SKIN CONDITIONS HEADER


age. It is often triggered by a streptococcal throat infection. this form of psoriasis is self-limiting and typically resolves within three to four months of onset. It can occur as a first presentation of psoriasis or as an acute exacerbation of plaque psoriasis. although long-term prognosis is unknown, it is estimated about a third of people with guttate psoriasis develop chronic plaque disease.1,2


ErYthroDErmIc pSorIaSIS causing erythromderma (generalised redness of the skin), erythrodermic psoriasis is a rare but dangerous form of psoriasis requiring urgent medical treatment. this form of psoriasis spreads rapidly to typically encompass over 90 per cent of the skin's surface.


characteristically the skin is red and hot with the dermatological characteristics of psoriasis often lost. Scale is usually finer and flakier than the classic silvery scale of plaque psoriasis. the patient can quickly become systemically unwell as the condition interferes with thermoregulation. this can result in excessive protein and fluid loss, leading to dehydration, heart failure and severe illness. onset can occur acutely over a few days or weeks, or gradually evolve over several months from pre-existing psoriasis.1,2


pSorIatIc arthrItIS around ten to twenty per cent of people with chronic plaque psoriasis will develop psoriatic arthritis. any joint can be affected but it most commonly affects the joints of the fingers and toes. any patient presenting with these symptoms should be referred to their gp.1


trEatmEntS Emollients, in addition to their effects on dryness, itch, scaling and cracking, may have an anti-proliferative effect in psoriasis. though emollients may be the only treatment necessary for mild psoriasis, they are generally used as an adjunct to other topical treatments; allowing for other active treatments to be better absorbed and therefore work more effectively. Emollients should be used as a soap substitute when bathing or washing and should be applied to the skin before anti-psoriasis treatment and as often as required.4


Keratolytic agents, such as salicylic acid, are useful where there is significant scaling - though nIcE highlights that evidence is lacking in this area. topical salicylic acid


preparations must not be used by people who are allergic to aspirin and should not be used on inflamed or broken skin.4,5


coal tar has anti-inflammatory and anti-scaling properties that are useful in chronic plaque psoriasis. a tar- based shampoo is an effective otc treatment for mild scalp psoriasis. Initial treatment can be recommended with overnight application of salicylic acid, tar preparations, or oil preparations (eg, olive or coconut oil) for those patients with thick scaling of the scalp. coal tar shampoos should never be used alone for treating severe scalp psoriasis.4,5


Vitamin D analogues, including calcipotriol, act by encouraging normal skin cell growth due to their effects on cell division and differentiation.5 nIcE recommend vitamin D analogues as part of first line therapy for the topical treatment of chronic plaque psoriasis.5


topical corticosteroids are one of the first treatment options for treating localised psoriasis (ie, those whose psoriasis covers <5 per cent of their body or is currently in exacerbation). however, long term use can lead to skin atrophy and can cause psoriasis to become unstable.4,5


nIcE recommend short-term intermittent use of a potent topical corticosteroid (eg, betamethasone) or a combined potent topical corticosteroid plus a Vitamin D analogue to gain rapid improvement in plaque psoriasis. Short-term intermittent use of a potent topical corticosteroid applied once daily is recommended in scalp psoriasis.


If there is a poor initial response, a combined topical preparation containing a potent corticosteroid and a vitamin D analogue can be trialled for up to four weeks. moderate potency topical corticosteroids (eg, clobetasone) are recommended for short-term use in facial and flexural psoriasis for up to two weeks.5


If other topical therapies have failed, tacrolimus can be considered as it reduces inflammation through its action as a calcineurin inhibitor. alternatively, the retinoid tazarotene can be used to treat well defined plaques if other therapies have been ineffective.4,5


for those with treatment-resistant psoriasis of the trunks or limbs,


pharmacY In focUS - 39 nEW for SElf-SElEctIon: DoUblEbaSE EmollIEnt gEl


Dermal have launched Doublebase Emollient gel with the same formulation as the UK’s most widely prescribed emollient gel, to make it available for self-selection within the pharmacy shop.


Doublebase Emollient gel is a highly moisturising emollient that is simple to apply and easily absorbs when smoothed into the skin to effectively manage dry skin conditions such as eczema and psoriasis. the gEl formulation contains a high concentration of oils and glycerol to soften, moisturise and protect dry skin.


clinically proven to provide effective protection against dryness. Suitable for all age groups including babies.


Doublebase Emollient gel is available in a 100g tube (trade price £2.65, pIp code: 404-7973) and a 250g pump dispenser (trade price £4.44, pIp code: 404-7981).


Dithranol prevents t-lymphocyte activation and normalises skin cell differentiation. contact with normal skin must be avoided due to irritation and staining of skin and clothing.


therapy should be short contact (around 30 minutes). Dithranol should be discontinued if it causes acute inflammation - continued use can result in the psoriasis becoming unstable. patients should use gloves and wash hands thoroughly after using these preparations.4,5


for severe, resistant, unstable or complicated forms of psoriasis, ultraviolet light therapy and systemic treatments including methotrexate, ciclosporin and acitretin can be initiated under specialist supervision in secondary care.4


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rEfErEncES 1. psoriasis association UK. https://www.psoriasis- association.org.uk/ psoriasis-and-treatments/ [online] 2. patient UK. psoriasis. https://patient.info/health/psoriasis-leaflet [online] 3. british association of Dermatologists. psoriasis - an overview. http://www.bad.org.uk/shared/get- file.ashx?id=178&itemtype=document [online] 4. british national formulary Issue 73. 5. nIcE psoriasis: assessment and management cg153. https://www.nice.org.uk/ guidance/cg153 [online]


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