How should I manage a patient with psoriasis who is experiencing significant psychological distress due to their skin condition?

Manage psychological distress in a patient with psoriasis by first assessing the impact of the condition on their psychological and social wellbeing. This includes asking about distress, mood impact, coping, and the effect on daily living and family or carers.

Provide tailored support and information about psoriasis, its nature, treatment options, and lifestyle advice to reduce exacerbations, ensuring the patient understands that psoriasis is not infectious and treatment aims to control symptoms rather than cure.

Assess for associated stress, anxiety, and depression and manage these appropriately, referring to relevant guidelines on generalized anxiety disorder and depression if needed.

Offer information on psychological aspects of psoriasis and signpost to support organizations such as the Psoriasis and Psoriatic Arthritis Alliance (PAPAA) and the Psoriasis Association, which provide leaflets and resources on coping with psychological distress related to psoriasis.

Develop a treatment strategy that meets the patient’s health goals, considering disease severity, impact, and individual circumstances, and discuss the risks and benefits of treatment options to optimize adherence and outcomes.

Arrange regular reviews to reassess disease severity, treatment response, and psychological impact, updating support and information as needed.