Psoriasis: Private Dermatologist Assessment in Surbiton

Psoriasis is a chronic immune-mediated condition that affects the skin, nails, and in around 30% of cases, the joints. Around 1.8 million people in the UK live with psoriasis — and many of them are undertreated, either because they have not sought specialist review, or because they are using treatments that are no longer adequately controlling their condition.

At Lambert Medical Practice in Surbiton, Dr Nancy Abdelrahman provides comprehensive private psoriasis assessments including disease severity scoring, psoriatic arthritis screening, and prescription of appropriate treatment — from topical therapies to systemic treatment pathways.

What Is Psoriasis?

Psoriasis is caused by T-cell mediated inflammation that dramatically accelerates skin cell turnover. Normal skin cells take 28–30 days to mature and shed; psoriatic cells turn over in 3–4 days. The result is a buildup of immature cells on the surface — the characteristic silver-white scale on erythematous (red) plaques.

Psoriasis has a strong genetic component (40–60% concordance in identical twins) but is triggered and exacerbated by environmental factors. It is not contagious and cannot be transmitted by skin contact.

Types of Psoriasis

Treatment Options

Topical Treatments (Mild-Moderate)

• Potent topical corticosteroids (betamethasone, mometasone) — first-line for most cases; rapidly reduce inflammation and scaling
• Vitamin D analogues (calcipotriol, calcitriol) — slow skin cell turnover; often combined with topical corticosteroid (Dovobet combines both in a single product)
• Coal tar preparations — reduce proliferation and inflammation; well-suited for scalp psoriasis
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) — useful for sensitive areas (face, flexures) where long-term steroid use is not appropriate

Systemic Treatments (Moderate-Severe)

When psoriasis affects more than 10% of the body surface area, involves the face, hands, feet, genitals, or nails, or significantly impacts quality of life, systemic treatment is appropriate:

• Narrowband UVB phototherapy — highly effective for widespread plaque psoriasis; not available at Lambert (requires hospital setting), but referral can be arranged
• Methotrexate — weekly oral immunosuppressant; gold standard for moderate-severe psoriasis for many decades; requires monitoring
• Ciclosporin — rapid-acting systemic treatment; useful for severe flares but not for long-term use
• Acitretin — retinoid; particularly effective for pustular and erythrodermic psoriasis
• Biologics (adalimumab, secukinumab, ixekizumab, risankizumab) — targeted biologic agents with excellent efficacy; available on NHS through hospital specialist prescribing after PASI criteria are met

Psoriatic Arthritis: Don't Miss It

Around 1 in 3 people with psoriasis develop psoriatic arthritis (PsA) — an inflammatory arthritis that can cause permanent joint damage if untreated. It is significantly underdiagnosed. Classic features include:

• Pain and swelling of fingers or toes (dactylitis — the "sausage digit")
• Enthesitis — pain at tendon or ligament insertion points (most commonly Achilles tendon or plantar fascia)
• Asymmetric oligoarthritis (a few joints on different sides)
• Lower back or buttock pain (sacroiliitis)
• Nail changes (a strong marker for PsA)

At every psoriasis review at Lambert Medical, Dr Abdelrahman screens systematically for psoriatic arthritis. If present, early referral to rheumatology is arranged — NICE recommends that people with PsA be on disease-modifying treatment to prevent joint damage.

Frequently Asked Questions