching.

This also helps prescribed psoriasis creams and ointments to work better.

(5) Treat skindirectly

For mild to moderate symptoms, a wide range of prescription creams and ointments can be applied directly to the psoriasis.

They mainly include corticosteroids, creams containing vitamin D and coal tar. sun.

Most work by slowing the turnover of skin cells but they all have pros and cons, which you can discuss with your doctor.

(6)See the light

If creams and ointments haven't worked, your doctor may suggest phototherapy, which uses UV light, sometimes in combination with drugs, to slow skin cell turnover.

(7) Take a treatment break

If you have the time and money, you could combine treatment with a holiday by taking a trip to the Dead Sea in Israel.

It has a high concentration of salt and other minerals, which seem to help healing in combination with the The exact mechanism isn't properly understood but when I visited the area several years ago, visitors seemed to have good results.

(8)Get a referral

If your symptoms don't clear up with treatments from your GP, ask to be referred to a dermatologist - an expert who specialises in skin disorders.

For severe cases, there are heavy-duty drugs such as methotrexate.

This reduces the production of skin cells, and cyclosporin, which suppresses the immune system.

However, the newest treatments for moderate to severe psoriasis include biological drugs, which target the specific action of certain immune cells.

FOR MORE INFORMATION, VISIT THE PSORIASIS ASSOCIATION'S WEBSITE AT WWW.PSORIASIS-ASSOCIATION.ORG.UK OR CALL 0845 676 0076.

CAPTION(S):

FEELING SORE: Scales build up when skin cell production goes into overdrive