Management
Management
There is currently no cure for CPP and the disease follows a relapsing-remitting course. Up to 80 per cent of patients have mild to moderate disease that is suitable for treatment in primary care with topical therapies. In mild cases of the disease, an emollient may be all that is needed. Pharmacy teams can help patients find a cosmetically acceptable emollient, as this is more likely to be used regularly.
Emollients soften and hydrate the stratum corneum and enhance desquamation (shedding of hyperkeratotic skin).
Although atopic eczema is widely recognised as an itchy skin condition, pharmacy technicians should remember that psoriasis can also cause significant pruritus.
As CPP is a dry skin condition, an emollient should be used as a soap substitute and applied after washing. Patients should use long, smooth strokes in the direction of hair growth, as vigorous rubbing can worsen the condition.
Emollients can be applied to pruritic lesions throughout the day. Patients should be advised not to pick or scratch them, as this can lead to bleeding.
All patients with CPP should use an emollient, regardless of other active treatments. In practice, many prefer a lighter product during the day and a richer ointment at night to reduce cracking.
When recommending an emollient, patients should be advised to apply it about 30 minutes before active treatment to enhance absorption. Adults with CPP typically use about 500g per week. Pharmacy teams should explain the fire risk associated with some paraffin-based emollients
How to support patients
Pharmacy technicians can support patients by improving treatment adherence. Studies suggest that people living with psoriasis often manage their condition sub-optimally because they lack adequate treatment advice. For instance, patients should not continue using a potent topical corticosteroid at the same site for more than eight weeks.
Studies of community pharmacy support for patients living with psoriasis have shown significant improvements in understanding, disease severity and quality
of life.
Pharmacy teams can also provide lifestyle advice. Many patients ask whether dietary changes could help – a recent trial found that after 16 weeks of following a Mediterranean diet, nearly half of participants achieved a 75 per cent improvement in disease severity.
Some patients report that vitamin D supplementation improves their skin symptoms but there is little objective evidence to support this. Where appropriate, weight loss can lead to a small but significant improvement in disease severity. Dietary change combined with increased physical activity can reduce disease severity by up to 48 per cent in overweight patients with psoriasis.
Many patients report that sun exposure improves their psoriasis, which is consistent with the benefits seen after phototherapy. However, excessive sun exposure and sunbed use are not recommended, particularly for people with fair skin or those prone to burning, because of the increased risk of skin cancer.