Psoriasis in Adults

Psoriasis is a chronic inflammatory condition that primarily affects the skin and, in some people, the joints. It is immune-mediated and leads to increased skin cell turnover, resulting in thickened, scaly patches on the skin.

Severity varies between individuals and can change over time. Even limited skin involvement can be significant, particularly when it affects visible, sensitive, or functionally important areas, or when associated with joint symptoms.

Psoriasis may present in different ways, including:

• Well-defined red plaques with scale

• Scalp involvement with thickening or scaling

• Nail changes such as pitting, thickening, or separation

• Involvement of skin folds

• Variable itch, discomfort, or skin sensitivity

The pattern and distribution often provide important diagnostic clues.

Psoriasis may affect the scalp, trunk, limbs, nails, skin folds, hands, or feet. Distribution and severity may fluctuate over time.

Psoriasis is recognised as a systemic inflammatory condition, not only a skin disease. It may be associated with:

• Metabolic conditions, including obesity, diabetes, and cardiovascular disease

• Psoriatic arthritis, which may cause joint pain, stiffness, or swelling

• Other inflammatory conditions

Assessment therefore often includes screening for joint symptoms and relevant medical comorbidities.

Certain factors may trigger or exacerbate psoriasis, including:

• Infections

• Psychological stress

• Skin injury or trauma (the Koebner phenomenon)

• Certain medications

Identifying potential triggers forms part of long-term management.

Medical review may be helpful to:

• Confirm the diagnosis

• Assess disease severity and extent

• Identify joint involvement or associated conditions

• Guide treatment selection and escalation

• Review treatment response and safety

Assessment involves a detailed history and skin examination, considering:

• Extent and distribution of skin involvement

• Severity of symptoms

• Nail and joint involvement

• Impact on daily life

• Medical history and current medications

This information guides management decisions and monitoring.

Management follows a stepwise, individualised approach based on disease severity, location, and patient factors. This may include:

• General skincare and avoidance of known triggers

• Topical therapies, with guidance on safe and appropriate use

• Phototherapy (light treatment), where appropriate

• Systemic treatments, selected with consideration of medical comorbidities

• Biologic therapies for moderate to severe disease or where other treatments are insufficient

Treatment plans are reviewed and adjusted over time.

Psoriasis is a long-term condition that benefits from regular review. Ongoing care focuses on maintaining disease control, monitoring for associated conditions, and coordinating care with the GP where appropriate.

Dermatologists are trained to assess psoriasis comprehensively, including its cutaneous and systemic aspects. Specialist review supports accurate diagnosis, appropriate treatment selection, and monitoring for associated conditions.

At Ready Dermatology, North Shore Health Hub, St Leonards, our dermatologist assesses adult psoriasis, evaluates disease severity and associated features, and provides guidance on appropriate, evidence-based management.