Psoriasis is 'more than just a skin condition'

Healthcare professionals should be aware that psoriasis can affect a person’s psychological and social wellbeing, and not just their physical health, says NICE.

Psoriasis is a long-term condition that is characterised by red, flaky, patches of skin covered with silvery scales, affecting around 1.8 million people in the UK.

While psoriasis can begin at any stage in life, most cases start before the age of 35, and peak between the ages of 50 and 60.

The condition can deeply affect a person’s psychological and social wellbeing, partly because it is highly visible, and so can be stigmatising. In cases it can also impact on a person’s employability and income.

To mark World Psoriasis Day, NICE is highlighting the range of guidance and support tools that are available to help healthcare professionals with the diagnosis and treatment of the condition.

In 2012, NICE published its first clinical guideline on psoriasis. The guidance recommends that assessment for people with any type of psoriasis should include the impact of the disease on physical, psychological and social wellbeing.

Questions that should be asked include what aspects of daily living are affected by a person’s psoriasis, how the person is coping with their condition, and if they need any further advice or support.

Psoriasis is also associated with the increased risk of a range of conditions such as cardiovascular disease, lymphoma and non-melanoma skin cancer.

Given this, NICE recommends that initial assessments should additionally cover disease severity, and whether they have any comorbidities.

Another condition associated with psoriasis is psoriatic arthritis, which develops in around 30 per cent of people with psoriasis.

This is a progressive condition that can cause pain, stiffness and swelling in and around the joints. Early diagnosis and treatment of the condition is key in helping to prevent progression of this disease.

To tackle this, NICE recommends that people with any type of psoriasis should be offered an annual assessment for psoriatic arthritis.

NICE says that assessment is especially important within the first 10 years of onset. Furthermore, a validated tool should be used for adults in primary care and specialist settings, such as the Psoriasis Epidemiological Screening Tool.

NICE also lists a range of criteria for when people with psoriasis should be referred for specialist advice.

These include when there is any diagnostic uncertainty, if any type of psoriasis is sever or extensive, or any type of psoriasis that cannot be controlled with topical therapy.

Richard Warren, Consultant Dermatologist at Salford Royal Foundation Hospital, and a member of the guideline development group, said: “On World Psoriasis Day, it’s important that we remember that psoriasis can impact deeply on a person’s psychological and social wellbeing.

“The NICE guideline on psoriasis aims to ensure that more people are assessed for the psychological and social impact of the condition. Early identification of these factors will mean people with psoriasis get access to timely and appropriate treatments.”

He added: “Psoriatic arthritis can affect a significant number of people with psoriasis. So it’s important that this condition is recognised and diagnosed early to halt its progression.

“Annual assessments for psoriatic arthritis, as recommended by NICE, will help people access the range of effective treatments that there are for this condition.”

NICE has also published a quality standard on psoriasis, aimed mainly at GPs, which includes six statements to encourage high quality care. The statements cover the full pathway of care from assessment to monitoring systemic therapy.

View the NICE pathway on psoriasis to see all of NICE’s guidance and support tools on the topic at a glance.

On World Psoriasis Day, it’s important that we remember that psoriasis can impact deeply on a person’s psychological and social wellbeing.

Richard Warren, Consultant Dermatologist at Salford Royal Foundation Hospital