I’ve suffered mild psoriasis all my life. Then, during the Covid pandemic, my condition became far worse. It’s everywhere now and very painful. What should I do?
Dr Ellie replies: Psoriasis is an inflammatory skin condition, and flare-ups typically need to be tackled with prescription creams – which your GP can provide.
The chronic disease causes scaly patches of skin that are dry, flaky and itchy. It tends to come and go in waves and most patients know what triggers their flare-ups.
It is not surprising that, for some, their condition worsened during the Covid pandemic. Stress is a proven catalyst of painful psoriasis spells and the psychological strain of lockdowns weighed heavy on many.
Other common triggers include certain medications, hormonal changes such as the menopause, alcohol and damage to the skin from injury or piercings.
Medical-grade moisturisers, known as emollients, tend to be the first treatment offered to patients, as well as a vitamin D-based cream that is shown to boost skin health.
If these treatments don’t work, the next step is typically steroid creams.
These medicines can ease skin inflammation, mellowing some of the worst psoriasis symptoms. Steroid creams can be used alongside emollients and, in most cases, need to be taken for at least a month to see results.
Psoriasis is an inflammatory skin condition, and flare-ups typically need to be tackled with prescription creams – which your GP can provide
Steroid creams also come in varying strengths so, if one doesn’t work, GPs will usually offer a more potent alternative.
Other specific psoriasis treatments are also available on prescription.
If the skin is not improving after three to four months of GP-prescribed treatment, it is entirely reasonable to request a referral to a dermatologist specialising in psoriasis.
I have constant constipation despite having a very good diet. I eat plenty of fibre, including fruit and vegetables, and drink more than enough water. Why won’t my symptoms improve?
Dr Ellie replies: Constipation that persists despite a healthy diet deserves a closer look.
Constipation means difficulty or discomfort when opening the bowels, often accompanied by infrequent motions.
It is worth noting that normal bowel habits vary considerably between individuals – some people open their bowels two or three times a day, others every few days, and both can be entirely normal.
What matters is that motions are comfortable, pain-free and soft enough to pass without straining.
The most common cause of constipation in Western populations is insufficient dietary fibre. Adults need about 30g per day, yet most people consume roughly half that.
There are two types of fibre to consider: soluble fibre, found in fruit and dried fruit, and insoluble fibre, found in bran, nuts and seeds.
Both play a role in promoting healthy gut bacteria and regular bowel movements, and eating a broad range of cereals, legumes, dried fruits and seeds is the best way to achieve the right balance.
It is important to increase fibre intake gradually, though, as a sharp rise can cause bloating and discomfort from excess gas.
However, in cases where fibre intake is genuinely good but symptoms persist, other causes should be considered. Constipation can be associated with irritable bowel syndrome (IBS) or diverticulosis – where pouches form in the lining of the colon, narrowing the passageway and hindering stool movement.
It can also be a side effect of certain medications, including some painkillers and iron supplements, or linked to conditions such as an under-active thyroid – where the hormone-producing gland does not function properly.
In rare cases, it can even be a sign of cancer, which is why a GP should always be consulted if your condition is long-standing or does not improve.
Keeping a food and symptom diary in advance of that appointment can be a helpful way to give the clearest possible picture.
Write to Dr Ellie: Do you have a question for Dr Ellie Cannon? Email DrEllie@mailonsunday.co.uk
