Tips from a GP about managing your Psoriasis

As part of our Psoriasis Awareness Week theme of 'Talking about Treatments', we spoke to Dr Steph Gallard, a Dermatology GPSI for the Liverpool Intermediate Community Assessment and Treatment Service (ICATS) at Liverpool University NHS Foundation Trust about the advice she would give to someone with psoriasis:

'A diagnosis of psoriasis can be overwhelming at first. Even if you have some familiarity with psoriasis (and up to 50% of psoriasis sufferers have a family history of the condition) it can still be a daunting thing to understand the best way to look after your skin, and where your GP can prescribe the right products to give you maximum benefit

The first rule is undoubtedly to be kind to your skin. Psoriatic skin can be dry, flaky, sore and itchy. The best management is undoubtedly to be gentle. No harsh scrubbing or rough exfoliation, no long baths in boiling water, no perfumed shower gel or moisturiser – all these things will just dry your skin out further and make the itch and irritation worse. So turn down the shower or bath temperature (to lukewarm or just above) and make sure that you have plenty of emollient (medical moisturiser) to hand. When you have psoriasis, emollient is your first line skincare. You can wash with it, shave with it, and then apply it after your bath or shower to soothe, smoothe, soften and hydrate your skin.

Emollient should be prescribed by your GP in 500g pump dispensers, and if you are using it to wash and moisturise with British Skin Foundation and NICE guidelines say you should be using 2kg (4 bottles) each month. Some people prefer to use a lighter moisturiser in the morning, and a heavier one in the evening and overnight – that is fine too. The best moisturiser to use is one that you like the “feel” – your GP or other health care professional might have sample pots for you to try before prescribing.

When it comes to the best treatments for your psoriatic plaques, the best treatment to use is a combination product containing both a steroid (which will work on the inflammation and itch) and a skin formulation of vitamin D (which will slow down the rate of skin growth/turnover in the red plaques of active psoriasis). We have three available on the UK market at present

• Dovobet – gel or ointment – very moisturising

• Enstilar – a foam, which penetrates deeper into the skin and can have a faster effect

• Wynzora – a cream, which is slightly less greasy

If your GP suggests you start out with one of these- and they can be used on both the body and the scalp – it is important that you give it long enough to work. You usually need to use them for a month to get the full benefit. And remember – you must still use a moisturiser as well. All of the above products can be used on up to a third of your body surface area for either 4 weeks (Dovobet, Enstilar) or 8 weeks (Wynzora). If after a month you feel it has not worked, it might be worth asking to swap to one of the other preparations.

For some people, an itchy scaly scalp can be the most troublesome, visible, aspect of their psoriasis. All of the products used above can be used on the scalp as well, usually overnight, but they will all work better in conjunction with a coal tar shampoo, which will help to both loosen scale and wash off any of the above applications'.