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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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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Skin cancer is the most common cancer in Ireland, with over 11,000 new cases diagnosed in 2015. The National Cancer Registry of Ireland (NCRI) expects this number to treble by 2040. Most skin cancers can be prevented.

The National Cancer Control Programme (NCCP) aims to prevent cancer, treat cancer. Similarly it aims to increase survival and quality of life for those who develop cancer. Cancer prevention is the cornerstone of the National Cancer Strategy. NCCP and partners aim to increase knowledge on ways to protect your skin and reduce the risk of skin cancer.

What causes/increases the risk of skin cancer?

Exposure to Ultraviolet (UV) rays from the sun, even on cloudy days, or from artificial sources like sunbeds is the most common cause increasing risk of skin cancer.

Effects of UV rays are not the same for everyone, the fairer your skin, the more cautious you need to be in the sun.

Know your skin type. Your skin type cannot be changed, it is determined by your genes and it does not vary according to how tanned you are. Most people living in Ireland have Fitzpatrick skin type 1 or 2 and are particularly vulnerable to sun damage and skin cancer. However anyone, no matter their skin tone, can get skin cancer.

Babies and young children are particularly vulnerable to sun exposure. Extended sun exposure can cause sunburn and serious eye damage. Even one episode of sunburn during childhood nearly doubles the risk of melanoma later in life.

Dispel the myths

The notion of a ‘healthy tan’ is a myth: Tanning of the skin is the body’s attempt to prevent further harm to skin cells’ DNA – tanned skin is damaged skin.

Most people think about sunburn as something that just happens when abroad on holiday or during a particularly sunny day in Ireland. However, the sun does not need to feel hot to increase risk of skin cancer. The skin is damaged by UV radiation, which is not seen or felt, so don’t be fooled by mild temperatures. UV radiation in Ireland is highest between the months of April and September.

Protect the skin you’re in

Be aware of protecting your skin while you’re out and about, especially between April and September. Getting outdoors and being active is good for your physical and mental health but remember to follow these top tips to protect the skin you’re in.

• Stay safe and limit time in the sun, especially when the sun is strongest in the late morning through mid-afternoon (11am-3pm).
• Seek shade when the sun is strongest, remember to cover prams.
• Wear a wide-brimmed hat, wraparound sunglasses with UV protection and opt for loose clothes that cover your skin.  
• Use water-resistant broad spectrum sunscreen with SPF 30+ and reapply regularly. No sunscreen can provide 100% protection; it works best when used alongside other protective measures such as clothing and shade.
• Never use indoor tanning devices such as sunbeds, tanning booths and sunlamps.

In Ireland, the risk is highest between 11am and 3pm. Be especially careful about protecting your skin from sunburn during these hours by seeking shade, covering up with clothing, a wide brimmed hat and sunglasses and using sunscreen on the parts you can’t cover.

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Skin cancer is the most common cancer in Ireland. Almost 12,000¹ people are diagnosed in this country every year.

Most cases of skin cancer are directly caused by UV rays from the sun, so it is really important that everyone protects their skin from sun damage as much as possible. Recently, we are seeing more men than women being diagnosed with skin cancer, even though it’s often seen, inaccurately, as a cancer more prominent in females.

The major risk factor when it comes to skin cancer is exposure to the sun and to UV rays. Past research has also pointed to the fact that skin cancer increasing among young people who are living in urban areas, which is likely a result of repeated sunburn during leisure activities².

Skin cancer can take 10-15 years to develop

Protection of the skin in childhood and adolescence is vital in reducing the risk of skin cancer in later years. Skin cancer takes approximately 10-15 years to develop and young people who get sunburnt in their formative years also increase the risk of melanoma, the most serious form of skin cancer in adult life.

Sunbed use pre-35 increases the risk of melanoma by 75%

It is also alarming that people continue to use sunbeds regularly, given the clear link with skin cancer. Analysis shows that almost 90% of first-time sunbed users were under the age of 29³. There is a 75% increased risk in melanoma when people begin tanning regularly before the age of 35.

According to research we carried out, two out of five sunbed operators are not complying with the requirement to ask customers their age, and many are making bookings for under 18s⁴. The Irish Cancer Society is concerned to see operators flouting sunbed legislation. We feel that greater resources must be made available so health officials who check for compliance and safety can carry out more inspections of sunbeds and sunbed operators, and that those found to be breaching the law are punished.

High UV levels – typically in summer – cause skin damage

Over the summer months, we all need to be sun smart in order to reduce our risk of skin cancer.  Many people think because we live in a country with a mild climate, that we don’t have to be as concerned about getting sunburnt. However, in Ireland, 90% of the days between April and September have a UV level high enough to cause skin damage.

How to stay smart in the sun:

• Cover up when there’s no shade around.
• Wear loose clothing and a cool, wide-brimmed hat.
• Seek shade! It is really important to do this from 11am to 3pm when UV levels are at their strongest. 
• Wear sunglasses. Whether you are young or old, make sure to get sunglasses that give UV protection.
• Use sunscreen with SPF of 30 and UVA protection. Apply sunscreen 20 minutes before going out in the sun and reapply every two hours.

Finally, always remember to check your skin regularly. If you notice any changes at all, like a mole changing colour or shape, or a new growth or sore that doesn’t heal in a few weeks, please talk to your GP.

^{1 Cancer In Ireland 1994-2016 with Estimates For 2016-18: Annual Report of the National Cancer Registry
2 Deady.S, Sharp. L, Comber, H. (2014): Increasing skin cancer incidence in young, affluent, urban populations: a challenge for prevention.  Dublin: National Cancer Registry of Ireland.
3 Ipsos MRBI research, July 2017
4 Ipsos MRBI research, 2018}

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