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2017 HCHB_digital

Psoriasis Psoriasis is a

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. Significant learning opportunity: Wound care Your new Group 3 CPD project Page 128 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION psoriasis within the community pharmacy setting are limited. More effective therapies are available through a GP or specialist and phototherapy (ultraviolet light) can also be prescribed. General measures to help long-term management of psoraisis include: • sun exposure, but avoid overexposure and burning • baths containing bath oil or coal-tar solution which help to soften the psoriasis and lift the scale • bland soaps or soap substitutes to avoid further irritation. Products containing antiseptics are not necessary and may make the psoriasis worse • moisturising creams or emollients to keep the psoriasis soft and prevent it from cracking and becoming sore • occlusive dressings which may help small localised patches of psoriasis • rest, particularly bedrest for short periods, is beneficial for psoriasis. Advice for customers • Stress is one of the main triggers of psoriasis. »» Find ways to relax, such as yoga or meditation. »» Build a good support network. Contact a local psoriasis support group (see page 212 for contact details of support groups). • Follow a healthy diet and limit intake of alcohol, fried or processed foods. • Try not to scratch or pick psoriatic lesions (it may make them more resistant to treatment and trigger new lesions). • Keep skin cool and moisturised to help reduce itching and scratching. Apply emollients frequently and regularly for relief. • Warn patients to be careful when getting out of the bath or when using bath additives that may make the bath slippery. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications)? • Are the lesions extensive or severe? • Have the lesions occurred following recent infection? • Do the lesions cause moderate-to-severe itching? • Could the diagnosis be something other than psoriasis? • Is the person feeling depressed or anxious about their psoriasis? • Is this the first time the person has experienced psoriasis? • Are the lesions pustular or do they look red or infected? • Are the lesions within the nails? • Have products been tried before without success? • Is the person the first person in the extended family to develop psoriasis? • Does the person have any allergies to topical medicines? Visit ELearning to start your project Facilitated by Dr Alesha Smith Page 129

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