Psoriasis is a chronic, immune-mediated inflammatory skin disease
affecting 1.3–2.2% of the UK population.1 Most commonly, psoriasis is
characterised by well-demarcated, red plaques with adherent scale with a
predilection for the scalp and extensor surfaces of the limbs. However, the
effects of psoriasis go far beyond a patient’s skin and may result in a degree of
disability and impaired quality of life similar to that of other major medical
conditions, such as cancer and heart disease. First-line therapies for most
patients are topical treatments such as topical corticosteroids and vitamin D
analogues. For those with more severe or treatment-resistant disease, secondor
third-line therapies include phototherapy, systemic therapies such as
methotrexate and more recently biologic therapies such as tumour necrosis
factor (TNF) inhibitors. These therapeutic modalities are proven to be highly
effective; however, the potential for long-term toxicity needs to be considered.
Aside from the visible skin disease, psoriasis is also increasingly recognised to
have important systemic manifestations. Psoriatic arthritis has long been
established as an associated condition and, more recently, it has emerged that
psoriasis is also associated with an increased risk of inflammatory bowel disease,
cardiovascular disease and the metabolic syndrome. Both National Institute for
Health and Care Excellence (NICE)2 and Scottish Intercollegiate Guidelines
Network (SIGN)3 have recently published guidelines for the assessment and
management of psoriasis which highlight the need for regular assessment in order
to detect the development of arthritis and the presence of other co-morbidities
such as obesity, diabetes, dyslipidaemia and hypertension.
