SummaryThe majority of people with psoriasis have localized disease, where topical therapy forms the cornerstone of treatment. We set out to summarize evidence on the relative efficacy, safety and tolerability of different topical treatments used in plaque psoriasis. We undertook a systematic review and meta-analyses of randomized trial data of U.K.-licensed topical therapies. The primary outcome was clear or nearly clear status stratified for (i) trunk and limbs; and (ii) scalp. Network meta-analyses allowed ranking of treatment efficacy. In total, 48 studies were available for trunk and limb psoriasis, and 17 for scalp psoriasis (22 028 patients in total); the majority included people with at least moderate severity psoriasis. Strategies containing potent corticosteroids (alone or in combination with a vitamin D analogue) or very potent corticosteroids dominated the treatment hierarchy at both sites (trunk and limbs, scalp); coal tar and retinoids were no better than placebo. No significant differences in achievement of clear or nearly clear status were observed between twice-and once-daily application of the same intervention or between any of the following: combined vitamin D analogue and potent corticosteroid (applied separately or in a single product), very potent corticosteroids, or potent corticosteroids (applied twice daily). Investigator and patient assessment of response differed significantly for some interventions (response rates to very potent corticosteroids: 78% and 39%, respectively). No significant differences were noted for tolerability or steroid atrophy, but data were limited. In conclusion, corticosteroids are highly effective in psoriasis when used continuously for up to 8 weeks and intermittently for up to 52 weeks. Coal tar and retinoids are of limited benefit. There is a lack of long-term efficacy and safety data available on topical interventions used for psoriasis.Psoriasis is a common chronic inflammatory skin condition and, although generally not life threatening, it can have a profound impact on physical, psychological and social wellbeing. 1 While recent advances and investment in high-cost biological therapies have revolutionized outcomes for people with severe disease, comparatively little attention has been paid to topical therapy, which forms the cornerstone of management for the majority of people with psoriasis. 2 Furthermore, the degree of disability does not necessarily correlate with objective measures of disease extent or severity, 3 and people with minimal involvement (less than the equivalent of three palm areas) state that psoriasis has a major effect on their life, 4 underscoring the importance of effective treatment in this group.Corticosteroids, vitamin D 3 and its analogues, calcineurin inhibitors, retinoids, tar, dithranol and keratolytic agents such as salicylic acid and urea are all used, 5 and come in a vast array of formulations, combinations and potencies. Choice of treatment is tailored to the needs of the patient and includes consideration of the nature of...

Pharmacists routinely encounter a small number of skin conditions and believe they can contribute towards the care of patients with skin diseases.

Patients with undiagnosed skin problems seek advice from pharmacies for reasons of professional advice, accessibility, familiarity and trust and because they perceive their conditions as non-serious.

Community pharmacists are extremely accessible sources of professional healthcare advice. It has long been recognized that pharmacists are highly qualified but under-utilized. In recent years, a more patient-centered role for community pharmacists to facilitate the safe and effective use of medicines has been proposed. One area for which there is a considerable demand in primary care for advice and support is dermatology and some evidence suggests that many people with skin problems manage their condition through self-care. Pharmacists have the potential to facilitate effective self-care for patients with dermatological problems. Furthermore the chronic nature of many skin conditions emphasizes the need for medicine management support to improve outcomes for those with conditions such as eczema and psoriasis. Nevertheless, little is known about the skin conditions encountered by pharmacists, their dermatological knowledge base or the extent to which they interact and support patients with long-term skin conditions.

Objective The aim of this study was to explore pharmacist and medicine counter assistant (MCA) perceptions of community pharmacy management of patients presenting with symptomatic skin problems. Methods The study involved semi‐structured telephone interviews with 10 pharmacists and 15 MCAs from seven pharmacies. Interviews focused on perceptions of their role in managing symptomatic skin problems and views on why people sought pharmacy advice and any barriers to management. Advice from the local ethics committee was that approval was not required for the study. We analysed the interviews using the framework approach. Key finding Pharmacists identified two key themes that defined their role; triage and reassurance. In contrast, MCAs defined their role as information gatherers and independent advisors. Themes identified by both pharmacists and MCAs relating to the use of pharmacy as a source of advice were convenience, the perceived non‐serious nature of conditions and inaccessibility of the GP. Additionally, MCAs believed familiarity with the pharmacist was important. Both pharmacists and MCAs identified their lack of dermatological knowledge as a barrier with pharmacists reporting insufficient time to deal effectively with patients. MCAs identified the potential for misdiagnosis by pharmacists as another potential barrier. Conclusion Our findings suggest that the role of pharmacists and MCAs is complementary; MCAs screen and provide the necessary information to pharmacists who then decide upon an appropriate course of action for the patient. Nevertheless, a major barrier to pharmacy‐supported self‐care of symptomatic skin problems is a perceived lack of knowledge and training in dermatology.

Background The majority of patients with psoriasis have mild to moderate disease which can be managed in primary care with topical therapies. The supportive role of pharmacists for patients with long‐term dermatological conditions is largely unknown. Objective To assess the impact of an educational intervention delivered by community pharmacists to improve self‐management for people with psoriasis. Method The study involved a pre‐ and post‐intervention design. Seven community pharmacies were selected based on their location (urban, rural etc.) and the pharmacists recruited via local comprehensive research networks. Patients with mild to moderate psoriasis were recruited either opportunistically or via a letter of invite by pharmacists who undertook a face‐to‐face consultation with one follow‐up visit after 6 weeks. The primary outcome was the change in person‐centred dermatology self‐care index (PEDESI) score and secondary outcomes were the self‐assessed psoriasis and severity index (SAPASI), measuring disease severity and the dermatology quality of life index (DLQI). Key findings A total of 47 patients were recruited. At 6 weeks, 42/47 (89.3%) patients completed the follow‐up consultation. There was a significant increase in mean PEDESI scores (25.15 versus 17.78, P < 0.001) at 6 weeks compared to baseline. Similarly, SAPASI (11.60 versus 7.74, P < 0.001) and DLQI (7.21 versus 4.14, P < 0.001) scores improved significantly. Conclusion Pharmacist‐assisted support for patients with psoriasis improved knowledge, reduced disease severity and the impact on quality of life. These results suggest that community pharmacists might have an important role to play in facilitating self‐management for patients with psoriasis.

Many pharmacists currently undertake dermatology MURs and rate themselves as confident in this role. Further work is needed to establish if such reviews lead to improvements in disease specific outcomes.

Objectives To compare the diagnostic ability of pharmacists, nurses and general practitioners (GPs) for a range of skin conditions. Methods An online study comprising 10 specifically developed dermatological case studies containing a digital image of the skin condition and a short case history. A total of 60 participants (20 representing each of pharmacists, GPs and primary care nurses) were required to identify the skin condition as well as the features in the case history that supported the diagnosis and the recommended first‐line management approach for the condition. Key findings The mean diagnostic scores for each group were GPs = 8.8 (95% confidence interval, CI, 7.9–9.6), pharmacists = 6.2 (95% CI, 5.4–6.9) and nurses = 7.0 (95% CI, 6.1–7.9). Post hoc analysis revealed that the difference in mean diagnostic scores was significant (P < 0.05) between GPs and both pharmacists and nurses. However, pharmacists' diagnostic accuracy was similar to GPs' for some skin conditions such as tinea corporis, scabies and plantar warts and overall at least 40% of pharmacists correctly identified all conditions. Conclusion This small study has demonstrated that for all of the skin conditions considered, pharmacists' overall diagnostic scores were significantly different from those of GPs but similar to those of nurses for the conditions assessed. However, further work with a larger sample is required to determine the accuracy of these preliminary findings and to establish whether advice given by pharmacists in practice results in the appropriate course of action being taken.