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Psoriasis is a miserable complaint because there is no cure and as it doesn’t kill anyone, it doesn’t have the “glamor” to attract money for research.

Few doctors see psoriasis as a challenge to their therapeutic skill and many leave their patients to their own devices, yet many people have turned away from life, hiding their skin and themselves from an insensitive world because of this disease.

Psoriasis is a skin disease of unknown cause. The fault appears to lie in the superficial skin cells which are produced too rapidly. The rash is usually dry, reddened and covered with silvery scales.

It is common on the extensor surfaces, such as the elbows and knees. It is also common on the lower back and can affect the hair and the nails and, sometimes, can affect the whole body. It may or may not itch.

Psoriasis usually starts in the teens or early 20s, but may appear for the first time in the elderly or it may develop in young children.

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These stronger cortisones, if used on the face may cause an acne-like rash around the mouth — peri-oral dermatitis — so the older hydrocortisone, which is weaker, is preferred for use on the face because it doesn’t have this side effect.

The pituitary gland at the base of the brain is the master gland producing hormones which stimulate the other endocrine glands to produce their own specific hormones.

A rise in the level of cortisone from taking tablets has a feed back or dampening effect on the pituitary. It produces less of its stimulating hormone and so normal production of cortisone from the adrenal is shut down. Cortisone is necessary to enable the body to deal with situations of stress.

Prolonged use of cortisone may upset this balance between the pituitary and the adrenal and so if the body is subject to stress, such as an operation, the adrenal may not have the capacity to produce hormones to deal with the stress.

After a prolonged course of cortisone, should an operation be required, a temporary cover of cortisone over one or two days may be necessary.

Short courses over one to two weeks can safely be stopped abruptly and the body rapidly regains its ability to produce the natural hormone.

Those on prolonged courses of cortisone should be given the smallest possible dose.

It has been suggested that if the total dose is given every second day in the morning this mimics the body’s natural morning surge of cortisone, and then on the second day, when it is not given, the body may produce its own.

Addison’s disease is failure of the adrenal gland — cortisone must then be taken for life.

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