10 November, 2020
Speak Up About Your Psoriasis
Know your options
Time with your dermatologist can be limited. Thinking about what feeling free from psoriasis would mean to you, understanding your disease severity and knowing the different classes of psoriasis treatments will enable you to get the most out of your consultation.
1 — LEARN
Discovering what's new
Psoriasis is by nature a chronic, and currently incurable disease with an unpredictable course of symptoms and triggers.1 Lifelong management is often required to control the inflammation related to the disease and to help avoid or delay the progression of the severity and/or developing additional conditions.1,2
Your dermatologist will select the right treatment approach that is most suitable for you, ensuring that it is not only efficacious (it works), but also safe over long periods.1
The understanding of psoriasis and its treatment has increased significantly over the years. Treatments are constantly evolving, bringing exciting possibilities and even the potential prospect of achieving clear/almost-clear skin. To reflect these scientific advancements, guidelines now recognise that clear/almost-clear skin may be a realistic target goal for those with psoriasis.3–6
What a psoriasis-free feeling could mean to you
Your dermatologist will consider different factors when setting up your management plan. Make sure you share your personal goals so they have all the information needed to make a decision.
One way to help determine your goals, related to psoriasis, is to think what you would do differently if you did not have psoriasis. You can think about it from a physical, mental or social perspective.
Feeling free from psoriasis could mean different things to different people, for example:
- reduce the constant itching, pain and discomfort, to sleep well at night.
- the ability to concentrate at work or restore intimacy with a partner.
- feel less frustrated to improve relationships with friends and family.
- reduce worry about everyday activities such as going to the hairdressers.
- wear the types and colours of clothes (e.g. summer clothes or swimwear) without second-guessing.
Share your goals with your dermatologist. It is normal if they change over time. Keep asking about the latest advances that may help you achieve your goals; the science in psoriasis is continually changing.
How severe is my psoriasis?
The level of severity of your psoriasis can be measured in different ways and each method is slightly different and considers different factors. Some scoring systems look at the physical impact (PASI, BSA) while others look at the impact on your quality of life (DLQI).
Knowing the severity of your psoriasis is important to help determine what management options should be considered.
If you don’t know how severe your psoriasis is, talk to your dermatologist.
Click on each scoring system to learn more:
PASI (Psoriasis Area Severity Index)7
PASI is now the standard in many medical guidelines. It measures the severity and extent of psoriasis. The severity of your psoriasis is categorized as “none” (0), “mild” (1), “moderate” (2), “severe” (3) or “very severe” (4).
Your dermatologist will take different points into consideration to calculate the severity:
- Location: the percentage area affected by psoriasis is evaluated in the four regions of the body (head and neck, upper limbs, trunk, lower limbs)
- Intensity of redness, thickness and scaling
BSA (Body Surface Area)8
BSA measures the amount of body surface area affected and the severity. It is still widely used in clinical practice. Using the surface of the hand to equal 1% BSA, psoriasis is considered:
- Mild when less than 3% of the body is affected
- Moderate when 3%-10% of the body is affected
- Severe when more than 10% of the body is affected
DLQI (Dermatology Life Quality Index)9
The aim of this questionnaire is to measure how much your skin problem has affected your life and daily activities over the last week. It consists of 10 questions concerning symptoms and feelings, daily activities, leisure, work, and school, personal relationships and treatment.
The final score will determine how psoriasis affects your life based on five outcomes ranging from “no effect at all on patient's life” to “extremely large effect on patient's life.”
Examine what my options are
There are many treatments or combinations of treatments your doctor can recommend to aid you in managing the situation and help your skin look and feel better. Then give the treatment time to work before evaluating if it is helpful. Bear in mind, though, that not all treatments work for everyone. If you’re not seeing results, talk to your doctor about it – so that you can find the treatment that’s right for you. Treatments that work well at first may lose their effectiveness over time. You may have to try a few of these treatments before you are eligible for other ones.10
Managing your goals will depend on the severity of your psoriasis, and even if you have a similar degree of severity to someone else, you may need a different treatment to them – one that suits you and your psoriasis.
You and your doctor will discuss what plan of care may be best for you based on the severity of your psoriasis, medical history and your lifestyle.
- Mild Psoriasis
- Moderate to Severe Psoriasis
Topicals11
Treatments applied directly to the plaques on the skin are called topicals and can come as creams, ointments, gels, shampoos, or lotions.
The different types of topical treatments are:
- vitamin D analogues
- coal tar preparations
- topical steroids
- dithranol
- vitamin A analogues
Corticosteroid treatments work to reduce inflammation. Topical vitamin D creams contain vitamin D3 and affect the growth of skin cells.
Some topical treatments are available without a prescription, but most need a doctor’s prescription. This is generally the first step in the treatment pathway.
Light therapy
Using controlled narrow-band ultraviolet B (UVB) rays, or ultraviolet A (UVA) rays in conjunction with a drug called psoralen (PUVA). The rays slow the growth of skin cells in the psoriasis patches. In the long-term, there is a small increased risk of skin cancer with light therapy. This risk is small with short courses of treatment, but may become more significant with longer, or multiple courses.13
Your psoriasis may not respond or may stop responding to topical treatments and/or light therapy, in which case, systemic medications may be prescribed.10
Systemics
Available in the form of an oral or injected medication, systemic medications work from inside the body, rather than outside, and are prescribed by a doctor.14
Biologics
One newer type of systemic treatment are the biologics. Rather than being chemically synthesised, they are protein based and produced by living cells. They also differ from some systemic treatments in that they target specific parts of the immune system. Biologics are given by injection or infusion. You will have to have tried other treatments including other systemic treatments before you may be eligible for PBS reimbursed biologic treatment.10,14,15
Know your options
If you are seeing a new doctor it’s always a good idea to discuss your current medicines, including any over-the-counter products, to avoid drug reactions. Also, talking with your doctor about the medicines you are taking can help ensure your treatment regimen is on course.
As you look at treatment options, one consideration you’ll likely have is cost. The good news: many treatment options are covered by the Government’s Pharmaceutical Benefits Scheme (PBS). Some medications have specific criteria to be eligible for the subsidised price, so check with your doctor or pharmacist if you are unsure whether your treatment is covered.
Discussion guide
Download our interactive discussion guide to help you plan questions for your next appointment.
Speak Clearly: Perspectives on Psoriasis
View articles
References
- WHO, 2016. Global report on psoriasis.
- Mrowietz. 2012, JEADV,26(s2):12-20.
- Amatore et al. 2019, JEADV,33(3):464-483.
- Gisondi et al. 2017. JEADV,31(5):774-790
- Dauden et al. 2016. JEADV,30 suppl.2:1-18.
- Smith et al. 2017. British Journal of Dermatology,177:628–636
- Papaa. 2008. Available at: http://www.papaa.org/articles/psoriasis-area-severity-index Accessed July 2019.
- Psoriasis speaks. Available at: https://www.psoriasis.com/psoriasis-severity Accessed June 2020.
- NICE. 2012. Psoriasis: assessment and management. Clinical guideline [CG153] Available at: https://www.nice.org.uk/guidance/cg153/chapter/1-Guidance#principles-of-care. Accessed June 2020.
- Australian Government, Services Australia. Severe chronic plaque psoriasis continuing PBS authority application form (PB113). Available at https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/pb113. Accessed June 2020.
- British Association of Dermatology. Topical treatments for psoriasis. Available at http://www.bad.org.uk/shared/get-file.ashx?id=123&itemtype=document. Accessed June 2020.
- British Academy of Dermatologists. Treatments for moderate or severe psoriasis. Available at http://www.bad.org.uk/shared/get-file.ashx?id=124&itemtype=document. Accessed June 2020.
- Australasian College of Dermatologists. A to Z of skin, phototherapy. Available at https://www.dermcoll.edu.au/atoz/phototherapy/. Accessed June 2020.
- Baker C et al. Australas J Dermatol 2013;54(2):148–54.
- National Psoriasis Foundation. Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs. Available at https://www.psoriasis.org/about-psoriasis/treatments/biologics. Accessed June 2020.
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