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PSORIASIS


a trigger event. These trigger events can include:


• An injury to the skin – such as a scrape, cut or insect bite (known as the Koebner response)


• Excessive intake of alcohol • Smoking • Stress


• Hormonal changes, particularly in women during puberty and menopause stages


• After taking certain medicines, for example:


• Lithium • Anti-malarial medicines


• Anti-inflammatory medicines including ibuprofen


• ACE inhibitors • Beta blocker medicines


• Throat infection, particularly streptococcal infections provocation of guttate psoriasis


• Other immune disorders – such as HIV.


TREATMENT OPTIONS FOR PSORIASIS Currently there is no cure for psoriasis, however avoidance of trigger sources and early treatment of flare-ups can,


ELAVE DERMATOLOGICAL RANGE


Ovelle Pharmaceuticals, Ireland are pleased to announce the launch of the Elave Dermatological Range in the UK. Elave Intensive Cream 50g & 125g tubes and 500g pump dispensers are medical devices and will be reimbursable in the Drug Tariff from July 2015. The rest of the range; Elave Shampoo, Body Wash, Body lotion and Body oil are reimbursable now on GP10A. Elave will initially be available to pharmacy from Pharmaceutical wholesalers AAH Pharmaceuticals and Phoenix Medical. www.elave.co.uk


in many cases, maintain “near- normal” skin conditions. There are many alternative therapies for patients with psoriasis, however this article will focus on the medicinal treatments currently available. The mainstay of treatment involves topical therapies, creams and ointments applied to the skin. Topical corticosteroids are most commonly used to treat mild to moderate psoriasis. The reduction in inflammation slows the productions of skin cells and can reduce the itching sensation. Calciptriol, calcitriol, and tacalcitol – vitamin D analogues, can be effective when used at the recommended doses on the limbs, trunk or scalp. Calcineurin inhibitors, such as tacrolimus and pimecrolimus, reduce the activity of the immune system and are more commonly used on sensitive areas such as scalp, genitals and creases of the skin. Coal tar is one of the oldest treatments for psoriasis, however many patients find the distinctive smell and staining nature unacceptable side effects of this topical preparation. Dithranol is another old remedy to treat psoriasis as it can act to slow the production of skin cells, although in too high concentrations can burn the surface of the skin.


Photodynamic therapy is a further


option for the treatment of psoriasis, however such therapies are usually conducted under the supervision of specialists in that field. Light of a specific wavelength is used in isolation, or in combination with another topical treatment such as coal tar, to slow the production of skin cells and help reduce the symptoms of psoriasis.


In cases of more moderate to severe disease it is often necessary to treat systemically with an immunosuppressive medicine, such as methotrexate or ciclosporin. These medicines have a number of negative side effects and as such require careful monitoring throughout the treatment course.


Biologic medicines have become more widespread, however are reserved for unresponsive, severe cases of psoriasis. Biologic medicines target specific cells within the immune system in order to reduce the overall symptoms of psoriasis. This class of medicines are significantly more expensive than traditional small molecule medicines and are associated with fewer side effects, however patients are more likely to display moderate or severe allergic responses. Etanercept, Infliximab, Adalimumab,


and Ustekinumab are some of the more commonly used biologic monoclonal antibody medicines, and are each administered parenterally. 8 If the treatments do not show a significant improvement within 12-16 weeks, these medicines are usually withdrawn. As improvement in monoclonal antibody humanisation capabilities develop within the Biotech-Pharma sector, biologic medicines will become less prone to triggering allergic responses, and already


fragment monoclonal


antibody medicines are coming to market. This will hopefully signify new treatment options for those who suffer from more severe psoriasis.


WHAT CAN COMMUNITY PHARMACY DO? Working with patients, to manage both their medicines and medical conditions, is integral to the daily running of a successful Pharmacy business. Pharmacy staff are therefore required to expand their knowledge base so that patients can receive the highest possible standard of care. Focusing on medicines, community pharmacy can provide information for patients, who can then make informed choices about their treatments, and ultimately, how it should be managed. •


REFERENCES:


1. Office for National Statistics - Population estimates for UK, England and Wales, Scotland and Northern Ireland, Mid 2013. Accessed on 07/05/2015. Available at: http://www. ons.gov.uk/ons/rel/pop-estimate/ population-estimates-for-uk--england- and-wales--scotland-and-northern- ireland/2013/index.html


2. Psoriasis Association Webpage – types of Psoriasis. Accessed on 01/05/2015. Available at: https://www.psoriasis- association.org.uk/pages/view/about- psoriasis/types-of-psoriasis/plaque


3. British Skin Foundation, Psoriasis. Accessed on 01/05/15. Available at: http://www.britishskinfoundation.org. uk/SkinInformation/AtoZofSkindisease/ Psoriasis.aspx


4. Notter RH (2000) Lung Surfactants: Basic Science and Clinical Applications. Marcel Dekker: New York p 120


5. Goldsmith LA (1990) My organ is bigger than your organ. Arch Dermatol 126:301–302


6. Journal of Investigative Dermatology (2014) 134, 581–582; doi:10.1038/ jid.2013.335; published online 12 September 2013


7. National Health Service UK Choices website, causes of Psoriasis. Accessed 02/05/2015. Available at: http://www. nhs.uk/Conditions/Psoriasis/Pages/ Causes.aspx


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