Impact of psoriasis more than skin deep
GPs and other healthcare professionals should routinely check the psychological and physical impact of psoriasis on people's lives when assessing the condition, according to latest guidance from NICE.
Psoriasis is a condition characterised by red, flaky, crusty patches of skin covered with silvery scales.
It is thought up to 2.2 per cent of the population in UK - around 1.3 million people - are affected by psoriasis. The majority of those with the condition are young people and adults under the age of 35.
NICE's first recommendations on psoriasis say the condition can have an impact on a person's psychological and social wellbeing. The condition can also have an effect on a person's employment and income.
Furthermore, NICE says people with psoriasis, and particularly those with severe forms of the disease, may also be at risk of comorbid conditions.
These conditions include cardiovascular disease, and diabetes, a disease which people with psoriasis are at 30 per cent increased risk of developing, according to research.
NICE recommends that GPs and other healthcare professionals should assess the severity and impact the condition has on a person at first presentation, and before referral for specialist advice.
This assessment should cover the impact the disease has on the physical, psychological and social wellbeing of those with the condition.
The severity of disease should also be assessed, as should the presence of comorbid conditions.
Risk factors for cardiovascular comorbidities should be discussed with people who have any type of psoriasis, and with their families or carers where appropriate.
Effective treatments recommended for the condition include topical therapies, phototherapy and systemic medication, depending on the severity and extent of the disease.
Dr Catherine Smith, a consultant dermatologist who chaired the development of the NICE guideline, said: “Psoriasis is much more than a skin irritation. The condition can have profound functional, psychological and social effects on a person's life.
“It is vital that GPs and other healthcare professionals recognise these possible consequences when they first see their patients, and that they routinely assess the impact that the disease is having on their daily lives.
She added: “Early and proactive identification will allow patients to receive the support and effective treatment they need in a timely manner.”
“Importantly, accurate assessment of people with psoriasis will ensure they can access the right treatment as early as possible whether in primary or specialist care.”
Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “Clinical practice for the treatment of psoriasis is variable across the NHS.
“This guideline provides clear advice for the NHS on the assessment and management of psoriasis in order to improve comfort and minimise the effects of living with the condition.”
The guideline also contains recommendations on psoriatic arthritis, a progressive condition that affects one in seven people with arthritis.
GPs and other healthcare professionals should assess whether a person has psoriatic arthritis at first presentation.
Annual assessments for psoriatic arthritis should be offered to people with any type of psoriasis. Assessment is especially important within the first 10 years of onset of psoriasis.
As soon as psoriatic arthritis is suspected, the person should be referred to a rheumatologist for assessment and advice about planning their care.
Dr Natasha Smeaton, a GP who helped develop the NICE guideline, said: "Psoriatic arthritis is rarely seen by GPs and so there may be confusion regarding how it should be diagnosed when compared to other joint problems, such as 'wear-and-tear' arthritis and gout."
"Early diagnosis is important because the condition is aggressive and associated with progressive joint damage. There are effective treatments available and so patients should receive these as soon as possible."
24 October 2012