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2017 ; 63
(4
): 278-285
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Diagnosis and management of psoriasis
#MMPMID28404701
Kim WB
; Jerome D
; Yeung J
Can Fam Physician
2017[Apr]; 63
(4
): 278-285
PMID28404701
show ga
OBJECTIVE: To provide primary care clinicians with an up-to-date and practical
overview of the diagnosis and management of psoriasis. QUALITY OF EVIDENCE:
PubMed, MEDLINE, EMBASE, and Cochrane databases were searched for relevant
meta-analyses, randomized controlled trials, systematic reviews, and
observational studies about the diagnosis and management of psoriasis. MAIN
MESSAGE: Psoriasis is a chronic, multisystem inflammatory disease with
predominantly skin and joint involvement. Beyond the physical dimensions of
disease, psoriasis has an extensive emotional and psychosocial effect on
patients, affecting social functioning and interpersonal relationships. As a
disease of systemic inflammation, psoriasis is associated with multiple
comorbidities, including cardiovascular disease and malignancy. The diagnosis is
primarily clinical and a skin biopsy is seldom required. Depending on the
severity of disease, appropriate treatment can be initiated. For mild to moderate
disease, first-line treatment involves topical therapies including
corticosteroids, vitamin D3 analogues, and combination products. These topical
treatments are efficacious and can be safely initiated and prescribed by primary
care physicians. Patients with more severe and refractory symptoms might require
further evaluation by a dermatologist for systemic therapy. CONCLUSION: Many
patients with psoriasis seek initial evaluation and treatment from their primary
care providers. Recognition of psoriasis, as well as its associated medical and
psychiatric comorbidities, would facilitate timely diagnosis and appropriate
management with effective and safe topical therapies and other medical and
psychological interventions, as needed. More severe and refractory cases might
warrant referral to a dermatologist for further evaluation and possible systemic
therapy.
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