Psoriasis is a chronic, non-infectious skin disorder which effects 2-3% of the UK population. Occuring at almost any site of the body, however, most commonly affected areas are the scalp, the extensor surfaces of the limbs and the lower back (Chemist & Druggist, 2003).
It is not a contagious disease but it is hereditary. It can skip a generation and for the disease to arise, there needs to be a provoking factor such as stress, skin injury, hormones, alcohol, infection and possibly smoking.
In the case of psoriasis, skin renews itself too quickly. So instead of the usual 28-day cycle, it renews itself about every four days. Cells build up on the skins surface forming the characteristic psoriasis patches. Inflammation and an increase in the blood supply to this area, causes redness.
Most patients with mild or moderate plaque psoriasis can be treated in primary care using topical therapies.
Unfortunately Psoriasis is a life-long recurring condition for which there is no permanent cure. The degree of accompanying psychological and social disability is commonly underestimated. Through effective treatment, the condition can be eased and cleared for long periods of time.
- Emollients should be used to soften scaling and reduce irritation.
- For localised plaque psoriasis, e.g. on the elbows or knees - Vitamin D3 analogue tacalcitol - tends to be less irritant and is more suitable for face or flexures.
- In palm and sole psoriasis, as for the scalp, both hyperkeratosis and inflammation are usually present and may require separate treatments. Hyperkeratosis usually needs to be treated with a keratolytic agent. Topical agents including vitamin D analogues may also be useful.
- In general, milder agents are used for flexures. These include low potency topical steroids, mild tar preparations, and tacalcitol or calcitriol.
- In facial psoriasis, use mild agents: emollients, mild corticosteroids, calcitriol, tacalcitol, mild tars.