Psoriasis Management
Psoriasis Management provides specialist dermatological care using topical therapies, phototherapy, and advanced biologic treatments to achieve clear or almost clear skin, reduce joint involvement, and significantly improve quality of life in patients with psoriasis.
Overview
Modern psoriasis management aims for PASI 90 or PASI 100 as the treatment target -- a paradigm shift enabled by highly effective IL-17, IL-23, and IL-12/23 biologics achieving clear skin in 60 to 80% of patients. Treatment follows a stepwise approach: topical therapies for mild disease, phototherapy for moderate disease, and systemic or biologic therapies for severe or refractory disease.
Types of Psoriasis
- Plaque Psoriasis (most common -- well-defined scaly plaques)
- Guttate Psoriasis (raindrop lesions -- often triggered by streptococcal infection)
- Pustular Psoriasis (sterile pustules -- generalised or palmoplantar)
- Erythrodermic Psoriasis (widespread erythema -- medical emergency)
- Inverse Psoriasis (smooth red plaques in skin folds)
- Nail Psoriasis (pitting, onycholysis, subungual hyperkeratosis)
- Psoriatic Arthritis (affects 30% of psoriasis patients)
- Scalp Psoriasis (thick silvery scale on the scalp)
Treatment Severity and Options
- Mild (PASI below 10 -- topical corticosteroids, vitamin D analogues, retinoids)
- Moderate (PASI 10 to 20 -- NB-UVB phototherapy or systemic therapy)
- Severe (PASI above 20 -- methotrexate, ciclosporin, or biologic therapy)
- Biologic Options (adalimumab, secukinumab, ixekizumab, guselkumab, risankizumab)
- PASI 90 at 16 weeks is the minimum acceptable biologic response target
- DLQI greater than 10 triggers systemic treatment consideration
- Pre-biologic screening for TB, hepatitis B/C, and HIV
- Concurrent psoriatic arthritis requires rheumatology co-management
Psoriasis Symptoms Requiring Specialist Assessment
- Psoriasis covering more than 10% of body surface area
- Severe scalp, facial, nail, or genital psoriasis affecting quality of life
- Failure to achieve adequate control with topical treatments
- Joint pain or stiffness associated with psoriasis
- Erythrodermic or generalised pustular psoriasis requiring urgent assessment
- Severe psychological distress or social withdrawal from psoriasis
- Psoriasis affecting employment or daily activities
- Consideration for biologic therapy requiring specialist initiation
Key Benefits
Discover the advantages of choosing our psoriasis management services.
IL-17 and IL-23 inhibitor biologics achieve PASI 90 in 60 to 75% of patients at 16 weeks
Early biologic therapy prevents the systemic inflammation of long-term untreated severe psoriasis
Quality of life improvement on successful biologic therapy is among the most dramatic in dermatology
Correct topical technique can transform inadequate topical response without medication change
Phototherapy avoids systemic treatment and its associated side effects for moderate psoriasis
Clinical Features
The technology, techniques and clinical approach behind our psoriasis management.
PASI and DLQI calculated at every appointment -- both required for biologic eligibility assessment
Topical therapy technique assessed and corrected at every appointment
NB-UVB phototherapy minimal erythema dose-guided dosing maximises efficacy
Biologic response assessed at 16 weeks -- non-responders switched to different mechanism
Psoriatic arthritis screening at every appointment
Preparation Instructions
Apply topical treatments consistently -- intermittent use leads to tachyphylaxis and poor control. Attend all phototherapy sessions as cumulative UV dose determines efficacy. Take systemic medications as directed and attend all blood monitoring. Contact your dermatologist for any sudden widespread flare, skin infection, or worsening joint symptoms. Attend psychological support if offered -- psoriasis significantly impacts mental health.
The Procedure
Step-by-step guide to what you can expect during your psoriasis management procedure.
PASI Score and DLQI Assessment
The Psoriasis Area and Severity Index (PASI) calculates disease extent and severity for each body region. The Dermatology Life Quality Index (DLQI) quantifies quality of life impact. Both scores at every appointment drive treatment escalation decisions.
Topical Therapy Review and Technique
Topical treatment technique is assessed at every appointment -- most patients apply insufficient quantity. The fingertip unit system guides correct dosing. Correct technique with optimal vehicle selection dramatically improves topical outcomes.
Phototherapy Administration
NB-UVB phototherapy is delivered 3 times weekly at increasing doses guided by the minimal erythema dose. A course of 20 to 30 sessions achieves 70% improvement in moderate psoriasis.
Systemic Therapy Initiation
Methotrexate or ciclosporin for moderate-severe psoriasis is initiated with baseline blood tests. Biologic therapy is initiated when PASI exceeds 10 and DLQI exceeds 10 and systemic therapy is inadequate.
Biologic Response Assessment at 16 Weeks
The minimum acceptable biologic response is PASI 75 at 16 weeks. PASI 90 or 100 is the ideal target. Non-responders at 16 weeks are switched to a biologic with a different mechanism.
Psoriatic Arthritis Screening
Every appointment screens for joint pain morning stiffness dactylitis and enthesitis -- symptoms of psoriatic arthritis affecting 30% of psoriasis patients. Positive screening triggers rheumatology referral.
What to Expect
Your dermatologist calculates PASI score and DLQI to quantify severity and quality of life impact. Treatment is stepped up when adequate response is not achieved. Biologic therapy requires pre-treatment screening and monitoring blood tests. Phototherapy at specialist UV centres is arranged when indicated.
Frequently Asked Questions
Common questions about psoriasis management.
Related Services
Explore other services in our Dermatology department.
Eczema and Atopic Dermatitis
Skin Lesion Assessment and Biopsy
Acne Vulgaris Management
Ready to Get Started?
Schedule your consultation today and take the first step towards better health.