Psoriasis: Management

Who is involved in treating psoriasis?

After receiving a diagnosis of psoriasis, the next step is to decide what sort of management or treatment would be best for you. This process should involve discussions with a team of healthcare professionals responsible for your care. This team is usually, but not always, led by your doctor (GP) or a dermatologist (a specialist in skin disorders).

Planning to treat

Diagnosing psoriasis should be easy, as most cases are identified through a visual examination by a GP. However, as psoriasis may be hidden under clothing, it is important to ensure your GP conducts a thorough examination. This will help determine the severity of your condition and the most appropriate course of treatment.

Try to recall when your symptoms first appeared, whether they developed suddenly or gradually. It may also be helpful to consider whether you had any symptoms other than the rash, such as a cold, virus, or sore throat, or if you experienced any trauma or stress. The more information you can provide, the easier it will be to identify the cause and confirm the diagnosis.

Psoriasis can sometimes resemble other skin conditions, such as seborrhoeic dermatitis, dandruff, eczema, mycosis fungoides, or pityriasis rubra pilaris. In rare cases, a small skin sample (biopsy) may be sent for examination to rule out other conditions or determine the specific type of psoriasis. While these tests may seem unnecessary, they can provide valuable information and reassurance.

Once a psoriasis diagnosis has been confirmed, healthcare professionals may use various diagnostic tools, usually validated questionnaires, to help determine the best treatment approach.

One such tool is the PASI (Psoriasis Area and Severity Index), though this is unlikely to be used in primary care. More commonly, the BSA (Body Surface Area) method is applied, as it is easier to estimate. To give context, the surface area of the hand including fingers, is approximately 1% of the total body area. Your GP may use this method, and the percentage they calculate may seem lower than your own perception.

Shared decision-making

For treatment to be effective, it is essential to follow your healthcare provider’s instructions carefully. This is often referred to as adherence, compliance, or concordance.

You should feel that you are actively involved in decision-making about your treatment. By working collaboratively with your clinician, you can take ownership of your symptoms and better understand what works best for you.

In some medical conditions, such as high blood pressure, strict adherence to treatment is vital to prevent complications. For psoriasis, maintaining good concordance with treatment can help:

• reduce the rate at which new skin cells are produced
• minimise side effects, such as burning or irritation from treatments
• control symptoms effectively
• keep your skin looking and feeling its best

Treatments

Although psoriasis is a chronic condition with no cure, it can be managed effectively, and symptoms may go into remission (disappear for a period or go away). The severity of psoriasis varies, and doctors classify it as mild, moderate, or severe.

The following are the main types of treatment you may be offered:

• Topical treatments (applied to the skin): Antifungals, antihistamines, steroids, coal tar, emollients, vitamin D analogues, combination therapies, dithranol.
• Systemic treatments (taken orally or by injection): Biologic agents, immunosuppressants, retinoids, phosphodiesterase-4 inhibitors.
• Phototherapy: A treatment using ultraviolet (UV) light, either UVB or PUVA. UVB (ultraviolet B) uses short-wave UVB light, while PUVA (psoralen + ultraviolet A) combines a plant-derived photosensitiser (psoralen) with long-wave UVA light.

For more information see Emollients and Psoriasis, Treatments for Psoriasis: An Overview, Psoriasis and the Sun, and Psoriasis and Phototherapy.

Patient-initiated follow-up (PIFU)

PIFU allows patients and their caregivers to arrange follow-up appointments as needed, rather than based on a fixed schedule. This system empowers you to manage your condition proactively and take an active role in the shared decision-making process.

Conclusion

Receiving a psoriasis diagnosis can be distressing, but with good management and support, you can learn to cope with this chronic condition. By actively participating in your healthcare decisions, you can improve your quality of life and achieve better long-term outcomes.

Download our Psoriasis: Management leaflet as a PDF