Beyond skin: the need for a new approach to the management of psoriasis in primary care

Psoriasis is a complex, long-term, inflammatory disease associated with significant physical, psychological, and social sequelae.1,2 It is currently incurable, with the majority of patients being diagnosed before the age of 30 years. This means that for most of their adulthood, people with psoriasis live with a chronic, disabling, and potentially stigmatising condition. The majority of patients are managed in primary care in the UK. Later this year, the National Institute for Health and Clinical Excellence (NICE) will publish guidelines for the management of psoriasis in the NHS in England, Wales, and Northern Ireland. The development of these guidelines closely follows publication of those for Scotland.3 The publication of these guidelines is timely given that, in recent years, there has been a paradigm shift in the way that psoriasis is perceived by dermatologists and by the wider scientific community. It is now accepted that psoriasis is an immune-mediated inflammatory disease — in the same class as inflammatory bowel disease and rheumatoid arthritis4 — and is a product of complex gene-environment interactions that are likely to …