So psoriasis is a kind of umbrella term for a type of inflammation of the skin, where you’ve got sort of scaly plaques. And there are several different types. The most common by far is something called chronic plaque psoriasis. And that’s the one which is probably about one to two percent of the population have chronic plaque psoriasis, so it’s not quite as common as eczema, but it’s really not uncommon. It’s often quite a hidden disease, I think people often feel quite stigmatised if they’ve got even a small amount of psoriasis. So they will, you know, often not sort of show their skin, or expose their skin to people. And that’s the type of psoriasis where you often get it on the elbows, you can get it on the scalp, and it tends to be, as the name suggests, it’s chronic. Tends to come and go, depending on different, you know times of life. But that’s- and it has quite a strong genetic link. So if you’ve got parents with psoriasis, you’re more likely to get that one. There’s another, the other sort of common type of psoriasis, and it’s a more reactive type of psoriasis, is called guttate psoriasis. And that you see with a sort of particular trigger. So you may have an infection, such as streptococcal throat infection, or something like that, and then you get a, that sort of triggers off your kind of immune system to produce very small little droplets of psoriasis often, in this kind of guttate picture. So sort of on someone’s back, in smaller plaques. If you have guttate psoriasis, you know you’re more prone to chronic plaque psoriasis, because some of the things are quite similar.

And those are, you know. But within the plaque psoriasis, you can be subdivided into, you know, which part of your body it’s affecting. So genital psoriasis, scalp psoriasis, so there’s, you know, a lot, every person with psoriasis will have a different pattern of disease. But the sort of similarities would be type of skin changes you get, the sort of clearly marked out plaques of psoriasis, often with a sort of silvery scale. And then there are associated types of psoriasis, so you can get- your nails can be affected, with nail psoriasis.

It’s kind of been like a rollercoaster I guess, where it was like, when I first got it, it was quite bad, and then it’s got better bad better, but I remember, I think it’s like June, July four, five years ago, and it got really bad, and we’d just broke up from school and it got really, really bad, like you couldn’t see my skin; like except from like my wrist down; and my feet, my arms, my body, my chest, my back, everything was completely covered. And like I felt really self-conscious, but I didn’t want to go out that whole summer, and like my sisters would go, “Do you want come play in the garden?” and I didn’t want to cos I was scared of cutting it as well.

Because I couldn’t like do the things that I wanted to do; like I couldn’t go on bike rides because if I fell off I’d cut myself. So I was like, it got to the point where I was like really scared to do things, so I’d just kind of stay in cos I didn’t want to hurt myself, because I knew that if I’d hurt myself it would cut and it would bleed, and then it would grow again; and it was kind of I knew that was going to happen.

Could you tell me a bit about how you first started noticing?

I started noticing a few patches on my arms. I didn’t really take it seriously. And then all of a sudden it just took over and I was covered, so there wasn’t a time where I thought oh, I need to go to the doctors to control it again’, because by the time, I was, I was going to it just came back. It does seem to, when I have a flare-up it does come back quite vigorously, quite quickly.

Was that the same when you were a teenager?

Yeah, as well, yep.

I had eczema as a child, so I’ve obviously kind of always had a predisposition to dry skin. My mum has really dry skin, but no actual skin conditions. It’s not led to any others. The type of psoriasis I’ve had has changed, so I had plaque psoriasis originally, so like it would be one big area would be covered, like this part of my elbow [points off camera] often was. And then after cyclosporine, when the kind of severe psoriasis started, I got a lot of guttate, which is basically like small droplets of psoriasis, and that, my legs and arms then were like just very, very small and kind of drops. And that was actually more difficult to treat like with creams because you just sort of have to like do every single little one. And with steroid creams they advise that you don’t put it on normal skin, so it made it virtually impossible to just kind of like reach those tiny areas all the way, all over.

So like in Year 7 when I first started secondary school I joined all the sports clubs.

Okay.

And I used to love them. I used to regret it afterwards because it was so painful.

Right.

And in year 8 I decided not to do that just so to give my feet some relief but yeh like county badminton was difficult because I was constantly on my feet and I was constantly moving and it was, it was a lot of pressure on my feet and we went on a badminton tour for, four weeks and playing badminton every day my feet were so bad and, but they get to a point where they can’t get any worse and they almost start getting better it’s just a change and they might be more red but they don’t have as much dry or pussy skin on them and you’ve just got to get past that stage, yeh.

And do you sort of know these different stages of your skin how it goes up and down and?

Yeh you recognise a pattern.

What’s really nice about brushing my hair, is it gets rid of it and that kind of helps with the itch. It sounds really horrible and gross talking about dead skin falling off you. That for me is really hard at school is that like I will take off my jumper and suddenly whoosh there’s like dead skin, and I’m like ahh’ or looking down and like I move my hair and I can see it on my clothes or on the table if I’m in a lesson or studying. And that for me is just like-, if I was someone else I’d be like, Ahh that’s horrible. Or like, you kind of-, if you see-, you don’t,- I don’t know for me I just feel like so like embarrassed and just want to kind of curl up and not be there anymore. Cos you’ve got to deal with it, or like on your jumpers or if I look, I’m like oh it’s on my jumper, just crap, I need to get rid of that.

I think my hair just randomly started falling out one day, and I got really panicky about it, so I was talking to my mum, and my-, we rang the hospital, and they said it could be because my psoriasis was growing thicker in my hair; like it was growing really quickly, and you couldn’t stop it growing even if I put the creams on, like it wouldn’t stop growing, so my hair just started falling out. And then they said to me that I had to like really carefully get like a comb, and carefully like not scrape, like carefully brush my hair so that my psoriasis would fall out of it, and like not cut the tops off of the skin, but take away the skin slowly so that it would reduce it growing so quickly. But I remember like trying to hide it; so I wouldn’t have my hair up; I’d wear my hair down all the time cos it was like right behind my ear, like here [points to left ear]. So, I used to wear my hair down so that you didn’t see it at all.

And did it help with what the dermatology department suggested of combing through your hair, did that help at all?

Yeah it stopped it from growing so quickly, because I was taking the like top layer off as soon as it would grow. So, then cos I brushed my hair like every day anyway; I had to brush it in the morning and the evening to make sure that all the scalp was like clear, and even though I knew it would grow again, I was prepared to go through it, like ready to take off the heads a bit again.

So at the moment I don’t really have it that badly. One of my nails is a bit sort of misshapen. But what happens is they can-, it gets sort of pitted and discoloured. So a lot of the time you’re wearing nail polish to cover it up which can’t exactly be good for the nail psoriasis, to kind of cover it in paint. It’s, it’s quite an embarra-, like I, I’d say nail psoriasis like did affect me quite badly because I guess like with women this idea of having nice nails is something that you really want and you seem, with your hands, to be really conscious of people looking at them. There were times when my nails were really bad, so that, you know, I could, they were basically just com-, breaking apart all the time. If it gets really bad, sometimes they recommend just pulling them out of your-, the nail bed completely so you basically don’t have any nails. So I was always so fearful-, like scared that it was gonna get to the stage where they would just take all my nails. And it is hard, it’s, it’s strange, but nails are just one of those things where you just think this-, people will see it and it will look awful and it, and it will disgust people’, but yeah, so that was quite hard. And it was just mostly my hands, I didn’t have any problems with my feet actually.

At first it started off on this finger here, my ring finger I believe. It I remember banging the fingertip really badly, again that’s just on a surface when I was moving, and I didn’t think anything of it but then it started to bruise. And I thought that was normal. But then two weeks later it started to turn into this sort of sickly almost like ivory white colour on the tips of my nails, like you can see, and it started to spread until it was about half. Now, it has gone down a little and I think that’s down to the shampoo that I use, Capasal, rubbing off into the, beneath the fingernails.

It started to spread really badly on my hands, sometimes it’s disappeared, other times it isn’t as good, especially here where it’s on a, it’s absolute worst, it’s pretty much covering the entire fingernail at this point. And especially on this finger here you can see that’s starting to really spread because it still has that ivory colour. I think, I believe it’s called epidural, epidermal, epidermal psoriasis. And it is essentially the same condition that it is on the scalp. Unfortunately, because of how it is, being underneath the cuticles there’s nothing really that can be done about it I mean you can try and fish some of it out but it’s gonna keep coming back. Because that’s just how it is. It’s psoriasis.