Interview with Dr AMODE: "The management of psoriasis."

The diagnosis of psoriasis is clinical. No further investigations are necessary.

"Beyond the patient interview, during which patients are asked about the impact of psoriasis on their life and its psychological repercussions, several severity scales are used:

• the affected skin surface area;

• the DLQI (Dermatology Life Quality Index) which objectively measures the dermatological impacts on quality of life;

• the PASI (Psoriasis Area and Severity Index) which is a composite score internationally utilised to objectively assess disease severity."

The choice is based on the severity, the type of lesion (guttate psoriasis, plaque psoriasis, inverse psoriasis, infantile psoriasis, etc.), the patient’s age, any plans for pregnancy, the patient’s medical history, potential drug interactions if the patient is already receiving treatment, the pharmaceutical formulation acceptable to the patient (spray, cream, gel, etc.), and the need for systemic therapy.

In practice, a score of more than 10 on any of the usual scales is considered sufficient to raise the question of systemic treatment—that is, an affected body surface area of over 10%, and/or a DLQI score above 10, and/or a PASI score above 10. However, the initiation of such treatment is not automatic. It is a joint decision."

The treatment will depend on the severity of the condition and how it impacts the patient. Treatment options include steroidal anti-inflammatory creams, medications, as well as phototherapy which is a light-based treatment.

"Skin lesions, which can be visually conspicuous, may have a psychological impact on the patient and social repercussions. The rare psoriatic erythrodermias (inflammation affecting 90% of the skin surface) carry a risk of dehydration and infection, and can be life-threatening. Mild-to-moderate psoriasis may not be treated if the patient does not request it."

There are medications that are contraindicated in pregnant women and women of childbearing potential. For example, acitretin is a retinoid that precludes any pregnancy for two years after treatment cessation. The ciclosporin and methotrexate are contraindicated during pregnancy. However, certain topical treatments (topical corticosteroids, vitamin D3, etc.) are permitted during pregnancy.

Phototherapy can be considered during pregnancy based on the patient’s individual circumstances (skin phototype, risk factors for cutaneous malignancies, melasma). It is important to remember that phototherapy is a medical treatment that must be prescribed and carried out by a dermatologist.

"Medications reputed to be able to trigger or exacerbate psoriasis are primarily beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and lithium, and more rarely non-steroidal anti-inflammatory drugs. The list is not exhaustive. It is therefore essential to remain vigilant and report any suspected triggering event."

"Antidepressants are not treatments for psoriasis. However, patient care is holistic and collaborative, meaning that several specialists as well as the general practitioner are involved. Treating depression in a patient with psoriasis therefore appears fundamental and may require the use of antidepressant therapy."