Actor, writer and comedian Toby Hadoke has battled with severe psoriasis for most of his life. He talks about treatments and why it's vital to tackle the psychological, as well as physical, symptoms.
As a performer, Tony Hadoke is used to speaking out. After two decades of having outbreaks of psoriasis, he's discovered the benefits of applying this approach to his skin condition.
"Psoriasis is a horrible condition. People who don't have it don't understand how physically and emotionally disabling it can be.
"My psoriasis covers pretty much my entire body, especially my trunk, arms and legs, and scalp. During an outbreak, my skin erupts into plaques. Even between outbreaks, I'm never completely clear of it - there's a reddened discolouration to my skin.
"The worst place to have psoriasis is on your face. When my face has been affected, it's made me very self-conscious. Complete strangers would make comments like, 'Hope it's not catching.' What a horrid thing to say. When you have psoriasis, you can be exposed to that kind of lack of empathy."
The emotional aspects of psoriasis
"It's in our nature to be pessimistic, not to complain and not to seek help. People with psoriasis are pre-programmed to suffer in silence.
"But it isn't acceptable to put up with a condition as unpleasant as psoriasis, and no one should feel guilty about feeling sorry for themselves or wanting to be treated.
"I've found it cathartic to talk about it. It makes me feel as if I'm in control of the psoriasis, rather than it being in control of me."
Psoriasis creams and lotions
Toby, 39 at the time of this interview, was diagnosed with psoriasis during childhood. Since then, he's tried a wide variety of treatments, with mixed results.
"I was about 11 when I had my first symptoms. I'd been prescribed penicillin for a throat infection and, almost straight away, I developed patches of dry, red skin. The doctor thought it was a penicillin-induced rash. But my mum, a nurse, suspected psoriasis - and she was right. I was treated with coal tar baths and it cleared up.
"For years my skin was fine, until, as a student at university, I noticed a couple of small red patches on my arm. Within hours, the psoriasis came back with a vengeance, and it's stayed with me ever since. I always know when a flare-up is coming on. Throat infections are a trigger.
"For years, I used loads of different treatments, including coal tar cream, dithranol and even holistic treatments. None of them made much difference. I thought that a certain level of discomfort was my lot in life."
Psoriasis tablets and injections
The turning point for Toby came in May 2012 when, after a particularly prolonged and severe outbreak of psoriasis that also covered his face, he was referred to the Royal Free Hospital in London.
"When I took my shirt off, the doctor was aghast at the state of my skin," he recalls. "Since then, I've been prescribed more powerful treatments under the care of the hospital.
"These have included UV light therapy, tablets of the immunosuppressant ciclosporin, and a tablet called acitretin, which reduces the production of skin cells. The treatments have helped to a certain extent, although the benefits have to be balanced against potential side effects.
"For instance, the acitretin worked, but one of the side effects is that the treatment can affect your mental health - and sure enough, I had a bit of a breakdown while taking it, so I had to stop."
At the moment, Toby is self-injecting once every two weeks with a "biologic" treatment. Biologics are a new type of psoriasis therapy that reduce inflammation by targeting overactive cells in the immune system.
"So far, so good. My face is clear and I'm cautiously optimistic," he says.
Psoriasis support and information
Toby urges people with psoriasis to be persistent when looking for help for medical and psychological symptoms.
"There are lots of treatment options for psoriasis, so if one doesn't work, tell your doctor and ask to move on to the next line of attack. Ask about UV light treatment. If creams don't work, try oral treatments. And if oral treatments don't work, ask about injections.
"It's not enough to simply treat your skin outbreaks: you also need to ask your doctor to refer you to someone qualified to talk you through the emotional aspects of the condition.
"I'd also recommend getting more clued-up about psoriasis in general. Knowledge is a good thing, as is talking about it - it spreads understanding and dispels fear."
Read more about psoriasis.
Article provided by NHS Choices