Psoriasis is a common chronic condition which affects up to 2% of the UK population.

It is an autoimmune disease characterised by inflammatory skin and joint symptoms (psoriatic arthritis affects up to 30%); and links with co-morbid conditions including psoriatic arthritis, cardiovascular and vascular inflammation, diabetes mellitus type 2, hypertension, and metabolic syndrome (insulin resistance, obesity and dyslipidaemia)1. There are several different types of psoriasis with chronic plaque affecting the truck, limbs, scalp, genitals and nails being the most common. Psoriasis can range in severity from mild to severe, 51.8% have mild psoriasis, 35.8% moderate psoriasis and 12.4% severe psoriasis, most patient with mild to moderate psoriasis will be treated in primary care citation ².

In Psoriasis Month, it is important for all health care professionals to reflect and consider how they manage their patients. Patients with severe psoriasis will generally be treated and monitored in secondary care and treated with phototherapy, immunosuppressant drugs or biologic therapies. In primary care, psoriasis patients need diagnosis, effective topical treatment and psychological support. Psoriasis of any severity impacts mental health and evidence links elevated pro-inflammatory markers to mental health conditions, patients with any severity of psoriasis are 1.5 times more likely to have anxiety and depression (20-50%) than individuals without psoriasis, and a higher suicidal ideation (12.7%) ³.

Patients with mild to moderate psoriasis need to be managed and supported in primary care and referred promptly to secondary care if topical treatments are not effective and/or if psoriatic arthritis is present. Most patients with psoriasis will be treated in primary care according to national guidelines, NICE, 20174, SIGN 20105, and evidence-based treatment pathways - PCDS, 20226. Psoriasis can have profound physical and psychological effects and HCPs should provide holistic psoriasis care, by supporting patients with evidence-based treatments plans and providing psychological support.

Patients should also be signposted to the patient support groups, The Psoriasis Association (https://www.psoriasis-association.org.uk/ ), PsoTeen (https://www.psoteen.org.uk)  and The Psoriasis and Psoriatic Arthritis Alliance (https://www.papaa.org) who have excellent resources and helplines.

The Primary Care Dermatology Society (PCDS) at  https://www.pcds.org.uk  provides clinical guidelines, treatment pathways and patient information (including an animated short video) on psoriasis. Here are some top tips for psoriasis management from the PCDS7:

• Ensure a holistic clinical assessment and examination, ask about areas affected (including scalp, nails, joints and genitals), symptoms and effect on quality of life
• Check for psoriasis arthritis annually, using the PEST tool. Patients with suspected PsA should be referred (usually to a rheumatologist) on an urgent basis as it is a destructive arthropathy
• Daily ongoing use of emollients are essential to reduce scale and make the skin more comfortable – prescribe/recommend
• Explore expectations and discuss treatment options initially using topical therapies – first line a calcipotriol/betamethasone combination product (cream, foam, gel or ointment depending on patient preference should be used first line, once daily, until lesions flatten, generally for 4 weeks and then if required maintenance treatment. 
• Discuss and emphasise the benefits of lifestyle change, reducing obesity, smoking and alcohol and managing psychological co-morbidities have been shown to improve psoriasis severity
• Refer to dermatology if moderate-severe psoriasis with inadequate treatment response 

References

1. Amin M, Lee EB, Tsai TF, Wu JJ. Psoriasis and Co-morbidity. Acta Derm Venereol. 2020 Jan 30;100(3): 5650.

2. Geale K, Schmitt-Egenolf M. Severity of psoriasis: time to disentangle severity from symptom control. Br J Dermatol. 2022 Jun;186(6):1033-1034.

3. Hedermann Tl, Lui X, Kang CN, Hussain M. Associations between psoriasis and mental health- an update for clinicians. General Hospital Psychiatry. 2022. March-April; 75: 30-37.

4. NICE (2017) Clinical Guidance 153. The Assessment and Management of Psoriasis — Full Guidance. Available https://www.nice.org.uk/guidance/cg153 [accessed August 2024]

5. SIGN (2010) Diagnosis and management of psoriasis and psoriatic arthritis in adults. SIGN 121 Guidance. Available: https://www.sign.ac.uk/assets/sign121.pdf

 [accessed August 2024]

6. Primary Care Dermatology Society (2022) Psoriasis-Primary care Treatment pathway. Available at: https://www.pcds.org.uk/files/general/Psoriasis-Pathway-2022-Update-web.pdf [accessed August 2024]

7. Primary Care Dermatology Society (2025) Psoriasis: an overview and chronic plaque psoriasis. Available http://www.pcds.org.uk/clinical-guidance/psoriasis-an-overview#management [accessed August 2024]

Written by: Julie Van Onselen, Dermatology Lecturer Practitioner and Executive Committee Member, PCDS