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Assess impact of psoriasis on daily lives, says NICE

Management of psoriasis should encompass physical, psychological and social wellbeing, says the first clinical guideline on the condition issued by the National Institute for Health and Clinical Excellence (24 October 2012).

Over a third of people with psoriasis experience anxiety and depression and the guideline recommends assessing psoriasis patients for depression at their initial consultation and during escalation of treatment.

Topical therapy should be offered as first-line treatment for psoriasis patients. However second- and third-line therapy (phototherapy or systemic treatment) should be offered immediately to those whose disease is unlikely to be controlled significantly with topical treatment alone. This can include patients whose psoriasis covers more than 10 per cent of their body or those with significant nail disease.

Approximately one in seven psoriasis patients develop psoriatic arthritis and the guideline recommends that assessment for the condition should be carried out at the initial consultation and annually thereafter since "early diagnosis is crucial".

Natasha Smeaton, a GP who helped develop the NICE guideline, said "early diagnosis [of psoriatic arthritis] is important because the condition is aggressive and associated with progressive joint damage. There are effective treatments available and so patients should receive these as soon as possible".

She went on to say that clinicians assessing the condition "should use a validated tool in these assessments, such as the Psoriasis Epidemiological Screening Tool. This will facilitate more timely referrals to rheumatologists so that patients can receive the treatments they need".

Citation: The Pharmaceutical Journal URI: 11110213

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