Patient Education for Psoriasis
Psoriasis is a chronic skin condition that cannot be cured but can be effectively controlled with treatment, and patients need to understand that treatment aims to induce remission or make the disease tolerable, not eliminate it permanently 1.
What Patients Need to Know About Their Disease
The Nature of Psoriasis
- Psoriasis is a lifelong condition - it comes and goes unpredictably, and relapses cannot be prevented with current treatments 1
- The disease can change over time - patients may experience different types of psoriasis throughout their lifetime, ranging from small patches to extensive body coverage 1
- Diagnosis is made by looking at the skin - blood tests and biopsies are rarely needed 1
Triggers to Avoid
Patients must understand that certain factors can worsen their psoriasis 1:
- Alcohol - can trigger or worsen disease
- Certain medications that may cause severe flare-ups:
- Lithium, chloroquine, and mepacrine (can cause life-threatening deterioration)
- Beta-blockers and NSAIDs (in some patients)
Treatment Expectations
Starting Simple
Most patients with stable plaque psoriasis can be managed with topical treatments alone 1. Patients should know:
- Treatment options include doing nothing - if the disease doesn't bother them, simple moisturizers may be sufficient 1
- Topical treatments take weeks to months to work - patients must use them consistently before seeing improvement 2
- If one topical treatment doesn't work, another might - switching between coal tar, dithranol, or corticosteroids is worth trying before escalating therapy 1
Topical Treatment Practicalities
Coal tar preparations:
- Extremely safe for long-term use 1
- Cruder preparations are messier but more effective than refined products
- Start with 0.5-1% concentration and increase to maximum 10% 1
Dithranol (anthralin):
- Will stain skin and clothing - patients must be warned upfront 1
- Can cause irritation - start at low concentrations (0.1-0.25%) and increase gradually 1
- Requires careful application, especially on face, skin folds, and genitals 1
Corticosteroid creams (if prescribed):
- Require regular monitoring - no unsupervised refills 1
- Should not exceed 100g of moderately potent preparation monthly
- Need periodic breaks with alternative treatments 1
When to See a Specialist
Patients should be referred to a dermatologist if 1:
- Topical treatments fail after adequate trial
- Disease is severe or rapidly worsening
- Systemic medications are being considered (these carry significant risks and require specialist supervision)
Adjunctive Care
Basic Skin Care
Emollients and moisturizers should be used regardless of disease severity 3:
- Help restore skin barrier function
- Increase time between flare-ups
- Enhance effects of other treatments
- Often underused by patients despite proven benefits 3
Quality of Life Considerations
Treatment decisions should balance two factors 1:
- The patient's own perception of disability and need for treatment
- Objective assessment of body surface involvement
Critical principle: The treatment should never be more unpleasant, intolerable, or dangerous than the disease itself 4.
Common Pitfalls to Avoid
- Expecting immediate results - topical treatments require consistent use for weeks before improvement is visible 2
- Stopping treatment too soon - premature discontinuation prevents adequate assessment of efficacy
- Using potent corticosteroids without supervision - can lead to skin thinning and other complications 1
- Not moisturizing regularly - basic skin care is essential even when disease appears controlled 3
Special Populations
Women of childbearing age must understand: