Our piece on 'Updates in Psoriasis' is now available in the October edition of the Hospital Professional News Ireland magazine and available to read on their website via: Updates in Psoriasis - Hospital Professional News.

You can also read the full article below:

Updates in Psoriasis

World Psoriasis Day is celebrated annually on 29th October across the world. In the UK, Psoriasis Awareness Week, also runs at the end of October and incorporates World Psoriasis Day. Its aim is to raise awareness of psoriasis and psoriatic arthritis. The theme for 2024 is community.

What is psoriasis?

Psoriasis is an immune-mediated inflammatory disease (IMID) primarily affecting the skin but also commonly associated with psoriatic arthritis (PsA), which impacts the joints.

In the United Kingdom and Ireland, psoriasis affects approximately 2% to 3% of the population. This condition results from an accelerated skin cell replacement process.

Typically, skin cells are replaced every 21-28 days. However, in individuals with psoriasis, this cycle is significantly shortened to just a few days. As a result, there is an excessive accumulation of skin cells on the skin’s surface, forming psoriatic plaques.

How to identify psoriasis?

Dry, thick, and raised patches on the skin are the most common sign of psoriasis. These patches are known as ‘plaques’ and are often covered with a silvery-white or grey coating called scale.

The appearance of psoriatic plaques can differ based on skin tone. On darker skin, they may appear as purple or brown patches with grey scales, while on lighter skin, they often present as pink or red patches with silvery white scales. Plaques can vary significantly in shape and size, ranging from small spots to several centimetres wide.

Psoriasis can cause discomfort, with affected areas often feeling itchy and sore. It is important to note that psoriasis is not contagious—it cannot be transmitted between individuals or spread from psoriatic to non-psoriatic skin.

Currently, there is no cure for psoriasis, but a range of treatments and lifestyle adjustments are available to help individuals manage the condition effectively and maintain a good quality of life.

Are there different types of psoriasis?

There are many different types of psoriasis, with plaque psoriasis being the most common, affecting around 80% of individuals.

It presents as silvery or grey plaques most commonly on elbows, knees, lower back and scalp. Scalp psoriasis can make the scalp feel itchy and tight, and cause dandruff-like flakes.

Other types include guttate psoriasis, commonly affecting children and teenagers, often triggered by throat infections.

Guttate psoriasis is characterised  by small, scaly patches. Rare forms include generalised pustular psoriasis (GPP), which causes small blisters, and erythrodermic psoriasis, affecting skin condition and body temperature. If you suspect you have GPP or erythrodermic psoriasis, it is important to seek immediate medical attention as both types
can be serious.

What causes psoriasis?

The precise role of genetics in psoriasis development, is complex, however, psoriasis can run in families. Research shows the psoriasis causing changes in the skin begin in the immune system when certain immune cells (T cells) are triggered and become overactive.

In most cases, psoriasis develops following a ‘trigger’. For example, an infection, injury to skin (Koebner’s Phenomenon) or hormonal changes may lead to psoriasis. Other triggers such as stress, diet, medication, alcohol or smoking may also cause psoriasis. These triggers can contribute to psoriasis getting worse or flaring.

How can psoriasis be treated?

There are four main types of psoriasis treatment. Depending on the type of psoriasis you have, and how severe it is determines the treatment you will receive.

Topical treatments (applied directly to the skin) are often the first line of treatment. Moisturisers, emollients, coal tar preparations and vitamin D based topicals may be prescribed by your doctor.

The following courses of action are recommended for psoriasis that doesn’t respond to these treatment types. Phototherapy (controlled exposure to UVB or UVA light in a phototherapy unit),  systemic (taken orally and affect the entire body) or biologics (injections that target specific parts of the immune system). Holistic approaches such as making changes to diet or lifestyle may also improve symptoms of psoriasis.

When should someone contact their GP?

If you notice any changes to your skin or a new itchy, scaly rash it is advisable to contact your GP to book an appointment at your earliest convenience.

For those already diagnosed with psoriasis, if your current treatment is not working or your psoriasis is worsening, do get back in touch with your GP.

A GP can diagnose psoriasis by examining your skin or scalp. If your doctor is unsure or your condition is severe, they may refer you to a dermatologist (skin specialist).

Can I see a specialist?

If your psoriasis is not improving with treatment, covers more than 10% of your body, affects sensitive areas (e.g. your face or genital area), or is impacting your mental health or daily life, your GP can refer you to a dermatologist.

Dermatologists have access to a wider range of treatments in comparison to primary care.

Can community pharmacists support people with psoriasis?

There are many treatment options available over the counter (OTC) for psoriasis.

This includes moisturisers and emollients, as well as coal tar shampoo and salicylic acid treatments which can treat scalp psoriasis. Pharmacists can familiarise themselves with these OTC psoriasis treatments.

Pharmacists should encourage proper usage of these treatments and following dosage guidelines.
This way, if patients return with symptoms or symptoms worsen, they can advise patients to see their GP.

Pharmacists may also direct patients to The Psoriasis Association or provide them with relevant literature, such as leaflets and information sheets.

Are there any current issues or advancements surrounding psoriasis care?

Skin of Colour: Psoriasis in individuals with skin of colour can be underdiagnosed, requiring special treatment considerations include addressing dyspigmentation and adjusting phototherapy.

Impact on Mental Health:

Psoriasis is not just a skin condition; it also has significant psychosocial impacts, including anxiety and depression. Few patients seek help; however, early treatment, including therapy and medication, is essential for managing these comorbidities.

Access to Specialist Care:

Historically, people with chronic conditions affecting the skin, like psoriasis, faced difficulties in re-accessing specialist dermatology services after being discharged to primary care. Often, this required a new referral and a long wait to see a specialist when the condition flared up. However, the NHS has introduced a “Patient-Initiated Follow-Up” (PIFU) system. Dr. Julia Schofield, Psoriasis Association Chair, shares, “PIFU provides a flexible way for patients to stay ‘on the books’ of the specialist service so that they can reaccess care in a timely fashion as and when necessary, without needing a new referral.” The PIFU system is especially beneficial for managing unpredictable flare-ups of psoriasis.

Advancements in Treatment:

New biosimilar versions of Ustekinumab for managing psoriasis and PsA are now available, following the expiration of Stelara’s patent in July 2024. This milestone introduces new treatment options for those living with these conditions, potentially improving management and outcomes.