Yes, there is a strong tradition of Western herbal medicine, with its origins going back into folklore. Unfortunately, there seems to be even less published work in this area, so very little evidence exists on which someone with a conventional approach can base advice. Herbalists do spend time taking a good medical history and tend to use creams that can be soothing and act as a good emollient, if nothing else.

Many of our modern remedies have been produced after the study of traditional plant-based remedies, but an active ingredient needs to be identified and thoroughly tested before it can be licensed as a drug. This method may well ignore the beneficial effects of groups of extracts that, on their own, may be ineffective but which work well together.

There are several reasons why the immune system is felt to be important in causing psoriasis. Some immuno-suppressive drugs (which damp down some parts of the body s immune reaction) work well in treating psoriasis. It is also a life-long disease, and this is taken as a sign that there is some memory in the immune system that produces the typical rash of psoriasis in response to certain triggers. This memory is part of the way our immune system works in recognising foreign bacteria and fighting them, and explains why immunisation prevents us developing certain diseases.

The way the disease can also clear up without treatment and then flare up again is also typical of a long-term immune response. Finally, some of the genes identified are known to be linked to the way our immune system works.

This is an attractive but rather over-simplified view. The combination of the concentrated salt solution that is the Dead Sea and strong sunshine does seem to be of benefit but the precise mechanism has not been fully evaluated. The seawater also contains some tars that may also be of benefit. Holidays in sunny places can be relaxing and if other people with psoriasis are at the same resort you would be much less afraid to take your clothes off and expose your skin, thus getting more benefit from the sun.

As the Dead Sea is below sea level, the atmosphere is relatively thicker and absorbs some of the UVB light that causes burning. This means that you can get a higher concentration of the helpful UVA light without burning, but this could lead to higher risks from skin cancer. Most of the reviews of Dead Sea treatment mention treatment times of under three hours. It is thought that the complex salt solution adds to the efficacy of natural sunlight and may in itself have some effect on skin cell turnover.

Even the dermatologists from the Ben Gurion University in Israel stress that treatment guidelines and standards have to be set in order to assess the cost effectiveness of Dead Sea therapy compared with other treatments. The NHS has to be very careful about spending money in this way, and many other patients might demand holidays because they feel better afterwards.

Natural sunlight is a good healer for many people with psoriasis, but there are some who do not respond and some who are made worse. Sunlight consists of several different types of light across a spectrum ranging from infra-red, through visible light, to ultraviolet (UV). It is the ultra-violet part that can help in treating psoriasis.

The skin cells contain specialised molecules (called chromophores) that are capable of absorbing the energy from UV light and then releasing it to power chemical reactions that affect the function of the cells. In psoriasis, this can result in the cells not multiplying so rapidly and behaving more like normal skin. A lot has been said about the Dead Sea and its benefits, and I understand that some countries such as Germany will help towards the cost of treatment there.

Although there is little scientific research into the effects of moisturisers on psoriasis, our own experience shows that: moisturisers make the skin much more comfortable they decrease the dryness, scaling, cracking and soreness, and itching; moisturisers allow the other active treatments you use (e.g. tar, vitamin D) to work more effectively.

Which moisturiser is best to use?

There are so many to choose from that sometimes it is difficult to know. There are, however, two golden rules: Moisturising is absolutely vital for anyone with psoriasis. Although it does not get rid of the psoriasis, it makes it less scaly and much more comfortable. The best moisturiser is the one that you feel happiest with and that you feel you can use easily on a regular basis. Discuss this with your GP and ask her or him to prescribe one that you like and will use.

I think you mean guttate psoriasis. Guttate means drop-like and is used to describe a type of psoriasis that is often the first manifestation in adolescents and young adults. It is an example of infection triggering the disease and often follows a sore throat, especially when a bacterium called Streptococcus is the cause. Very small drop-like patches of psoriasis appear on the trunk and limbs, and may slowly clear on their own after several months.

This can look quite dramatic, sometimes like having been splattered with red paint. Having an attack of guttate psoriasis does not necessarily mean that you will go on to develop other forms of the disease, but it may return if you suffer from the same type of sore throat again. Specific treatments Whatever treatment you use, moisturisers will be the mainstay. Emollients are substances used to moisturise the skin either by being rubbed in or by putting them in the bath or shower.

There is a huge range available and every individual should be able to find an acceptable one. Tar is a useful substance to treat psoriasis although it tends to have a strong smell and can be very messy. Tar-based products range from weak substances (e.g. in Alphosyl) to much stronger ones (e.g. coal tar and salicylic acid ointment, which tends to be prepared and used in hospital departments).

Although there is no conclusive evidence linking the use of coal tar with cancer, there have been concerns about a risk in people who use it extensively over long periods of time. Tar can be used on small or large plaques of psoriasis; although it can irritate unaffected skin, this is only temporary and mild, and makes tar suitable for psoriasis plaques that do not have a definite edge and/or are widespread across the body. It is not generally recommended for delicate areas of skin (e.g. skin folds or the face), but can be very useful for pustular psoriasis on the hands and feet.

Dithranol, now manufactured chemically, was originally extracted from a special tree bark extract. Its value in psoriasis was discovered by accident when a patient with psoriasis and arthritis was given a powder produced from the tree to treat the arthritis. His psoriasis cleared even though the arthritis did not. Dithranol is now used to treat well-defined plaques of psoriasis. It can irritate quite seriously if it is allowed to get onto skin with no psoriasis on it, so it needs to be applied carefully. It is usually applied for only a short period of time before being washed off. It doesn't smell but it does tend to stain clothes and surrounding furniture a distinctive purple colour.

Vitamin D derivatives for example, Dovonex (calcipotriol) and Curatoderm (tacalcitol) are newer treatments for psoriasis, and have the advantage of being relatively clean and non-smelly. They are easy to apply, and, although some irritation has been experienced by some people, this is usually fairly mild and only temporary.

Vitamin A derivatives for example, Zorac (tazarotene) are the newest topical treatment for psoriasis. They are applied once a day and can be used for up to 12 weeks. The face and skin folds should be avoided because it can cause irritation. The preparations are relatively clean and non-smelly.

Topical steroids are not used routinely for treating chronic plaque psoriasis because, although potent or very potent steroids can have a very spectacular positive effect, the psoriasis often comes back (rebounds) as bad if not worse than before once they have been stopped. However, short-term use of steroids can be very helpful, especially when psoriasis is inflamed or when it exists in delicate areas of the skin (e.g. skin folds or the face).

Topical treatments often take four to eight weeks to have any effect, which can be quite demoralising. However, they can work very well and the best strategy is to choose treatments that fit best into your life-style. It is very important that you use the correct amount of cream or ointment: some treatments need to be applied sparingly whereas others are put on more thickly.

Many people notice that, if one or two plaques start to fade with the treatment, the others do so of their own accord. If treating all the psoriasis seems too much trouble, it is worth tackling the bits that are most bothersome and seeing if the others fade by themselves. We would always recommend that you put moisturiser on all over the body, as this really does help to soothe and smooth.

Pustular psoriasis can affect just the hands and feet, with round yellow pustules (raised areas of skin containing pus) appearing under the skin surface of the palms or soles, or both. They gradually turn brown as they reach the surface and are shed as scales. The pustules are sterile and not due to infection. This pattern is most often seen in middle-aged people who are smokers. Generalised pustular psoriasis, with sheets of very small pustules on a background of very red, hot skin, is a medical emergency. A person can become very ill from loss of heat and fluid, and feels very feverish. It is sometimes triggered if large amounts of strong steroid creams have been used to treat widespread plaques or after oral steroids.

The treatment of nails is very difficult. You should keep them short to prevent further damage from catching them, and ask your doctor about having the clippings analysed to make sure you do not have a fungal infection. A fungal infection can be an additional problem in damaged nails but can also mimic the typical changes of psoriasis. Topical vitamin D agents on the affected part can sometimes work if applied and covered with polythene, but this may only be practical at night. Other treatments include injecting the growing part of your nail with a steroid, or using some of the tablet treatments. Nails do sometimes improve if the rest of your psoriasis clears up.

The treatment that you use on your scalp will depend very much on the extent to which it is affected and what you want to achieve.

Coconut oil: This is good if your scalp is dry but not necessarily covered with active psoriasis. It is solid at room temperature but melts on contact with the skin and is therefore quite greasy; it has a very light but not unpleasant smell. Use as much as you need to make your scalp feel comfortable.

Coal tar solution (Cocois): If the psoriasis on your scalp is thick and active, this is the best treatment to use, as it moistens the plaques and encourages them to lift off. Because it has tar in it, though, it tends to be a bit messy and has a distinctive smell. The amount you use will depend on how thick your psoriasis is, but apply enough to turn the scale from white to the colour of the ointment.

Steroid (e.g. Betnovate) scalp application: This is useful for short-term treatment if your scalp is inflamed but the plaques are not particularly thick. (Beware, though: the scalp application is an alcohol- based solution and can sting when applied.) It is relatively clean and odour free.

Vitamin D scalp application: This is useful when the plaques are thin but active. It is clean and odour free. One or two drops are enough to cover an area of your head about the size of a postage stamp.

It is very difficult to apply my scalp treatment Have you any advice?

With scalp treatment, the method of application is almost as important as which treatment you use. Applying the treatment involves parting the hair in sections and rubbing the treatment along the exposed area. It is best to do this in a sequential fashion, starting at the front of the scalp and working your way round. If the scale/plaques are very thick, once they have been moisturised with the treatment (especially Cocois) they can be gently lifted up using a comb.

It is easier to get someone else to do this for you, as it is difficult to see the top of your head and (a) rub the treatment in where it is needed and (b) lift the scale where appropriate. When doing this some hair may come out, but it will grow back so don't be too perturbed! The best time to do a scalp treatment is before going to bed, because the treatment (especially Cocois and coconut oil) will make your hair look greasy and can smell.

Try wearing a cotton night cap, a shower cap or something similar and cover your pillows with old pillowcases to protect them. (You can buy pillowcase protectors from bed-linen shops/departments, which give useful extra protection to your pillows.) Wash your hair the next morning with an anti-psoriasis shampoo (i.e. tar-based). An advantage of the coconut-based treatments is that they are wonderful conditioners for your hair!

It might sometimes seem this way, but it is important that you feel able to see your GP whenever you need to discuss the treatments you are using and whether they are working or not. Your GP is there to provide care to all the patients on her books and she will not think that you are any less important than the other people she sees.

If, however, you feel that you are not getting the information you need about the treatments from your GP, you might like to ask whether there is anyone else who can help there may be a nurse available who has more time to discuss things with you. It may also be worth considering making contact with the Psoriatic Arthropathy Alliance or the Psoriasis Association. Both are organisations with access to information about treatments as well as being support groups of people with psoriasis who may be experiencing the same sort of thing as you.

The chances are much more than doubled, presumably due to the chance of inheriting more than one of the psoriasis genes. If only one of you had psoriasis, the chances of your children developing it would be only 15%; because both of you have it, though, the chances rise to 75%. It is very difficult to answer individual questions about risk: for example, if neither of you had psoriasis but you had a child with the disease, the risk of another child being affected would be 20%.

Many people with psoriasis feel isolated and alone with their condition. The statistics, however, tell a different story: at least 1 in every 50 people has psoriasis think how many people at your average football match must have it! Isolation often occurs because people feel unable to talk to others about their psoriasis, especially when it has first been diagnosed. The most effective way of getting round the feelings of isolation is to seek support from others around you.

Although you may feel embarrassed to talk about psoriasis, others will not be able to help or support you unless you do and thus let them know how you are feeling. Support groups are good places to find help: the people there understand what you are going through, as it is likely that they will have had similar experiences themselves.