2017 HCHB_digital

Psoriasis
Psoriasis is a long-term skin condition that can occur on any part of the body. It
affects 2%–4% of New Zealanders and is more common in those with European
ancestry. Psoriasis can occur at any age, but more commonly begins in the late
teens or around the age of 50. Psoriasis affects males and females equally,
although in children it more commonly affects girls.
About 25% of people find their psoriasis is itchy and others may have a
burning feeling on the skin. The appearance of psoriasis depends on what part of
the body is affected. On the back, trunk, arms and legs there may be red patches,
often covered with thick silvery-white scales (“plaque” psoriasis), or there may
be small red spots scattered across the skin (“guttate” psoriasis).
On the scalp it can look like severe dandruff and there can be hair loss.
Psoriasis can affect nails, distorting their shape and making them pitted and
yellow. On the palms of the hands and the soles of the feet, psoriasis can look
like pustules – blisters surrounded by red skin. Psoriasis can also occur in the skin
folds, such as in the groin area, under the breasts or in the armpits. Here, it often
appears as smooth, shiny red patches.
Approximately 5% of people with psoriasis will also have psoriatic arthritis,
which causes pain, stiffness and swelling of the joints and can be very debilitating.
Psoriasis tends to come and go over time, and 80% of people have a mild
form of the disease. Rarely, hospitalisation is necessary if the disease is severe.
Psoriasis may be confused with seborrhoeic dermatitis and other types
of dermatitis (see Dermatitis/Eczema), candida and dermatophyte fungal
infections (see Fungal Infections: Superficial), as well as other skin conditions
Triggers of psoriasis
The cause of psoriasis is not fully understood but it may result from either an
TREATMENT OPTIONS
Category Examples Comments
abnormal activation of cell death pathways (apoptosis) or an overactive immune
system that causes inflammation, proliferation of extra blood vessels and
increased skin cell turnover. Up to 50% of people with psoriasis will know of
another affected family member. Certain triggers seem to precipitate psoriasis or
make it worse and include:
• alcohol
• certain medicines (eg, beta-blockers, lithium, withdrawal from oral or topical
corticosteroids)
• hormonal changes (commonly occurs post-puberty)
• infections (eg, streptococcal throat infections, candida, Malassezia yeasts)
• injury to the skin, including sunburn
• obesity (severity of psoriasis correlates with insulin resistance)
• smoking
• stress, both physical and psychological.
Initial assessment
Psoriasis can significantly impact a person's quality of life so take a supportive
approach and help your customer find non-irritating moisturisers, shampoos and
body washes; offer samples if you can. Refer any customers requiring treatment
for flare-ups of psoriasis to a pharmacist.
Treatment
There is no cure for psoriasis and it can be difficult to treat, although satisfactory
control of the psoriasis can be achieved for most people. Some customers may
have to try several different products before finding one that works for them.
Topical treatment options are available for mild-to-moderate plaque and scalp
Moisturisers [GENERAL SALE]
eg, Dermasoft, Epaderm, Lipobase, Lucas Papaw
ointment, NeoStrata Ultra Moisturising Cream,
QV Skin Lotion*
Products containing
coal tar
Combination coal tar products
[GENERAL SALE]
eg, Pinetarsol*, Egoderm, Egopsoryl TA Gel,
eg, shampoos (Neutrogena T Gel, Sebitar, Scytera
Coal Tar Foam, Polytar)
[GENERAL SALE]
eg, Coco-Scalp*
Topical corticosteroids [PHARMACY ONLY MEDICINE 0.5%]
[PHARMACIST ONLY MEDICINE 1.0%]
eg, hydrocortisone (Dermaid, Skincalm)
Frequently used to help soften and soothe skin, reducing cracking and dryness.
Useful for mild psoriasis. It is best to patch-test products to ensure no skin sensitivity
reactions occur.
Coal tar and coal tar-related products (eg, pine tar, oil of cade or ichthammol) are old but
effective treatments, although it is not known how they work. Tar is most useful for scalp
psoriasis and chronic plaque psoriasis. Can be messy and some people may dislike the smell.
Contains coal tar, sulphur and salicylic acid in a coconut-oil base. It effectively removes
skin scales on the scalp. Apply to the scalp for an hour, then wash off, usually with a tarcontaining
shampoo.
Restrict use to small areas to reduce risk of absorption.
Use for longer than seven days only on medical advice.
May be used in combination with an antifungal agent to combat candida.
Natural / herbal products /
supplements
Aloe, honey, Milk thistle, Vitamin D,
eg, Hopes Relief, Plasmalg Gel, Skybright
Chickweed cream
Some natural extracts may help decrease symptom severity. Topical vitamin D is effective at
treating plaque psoriasis in some patients.
Products with an asterisk have a detailed listing in the Psoriasis section of OTC Products, on page 256.
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Page 128 HEALTHCARE HANDBOOK 2017-2018 Common Disorders