Diagnosing and managing psoriasis in primary care

Psoriasis is a common skin condition occurring worldwide and is often a long-term chronic condition. The problem often follows a relapsing and remitting course with intermittent flare ups when the problem becomes troublesome again after a period of absence of symptoms. It is categorized as a non-communicable disease which is painful, disfiguring and disabling, and for which there is no cure (World Health Organisation (WHO) 2016). There are several different forms of psoriasis, which can make diagnosis difficult. This article therefore will give a brief overview of the condition, its signs and symptoms, treatment, and prognosis, and hopes to give nurses and non-medical prescribers more confidence in recognising and treating this disease.

There are several types of psoriasis, some more common than others. Chronic plaque psoriasis is the commonest type accounting for more than 80% of cases (Yoo, 2023) and can occur as large plaque, small plaque or guttate psoriasis. Although this can occur anywhere on the body, the most frequently affected sites are the extensor surfaces, such as the knees, elbows, and the lower back. Pustular psoriasis (sometimes called palmoplantar pustulosis), can be localised or more generalised is the second most common type and usually affects the palms of the hands and the soles of the feet (McKechnie, 2023). Psoriasis affecting the fingernails can also be problematic and can occur alone or alongside psoriasis at other sites. In rare cases of severe disease psoriasis causes a widespread erythematous rash (commonly affecting the scalp) which is life threatening due to potential complications.