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Psoriasis is more than skin deep, says NICE

GPs should proactively assess the impact that psoriasis may be having on the daily lives of their patients, advises the National Institute for Health and Care Excellence (NICE) in new guidance out today (Wednesday 24 October).

Psoriasis is a skin condition characterised by red, flaky, crusty patches of skin covered with silvery scales. It is believed to affect up to 2.2% of the UK population (i.e. over 1.3 million people) with most cases seen in young people and adults under the age of 35. The disease can contribute to low self-esteem, anxiety, embarrassment and depression, much like other chronic conditions but this may be overlooked by healthcare professionals. For example, over a third of people who have psoriasis report clinically significant anxiety and depression. The condition can also affect a person's participation in social and physical activities, employment and education.

In its first clinical guideline on the assessment and management of the condition, NICE advises GPs and other healthcare professionals to assess the impact that psoriasis has on the physical, psychological and social wellbeing of their patients. They should do this when they first see their patients, before they refer them to specialists, and when they monitor how they are responding to treatments.

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. 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."

Also in its new clinical guideline, NICE advises that everyone with psoriasis should be assessed for psoriatic arthritis on an annual basis, particularly during the first ten years as this is when the condition is most likely to develop.

Around one in seven people who have psoriasis will develop psoriatic arthritis, a progressive condition, which can cause pain, stiffness and swelling in and around the joints. Early diagnosis is crucial and so annual assessments will allow those with actual or suspected psoriatic arthritis to be referred to specialists sooner.

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.

"The NICE guideline advises healthcare professionals to offer annual assessments for psoriatic arthritis to all of their patients who have psoriasis. They should use a validated tool in these assessments, such as the Psoriasis Epidemiological Screening Tool. This will facilitate more timely referrals to rheumatologists so that patients can receive the treatments they need."

Today's guideline is the first to be produced by NICE to help GPs and other healthcare professionals assess and treat their patients with this condition.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "Whilst there is no cure for psoriasis, treatments are effective and can include topical therapies, phototherapy and systemic medication, depending on the severity and extent of the disease.

"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."

Ends

Notes to Editors

About the clinical guideline

1. The clinical guideline on the assessment and management of psoriasis is available from 00.01 Wednesday 24 October 2012 at: www.nice.org.uk/CG153.

2. Case studies are available on request from the NICE press office.

3. For further information about psoriasis, please visit NHS Choices.

4. Over a third of people with psoriasis report clinically significant anxiety and depression. Finlay AY, Coles EC. The effect of severe psoriasis on the quality of life of 369 patients. Br J Dermatol 1995;132:236-44.

5. The Psoriasis Epidemiological Screening Tool (PEST) is a set of questions which healthcare professionals use to determine whether a person has psoriasis and what the severity of their condition is.

6. Psoriasis is a skin disease in which normal skin cells are produced faster than they are shed; this causes a build-up of cells seen as patches of raised, red, flaky, skin covered with silvery scales (known as plaques). The skin can also become inflamed (red and swollen). Psoriasis can occur on any area of the body, including the scalp, hands, feet and genitals, although different types tend to occur on different areas. The prevalence is estimated to be between 1.3% and 2.2% in the UK. It can occur in any age, although the majority of cases occur before 35 years of age. It is, however, uncommon in children.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS

3. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 23 October 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.