Psoriasis

Dr Maneka Deo, Specialist Dermatologist talks with Dr Diana North, Goodfellow GP Advisor about the management of psoriasis in primary care, including what is it and who gets it, causes and types, assessment and when to refer.

She also overviews:

  • treatment, inc medication and treatment goals
  • aggravating factors
  • safe use of steroids, inc strengths and risks
  • treatment of specific areas – limbs, trunk, scalp, face.

  

Resources

Peer group discussion points

1. The Psoriasis Area and Severity Index (PASI) score is mentioned as a way to assess the severity of psoriasis. It is also used as a guide as to when referral to specialist assessment is appropriate (and may be required for referral in some circumstances).

  • Do you ever use the PASI score in practice? Do you find it useful (or do you think it would be useful to use this in your assessment of patients with psoriasis)? Is anyone aware of a convenient way to access the PASI questionnaire? Are there any other questionnaires that are required as part of a referral in your area?
  • What has been your experience with timeliness of referrals for specialist dermatology assessment and management? Are you able to contact specialist dermatologists for advice in your area? What would your approach to the management of the patient be if management was required in primary care?

2. Potent corticosteroids, Vitamin D analogues (e.g. Daivonex) and Calcineurin inhibitors (e.g. Pimecrolimus) are management options for psoriasis.

  • How comfortable are you with the use of each of these medications?
  • Does anyone have any useful resources they give to patients in terms of explaining psoriasis or the appropriate use of these medications?
  • How has the patient experience been with these medications?
  • Has anyone had any difficult experiences with the use of any of these treatment options?
  • Are there any strategies to overcome these difficulties?

3. Those with psoriasis are at increased risk of developing metabolic syndrome, cardiovascular disease and depression.

  • How do you go about proactively managing the cardiovascular risk factors and screening for depression in patients with chronic psoriasis?
  • If you do not have any formal mechanisms in place, do you think they are necessary? Why/Why not?
  • Is this something that you discuss your patients as part of their education and management? If not, should it be?
  • How would you go about doing this?

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Date Published: 
Wednesday, March 1, 2017