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The need for this depends both on the patient’s own perception of his or her disability, and on the doctor’s objective assessment of how severe the skin disease is. The two do not always tally.
Explanations and reassurances must be geared to the patient’s or the parent’s intelligence. Information leaflets help to reinforce verbal advice. The doctor as well as the patient should keep the disease in per-spective, and treatment must never be allowed to be more troublesome than the disease itself. The dis-ease is not contagious. At present there is no cure for psoriasis; all treatments are suppressive and aimed at either inducing a remission or making the condition more tolerable. However, spontaneous remissions will occur in 50% of patients. Treatment for patients with chronic stable plaque psoriasis is relatively simple and may be safely administered by the family practitioner. However, systemic treatment for severe psoriasis should be monitored by a dermatologist. No treatment, at present, alters the overall course of the disease.
Physical and mental rest help to back up the specific management of acute episodes. Concomitant anxiety and depression should be treated on their own merits (see Table 5.1 for appropriate treatments).
These can be divided into four main categories: local, ultraviolet radiation, systemic and combined. Broad recommendations are listed in Table 5.1, but most physicians will have their own favourites. In many ways it is better to become familiar with a few remedies than dabble with many. The management of patients with psoriasis is an art as well as a science and few other skin conditions benefit so much from patience and experienceaof both patients and doctors.
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