The diagnosis of psoriasis is clinical, and laboratory investigations are rarely helpful. There are several forms of psoriasis, and an affected individual may move from one type to another. The extent of involvement can range from small areas to almost total coverage. Psoriasis can change from stable plaques to an unstable form, typified by eruptive inflammatory lesions that are easily irritated by topical treatment.
Drugs thought to precipitate or worsen psoriasis include alcohol, lithium, chloroquine and possibly, sometimes beta-adrenoreceptor blocking drugs and ACE inhibitors. Components involved in the assessment of severity should include: the patient's disability, which can be measured by tools such as the Dermatology Life Quality index (DLQI) the need for treatment, together with an objective assessment of the extent and severity of the disease, assessed by PASI score or body surface area affected. Management should take the patient's views into account. It is helpful to record the patient's view of the most upsetting aspect of their psoriasis.
Management strategies can then be directed appropriately within therapeutic limitations based on the risk:benefit ratio.
This information forms part of the current BAD guidance document for the general management of psoriasis. Other sections in the document comprise:
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