Explaining psoriasis

Question 1

What are the steps in explaining psoriasis to a patient?

Answer 1

1. Info sharing:
   - Brief history
   - Understanding
   - ICE
2. Explaining:
   - Normal anatomy
   - What the disease is
   - Cause
   - Problems/complications
   - Management

Question 2

How would you start off a consultation with a patient for an ‘Explaining psoriasis’ station?

Answer 2

• Wash hands, intro etc
• Ask patient what has brought them in today
• What symptoms do they have?
• Are there any risk factors to be identified? (lifestyle, family history, drugs etc)

Question 3

What questions might you ask patients to check their understanding of psoriasis?

Answer 3

• “What do you think is causing your symptoms?”
• “What do you know about psoriasis?”
• “What has been explained to you about psoriasis so far?”

Question 4

What would you say in regards to normal anatomy in relation to psoriasis?

Answer 4

• Normal skin is made up of many layers of skin cells
• The top layer gradually sheds
• New cells are constantly being made underneath to replace the top layer of cells
• This process normally takes 28 days
• In psoriasis, people make more skin cells than normal and make them faster than normal
• This is what causes the red, inflamed, itchy and raised plaques that you might have seen

Question 5

How would you explain the incidence of psoriasis?

Answer 5

• Affects 2-4% of the population, more commonly affecting Caucasian people
• Frequently affected areas are the scalp, elbows, knees

Question 6

How would you explain the cause of psoriasis?

Answer 6

• Development of psoriasis is very complicated and there are lots of factors that contribute
• The exact cause isn’t known, but it is thought to be due to a combinate of genetic, immune, and environmental factors
• There can be some factors that precipitate psoriasis such as infections, hormonal changes, and certain medications
• Things that make psoriasis worse include skin trauma, smoking, alcohol, and stress

Question 7

What complications should patients be made aware of in regards to psoriasis?

Answer 7

• Disease that comes and goes throughout life - persistent disease and symptoms
• Anxiety and depression
• Reduced quality of life
• Development of associated conditions such as psoriatic arthritis
• Rare complications such as pustular and erythrodermic psoriasis, which can be fatal

Question 8

How would you explain pustular and erythrodermic psoriasis to a patient?

Answer 8

A rare complication of psoriasis is the development of a severe flare, known as either pustular or erythrodermic psoriasis.
These flares are serious and require emergency medical treatment.
If you notice that you begin to develop multiple pus-filled blisters on your body quickly, or that you begin to develop painful and itchy rashes all over your body then please seek urgent medical advice.

Question 9

How would you explain management of psoriasis to a patient?

Answer 9

“The symptoms of psoriasis can be very unpleasant and disruptive to your life so it’s important that we work to try and get them under control.”

“The mainstay of treatment will be topical creams. You will have one type called an emollient. Emollients work by creating a film on the skin, which stops irritants from getting in and prevents water from escaping, and helps to moisturise the skin. This can also reduce the number of flare-ups and improve your general symptoms. There are lots of different types of emollients such as creams, ointments, and gels, so we can pick ones that are most effective and work best for you. This can sometimes be a case of trial and error at the beginning. I can give you some samples of the different types of emollients, and ask a specialist nurse to speak to you about them today if you would like?”

“You will also have another type of topical treatment to use alongside the emollient to help manage your symptoms. This will generally either be a retinoid, steroid cream, or a coal tar preparation. We tend to try topical steroids first as they are very effective but can change to an alternative if they don’t help. Potent and very potent steroids should not be used on the face as they can cause thinning of the skin and other side effects. You should always wash your hands after applying steroid creams.”

“In most people, the treatments we have discussed will control your psoriasis extremely well. However, we do have other options for treatment if these are not successful and we can discuss those if it becomes appropriate.”

Question 10

What factors might aggravate psoriasis?

Answer 10

• Stress
• Smoking
• Obesity/being overweight
• Alcohol
• Infections
• Medication (propranolol, anti-malarials, lithium, ibuprofen, ACE-Is, and some abx)
• Trauma
• Hormonal changes (worst during puberty and menopause)
• Sunlight (sunlight itself can improve psoriasis, but sunburn can lead to flare ups)