Psoriasis

Psoriasis is a chronic autoimmune related skin condition characterised by areas of inflamed hyperkeratotic skin with fine silvery scale surrounded by normal skin. It is more commonly found on extensor surfaces of limbs and overlying the spine especially the sacrum. There are various forms:

• Chronic stable plaque psoriasis
• Guttate psoriasis
• Inverse psoriasis
• Pustular psoriasis
• Erythrodermic

Pustular and erythrodermic psoriasis are serious conditions and often require hospitalisation.

There is no cure and the condition is lifelong but the patient can undergo periods of remission. In a proportion of cases nails and joints can be affected leading to an inflammatory joint disease that can affect small and large joints as well as the axial skeleton.

Most cases can be managed adequately in primary care but specialist intervention may be required for managing acute flare ups and the articular manifestations. A range of treatments can be offered including:

• Topical therapy
• Ultraviolet light therapy (PUV)
• Immunosuppressant drug therapy (methotrexate, azathioprine, cyclophosphamide)
• Biological therapies

Other important information for referring practitioners

Lifestyle changes

• Promote healthy lifestyle
• Reduce or stop smoking
• Reduce stress

Medical management

This depends on the type of psoriasis and severity

• Chronic plaque psoriasis

Referral requirements

A referral may be rejected without the following information.