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Communication Skills – explain conditions – Psoriasis
Introduction Identification Explanation Consent Ideas Concerns Expectations
How much do they know already?
(not much doctor, I just got diagnosed with psoriasis)
What the condition is (signs + symptoms) & how it’s diagnosed.
Psoriasis = common inflammatory skin condition affecting ~2% population
can occur @ any age – comes & goes unpredictably.
NOT infectious
affects skin mainly but nails & joints can also be affected – if notice swelling or stiffness of joints, go to GP
↑ risk of heart disease, DVT, stroke, anxiety, depression, DM, obesity, alcoholism etc.
Skin changes of psoriasis – often known as plaques, are pink or red areas with silvery-white scales – because
of the quick turnover of skin. Normal = 3-4/52 but psoriasis = 3-4 days.
skin can be itchy esp. scalp, lower legs & groin. If it affects hands + feet, painful fissures or cracks can develop
& may affect use of hands & walking.
Diagnosis = clinical based on appearance & distribution. No routine tests (unless being considered for
treatment)
Who gets it & what causes it?
Both genetic + environmental factors – psoriasis is inherited but complex pattern.
Management
Assessment tools available e.g. physician global assessment (PGA).
No cure but many effective options – although complete clearance may not be possible
Avoid triggers e.g. stress, alcohol, infections, smoking, certain drugs e.g. β blockers, lithium
topical, light treatment (phototherapy), tablet treatment or injection.
Topical treatment – emollients helps to moisture skin & reduces excessive scaling; tar preparations – helps
to remove loose scales
Phototherapy – UV light (narrow-band UV B) delivered in a controlled way to treat psoriasis. A course ~8-
10/52 @ 2-3 weekly sessions – done @ a phototherapy unit
Tablet options include actretin (related to vit. A), ciclosporin (suppression immune system), methotrexate
(slow down rates @ which cells are dividing in psoriasis)
Biologics such as TNFα inhibitors e.g. adalimumab, etanercept (both given s/c)
report any joint/nail changes
adopt a healthy lifestyle – weight loss, balanced diet, stop drinking + smoking, regular exercise
Miscellaneous – pregnancy, drug storage, alert card/bracelet/necklace, education leaflet & contact number
(pause for questions in between sections & reaffirm understanding)
finger-tip units (FTUs) for steroids – if steroid is being used topically, should only use a thin layer on affected area, in
bursts of 3-7 days. If used in combo. with an emollient, then apply emollient first, wait for 30 mins before applying
steroid. One FTU is ~500mg & is enough to treat a skin area about twice palm size.
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NICE CKS Psoriasis (last revised March 2018)
Pustular or erythrodermic psoriasis
if diagnosed = medical emergency, needs same-day specialise dermatology assessment & management
if suspected localised pustular psoriasis – offer information, support & refer (urgency depends on clinical
judgement)
Trunk & limbs
chronic plaque psoriasis – offer information (e.g. lifestyle advice), support
offer treatment with topical preparations e.g. creams, ointments, lotions
topical steroids only suitable for localised areas of psoriasis
review 4 weeks after initiation of treatment to review response & compliance
seek urgent medical advice if unexplained joint pain or swelling – may be a sign of psoriatic arthritis
assess CVD risks at least every 5 years esp. if psoriasis is severe
emollient to help reduce scale & relieve itch
a potent topical steroid + a topical vit. D preparation (both applied once daily but at different times of day)
if poor response after 8-12 weeks, increase steroid to twice daily or add a coal tar preparation applied once
or twice daily
phototherapy, systemic therapy & biologics if sever & poor response to therapy (but these are done in
secondary care)
Scalp
same as above
Face/flexural/genital psoriasis
same as above except more cautious with steroids & advise ‘treatment breaks’
Guttate prosiasis
usually self-limiting resolves ~3-4 months
not infectious
management same as above
Nail psoriasis
keep nails short, avoid manicure and prosthetic nails
if mild & not causing discomfort or distress – no treatment needed
if severe then consider if alternative diagnosis, refer appropriately
