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7HILE PSORIASIS REMAINS INCURABLE '0S CAN BY PRESCRIBING APPROPRIATE TOPICAL
TREATMENTS AND JUDICIOUSLY REFERRING MARKEDLY IMPROVE OUTCOMES .EVERTHELESS AS
$R 2ICHARD 0ARSLEW EXPLAINS '0S NEED TO CONSIDER SEVERAL ISSUES WHEN MANAGING PSORIASIS
IN THE ELDERLY INCLUDING THOSE OF PRIMARY CAUSES EMOTIONAL AND PHYSICAL CONSEQUENCES
AND CLINICAL TREATMENTS
!
ROUND MILLION PEOPLE IN THE 5+ 5BCMF5ZQFTPGQTPSJBTJTBOEUIFJS
SUFFER FROM PSORIASIS AND WITH THE DMJOJDBMGFBUVSFT
AGEING OF THE POPULATION IT IS BECOMING
INCREASINGLY WIDESPREAD AMONG THE MIDDLE
AGED 5ZQFPGQTPSJBTJT $MJOJDBMGFBUVSFT
AND ELDERLY !NY ONE OF THE SEVERAL TYPES OF
PSORIASIS SEE 4ABLE CAN UNDERMINE HEALTH
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RELATED QUALITY OF LIFE (21O, AT ANY AGE TDBMFBDDPVOUTGPSQFS
(OWEVER THE PSYCHOLOGICAL BURDEN AND (21O, DFOUPGDBTFT
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IMPACT MAY BE EVEN GREATER AMONG THE ELDERLY
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7HILE THE PRIMARY CAUSE REMAINS UNKNOWN THE
CONSENSUS AMONG RESEARCHERS SUGGESTS THAT
PSORIASIS ARISES FROM THE INTERACTION OF MULTIPLE 1VTUVMBS
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GENES IMMUNE DYSFUNCTION AND ENVIRONMENTAL QVTUVMFT6TVBMMZPDDVST
FACTORS 3EVERAL LINES OF EVIDENCE SUPPORT THIS POQBMNTPSTPMFT
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MODEL &OR EXAMPLE QTPSJBTJT
ABOUT PER CENT OF PATIENTS HAVE A
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DEGREE RELATIVE WHO SUFFERS FROM THE 1VTUVMBS
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DISEASE AND PSORIASIS SEEMS MORE COMMON XJEFSJOWPMWFNFOUNBZ
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AMONG #AUCASIANS THAN IN OTHER ETHNIC TZTUFNJDTZNQUPNT
GROUPS BOTH OF WHICH IMPLICATE GENETIC GFWFS
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FACTORS EPOPUIBWFQSFFYJTUJOH
NUMEROUS ENVIRONMENTAL FACTORS TRIGGER OR QTPSJBTJT
EXACERBATE PSORIASIS INCLUDING STRESS
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INFECTIONS TRAUMA +OEBNER PHENOMENON HFOFSBMJTFEFSZUIFNB
AND CERTAIN MEDICATIONS INCLUDING SOME BOETDBMJOHDPWFSTCPEZ
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WIDELY USED BY ELDERLY PEOPLE SUCH AS BETA
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BLOCKERS .3!)$S AND !#% INHIBITORS TPNFQBUJFOUTEPOPU
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0SORIASIS SEEMS TO ARISE WHEN AN ENVIRONMENTAL QTPSJBTJT
FACTOR INTERACTS WITH THE INHERITED PREDISPOSITION TO
EXAMINE WHETHER THIS CHANGES OVER TIME (OWEVER PATIENTS #ORTICOSTEROID COMBINATIONS AND TOPICAL
ONE RECENT STUDY EXAMINED (21O, DURING AN VITAMIN $ ANALOGUES WERE EACH USED BY AROUND
YEAR FOLLOW
UP USING THE )MPACT OF 0SORIASIS PER CENT OF PATIENTS RESPECTIVELY *UST ONE IN
1UESTIONNAIRE )03/ 4HE IMPACT ON MOST SOCIAL PATIENTS USED A SYSTEMIC AGENT 4HE WIDESPREAD
DETERMINANTS OF (21O, REMAINED STABLE )N USE OF STEROIDS IS TESTAMENT TO THEIR EFl CACY AND
CONTRAST CONCERNS ABOUT PHYSICAL APPEARANCE TOLERABILITY ALTHOUGH SIDE EFFECTS MAY INCLUDE SKIN
DECREASED AND MEAN )03/ SCORES DECLINED BY A ATROPHY STRIAE AND TACHYPHYLAXIS IF THEY ARE USED
l FTH &URTHERMORE THE PROPORTION OF PATIENTS IN INAPPROPRIATELY #ONCERNS ABOUT SIDE EFFECTS MAY
WHOM PSORIASIS SEEMS TO HAVE A LOW OVERALL IMPACT LEAD SOME PATIENTS AND PHYSICIANS UNDERDOSING
ON (21O, INCREASED FROM PER CENT AT BASELINE WITH TOPICAL STEROIDS (OWEVER AS THERE IS MORE
TO PER CENT AFTER YEARS 4HE IMPROVEMENT WAS UNDERSTANDING AS TO THEIR NATURE TOPICAL STEROIDS
ESPECIALLY MARKED IN PATIENTS REPORTING POOR ARE NOW AVAILABLE IN A VARIETY OF POTENCIES
HEALTH WHERE THE MEAN INCREASE WAS AROUND THREE STRENGTHS AND FORMULATIONS 4HIS ALLOWS CLINICIANS
TIMES GREATER THAN AMONG THOSE IN GOOD HEALTH TO TAILOR TREATMENT ACCORDING TO THE PATIENT AS
4HESE STUDIES SUGGEST THAT WHILE SOME PATIENTS WELL AS DIFFERENCES IN THE SENSITIVITY AND THICKNESS
ADAPT TO SUFFERING FROM THEIR DISEASE PSORIASIS OF THE SKIN
UNDERMINES PSYCHOLOGICAL WELL
BEING AND (21O,
AT ALL AGES 6ITAMIN $ DERIVATIVES EG CALCIPOTRIOL
NORMALISE KERATINOCYTE PROLIFERATION AND
0SORIASIS IMPOSES A HEAVY ECONOMIC BURDEN DIFFERENTIATION #ALCIPOTRIOL IS AS EFFECTIVE AS POTENT
3IXTY PER CENT OF 5+ PATIENTS WITH SEVERE PSORIASIS TOPICAL STEROIDS BUT MAY CAUSE PRURITUS OR BURNING
TOOK TIME OFF WORK IN THE PREVIOUS YEAR BECAUSE OF (YPERCALCAEMIA IS UNLIKELY WHEN USED ACCORDING
THEIR CONDITION &URTHERMORE PEOPLE WITH SEVERE TO THE LABEL -OST REPORTS OF HYPERCALCAEMIA
DISEASE MAY REQUIRE ONE OR MORE HOSPITALISATIONS OCCURRED IN PATIENTS WHO RECEIVED PROLONGED
EACH YEAR %ACH STAY LASTS FOR AN AVERAGE OF DAYS TREATMENT WITH G OR MORE WEEKLY 4HE MAIN
AND INPATIENT CARE COSTS EXCLUDING DRUGS TOTAL SIDE EFFECT IS IRRITATION AROUND THE LESION ALTHOUGH
AROUND a FOR EACH PERSON $URING FEW PATIENTS CEASE TREATMENT AS A RESULT !GAINST
DOCTORS WROTE NEARLY ONE MILLION PRESCRIPTIONS FOR THIS BACKGROUND COMBINATION THERAPY OFFERS
PSORIASIS THERAPIES WHICH COST aM 4HIS SEVERAL BENEl TS
EXCLUDES TREATMENTS USED FOR OTHER CONDITIONS EG USED AS A COMBINATION THERAPY STEROIDS AND
CORTICOSTEROIDS OR METHOTREXATE AS WELL AS COSTS CALCIPOTRIOL ARE MORE EFFECTIVE THAN EITHER AGENT
ARISING FROM SECONDARY AND TERTIARY CARE AND SO USED ALONE
MARKEDLY UNDERESTIMATES THE COST #LEARLY STEROID LESSENS THE IRRITATION ASSOCIATED WITH
OPTIMISING OUTCOMES IS IMPORTANT TO LIMIT THE CALCIPOTRIOL
ECONOMIC BURDEN STEROIDS ACT RAPIDLY CALCIPOTRIOL MAY TAKE UP
TO SIX TO EIGHT WEEKS FOR FULL EFFECTS TO EMERGE
APPLYING TOPICAL TREATMENTS MAY BE MESSY AND
1SJNBSZDBSFNBOBHFNFOU TIME CONSUMING WHICH MAY COMPROMISE
#LINICIANS NEED TO COUNSEL PATIENTS THAT PSORIASIS IS COMPLIANCE USING ONE FORMULATION RATHER THAN
INCURABLE AND ENSURE SUFFERERS FOCUS ON TWO OBVIOUSLY REDUCES THE TIME AND MESS
IMPROVEMENTS RATHER THAN CLEARANCE !S ONLY
BETWEEN PER CENT AND PER CENT OF PATIENTS 3EVERAL FORMULATIONS ARE AVAILABLE INCLUDING
HAVE MODERATE THREE TO PER CENT OF BODY CALCIPOTRIOL PLUS BETAMETHASONE DIPROPIONATE
SURFACE AREA TO SEVERE PSORIASIS PER CENT WHICH AN ANALYSIS OF 5+ PRESCRIBING HABITS FOUND
TOPICAL AGENTS ARE THE l RST
LINE TREATMENT '0S ACCOUNTED FOR PER CENT AND PER CENT OF
SHOULD ALSO ENCOURAGE PATIENTS TO USE EMOLLIENTS PSORIASIS SCRIPS RESPECTIVELY #ALCIPOTRIOL PLUS
(OWEVER PATIENTS SHOULD AVOID EMOLLIENTS AND BETAMETHASONE IS A ONCE DAILY TREATMENT AND
OTHER PRODUCTS CONTAINING LACTIC ACID OR ALPHA
CAN BE USED FOR UP TO FOUR WEEKS REPEAT COURSES
HYDROXY ACID WHICH MAY IRRITATE INm AMED OR CAN THEN BE PRESCRIBED IF DEEMED SUITABLE BY THE
BROKEN SKIN HEALTHCARE PROFESSIONAL )F ADEQUATE DOSES OF
CALCIPOTRIOL AND STEROIDS USED IN COMBINATION
.UMEROUS STUDIES SHOW TOPICAL STEROIDS FAIL TO PRODUCE AN ADEQUATE RESPONSE PATIENTS
INCLUDING BETAMETHASONE MOMETASONE AND MAY BENEl T FROM A TRIAL OF ONE OR MORE
CLOBETASOL IMPROVE PSORIASIS )NDEED DOCTORS TOPICAL THERAPIES
ISSUED STEROIDS TO AROUND PER CENT OF 5+ TOPICAL RETINOIDS EG TAZAROTENE NORMALISES
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